Text-Message CBT for Anxiety

Overseen By Michael J Mason, PhD

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: The University of Tennessee, Knoxville

Disqualifiers: Recent anxiety treatment, No phone, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 4

Duration: 8 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a new text-message-based program designed to help young adults manage anxiety. The goal is to determine if this 8-week, text-delivered cognitive behavioral therapy (CBT) can effectively reduce anxiety symptoms. Participants will be divided into two groups: one receiving the text-message treatment and another serving as a control group with no intervention. This trial may suit young adults (18-25) in the U.S. who frequently experience anxiety and are open to receiving text messages. As an unphased trial, this study offers a unique opportunity to contribute to innovative research that could enhance anxiety management for young adults.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. However, if you have been treated for anxiety in the past three months, you may not be eligible to participate.

What prior data suggests that this text-delivered counseling program is safe for young adults with anxiety?

Research shows that text-based cognitive behavioral therapy (CBT), such as the CBT-txt-Anxiety program, is generally user-friendly. Studies of similar programs have found they can reduce anxiety symptoms without major side effects. For example, other digital CBT programs have helped many people feel less anxious, depressed, and stressed.

Text-message-based therapy is non-invasive, meaning it doesn't involve physical procedures. This reduces the likelihood of side effects compared to treatments involving medication or surgery. Reports of unwanted side effects in similar digital therapy programs have been minimal. Participants usually find the treatment manageable, with few complaints.

In summary, while every treatment carries some risks, evidence suggests that text message-based CBT is a safe option for reducing anxiety symptoms. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about CBT-txt-Anxiety because it delivers Cognitive Behavioral Therapy (CBT) through automated text messages. Unlike traditional CBT, which involves face-to-face sessions with a therapist, this treatment offers a convenient and accessible option for individuals with Generalized Anxiety Disorder. This approach makes mental health support more readily available to those who may have barriers such as time constraints or geographical limitations, potentially reaching a broader audience. Additionally, the use of text messaging could encourage more frequent engagement with the therapeutic content, enhancing the treatment's effectiveness.

What evidence suggests that CBT-txt-Anxiety might be an effective treatment for anxiety?

Research shows that CBT-txt-Anxiety, a therapy using text messages, effectively reduces anxiety symptoms. In this trial, participants will either receive the CBT-txt-Anxiety treatment or join a control group with assessment only. Previous studies found a significant drop in anxiety, with one study noting a 19.63% decrease in anxiety scores for participants. This method transforms a successful in-person therapy into a convenient text format, making it easier for young adults to access help. Text messaging also enhances engagement and strengthens connections between participants and therapists. Overall, the evidence supports its potential to help young adults manage anxiety effectively. ^{1 2 4 6 7}

Are You a Good Fit for This Trial?

This trial is for young adults aged 18-25 who are experiencing elevated anxiety symptoms. Participants must be willing to engage with a text-message-based therapy program and available for follow-up assessments. Specific inclusion or exclusion criteria details were not provided.

Inclusion Criteria

GAD-7 score of at least 10 (indicating elevated anxiety symptoms)

Resides in the United States

Consents to receiving text messages from the study

Exclusion Criteria

I am not fluent in English.

Lack of access to a text-capable phone

Unable or unwilling to commit to three months of follow-up

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline Assessment

Participants complete an online baseline survey via Qualtrics

1 day

1 virtual visit

Treatment

Participants receive 32 text conversations over a 60-day period as part of the CBT-txt-Anxiety intervention

8 weeks

Daily virtual interactions

Follow-up

Participants are monitored for changes in anxiety symptoms through online surveys at 1-, 2-, and 3-months post-baseline

3 months

3 virtual visits

What Are the Treatments Tested in This Trial?

Interventions

• CBT-txt-Anxiety

Trial Overview

The study is testing CBT-txt-Anxiety, an 8-week cognitive behavioral therapy program delivered through text messages, designed to reduce anxiety in young adults. It will compare the effectiveness of this intervention against a waitlist control group over several months.

How Is the Trial Designed?

Group I: CBT-txt-A Experimental Treatment 1 Intervention

8-week automated text-message delivered treatment for Generalized Anxiety Disorder

Group II: Control Active Control 1 Intervention

Assessment only condition

Who Is Running the Clinical Trial?

The University of Tennessee, Knoxville

Lead Sponsor

Trials

93

Recruited

19,500+

Published Research Related to This Trial

This study will evaluate the effectiveness of a smartphone-supplemented internet-administered cognitive behavioral therapy (iCBT) program for anxiety disorders, involving 150 participants diagnosed with social anxiety disorder and/or panic disorder.

The trial will compare three groups: one receiving iCBT with therapist support, one without support, and a control group, assessing outcomes over time to determine both immediate and long-term effects of the intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Guided and unguided CBT for social anxiety disorder and/or panic disorder via the Internet and a smartphone application: study protocol for a randomised controlled trial. Lindner, P., Ivanova, E., Ly, KH., et al.[2022]

An automated text-messaging system was developed to support cognitive-behavioral therapy (CBT) for depression, focusing on enhancing homework adherence and tracking patient progress among low-income patients.

In a feasibility test with 12 participants in two CBT groups, the system achieved a 65% response rate to daily mood inquiries and received positive feedback, suggesting it could be a cost-effective tool to improve mental health care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Text Messaging as an Adjunct to CBT in Low-Income Populations: A Usability and Feasibility Pilot Study. Aguilera, A., Muñoz, RF.[2022]

The study involved 68 participants who received individually tailored text messages alongside telephone-based psychotherapy, but there were no significant differences in clinical outcomes compared to a historical control group of 157 participants who only received psychotherapy.

While both groups showed improvement over time, the SMS intervention did not enhance clinical outcomes, and the study suggests that further research with a larger sample size is needed to better assess the potential benefits of text messaging in psychotherapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A comparison between phone-based psychotherapy with and without text messaging support in between sessions for crisis patients. Furber, G., Jones, GM., Healey, D., et al.[2021]

A pilot study involving 85 participants found that internet-delivered cognitive behavior therapy (ICBT) significantly improved worry and anxiety symptoms in individuals with generalized anxiety disorder (GAD), with moderate to large effect sizes on the primary measure of worry.

Both worry-specific and self-tailored ICBT treatments were effective, and while participants preferred scheduled support over on-demand support, there were no significant differences in outcomes between the treatment groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Worry-specific versus self-tailored internet-based treatments for generalized anxiety disorder, with scheduled support or support on demand: A pilot factorial design trial. Dahlin, M., Johansson, A., Romare, H., et al.[2022]

Internet- and computer-based cognitive-behavioral treatments (ICT) have been shown to be effective in reducing anxiety, with effect sizes ranging from 0.49 to 1.14 compared to waitlist and placebo groups, based on a review of 19 randomized controlled trials.

The efficacy of ICT is comparable to traditional therapist-delivered treatments across various anxiety disorders, although the findings are limited by small sample sizes and methodological issues, highlighting the need for larger, well-designed studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A meta-analysis of the effects of internet- and computer-based cognitive-behavioral treatments for anxiety. Reger, MA., Gahm, GA.[2022]

The study developed a protocol for evaluating the effectiveness of cell phone-supported cognitive behavioral therapy (CBT) for managing anxiety disorders in real-world clinical settings, addressing the limitations of traditional randomized controlled trials.

Key aspects of the protocol include analyzing therapist roles and ensuring adherence to treatment, which will help identify effective CBT methods that can be integrated into health services more broadly.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cell phone-supported cognitive behavioural therapy for anxiety disorders: a protocol for effectiveness studies in frontline settings. Ekberg, J., Timpka, T., Bång, M., et al.[2021]

The study involved 755 depressed patients and demonstrated that an automated SMS system for weekly depression monitoring was feasible and well-accepted, with a high response rate of 94.5% among participants who consented.

The SMS depression rating scale showed a moderate to high correlation with the established PHQ-9 scale and was more responsive to treatment changes, indicating its potential as a valid and sensitive tool for tracking depression in clinical research.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility, acceptability and validity of SMS text messaging for measuring change in depression during a randomised controlled trial. Richmond, SJ., Keding, A., Hover, M., et al.[2018]

In a study of 96 clients undergoing internet-delivered cognitive behaviour therapy (ICBT), 61.5% reported experiencing at least one negative effect during treatment, highlighting the importance of monitoring these effects in real-time rather than relying solely on post-treatment reports.

Common negative effects included technical difficulties and negative emotional states, but serious adverse events like symptom deterioration were not reported, suggesting that while ICBT is generally effective, there are still challenges that need to be addressed to improve client experience.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Negative effects associated with internet-delivered cognitive behaviour therapy: An analysis of client emails. Gullickson, KM., Hadjistavropoulos, HD., Dear, BF., et al.[2020]

In a study analyzing 712 emails from therapists to 71 participants in a randomized controlled trial of internet-based cognitive behavioral therapy (CBT) for bulimic disorders, 95.4% of the emails contained supportive comments, highlighting the emphasis on encouragement in therapeutic communication.

Only 14.7% of the emails included specific CBT comments, suggesting that while therapists provided substantial emotional support, there was limited direct application of CBT techniques in their email interactions, with an average of 45 minutes spent on email support per participant throughout the program.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of email guidance in internet-based cognitive-behavioural self-care treatment for bulimia nervosa. Sánchez-Ortiz, VC., Munro, C., Startup, H., et al.[2022]

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