Cargando…

Two-way messaging therapy for depression and anxiety: longitudinal response trajectories

BACKGROUND: Telemedicine is a strategy for overcoming barriers to access evidence-based psychotherapy. Digital modalities that operate outside session-based treatment formats, such as ongoing two-way messaging, may further address these challenges. However, no study to date has established suitabili...

Descripción completa

Detalles Bibliográficos
Autores principales: Hull, Thomas D., Malgaroli, Matteo, Connolly, Philippa S., Feuerstein, Seth, Simon, Naomi M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291694/
https://www.ncbi.nlm.nih.gov/pubmed/32532225
http://dx.doi.org/10.1186/s12888-020-02721-x
_version_ 1783545958246645760
author Hull, Thomas D.
Malgaroli, Matteo
Connolly, Philippa S.
Feuerstein, Seth
Simon, Naomi M.
author_facet Hull, Thomas D.
Malgaroli, Matteo
Connolly, Philippa S.
Feuerstein, Seth
Simon, Naomi M.
author_sort Hull, Thomas D.
collection PubMed
description BACKGROUND: Telemedicine is a strategy for overcoming barriers to access evidence-based psychotherapy. Digital modalities that operate outside session-based treatment formats, such as ongoing two-way messaging, may further address these challenges. However, no study to date has established suitability criteria for this medium. METHODS: A large outpatient sample (n = 10,718) engaged in daily messaging with licensed clinicians from a telemedicine provider. Patients consisted of individuals from urban and rural settings in all 50 states of the US, who signed up to the telemedicine provider. Using a longitudinal design, symptoms changes were observed during a 12 week treatment course. Symptoms were assessed from baseline every three weeks using the Patient Health Questionnaire (PHQ-9) for depression, and the Generalized Anxiety Disorder (GAD-7) for anxiety. Demographics and engagement metrics, such as word count for both patients and therapists, were also assessed. Growth mixture modeling was used to tease apart symptoms trajectories, and identify predictors of treatment response. RESULTS: Two subpopulations had GAD-7 and PHQ-9 remission outcomes (Recovery and Acute Recovery, 30.7% of patients), while two others showed amelioration of symptoms (Depression and Anxiety Improvement, 36.9% of patients). Two subpopulations experienced no changes in symptoms (Chronic and Elevated Chronic, 32.4% of patients). Higher use of written communication, patient characteristics, and engagement metrics reliably distinguished patients with the greatest level of remission (Recovery and Acute Recovery groups). CONCLUSIONS: Remission of depression and anxiety symptoms was observed during delivery of psychotherapy through messaging. Improvement rates were consistent with face-to-face therapy, suggesting the suitability of two-way messaging psychotherapy delivery. Characteristics of improving patients were identified and could be used for treatment recommendation. These findings suggest the opportunity for further research, to directly compare messaging delivery with a control group of treatment as usual. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT03699488, Retrospectively Registered October 8, 2018.
format Online
Article
Text
id pubmed-7291694
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-72916942020-06-12 Two-way messaging therapy for depression and anxiety: longitudinal response trajectories Hull, Thomas D. Malgaroli, Matteo Connolly, Philippa S. Feuerstein, Seth Simon, Naomi M. BMC Psychiatry Research Article BACKGROUND: Telemedicine is a strategy for overcoming barriers to access evidence-based psychotherapy. Digital modalities that operate outside session-based treatment formats, such as ongoing two-way messaging, may further address these challenges. However, no study to date has established suitability criteria for this medium. METHODS: A large outpatient sample (n = 10,718) engaged in daily messaging with licensed clinicians from a telemedicine provider. Patients consisted of individuals from urban and rural settings in all 50 states of the US, who signed up to the telemedicine provider. Using a longitudinal design, symptoms changes were observed during a 12 week treatment course. Symptoms were assessed from baseline every three weeks using the Patient Health Questionnaire (PHQ-9) for depression, and the Generalized Anxiety Disorder (GAD-7) for anxiety. Demographics and engagement metrics, such as word count for both patients and therapists, were also assessed. Growth mixture modeling was used to tease apart symptoms trajectories, and identify predictors of treatment response. RESULTS: Two subpopulations had GAD-7 and PHQ-9 remission outcomes (Recovery and Acute Recovery, 30.7% of patients), while two others showed amelioration of symptoms (Depression and Anxiety Improvement, 36.9% of patients). Two subpopulations experienced no changes in symptoms (Chronic and Elevated Chronic, 32.4% of patients). Higher use of written communication, patient characteristics, and engagement metrics reliably distinguished patients with the greatest level of remission (Recovery and Acute Recovery groups). CONCLUSIONS: Remission of depression and anxiety symptoms was observed during delivery of psychotherapy through messaging. Improvement rates were consistent with face-to-face therapy, suggesting the suitability of two-way messaging psychotherapy delivery. Characteristics of improving patients were identified and could be used for treatment recommendation. These findings suggest the opportunity for further research, to directly compare messaging delivery with a control group of treatment as usual. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT03699488, Retrospectively Registered October 8, 2018. BioMed Central 2020-06-12 /pmc/articles/PMC7291694/ /pubmed/32532225 http://dx.doi.org/10.1186/s12888-020-02721-x Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Hull, Thomas D.
Malgaroli, Matteo
Connolly, Philippa S.
Feuerstein, Seth
Simon, Naomi M.
Two-way messaging therapy for depression and anxiety: longitudinal response trajectories
title Two-way messaging therapy for depression and anxiety: longitudinal response trajectories
title_full Two-way messaging therapy for depression and anxiety: longitudinal response trajectories
title_fullStr Two-way messaging therapy for depression and anxiety: longitudinal response trajectories
title_full_unstemmed Two-way messaging therapy for depression and anxiety: longitudinal response trajectories
title_short Two-way messaging therapy for depression and anxiety: longitudinal response trajectories
title_sort two-way messaging therapy for depression and anxiety: longitudinal response trajectories
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291694/
https://www.ncbi.nlm.nih.gov/pubmed/32532225
http://dx.doi.org/10.1186/s12888-020-02721-x
work_keys_str_mv AT hullthomasd twowaymessagingtherapyfordepressionandanxietylongitudinalresponsetrajectories
AT malgarolimatteo twowaymessagingtherapyfordepressionandanxietylongitudinalresponsetrajectories
AT connollyphilippas twowaymessagingtherapyfordepressionandanxietylongitudinalresponsetrajectories
AT feuersteinseth twowaymessagingtherapyfordepressionandanxietylongitudinalresponsetrajectories
AT simonnaomim twowaymessagingtherapyfordepressionandanxietylongitudinalresponsetrajectories