Journal Article

Cognitive behavioral therapy skills via a smartphone app for subthreshold depression among adults in the community: the RESiLIENT randomized controlled trial

Akechi, Tatsuo, Whitton, Alexis, Nahum-Shani, Inbal, Noma, Hisashi, Kessler, Ronald C., Horikoshi, Masaru, Wason, James M. S., Sakata, Masatsugu, Tajika, Aran, Fukuma, Shingo, Cuijpers, Pim, Luo, Yan, Kondo, Naoki, Furukawa, Toshi A., Kawakami, Norito, Nakayama, Takeo, Lutz, Wolfgang, Toyomoto, Rie, Christensen, Helen

2025

Overview

Subthreshold depression, defined as a depressive status falling short of the diagnostic threshold for major depression, is common, disabling and constitutes a risk factor for future depressive episodes. Cognitive behavioral therapies (CBT) have been shown to be effective but are usually provided as packages of various skills. Little research has been done to investigate whether all their components are beneficial and contributory to mental health promotion. We addressed this issue by developing a smartphone CBT app that implements five representative CBT skills (behavioral activation, cognitive restructuring, problem solving, assertion training and behavior therapy for insomnia), and conducting a master randomized study that included four 2 × 2 factorial trials to enable precise estimation of skill-specific efficacies. Between September 2022 and February 2024, we recruited 3,936 adult participants with subthreshold depression. Among those randomized, the follow-up rate was 97% at week 6 and adherence to the app was 84%. The study showed that all included CBT skills and their combinations differentially beat all three control conditions of delayed treatment, health information or self-check, with effect sizes ranging between −0.67 (95% confidence interval: −0.81 to −0.53) and −0.16 (−0.30 to −0.02) for changes in depressive symptom severity from baseline to week 6, as measured with the Patient Health Questionnaire-9 scores. Knowledge of the active ingredients of CBT can better inform the design of more effective and scalable psychotherapies in the future. (UMIN Clinical Trials Registry UMIN000047124 ). A trial that used a master randomized design found that the skills commonly found in smartphone-based cognitive behavioral therapy, when tested alone or in combination with behavioral activation, were differentially efficacious in improving mental health symptoms in adults with subthreshold depression.

• Publisher: Nature Publishing Group US,Nature Publishing Group
• Subject: 631/477 / 692/308/409 / 692/699/476/1414 / Adult / Adults / Behavior modification / Behavior therapy / Biomedical and Life Sciences / Biomedicine / Cancer Research / Clinical trials / Cognitive behavioral therapy / Cognitive Behavioral Therapy - methods / Depression - psychology / Depression - therapy / Female / Health promotion / Humans / Infectious Diseases / Insomnia / Male / Mental depression / Mental health / Metabolic Diseases / Middle Aged / Mobile Applications / Molecular Medicine / Neurosciences / Problem solving / Risk factors / Skills / Sleep disorders / Smartphone / Smartphones / Therapy / Treatment Outcome