Two-way messaging therapy for depression and anxiety: longitudinal response trajectories
Abstract 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 s...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-06-01
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| Series: | BMC Psychiatry |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12888-020-02721-x |
| _version_ | 1818262191051112448 |
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| author | Thomas D. Hull Matteo Malgaroli Philippa S. Connolly Seth Feuerstein Naomi M. Simon |
| author_facet | Thomas D. Hull Matteo Malgaroli Philippa S. Connolly Seth Feuerstein Naomi M. Simon |
| author_sort | Thomas D. Hull |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-12T18:59:12Z |
| format | Article |
| id | doaj.art-726fb87fa9514a21a75475d5d8d39500 |
| institution | Directory Open Access Journal |
| issn | 1471-244X |
| language | English |
| last_indexed | 2024-12-12T18:59:12Z |
| publishDate | 2020-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Psychiatry |
| spelling | doaj.art-726fb87fa9514a21a75475d5d8d395002022-12-22T00:15:08ZengBMCBMC Psychiatry1471-244X2020-06-0120111210.1186/s12888-020-02721-xTwo-way messaging therapy for depression and anxiety: longitudinal response trajectoriesThomas D. Hull0Matteo Malgaroli1Philippa S. Connolly2Seth Feuerstein3Naomi M. Simon4Teachers College, Columbia University, TalkspaceNew York University Grossman School of MedicineMount Sinai Beth Israel Medical Center, Teachers College, Columbia UniversityYale University Center for Biomedical and Interventional TechnologyNew York University Grossman School of MedicineAbstract 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.http://link.springer.com/article/10.1186/s12888-020-02721-xTelemedicineDepressionAnxietyLongitudinal designDigital healthMessaging therapy |
| spellingShingle | Thomas D. Hull Matteo Malgaroli Philippa S. Connolly Seth Feuerstein Naomi M. Simon Two-way messaging therapy for depression and anxiety: longitudinal response trajectories BMC Psychiatry Telemedicine Depression Anxiety Longitudinal design Digital health Messaging therapy |
| 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 | Telemedicine Depression Anxiety Longitudinal design Digital health Messaging therapy |
| url | http://link.springer.com/article/10.1186/s12888-020-02721-x |
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