JMIR Publications

ABSTRACT

Background:

Despite the high prevalence of major depressive disorder and the related societal burden, access to effective traditional face-to-face or video-based psychotherapy is a challenge. An alternative that offers mental healthcare in a flexible setting is asynchronous messaging therapy. To date no study has evaluated its efficacy and acceptability in a randomized controlled trial for depression.

Objective:

The aim of the present pilot randomized controlled trial was to compare the efficacy and acceptability of message-based psychotherapy for depression to once-weekly video-based psychotherapy.

Methods:

Individuals (N=83) with depressive symptomatology (Patient Health Questionnaire-9 ≥10) were recruited online and randomly assigned to either a message-based intervention group or (n=46) a once-weekly video-based intervention group (n=37). Patients in the message-based treatment condition exchanged asynchronous messages with their therapist following an agreed upon schedule. Patients in the video-based treatment condition met with their therapist once each week for a 45-minute video teletherapy session. Self-report data for depression, anxiety, and functional impairment were collected at pretreatment, weekly during treatment, at posttreatment, and at a 6-month follow-up. Self-reported treatment expectancy and credibility for the assigned intervention were assessed at pretreatment, and therapeutic alliance at posttreatment.

Results:

Findings from multilevel modeling indicated significant, medium to large improvements in depression (d=1.04; 95% CI 0.60-1.46), anxiety (d=0.61; 95% CI 0.22-0.99), and functional impairment (d=0.66; 95% CI 0.27-1.05) for patients in the message-based treatment condition. Changes in depression (d=0.11; 95% CI -0.43 to 0.66), anxiety (d=-0.01; 95% CI -0.56 to 0.53), and functional impairment (d=0.25; 95% CI -0.30 to 0.80) in the message-based treatment condition were non-inferior to those in the video-based treatment condition. There were no significant differences in treatment credibility (d=-0.09; 95% CI -0.64 to 0.45), therapeutic alliance (d=-0.15; 95% CI -0.75 to 0.44), and engagement (d=0.24; 95% CI -0.20 to 0.67) between the two treatment conditions.

Conclusions:

Message-based psychotherapy could present an effective and accessible alternative treatment modality for patients who might not be able to engage in traditional scheduled services such as face-to-face or video-based psychotherapy. Clinical Trial: ClinicalTrials.gov NCT05467787; https://www.clinicaltrials.gov/ct2/show/NCT05467787