@Article{info:doi/10.2196/14754,
author="Schure, Mark B
and Lindow, Janet C
and Greist, John H
and Nakonezny, Paul A
and Bailey, Sandra J
and Bryan, William L
and Byerly, Matthew J",
title="Use of a Fully Automated Internet-Based Cognitive Behavior Therapy Intervention in a Community Population of Adults With Depression Symptoms: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2019",
month="Nov",
day="18",
volume="21",
number="11",
pages="e14754",
keywords="internet-based cognitive behavior therapy; iCBT; depression symptoms; rural populations; RCT; randomized controlled trial; CBT",
abstract="Background: Although internet-based cognitive behavior therapy (iCBT) interventions can reduce depression symptoms, large differences in their effectiveness exist. Objective: The aim of this study was to evaluate the effectiveness of an iCBT intervention called Thrive, which was designed to enhance engagement when delivered as a fully automated, stand-alone intervention to a rural community population of adults with depression symptoms. Methods: Using no diagnostic or treatment exclusions, 343 adults with depression symptoms were recruited from communities using an open-access website and randomized 1:1 to the Thrive intervention group or the control group. Using self-reports, participants were evaluated at baseline and 4 and 8 weeks for the primary outcome of depression symptom severity and secondary outcome measures of anxiety symptoms, work and social adjustment, psychological resilience, and suicidal ideation. Results: Over the 8-week follow-up period, the intervention group (n=181) had significantly lower depression symptom severity than the control group (n=162; P<.001), with a moderate treatment effect size (d=0.63). Moderate to near-moderate effect sizes favoring the intervention group were observed for anxiety symptoms (P<.001; d=0.47), work/social functioning (P<.001; d=0.39), and resilience (P<.001; d=0.55). Although not significant, the intervention group was 45{\%} less likely than the control group to experience increased suicidal ideation (odds ratio 0.55). Conclusions: These findings suggest that the Thrive intervention was effective in reducing depression and anxiety symptom severity and improving functioning and resilience among a mostly rural community population of US adults. The effect sizes associated with Thrive were generally larger than those of other iCBT interventions delivered as a fully automated, stand-alone intervention. Trial Registration: ClinicalTrials.gov NCT03244878; https://clinicaltrials.gov/ct2/show/NCT03244878 ",
issn="1438-8871",
doi="10.2196/14754",
url="http://www.jmir.org/2019/11/e14754/",
url="https://doi.org/10.2196/14754",
url="http://www.ncbi.nlm.nih.gov/pubmed/31738173"
}