a field trial of a coach-supported internet intervention for the treatment of depression: patient...

A Field Trial of a Coach-Supported Internet Intervention for the Treatment of Depression: Patient Use and

Clinical OutcomesStephen M. Schueller, Jennifer Duffecy, Susan M. Kaiser, Colleen Stiles-Shields, Kristina M. Pecora,

David C. MohrNorthwestern University

NIMH: R01 MH095753 (PI: Mohr)

www.cbits.northwestern.edu

http://www.cbits.northwestern.edu/


Rationale

• Depression is widespread– About 1 in 15 people in the US each year or about 21

million• Not enough therapists to meet this demand

– Assuming a 20 session course of CBT (1 hour/session), 1 therapist could treat about 100 patients in a year

– 210,000 therapists needed• Some people might benefit from less intensive

treatments


Low Intensity Treatment: Internet CBT

• Internet CBT is effective at reducing depressive symptoms

• Supported programs are more effective than self-guided programs

• However, even supported programs can reduce the amount of time a professional has to spend


Supportive Accountability


ThinkFeelDo

• A 12-week intervention that includes:– Lessons– Interactive tools– Coach (Supportive Accountability)

• Weekly Phone Calls (~10-20 minutes)• Messaging• Coach Dashboard


Home Page


Activity Monitoring


Record an Automatic Thought


Data Visualizations


Lessons


Coach Dashboard


Why You Should Conduct a Field Trial

• Design process– Iterative development

• Work out bugs• Work out conceptual issues• Figure out what people use and don’t use• If you don’t your first participants will be a

field trial anyways


Field Trial 1

• 9 participants (4 male, 5 female)– Mean Age = 42.8– Marital Status (4 single, 4 married/domestic

partner, 1 divorced)– Race (2 Asian-American, 7 White)– 5 Employed, 3 Unemployed, 1 Retired

– PHQ-9 at baseline (12, 12, 15, 16, 17, 18, 22, 23, 23, M: 17.6 )


Ratings from SiteLike it Easy to use Learned quickly Useful/Helpful

Lessons 6.3 6.3 6.6 6.8

Mood Tracker 6.0 6.7 6.7 5.9

Activity Tool 5.7 5.8 5.6 5.9

Thought Tool 4.7 5. 5.9 4.4


User Feedback

• Lesson content was reviewed most favorably while the Thought Tracker generated the most criticisms– Hard to recall and record thoughts– Instructions unclear– More of a journal style layout

• Majority of criticisms across all tools related to instructions/use of tools– Lack of clarity on “how” and “why” to use


Iterate

• Tools changed into “Modules”– More focus on teaching “how” and “why” when

they first use the tools• Simplified entry process

– Enter a full day’s worth of activities– Thought tool simplified to remove situation and

emotion rating


Modules vs. Tools

Field Trial 2

• 5 participants (4 male, 1 female)– Mean Age = 34.3– Marital Status (4 single, 1 divorced)– Race (2 African-American, 1 Asian-American, 1

White)– 3 Employed, 2 Unemployed

– PHQ-9 at baseline (10, 12, 17, 23, M: 15.5)


19

Usage SnapshotSessions

N=56

FTSC63223 (41%)

FTSC7045 (9%)

FTSC74513 (23%)

FTSC75215 (27%)

FTSC7560

ToolsN=219

FTSC632113 (63%)

FTSC70432 (18%)

FTSC74523 (13%)

FTSC7526 (3%)

FTSC7565 (3%)

LessonsN=40

FTSC63214 (35%)

FTSC7043 (8%)

FTSC74511 (28%)

FTSC7526 (15%)

FTSC7566 (15%)

VideosN=74

FTSC63211 (15%)

FTSC70418 (24%)

FTSC74512 (16%)

FTSC75215 (20%)

FTSC75618 (24%)


20

Session Time (Minutes)Session Definition: Timepoint when user logs into website or timepoint when use resumes activity after 5 minutes of inactivity on website

FTSC756: Zero sessions

N Mean (SD) Median (IQR)

Total Sample 56 8.6 (9.3) 4 (1-16)

FTSC632 23 12.7 (6.8) 14 (6-18)

FTSC704 5 9.8 (12.4) 2 (1-19)

FTSC745 13 8.6 (12.7) 3 (1-10)

FTSC752 15 1.7 (2.7) 1 (0-30)


21

Session Time: by ID


22

Modules

179

view

edActivity Tool

65 (36%)

Mood Tool60 (34%)

Thought Tool54 (30%)



Ratings from SiteLike it Easy to use Learned quickly Useful/Helpful

Lessons 5.75 5.5 5.5 5.75

Lesson Summaries

5.5 4.75 5.25 5

Mood Tracker 4.5 6 5.5 4.67

Emotion Tracker 5 5.5 5.25 5.75

Activity Tool 5.67 5.67 6 6.33

Thought Tool 5.67 4.67 4.67 6.33

User Quotes

• People like the interactivity: “didn’t think there would be this much helpful content”

• Mixed in terms of the activity (“gives me an idea of what activities promote a good mood”) and thought (“the best tool”) tools

• People want structure: “it doesn’t seem clear when one section ends, and another begins” would like something “like a class syllabus – a schedule provides a sense of responsibility and incentive [to complete the work]”



Link Between Depression and UsageSessions Minutes Time/

Session# Tools # Lessons Total

PHQ-9 Change

r = .55 r = .86 r = .77 r = .73 r = .38 r = .72

Sessions Minutes Time/Session

#Tools # Lessons Total

FTSC745ΔPHQ -8

13 112 8.6 23 11 34

FTSC752ΔPHQ -8

15 26 1.7 6 6 12

FTSC704ΔPHQ -3

5 49 9.8 32 3 35

FTSC756ΔPHQ +1

5 6 11

FTSC632ΔPHQ +6

23 292 12.7 113 14 127



Take-Away Points

• Get feedback early, get feedback often• When people say they don’t like something (or

don’t use something) it may be the concept or the implementation– Interactions benefit from structure

• The link between use and clinical outcomes is tricky– Do people who start to benefit then use less? – Site use may be a poor proxy for real-world use

Contact:[email protected]: @steveschueller

NIMH: R01 MH095753 (PI: Mohr)

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