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Using High-Risk Adolescents' Voices to Develop a Comprehensible Cognitive Behavioral Therapy-Based Text-Message

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At-risk adolescents understood and preferred cognitive behavioral therapy (CBT) content delivered via text messages for depression prevention. Tailoring messages to address peer violence and emotional regulation improved engagement.

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Area of Science:

  • Psychiatry
  • Digital Health
  • Adolescent Mental Health

Background:

  • Text message (SMS) interventions offer a scalable approach for adolescent mental health.
  • Cognitive behavioral therapy (CBT) is an evidence-based treatment for depression.
  • Understanding adolescent preferences is crucial for intervention effectiveness.

Purpose of the Study:

  • To investigate at-risk adolescents' comprehension and preferences for CBT-based depression prevention content delivered via SMS.
  • To identify factors influencing content preferences in this population.

Main Methods:

  • Two qualitative studies were conducted.
  • Forty-one at-risk adolescents with depressive symptoms and peer violence history were interviewed.
  • Semi-structured interviews and thematic analysis were employed.

Main Results:

  • CBT-based messages were generally well-understood and preferred by adolescents.
  • Peer violence, comorbid symptoms, and prior mental health system exposure influenced content preferences.
  • Emotional regulation messages were favored; mindfulness content was challenging via SMS.
  • Cognitive restructuring content was best received when linked to self-efficacy.
  • Adolescents generated relevant CBT content in their own language.

Conclusions:

  • CBT-informed content can be effectively adapted into 160-character SMS messages for at-risk adolescents.
  • Intervention content should be tailored to address specific adolescent needs, such as emotional regulation and self-efficacy.
  • Adolescent input is valuable for developing engaging and comprehensible digital mental health interventions.