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Cognitive therapy, pioneered by Aaron T. Beck in the 1960s, is a structured approach to addressing psychological distress by focusing on the influence of thoughts on emotions and behaviors. All cognitive therapies involve the basic assumption that human beings have control over their feelings, and that how individuals feel about something depends on how they think about it. Unlike psychoanalytic methods that delve into unconscious processes or humanistic approaches emphasizing...
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An Unguided, Computerized Cognitive Behavioral Therapy Intervention (TreadWill) in a Lower Middle-Income Country:

Arka Ghosh1, Rithwik J Cherian1,2, Surbhit Wagle1,3

  • 1Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur, India.

Journal of Medical Internet Research
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Summary

Unguided computerized cognitive behavioral therapy (cCBT) shows promise for treating depression in low- and middle-income countries. The TreadWill intervention significantly reduced depression and anxiety symptoms, demonstrating its effectiveness and engagement potential.

Keywords:
cCBTcomputerized cognitive behavioral therapydepressiondigital interventionmobile phone

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Area of Science:

  • Digital mental health interventions
  • Global mental health research
  • Behavioral science and technology

Background:

  • Depression treatment is often inadequate globally, especially in low- and middle-income countries (LMICs).
  • Unguided computerized cognitive behavioral therapy (cCBT) offers a potential solution to bridge this treatment gap.
  • Real-world effectiveness of unguided cCBT in LMICs requires further investigation.

Purpose of the Study:

  • To design and develop TreadWill, a novel, automated, and accessible unguided cCBT intervention for LMICs.
  • To pragmatically evaluate the effectiveness and engagement of TreadWill.
  • To provide a scalable digital mental health resource for underserved populations.

Main Methods:

  • A double-blind, fully remote randomized controlled trial was conducted with 598 participants in India.
  • The study employed a completer's analysis to assess outcomes.
  • A full-featured version of TreadWill was compared against a plain-text version and a waitlist control.

Main Results:

  • Participants completing at least half of TreadWill modules showed significant reductions in depression (P=.04) and anxiety (P=.02) symptoms compared to the waitlist control.
  • The full-featured TreadWill intervention demonstrated significantly higher user engagement (P=.01) than a plain-text version.
  • The intervention proved effective in reducing symptoms within the target population.

Conclusions:

  • This study introduces TreadWill, a new resource for unguided cCBT in LMICs.
  • Evidence supports the use of unguided cCBT as a scalable and effective intervention for depression in LMICs.
  • The findings highlight the potential of digital health tools to improve mental healthcare access globally.