Principal Findings
depression, depressive symptoms
RECRUITMENT
The findings from this investigation contribute to the mHealth literature by providing convincing evidence that text-delivered CBT treatment can significantly and consistently reduce depressive symptoms in young adults. These findings also specify 3 treatment mechanisms that each explain a significant portion of the treatment effect when separately introduced into the mediation analysis models and even larger effects when combined. These results support the specification of 3 candidate therapeutic mechanisms of change within CBT-txt.All 4 of our hypotheses were supported in this trial’s findings. Our primary hypothesis tested the efficacy of CBT-txt to reduce depressive symptoms, relative to the control condition. The results supported this hypothesis across all 3 months of the study, revealing a strong treatment effect. The mediation analyses also supported our hypotheses regarding the mechanisms of change within the CBT-txt treatment structure. Separate models showed that each mediator accounted for a substantial proportion of the CBT-txt treatment effect on depression. Models with all mediators included showed that, combined, these mechanisms explained 63% of the CBT-txt treatment effect, with changes in perseverative thinking showing the strongest independent indirect effect.Although we did not experimentally test dosage effects in this trial, this study was a follow-up to our initial CBT-txt trial [Finally, these findings provide further support for recruiting young adults with depression via Facebook and Instagram, providing an efficient pathway toward engaging this hard-to-reach and underserved population. We recruited a sample of 103 participants in 7 weeks with excellent rates of retention, satisfaction, and engagement. These findings also support the use of CBT-txt as part of a continuum of care. For example, CBT-txt could serve as a form of pretreatment while individuals are placed on waitlists to be seen by clinicians. This approach could quickly reduce the severity of symptoms, particularly for individuals who are experiencing moderate to severe depressive symptoms. Targeting those with the most severe depression with CBT-txt may provide rapid symptom relief, which could then be followed up by a clinician. For some, CBT-txt may be enough; for others, it may serve as a jump start to their treatment and others may find it useful to combine CBT-txt while seeing a clinician for therapy. Supporting this latter idea, it is noteworthy that 278 participants were excluded from the study for reporting current or recent treatment for depression, suggesting that some young adults may recognize a need for supplemental options to traditional depression treatment. Social media recruitment may also reach young adults seeking preventive or early intervention services. Of note, 110 participants were not eligible for the study, as they reported only minimal (25/110, 22.7%) or mild (85/110, 77.3%) depression symptoms on the PHQ-9.