Can a CBT phone app help stubborn depression?
Adding a smartphone CBT program to a medication switch improved depressive symptoms more than switching antidepressants alone.
Source
Smartphone Cognitive Behavioral Therapy as an Adjunct to Pharmacotherapy for Refractory Depression: Randomized Controlled Trial
Study at a glance
- Design
- RCT — Kokoro-app smartphone CBT plus antidepressant switch vs medication change alone
- N
- N=164 · ITT; primary outcome at week 9 in 163/164 (99.4%)
- Population
- Adults in Japan with antidepressant-refractory major depression
- Outcome
- PHQ-9 at week 9
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Can a CBT phone app help stubborn depression?
These passages occur verbatim in the stored paper text. They support the points listed below; they do not verify every statement in the explanation.
CBT app group scored 2.48 PHQ-9 points lower at week 9 (SMD 0.40)
In the intention-to-treat analysis of the total sample, patients who were allocated the CBT app (n=81) scored 2.48 points (95% CI 1.23-3.72, P <.001; standardized mean difference [SMD] 0.40) lower on PHQ-9 than those who were not (n=83) at week 9 (, ).
Response odds ratio 2.73 with smartphone CBT
Significantly more participants showed response (OR 2.73, 95% CI 1.35-5.53, P =.005).
What they did
In Japan, adults with antidepressant-refractory major depression were switched to escitalopram or sertraline and randomized to add a structured smartphone CBT app (Kokoro-app) or medication change alone. The primary outcome was PHQ-9 at week 9 in an intention-to-treat analysis of 164 randomized participants.
What they found
At week 9, the CBT app group scored about 2.5 PHQ-9 points lower than controls (SMD 0.40) and were more likely to meet response criteria. Remission and side-effect burden differences were not statistically significant. App engagement was high among those assigned CBT.
The limits
What it doesn't show
The trial was relatively short (9 weeks), compared adjunctive app CBT with medication switch rather than face-to-face CBT, and does not prove long-term relapse prevention or effectiveness outside Japanese specialty settings.
Key terms
- Refractory depression
- Major depression that remains clinically significant despite adequate antidepressant treatment.
- PHQ-9
- Nine-item Patient Health Questionnaire scale used to track depression symptom severity.
- Smartphone CBT
- Cognitive behavioural therapy delivered through a guided mobile app with sessions such as behavioural activation and cognitive restructuring.
- Response
- A predefined clinically meaningful improvement in depression symptoms, often a substantial PHQ-9 reduction.
- Intention-to-treat
- Analysis that includes participants in the groups to which they were randomized, regardless of adherence.
- Adjunctive therapy
- A treatment added to an existing or newly changed primary therapy, here antidepressants.
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What was the primary endpoint of the Kokoro-app trial?
Common questions
What was the control condition?
Medication change alone (switch to escitalopram or sertraline) without the CBT app.
Did remission improve significantly?
Remission odds were higher with the app but did not reach statistical significance in this sample.
Was the app well used?
Nearly all intervention participants completed at least half the sessions, and most completed at least six of eight.
Who was studied?
Adults with major depression that had not responded adequately to antidepressants, typically with multi-year current episodes.
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