Comparative effectiveness of remote digital gamified and group CBT skills training interventions for anxiety and depression among college students: Results of a three-arm randomised controlled trial.

Journal: Behaviour research and therapy

Volume: 178

Issue: 

Year of Publication: 

Affiliated Institutions:  Mental Health, Alcohol, Substance Use and Tobacco (MAST) Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, South Africa. Electronic address: Jason.Bantjes@mrc.ac.za. Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, South Africa. Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands. Department of Psychology, Yale University, New Haven, CT, USA. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. Department of Statistics, University of Washington, Seattle, WA, USA; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. Department of Statistics, Harvard University, Cambridge, MA, USA. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA. Centre for Student Counselling and Development, Student Affairs, Stellenbosch University, South Africa. Student Counselling and Development, University of the Free State, South Africa. Student Counselling and Development, University of Western Cape, Cape Town, South Africa. Department of Psychiatry and Mental Health, University of Cape Town, South Africa; Department of Psychiatry, SAMRC Unit on Risk and Resilience in Mental Disorders, Stellenbosch University, South Africa.

Abstract summary 

Digital interventions can enhance access to healthcare in under-resourced settings. However, guided digital interventions may be costly for low- and middle-income countries, despite their effectiveness. In this randomised control trial, we evaluated the effectiveness of two digital interventions designed to address this issue: (1) a Cognitive Behavioral Therapy Skills Training (CST) intervention that increased scalability by using remote online group administration; and (2) the SuperBetter gamified self-guided CBT skills training app, which uses other participants rather than paid staff as guides. The study was implemented among anxious and/or depressed South African undergraduates (n = 371) randomised with equal allocation to Remote Group CST, SuperBetter, or a MoodFlow mood monitoring control. Symptoms were assessed with the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Intention-to-treat analysis found effect sizes at the high end of prior digital intervention trials, including significantly higher adjusted risk differences (ARD; primary outcome) in joint anxiety/depression remission at 3-months and 6-months for Remote Group CST (ARD = 23.3-18.9%, p = 0.001-0.035) and SuperBetter (ARD = 12.7-22.2%, p = 0.047-0.006) than MoodFlow and mean combined PHQ-9/GAD-7 scores (secondary outcome) significantly lower for Remote Group CST and SuperBetter than MoodFlow. These results illustrate how innovative delivery methods can increase the scalability of standard one-on-one guided digital interventions. PREREGISTRATION INTERNATIONAL STANDARD RANDOMISED CONTROLLED TRIAL NUMBER (ISRTCN) SUBMISSION #: 47,089,643.

Authors & Co-authors:  Bantjes Jason J Hunt Xanthe X Cuijpers Pim P Kazdin Alan E AE Kennedy Chris J CJ Luedtke Alex A Malenica Ivana I Petukhova Maria M Sampson Nancy N Zainal Nur Hani NH Davids Charl C Dunn-Coetzee Munita M Gerber Rone R Stein Dan J DJ Kessler Ronald C RC

Study Outcome 

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Statistics
Citations : 
Authors :  15
Identifiers
Doi : 10.1016/j.brat.2024.104554
SSN : 1873-622X
Study Population
Male,Female
Mesh Terms
Other Terms
Digital interventions;Online cognitive behavioral therapy (CBT);Randomised controlled trial;South Africa;SuperBetter;University students
Study Design
Study Approach
Country of Study
South Africa
Publication Country
England