Wang Liyuan, Miller Lynn
Children's Hospital, Los Angeles, Department of Adolescent and Young Adult, Los Angeles, CA, United States.
University of Southern California, Annenberg School for Communication and Journalism, Los Angeles, CA, United States.
JMIR Form Res. 2023 Jan 5;7:e37270. doi: 10.2196/37270.
A just-in-time adaptive intervention (JITAI) is "designed to address the dynamically changing needs of individuals via the provision of the type or amount of support needed, at the right time when needed." If and how rumination-focused cognitive behavioral therapy (RFCBT), the gold standard, blocks emotional cascades underlying rumination is unclear. Furthermore, cognitive behavioral therapy has been successfully used as a mobile variant, but RFCBT has not been adapted for a mobile variant (mobile RFCBT [MRFCBT]) or for a JITAI variant.
This study aimed to pilot-test a fully automated JITAI leveraging RFCBT and ways to identify and block cascading depressive rumination.
Patients in therapy for clinical depression were recruited for a randomized controlled trial (RCT). After consenting to be part of the RCT, they were randomly assigned to either of the 2 mobile versions of the RFCBT conditions personalized to the individual's rumination timing patterns (JITAI-MRFCBT) or a no-treatment control condition through a double-blind procedure. Although the initial design was to have a 3-armed trial with 2 JITAI conditions (a JITAI and a narrative JITAI condition), we later opted to collapse those 2 conditions into 1 JITAI condition because of the low number of participants. All participants were recruited and participated through their smartphones, receiving 5 SMS text message reminders on each of the 35 days to self-report their rumination-related symptoms (eg, rumination episodes and duration). In the JITAI-MRFCBT condition, they also received treatment materials. The first 7 days provided a rumination baseline, and the last 7 days provided a postintervention rumination value. In total, 42% (25/59) of volunteers were eligible and provided their phone numbers, 20% (5/25) of whom never replied to the SMS text message reminding them to start the RCT. A total of 90% (18/20) of volunteers completed it (ie, finishing, as prespecified, 80% of the questionnaires and training tasks) and, therefore, were included in the analysis.
Using independent 2-tailed t tests with bootstrapping, results showed that participants in the JITAI-MRFCBT condition, compared with those in the control condition, reported a greater reduction in counts of rumination episodes (mean -25.28, SD 14.50 vs mean 1.44, SD 4.12, P<.001) and greater reduced average time (minutes) spent in rumination (mean -21.53, SD 17.6 vs mean 1.47, SD 1.5; P=.04). Results also suggest that, compared with those in the control group, those in treatment reduced ruminative carryover from one episode to the next.
The results suggest that JITAI-MRFCBT may reduce negative rumination by providing RFCBT just in time following rumination, thereby blocking the next rumination episode using the same trigger. This study supports a subsequent, full-scale JITAI and the importance of leveraging mobile smartphone technology with MRFCBT to curb depressive symptoms.
ClinicalTrials.gov NCT04554706; https://clinicaltrials.gov/ct2/show/NCT04554706.
即时自适应干预（JITAI）“旨在通过在需要的正确时间提供所需支持的类型或数量，来满足个体动态变化的需求”。作为金标准的以反刍为重点的认知行为疗法（RFCBT）是否以及如何阻断反刍背后的情绪级联尚不清楚。此外，认知行为疗法已成功应用于移动版本，但RFCBT尚未被改编为移动版本（移动RFCBT [MRFCBT]）或即时自适应干预版本。
本研究旨在对利用RFCBT的全自动即时自适应干预以及识别和阻断级联性抑郁反刍的方法进行试点测试。
招募临床抑郁症治疗患者进行随机对照试验（RCT）。在同意参与RCT后，他们通过双盲程序被随机分配到根据个体反刍时间模式个性化定制的2个移动版本的RFCBT条件之一（JITAI-MRFCBT）或无治疗对照条件。尽管最初的设计是进行一项三臂试验，有2个即时自适应干预条件（一个即时自适应干预条件和一个叙事性即时自适应干预条件），但由于参与者数量较少，我们后来选择将这2个条件合并为1个即时自适应干预条件。所有参与者均通过智能手机招募并参与，在35天中的每一天都会收到5条短信提醒，以自我报告与反刍相关的症状（例如，反刍发作次数和时长）。在JITAI-MRFCBT条件下，他们还会收到治疗材料。前7天提供反刍基线，后7天提供干预后的反刍值。共有42%（25/59）的志愿者符合条件并提供了他们的电话号码，其中20%（5/25）从未回复提醒他们开始RCT的短信。共有90%（18/20）的志愿者完成了试验（即按照预先规定完成了80%的问卷和训练任务），因此被纳入分析。
使用带有自抽样的独立双尾t检验，结果显示，与对照组相比，JITAI-MRFCBT条件下的参与者报告反刍发作次数减少得更多（平均减少25.28，标准差14.50，而对照组平均为1.44，标准差4.12，P<0.001），平均反刍时间（分钟）减少得也更多（平均减少21.53，标准差17.6，而对照组平均为1.47，标准差1.5；P=0.04）。结果还表明，与对照组相比，接受治疗的患者减少了从一次反刍发作到下一次反刍发作的反刍延续。
结果表明，JITAI-MRFCBT可能通过在反刍发生后及时提供RFCBT来减少负面反刍，从而使用相同的触发因素阻断下一次反刍发作。本研究支持后续进行全面的即时自适应干预，以及利用移动智能手机技术与MRFCBT相结合来抑制抑郁症状的重要性。
ClinicalTrials.gov NCT04554706；https://clinicaltrials.gov/ct2/show/NCT04554706 。
