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Review
. 2020 Jul 1;17(7-9):21-25.

Behavioral Activation Contributed to the Total Reduction of Depression Symptoms in the Smartphone-based Cognitive Behavioral Therapy: A Secondary Analysis of a Randomized, Controlled Trial

Hissei Imai  1   2   3   4 , Mitsuhiko Yamada  1   2   3   4 , Masatoshi Inagaki  1   2   3   4 , Norio Watanabe  1   2   3   4 , Bun Chino  1   2   3   4 , Akio Mantani  1   2   3   4 , Toshiaki A Furukawa  1   2   3   4
Affiliations
Review

Behavioral Activation Contributed to the Total Reduction of Depression Symptoms in the Smartphone-based Cognitive Behavioral Therapy: A Secondary Analysis of a Randomized, Controlled Trial

Hissei Imai et al. Innov Clin Neurosci. .

Abstract

Objective: The contribution of components in cognitive behavior therapy (CBT) to the total reduction of depression symptoms has not been well elucidated, and previous studies couldn't exclude the human factors in the therapy. Design: This is a secondary analysis of a randomized, controlled trial comparing automated smartphone CBT without human factors plus antidepressant switch against antidepressant switch alone among patients with antidepressant-resistant depression. The present CBT consisted of self-monitoring, behavioral activation, and cognitive restructuring. We used linear regression to predict the overall pre- to post-symptom improvement based on improvement achieved by sessions teaching each cognitive or behavioral skill. The overall improvement was measured with the Beck Depression Inventory-II and the session-to-session improvement with K6. Results: Of the 164 participants originally enrolled in the study, 94 participants who completed all K6 evaluation were included in the primary analyses. The results indicated that K6 score reduction in the first half of behavioral activation significantly predicted BDI-II score reduction. The sensitivity analysis including 162 participants did not change the result. K6 score reductions after other CBT sessions did not significantly predict BDI-II score reduction. Conclusion: The behavioral activation seems to contribute to the total reduction of depressive symptoms even if human factors are excluded by using automated smartphone CBT.

Keywords: Cognitive behavioral therapy; component study; depression; information technology; smartphone.

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Conflict of interest statement

FUNDING:The study was funded by the Ministry of Health, Labor and Welfare, Japan (H-22-Seishin-Ippan-008) from April 2013 through March 2014, and thereafter by the Japan Foundation for Neuroscience and Mental Health (JFNMH). The JFNMH received donations from Asahi Kasei, Eli-Lilly, GSK, Janssen, MSD, Meiji Seika, Mochida, Otsuka, Pfizer, Shionogi, Taisho, and MitsubishiTanabe. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. DISCLOSURES:Dr Mitsuhiko Yamada has received speaking fees from Meiji and has contracted research with Nippon Chemiphar. Dr Masatoshi Inagaki has received lecture fees from Pfizer, Mochida, Shionogi, Daiichi-Sankyo, Meiji, Takeda, and Sumitomo Dainippon Pharma. He has received royalties from Nippon-Hyoron-Sha, Nanzando, Seiwa-Shoten, Igaku-Shoin, and Technomics. Dr Norio Watanabe has received royalties from Akatsuki and Sogen-sha. Dr Chino has received lecture fees from Eli Lilly, Meiji and MitsubishiTanabe. Dr Mantani has received lecture fees from Mochida, Eli Lilly and Meiji. Dr Kato has received lecture fees from Eli Lilly and Mitsubishi-Tanabe, and has contracted research with GlaxoSmithKline, MSD and Mitsubishi-Tanabe. He has received royalties from Kyowa Yakuhin and Medical Tribune. Dr Furukawa reports personal fees from Meiji, Mitsubishi-Tanabe, MSD and Pfizer and a grant from Mitsubishi-Tanabe, outside the submitted work; he has a patent 2018-177688 pending. Dr Hissei Imai received the lecture fee from Tanabe-Mitsubishi pharma and Kyowa pharmaceutical industry outside the submitted work.

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