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

Jason Bantjes, Xanthe Hunt, Pim Cuijpers, Alan E. Kazdin, Chris J. Kennedy, Alex Luedtke, Ivana Malenica, Maria Petukhova, Nancy Sampson, Nur Hani Zainal, Charl Davids, Munita Dunn-Coetzee, Rone Gerber, Dan J. Stein, Ronald C. Kessler

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Article number104554
JournalBehaviour Research and Therapy
Volume178
DOIs
StatePublished - Jul 2024
Externally publishedYes

Keywords

  • Digital interventions
  • Online cognitive behavioral therapy (CBT)
  • Randomised controlled trial
  • South Africa
  • SuperBetter
  • University students

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