The prevalence of mental health problems is on the rise among young people, with about 22% of young people in the UK estimated to have a probable mental disorder (Newlove-Delgado et al., 2022). In this population, there has been a significant increase in depression and anxiety, which may have been exacerbated by the COVID-19 pandemic (Rees, 2020). Research suggests that the rise in loneliness during lockdown was associated with an increase in depression among young adults (Lee et al., 2020). Alarmingly, despite being at a higher risk of developing mental health problems, young adults are the least likely age group to receive treatment (Babajide et al., 2020; Roche et al., 2020). This highlights the need for services to adapt and ensure that mental health treatment is accessible to young people, including by introducing new initiatives to reach groups less likely to access current services. Cognitive Behavioural Therapy (CBT) is one of the recommended treatments for depression in adults (NICE, 2022). It involves reviewing the cycle between thoughts, physical feelings, and actions, and modifying unhelpful thoughts or behaviors (NHS, 2023).
This blog summarizes a recent paper by Mason et al. (2023a), which describes a randomized controlled trial (RCT) of CBT delivered to young adults with depression via text messages. Methods This study builds on a previous four-week pilot of CBT delivered via text messages (CBT-txt) conducted by the same author group (Mason et al., 2023b). To conduct this RCT, US-based young adults aged 18-25 with depressive symptoms were recruited through social media sites and randomly allocated to either receive the eight-week CBT-txt intervention or be allocated to a control group. The CBT-txt intervention was adapted from an in-person CBT manual and consisted of an automated text-message program sending follow-up messages and initial messages every other day for the duration of the eight-week intervention. Measures of depression severity, behavioral activation, cognitive distortion, and perseverative thinking were taken at monthly intervals for three months after the end of treatment, and data was analyzed using latent change score analyses.
Results indicated that participants in the CBT-txt group experienced a significantly larger reduction in depression symptoms at each follow-up point after the end of treatment. Additionally, the CBT-txt intervention resulted in higher levels of behavioral activation, and lower levels of cognitive distortion and perseverative thinking. The intervention was also found to be acceptable to participants, with 80% finding it helpful. The study provides preliminary evidence that CBT delivered via text messages may be an effective and acceptable method of reducing depressive symptoms in young adults.
A strength of the study is the promise of a novel intervention to meet the increasing demand for mental health services in young people. A limitation is that the CBT-txt intervention was only compared to a control group on a waiting list, so it is unclear whether it would be as effective as other methods of delivering CBT. It is also unclear whether the study authors were blinded to the allocation of the participants to either the intervention or control group, which may result in bias. Additionally, the recruitment methods used may have biased the results. Moreover, the majority of participants were female, and larger-scale studies are needed to confirm the findings.
Despite these limitations, the study’s findings suggest that CBT delivered via text messages may be a valuable tool in meeting the mental health needs of young people.
