A BRIGHT Technological Future for Mental Health Trials
The BRIGHTEN study
• Science Update
Playing games, watching movies, and paying bills through smartphones and tablets has become commonplace. Americans are used to doing almost everything through the technology in their pockets. Is mobile mental health research the next frontier in this smartphone revolution? Based on Dr. Patricia Areán’s pioneering BRIGHTEN study, research via smartphone app is already a reality.
The BRIGHTEN study was remarkable because it used technology to both deliver treatment interventions and also to actually conduct the trial. In other words, the research team used technology to recruit, screen, enroll, treat, and assess participants. BRIGHTEN was especially remarkable because the study showed that technology is an efficient way to pilot test promising new treatments.
Areán’s goal was to see if it was possible to do a randomized controlled trial (RCT) using nothing but mobile devices. An RCT is a study in which participants are randomly assigned to different therapies so that researchers can compare their effectiveness. Areán wanted to know if people would agree to participate in a mobile depression study, if a mobile study would be affordable, and if people would continue to use the mobile therapies. Areán’s findings suggest that it is possible to recruit a large number of participants in a short amount of time. She also found that it was possible to conduct a study for minimal cost. However, keeping participants interested in the study was more challenging.
Areán and her team used three methods to recruit people for the BRIGHTEN depression study. They placed ads in city buses, newspapers, and on Craigslist across the country. They used ads on Facebook and Twitter, as well as GoogleAdwords, which pushed ads out to people using the Internet. The research team hoped to find 150 participants. They reached that goal in one week, which prompted the team to apply for an extension of the study.
A Model of the U.S.
Five months later, the team had more than 2,900 participants. The group was ethnically similar to the 2013 U.S. Census. In addition, participants represented people from 8 of the 15 most rural states. This diversity and the ability to reach underserved populations was a notable accomplishment for the BRIGHTEN study.
People responding to the BRIGHTEN ads were directed to the study’s website. Those who were interested could answer questions about their mobile devices, watch a consent video, and respond to questions that showed they understood the details of the study. After the consent process, visitors took a quiz to see if they were eligible for the study. Participants were randomly assigned to one of three depression treatments and then watched a video on how to download their treatment app. Each participant had a customized dashboard for monitoring study progress. Participants enrolled for 12 weeks and were asked to use the app daily, as well as complete monthly assessments. The apps provided a depression intervention and also collected data on participants’ social behavior (number of texts sent, places visited, etc.). Participants were compensated for being part of the study.
Typical RCTs for treating depression involve participants working “face-to-face” with a therapist. These traditional, in-person RCTs can be very expensive and may take 3-5 years to recruit enough participants. Finding people who represent the population of the U.S. can be challenging and expensive. For example, it can be difficult to recruit people in rural New Mexico if the study is based on the East Coast. The BRIGHTEN study easily recruited people from all over the country in a very cost-effective way. As a result, the BRIGHTEN study cost less than most studies of the same size.
Staying the Course
Not all participants stayed with the study for the full 12 weeks: 66% completed four weeks, 50% completed 8 weeks, and 41% finished the 12-week assessment. Of course, not all research participants complete traditional psychotherapy trials that involve conventional, face-to-face therapy; however, dropout rates seem to be lower in trials that involve psychotherapy with some human contact. In more traditional psychotherapy trials, dropout rates vary but appear to average around 20%. In studies that involve computer-administered therapy for depression, dropout rates appear to be lower among psychotherapy conditions that include at least some human contact.
The research team is still analyzing data to determine how well the apps treated depression and if one app was better than the others. However, early results show all three apps had a significant impact on mood and disability over time.
The BRIGHTEN study was not the first to use apps or mobile technology as part of a research project. However it did show that mobile technology is a successful way to recruit participants, reach a wide section of the population, and provide depression-oriented interventions. As more and more studies use app-based treatments as part of their research, finding ways to keep participants interested in using those interventions will be an important next step.
Dr. Patricia Areán is professor in Psychiatry at University of Washington & co-director of the BRIGHTEN Center. Dr. Areán is a licensed clinical psychologist and mental health researcher. She runs several clinical trials, and has served on health committees, including the Institute of Medicine committee for setting standards for psychosocial interventions and the National Advisory Council to the National Institute of Mental Health.
Dr. Areán’s paper was published in the January issue of BMJ Innovations.