DepressionPhase 1/2NCT01891734
Enhancing Delivery of Problem Solving Therapy Using SmartPhone Technology
A Phase 1/2 study testing Problem Solving Therapy plus Moving Forward and Problem Solving Therapy in people with Depression and Anxiety, run by VA Office of Research and Development at 1 site in United States.
Trial summary
This project will be the first to evaluate the Moving Forward app in VA. Identifying an effective treatment for anxiety and depression in primary care is imperative within Veterans Health Administration as they are both common, chronic, and debilitating conditions associated with a number of personal and… Read more about this study
- Who is it for?
- Ages 18 to 64 yearsHealthy volunteers can take part
- Conditions the study is for
- Depression, Anxiety
- What is being tested?
- Problem Solving Therapy plus Moving Forward and Problem Solving Therapy
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 33 participants
- Where
- 1 siteUnited States
- Study dates
- Apr 2014to Mar 2015
- Phase
- Phase 1/2
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 64 years
- All sexes
- Healthy volunteers accepted
- Adult
Who may be able to join
- Veterans will be eligible if they are 18 years old or older,
- speak and understand English,
- are patients in the Central Arkansas Veterans Healthcare System Primary Care-Mental Health Integration,
- and have a current diagnosis of depression
- major depressive disorder, 296.2x and 296.3x
- dysthymic disorder, 300.4
Show all 20Show fewer
- depressive disorder not otherwise specified, 311
- and/or anxiety
- panic disorder without agoraphobia, 300.01
- panic disorder with agoraphobia, 300.21
- specific phobia, 300.29
- social phobia, 300.23
- obsessive-compulsive disorder; 300.3
- posttraumatic stress disorder, 309.81
- acute stress disorder, 308.3
- generalized anxiety disorder, 300.02
- anxiety disorder not otherwise specified, 300.00
- We considered enrolling only those Veterans diagnosed with mild-to-moderate depression, but chose to include a range of anxiety and depression-related disorders in order to reflect the population of Veterans seen in Primary Care-Mental Health Integration.
- Additionally, Problem Solving Therapy is designed to treat a range of stress-related problems, including both anxiety and depressive disorders.
- Veterans taking prescribed anxiolytics or anti-depressants will be eligible if they are on a stable medication regimen.
Who cannot join
- Exclusionary criteria include any current suicidal ideation,
- substance dependence diagnosis and current use,
- any psychotic spectrum diagnoses or
- inability to provide informed consent.
- Diagnosis will be confirmed by chart review and Mini International Neuropsychiatric Interview.
- Acute suicidal ideation will be determined by the assessing or treating clinician.
- During the baseline and follow-up interviews, any Veteran who endorses a "1" or higher on item # 21 on the Depression Anxiety and Stress Scale "I feel that life isn't worthwhile" or item # 9 on the Patient Health Questionnaire-9 "thoughts that you would be better off dead or of hurting yourself" will be asked follow-up questions on the suicide risk protocol (see appendix 3).
- Current substance or alcohol use will be determined by the alcohol and substance use modules of the Mini International Neuropsychiatric Interview.
Trial locations and contacts
1 site in 1 country.
United States1 site
Central Arkansas Veterans Healthcare System Eugene J. Towbin Healthcare Center, Little Rock, AR
No. Little Rock, Arkansas, 72114-1706
About this study
This project will be the first to evaluate the Moving Forward app in VA. Identifying an effective treatment for anxiety and depression in primary care is imperative within Veterans Health Administration as they are both common, chronic, and debilitating conditions associated with a number of personal and health-related costs. In close partnership with app developers at Mental Health Services, a major contribution of this research is the actionable feedback on the acceptability, feasibility and effectiveness of augmenting traditional Problem Solving Therapy with the Moving Forward app for future app development. If effectiveness can be established, Moving Forward has the potential for integration into the larger continuum of care for depression and anxiety in Primary Care-Mental Health Integration (e.g., care management, co-located collaborative care). Lastly, this pilot project will provide preliminary data for future research on SmartPhone technology. Veteran feedback on treatment components, ease of executing the study successfully and preliminary effect size calculations, will inform the design of the larger project.
Read the detailed description
Access and engagement in evidence-based psychotherapies for Veterans are high priorities for the Veterans Health Administration, especially the Office of Rural Health and the office of Mental Health Services. SmartPhone applications are an emerging technology with a vast potential to extend the reach of traditional in-person psychotherapy by allowing increased digital access to providers and self-management tools. Due to the relatively recent development of this technology, there are no data on the effectiveness of SmartPhone-delivered psychotherapy. Preliminary data on acceptability and satisfaction are promising, suggesting a need for further research. The National Center for Posttraumatic Stress Disorder in collaboration with the National Center for Telehealth \& Technology (T2) recently completed the development of an app called Moving Forward, a Veteran-friendly adaptation of Problem Solving Therapy, an evidence based therapy available through Primary Care Integration Clinics. In partnership with Mental Health Services, this proposed pilot project will gather preliminary data on the effectiveness and acceptability of Moving Forward and provide timely feedback to the app creators. Participants will include approximately 40 Veterans diagnosed with an anxiety or mood disorder interested in obtaining mental health treatment in Primary Care -Mental Health Integration. Participants will be randomly assigned to receive either Problem Solving Therapy augmented by the Moving Forward app or Problem Solving Therapy alone. Participants will complete assessments at baseline, 6 weeks and 12 weeks. Investigators propose 3 specific hypotheses. In hypothesis 1, investigators predict a moderate effect size will be observed when comparing homework completion and satisfaction for patients randomized to Problem Solving Therapy plus the Moving Forward app compared to patients randomized to Problem Solving Therapy alone. In hypothesis 2, investigators predict a moderate effect size will be observed when comparing change scores on the problem solving style for patients randomized to Problem Solving Therapy plus the Moving Forward app compared to patients randomized to Problem Solving Therapy alone. In hypothesis 3, investigators predict a moderate effect size will be observed when comparing depression, anxiety, stress and quality of life change for patients randomized to Problem Solving Therapy plus the Moving Forward app compared to patients randomized to Problem Solving Therapy alone. Key informant interviews will provide qualitative feedback on the Moving Forward app which investigators will share with our partners at Mental Health Services. The proposed project is important to the VA mission to improve access for all Veterans particularly those who face barriers to engagement in traditional face-to-face treatment. The proposed research addresses one of three primary focus areas of the Office of Research and Development (Access), two of Health Services Research \&Development's research priorities (Access/Rural Health and Mental Health), and three of Secretary Shinseki's Transformational Initiatives for the 21st Century including improving: 1) access to care, 2) mental health, and 3) patient-centeredness. This proposed work is innovative as it focuses on a rapidly emerging mobile technology that has great potential to improve access and engagement in mental health service delivery. To date, there have been no randomized effectiveness trials that have examined SmartPhone apps for mental health service delivery. The project is also timely as there is a temporary moratorium (imposed by the Office of Information Technology) on app dissemination within Veterans Health Administration, presenting an opportunity to study Moving Forward prior to its release. At the completion of this project, investigators expect that the work proposed in this study will highlight the clinical value of the Moving Forward app, which will inform both VA policy makers and the scientific community at large about the utility of SmartPhone technology in mental health care delivery. Investigators also expect that this study will provide our partners at Mental Health Services with helpful feedback on the Moving Forward app design and future app development.
- Conditions
- Depression, Anxiety
- Being tested
- Problem Solving Therapy plus Moving Forward, Problem Solving Therapy
- Keywords
- Veterans, Health Services, Mental Health, Technology, Primary Health Care, Psychotherapy
- Medical subject headings
- Depression, Anxiety Disorders, Psychological Well-Being
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Problem Solving Therapy plus Moving ForwardOther
All Veterans will receive a standard 6-session administration of Problem Solving Therapy (Nezu \& D'Zurilla, 1999). Session 1 will take place in-person during a scheduled appointment and will last for 1 hour. Subsequent sessions will take place over the telephone and will last for approximately 30 minutes. Participants in this arm will also receive the Moving Forward app for SmartPhones, which was adapted from Problem Solving Therapy to be used either as a standalone treatment or as an adjunct to other related therapies such as in-person Problem Solving Therapy or the Moving Forward website. The phone content matches Problem Solving Therapy. Benefits of the app include 24-hours accessibility of psychoeducational materials and worksheets.
Problem Solving TherapyOther
All Veterans will receive a standard 6-session administration of Problem Solving Therapy (Nezu \& D'Zurilla, 1999). Session 1 will take place in-person during a scheduled appointment and will last for 1 hour. Subsequent sessions will take place over the telephone and will last for approximately 30 minutes.
| Study group | Role | What they receive |
|---|---|---|
| Problem Solving Therapy plus Moving Forward (PST-MF) | Experimental | All Veterans will receive a standard 6-session administration of Problem Solving Therapy (Nezu \& D'Zurilla, 1999). Session 1 will take place in-person during a scheduled appointment and will last for 1 hour. Subsequent sessions will take place over the telephone and will last for approximately 30 minutes. Participants in this arm will also receive the Moving Forward app for SmartPhones, which was adapted from Problem Solving Therapy to be used either as a standalone treatment or as an adjunct to other related therapies such as in-person Problem Solving Therapy or the Moving Forward website. The phone content matches Problem Solving Therapy. Benefits of the app include 24-hours accessibility of psychoeducational materials and worksheets. Receives: Other: Problem Solving Therapy plus Moving Forward |
| Problem Solving Therapy | Active comparator | All Veterans will receive a standard 6-session administration of Problem Solving Therapy (Nezu \& D'Zurilla, 1999). Session 1 will take place in-person during a scheduled appointment and will last for 1 hour. Subsequent sessions will take place over the telephone and will last for approximately 30 minutes. Receives: Other: Problem Solving Therapy |
What is being measured
The primary outcome is the main question the study is designed to answer.
Depression Anxiety and Stress Scale (DASS)
The 7-item depression subscale on the Depression Anxiety and Stress Scale (DASS) is measured on a 0-42 scale. Higher scores represent worse depression symptoms. The 7-item anxiety subscale on the Depression Anxiety and Stress Scale (DASS) is measured on a 0-42 scale. Higher scores represent worse anxiety symptoms. The 7-item stress subscale on the Depression Anxiety and Stress Scale (DASS) is measured on a 0-42 scale. Higher scores represent worse stress symptoms.
Measured: 6 weeks, 12 weeks
Secondary outcomes (2)
Short Form Health Survey-12-Veterans (SF-12 V) Mental Composite Score
The 12-item Short Form Health Survey-12-Veterans (SF-12 V) Mental Composite Score is rated on a 0-100 scale. Higher scores represent better mental health functioning.
Measured: 6 weeks, 12 weeks
Client Satisfaction Questionnaire (CSQ-8)
The 8-item Client Satisfaction Questionnaire (CSQ-8) is rated on an 8-32 scale. Higher scores represent greater satisfaction with the intervention.
Measured: 6 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted3 Jul 2013 (estimated)
- Study startApr 2014
- Primary completionMar 2015
- Study completionMar 2015
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Other trials for DepressionStudies of the same condition, open and under way.
- More trials run by VA Office of Research and DevelopmentThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 1/2
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 33 participants (actual)
Sponsor and investigators
- Lead sponsor
- VA Office of Research and Development
- Sponsor type
- US federal agency
- Responsible party
- Sponsor
- Investigators
- Kathleen M Grubbs, PhD, Principal investigator, Central Arkansas Veterans Healthcare System Eugene J. Towbin Healthcare Center, Little Rock, AR
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01891734
- Sponsor's protocol ID
- PPO 13-122
- Status last verified
- Oct 2016
- First submitted
- 25 Jun 2013
- Last updated
- 28 Nov 2016
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 28 Nov 2016. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Enhancing Delivery of Problem Solving Therapy Using SmartPhone Technology
- ClinicalTrials.gov ID
- NCT01891734
- Acronym / sponsor ID
- PPO 13-122
- Conditions
- Depression, Anxiety
- Keywords
- Veterans, Health Services, Mental Health, Technology, Primary Health Care, Psychotherapy
- Phase
- Phase 1/2
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 33 participants (actual)
- Lead sponsor
- VA Office of Research and DevelopmentUS federal agency
- Study start
- Apr 2014
- Primary completion
- Mar 2015 (actual)
- Study completion
- Mar 2015 (actual)
- First posted
- 3 Jul 2013 (estimated)
- Results
- Posted 16 Sep 2016
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This project will be the first to evaluate the Moving Forward app in VA. Identifying an effective treatment for anxiety and depression in primary care is imperative within Veterans Health Administration as they are both common, chronic, and debilitating conditions associated with a number of personal and health-related costs. In close partnership with app developers at Mental Health Services, a major contribution of this research is the actionable feedback on the acceptability, feasibility and effectiveness of augmenting traditional Problem Solving Therapy with the Moving Forward app for future app development. If effectiveness can be established, Moving Forward has the potential for integration into the larger continuum of care for depression and anxiety in Primary Care-Mental Health Integration (e.g., care management, co-located collaborative care). Lastly, this pilot project will provide preliminary data for future research on SmartPhone technology. Veteran feedback on treatment components, ease of executing the study successfully and preliminary effect size calculations, will inform the design of the larger project.
Detailed description
Access and engagement in evidence-based psychotherapies for Veterans are high priorities for the Veterans Health Administration, especially the Office of Rural Health and the office of Mental Health Services. SmartPhone applications are an emerging technology with a vast potential to extend the reach of traditional in-person psychotherapy by allowing increased digital access to providers and self-management tools. Due to the relatively recent development of this technology, there are no data on the effectiveness of SmartPhone-delivered psychotherapy. Preliminary data on acceptability and satisfaction are promising, suggesting a need for further research. The National Center for Posttraumatic Stress Disorder in collaboration with the National Center for Telehealth \& Technology (T2) recently completed the development of an app called Moving Forward, a Veteran-friendly adaptation of Problem Solving Therapy, an evidence based therapy available through Primary Care Integration Clinics. In partnership with Mental Health Services, this proposed pilot project will gather preliminary data on the effectiveness and acceptability of Moving Forward and provide timely feedback to the app creators. Participants will include approximately 40 Veterans diagnosed with an anxiety or mood disorder interested in obtaining mental health treatment in Primary Care -Mental Health Integration. Participants will be randomly assigned to receive either Problem Solving Therapy augmented by the Moving Forward app or Problem Solving Therapy alone. Participants will complete assessments at baseline, 6 weeks and 12 weeks. Investigators propose 3 specific hypotheses. In hypothesis 1, investigators predict a moderate effect size will be observed when comparing homework completion and satisfaction for patients randomized to Problem Solving Therapy plus the Moving Forward app compared to patients randomized to Problem Solving Therapy alone. In hypothesis 2, investigators predict a moderate effect size will be observed when comparing change scores on the problem solving style for patients randomized to Problem Solving Therapy plus the Moving Forward app compared to patients randomized to Problem Solving Therapy alone. In hypothesis 3, investigators predict a moderate effect size will be observed when comparing depression, anxiety, stress and quality of life change for patients randomized to Problem Solving Therapy plus the Moving Forward app compared to patients randomized to Problem Solving Therapy alone. Key informant interviews will provide qualitative feedback on the Moving Forward app which investigators will share with our partners at Mental Health Services. The proposed project is important to the VA mission to improve access for all Veterans particularly those who face barriers to engagement in traditional face-to-face treatment. The proposed research addresses one of three primary focus areas of the Office of Research and Development (Access), two of Health Services Research \&Development's research priorities (Access/Rural Health and Mental Health), and three of Secretary Shinseki's Transformational Initiatives for the 21st Century including improving: 1) access to care, 2) mental health, and 3) patient-centeredness. This proposed work is innovative as it focuses on a rapidly emerging mobile technology that has great potential to improve access and engagement in mental health service delivery. To date, there have been no randomized effectiveness trials that have examined SmartPhone apps for mental health service delivery. The project is also timely as there is a temporary moratorium (imposed by the Office of Information Technology) on app dissemination within Veterans Health Administration, presenting an opportunity to study Moving Forward prior to its release. At the completion of this project, investigators expect that the work proposed in this study will highlight the clinical value of the Moving Forward app, which will inform both VA policy makers and the scientific community at large about the utility of SmartPhone technology in mental health care delivery. Investigators also expect that this study will provide our partners at Mental Health Services with helpful feedback on the Moving Forward app design and future app development.
Study design
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Problem Solving Therapy plus Moving Forward (PST-MF) | Experimental | Other: Problem Solving Therapy plus Moving ForwardAll Veterans will receive a standard 6-session administration of Problem Solving Therapy (Nezu \& D'Zurilla, 1999). Session 1 will take place in-person during a scheduled appointment and will last for 1 hour. Subsequent sessions will take place over the telephone and will last for approximately 30 minutes. Participants in this arm will also receive the Moving Forward app for SmartPhones, which was adapted from Problem Solving Therapy to be used either as a standalone treatment or as an adjunct to other related therapies such as in-person Problem Solving Therapy or the Moving Forward website. The phone content matches Problem Solving Therapy. Benefits of the app include 24-hours accessibility of psychoeducational materials and worksheets. |
| Problem Solving Therapy | Active comparator | Other: Problem Solving TherapyAll Veterans will receive a standard 6-session administration of Problem Solving Therapy (Nezu \& D'Zurilla, 1999). Session 1 will take place in-person during a scheduled appointment and will last for 1 hour. Subsequent sessions will take place over the telephone and will last for approximately 30 minutes. |
Who may qualify
- Ages
- 18 to 64 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult
Key inclusion criteria (20 listed)
- Veterans will be eligible if they are 18 years old or older,
- speak and understand English,
- are patients in the Central Arkansas Veterans Healthcare System Primary Care-Mental Health Integration,
- and have a current diagnosis of depression
- and/or anxiety
Key exclusion criteria (8 listed)
- Exclusionary criteria include any current suicidal ideation,
- substance dependence diagnosis and current use,
- any psychotic spectrum diagnoses or
- inability to provide informed consent.
- Diagnosis will be confirmed by chart review and Mini International Neuropsychiatric Interview.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Problem Solving Therapy plus Moving ForwardAll Veterans will receive a standard 6-session administration of Problem Solving Therapy (Nezu \& D'Zurilla, 1999). Session 1 will take place in-person during a scheduled appointment and will last for 1 hour. Subsequent sessions will take place over the telephone and will last for approximately 30 minutes. Participants in this arm will also receive the Moving Forward app for SmartPhones, which was adapted from Problem Solving Therapy to be used either as a standalone treatment or as an adjunct to other related therapies such as in-person Problem Solving Therapy or the Moving Forward website. The phone content matches Problem Solving Therapy. Benefits of the app include 24-hours accessibility of psychoeducational materials and worksheets. | Other | Problem Solving Therapy plus Moving Forward (PST-MF) |
| Problem Solving TherapyAll Veterans will receive a standard 6-session administration of Problem Solving Therapy (Nezu \& D'Zurilla, 1999). Session 1 will take place in-person during a scheduled appointment and will last for 1 hour. Subsequent sessions will take place over the telephone and will last for approximately 30 minutes. | Other | Problem Solving Therapy |
Primary outcome
Depression Anxiety and Stress Scale (DASS)
Time frame: 6 weeks, 12 weeks
The 7-item depression subscale on the Depression Anxiety and Stress Scale (DASS) is measured on a 0-42 scale. Higher scores represent worse depression symptoms. The 7-item anxiety subscale on the Depression Anxiety and Stress Scale (DASS) is measured on a 0-42 scale. Higher scores represent worse anxiety symptoms. The 7-item stress subscale on the Depression Anxiety and Stress Scale (DASS) is measured on a 0-42 scale. Higher scores represent worse stress symptoms.
2 secondary outcomes
Short Form Health Survey-12-Veterans (SF-12 V) Mental Composite Score
Time frame: 6 weeks, 12 weeks
Client Satisfaction Questionnaire (CSQ-8)
Time frame: 6 weeks
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 28 Nov 2016.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Kathleen M Grubbs, PhD principal investigator
Central Arkansas Veterans Healthcare System Eugene J. Towbin Healthcare Center, Little Rock, AR
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 1/2 study testing Problem Solving Therapy plus Moving Forward and Problem Solving Therapy in people with Depression and Anxiety, run by VA Office of Research and Development at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 20 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 28 Nov 2016. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this combined phase mean?
Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.
Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Yes. Results are posted in the registry (first posted 16 Sep 2016). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Depression Anxiety and Stress Scale (DASS) (time frame: 6 weeks, 12 weeks). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Nov 2016.