DepressionPhase 2COMET-DWMNCT05441111
Low-intensity Stepped Care for Internalizing Distress
A Phase 2 study testing Common Elements Toolbox, Doing What Matters in Times of Stress: An Illustrated Guide and Guided self-help in people with Depression and Anxiety, run by Indiana University at 1 site in United States.
Trial summary
The purpose of this study is to test the feasibility and efficacy of combining a single session intervention, COMET, with a self-help intervention, Doing what matters in times of stress. In step I, all individuals receive COMET. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Depression, Anxiety, Emotion Regulation
- What is being tested?
- Common Elements Toolbox, Doing What Matters in Times of Stress: An Illustrated Guide and Guided self-help
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 275 participants
- Where
- 1 siteUnited States
- Study dates
- 29 Jun 2022to 22 Sep 2023
- Phase
- Phase 2
- Are there results?
- None posted in the registry
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 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- At least mild distress: K6 score ≥ 6
- Having reasonably regular access to the internet or a telephone
Who cannot join
- Suicidality: on the Patient Health Questionnaire 9 (PHQ9) item 9 ("thoughts that you would be better off dead, or of hurting yourself ") ≥ 2 ("more than half the days")
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Combining Guided Self-help Approaches for Common Mental Disorders
The purpose of this study is to test the feasibility and efficacy of combining a single session intervention, COMET, with a self-help intervention, Doing what matters in times of stress. In step I, all individuals receive COMET. In Step II, all individuals receive Doing what matters in times of stress but are randomized 1:1 to guided (Doing what matters in times of stress with paraprofessional support) vs. unguided self-help (Doing what matters in times of stress with no support).
Read the detailed description
The first page participants will see is the informed consent document describing the study, delineating risks/benefits, payment, who to contact with problems, etc. Once participants have read through the informed consent, those who wish to participate will be taken to the survey battery.
The baseline survey should take about 15 minutes to complete. Individuals who score at least a 6 on the Kessler Psychological Distress Scale (K6) are eligible to participate. After participants are deemed eligible, they will be randomized to one of 2 conditions: guided self-help bibliotherapy or unguided self-help bibliotherapy. Participants who qualify and are randomized to the guided self-help condition will provide their phone number, email, address, whether they would like the Doing what matters in times of stress book to also be mailed to them, what their preferred method of initial contact is, and a list of timeframes in which they would have the privacy to be contacted by the research team. Participants who qualify and are randomized to the unguided self-help condition will provide their phone number, email, address, and confirm whether they would like the Doing what matters in times of stress book to also be mailed to them. Participants who do not qualify will be thanked for their time and receive the link to the book so they can use it on their own time if they wish.
After filling out their contact information, eligible participants will be taken directly to the Common Elements Toolbox (COMET) intervention. The COMET intervention will be delivered via Qualtrics and will include the following modules: cognitive restructuring (labeled "flexible thinking"), behavioral activation (labeled "positive activities"), gratitude, and self-compassion. The total time for completing the COMET intervention is around 45 minutes, which means the total approximate time for completing the entire baseline assessment (survey + COMET) is around 60 minutes.
For participants in the guided self-help condition, within 1 week of completing the baseline assessment a member of the research team will either email participants to schedule a time to call, or call eligible participants to explain the study in more detail, and answer any questions they may have. Participants will be sent a welcome email with the Doing what matters in times of stress book, a copy of the informed consent, and a participation guide. Each participant will receive a unique Zoom Health link to use for participation. These calls will not be recorded. This initial call will also serve to introduce the participant to the Doing what matters in times of stress book, create a plan for using the book, and schedule the remaining calls. The welcome call should take up to 30 minutes.
For participants in the unguided condition, within 1 week of completing the baseline assessment they will be emailed a copy of the book, the informed consent statement, the Making a Plan Worksheet, and a participation guide.
The next phase of the study involves participants using the Doing what matters in times of stress book either on its own or with guided interaction over video or phone calls. Each participant in the guided condition will meet weekly with a Research Assistant (RA) who will be trained to the therapeutic material and supportive accountability model. The supportive accountability model frames the relationship in self-help treatments as one in which the helper facilitates the participant's acquisition of skills by being supportive and promoting adherence to the material. This is different than the working alliance in individual therapy in which the patient and therapist work together on a mutually agreed-upon goal in that the relationship in guided self-help puts the emphasis on participants working on their own goals. To be clear, the RA will not be acting as a therapist - their role is only to help participants read through the book. The goal of these weekly guided interactions will be to provide supportive accountability and promote adherence to the intervention. The guided interactions will focus on how the participant interacts with the self-help material (i.e. how the participant feels about the material, goal setting, and performance monitoring). Guidance in the context of self-help has proven to increase treatment adherence compared to unguided self-administered treatment. This weekly guided self-help will be provided for 6 weeks. During this time the participant and trained RA will meet once a week for 3-6 weeks (depending on what the participant prefers). We will send out a reminder email the day before each meeting. Participants in the unguided condition will follow the same procedures, except they will not receive guidance.
- Conditions
- Depression, Anxiety, Emotion Regulation
- Being tested
- Common Elements Toolbox, Doing What Matters in Times of Stress: An Illustrated Guide, Guided self-help
- Medical subject headings
- Depression, Anxiety Disorders, Emotional Regulation
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Common Elements ToolboxBehavioural
Also called COMET, Single-session intervention
COMET consists of the following modules: cognitive restructuring (labeled "flexible thinking"), behavioral activation (labeled "positive activities"), gratitude, and self-compassion. Participants complete these COMET modules by themselves. The format is reading psychoeducational along with completing specific activities
Doing What Matters in Times of Stress: An Illustrated GuideBehavioural
Also called Self-help Plus
From the WHO's website: Doing What Matters in Times of Stress: An Illustrated Guide is a stress management guide for coping with adversity. The guide aims to equip people with practical skills to help cope with stress. A few minutes each day are enough to practice the self-help techniques. The guide can be used alone or with the accompanying audio exercises.
Informed by evidence and extensive field testing, the guide is for anyone who experiences stress, wherever they live and whatever their circumstances.
Guided self-helpBehavioural
Participants in the guided self-help condition are assigned an "eCoach" who provides emotional support as well as who promote adherence to the intervention
| Study group | Role | What they receive |
|---|---|---|
| COMET + guided self-help bibliotherapy | Experimental | Participants are given access to a single session intervention the Common Elements Toolbox (COMET) and, a week after, are given access to the World Health Organization's (WHO) "Doing what matters in times of stress: An illustrated guide" (https://www.who.int/publications/i/item/9789240003927) virtually (i.e., as a pdf) and/or in print. Each participant is assigned an "eCoach" -- an undergraduate, post-baccalaureate, or graduate research assistant -- who will meet with the participant for a 60-minute welcome call describing the intervention and 3-6 sessions of guidance focused on promoting adherence to the manual and using skills in everyday life. Receives: Behavioral: Common Elements Toolbox; Behavioral: Doing What Matters in Times of Stress: An Illustrated Guide; Behavioral: Guided self-help |
| COMET + unguided self-help bibliotherapy | Active comparator | Participants are given access to a single session intervention the Common Elements Toolbox (COMET) and, a week after, are given access to the World Health Organization's (WHO) "Doing what matters in times of stress: An illustrated guide" (https://www.who.int/publications/i/item/9789240003927) virtually (i.e., as a pdf) and/or in print. Participants are left to read the book on their own (i.e., without an eCoach) Receives: Behavioral: Common Elements Toolbox; Behavioral: Doing What Matters in Times of Stress: An Illustrated Guide |
What is being measured
The primary outcome is the main question the study is designed to answer.
6-week change in Kessler 6 Psychological Distress Scale (K6)
Changes in K6 from baseline to Week 6. The K6 is a measure of distress and the measure is scored on a scale of 0 - 24 where higher scores indicate higher distress (i.e., are negative). Thus, lower scores relative to baseline indicate more positive outcomes.
Measured: 6 weeks
6-week change in the WHO 5 Well-being Index (WHO-5)
Changes in WHO-5 from baseline to Week 6. The WHO-5 is a measure of well-being and the measure is scored on a scale of 0 - 100 where higher scores indicate higher satisfaction with life (i.e., are positive). Thus, higher scores relative to baseline indicate more positive outcomes.
Measured: 6 weeks
Secondary outcomes (4)
6-week change in Emotion Regulation Scale (ERQ) - Reappraisal subscale
Changes in the ERQ Reappraisal subscale from baseline to Week 6. The Reappraisal scale is a measure of regulating emotions by engaging in reappraisal (i.e., changing the one one thinks about an emotion evoking stimuli), widely considered an adaptive strategy. The measured is scored on a 1-7 scale where higher scores indicate greater use of adaptive emotion regulation strategies (i.e., positive). Thus, higher scores relative to baseline indicate more positive outcomes.
Measured: 6 weeks
6-week change in the Emotion Regulation Scale (ERQ) - Suppression subscale
Changes in the ERQ Suppression Scale from baseline to Week 6. The ERQ Suppression scale is a measure of regulating emotions by engaging in suppression (i.e., trying not to think or feel), which is considered a maladaptive emotion regulation strategy. The measure is scored on a scale of 1 - 7 where higher scores indicate higher use of suppression (i.e., negative). Thus, lower scores relative to baseline indicate more positive outcomes.
Measured: 6 weeks
3-month change in Kessler 6 Psychological Distress Scale (K6; 0 - 24)
Changes in K6 from baseline to 3 months after the termination of the study. The K6 is a measure of distress and the measure is scored on a scale of 0 - 24 where higher scores indicate higher distress (i.e., negative). Thus, lower scores relative to baseline indicate more positive outcomes.
Measured: 3 months
3-month change in the WHO 5 Well-being Index (WHO-5)
Changes in WHO-5 from baseline to 3 months after the termination of the study. The WHO-5 is a measure of well-being and the measure is scored on a scale of 0 - 100 where higher scores indicate higher satisfaction with life (i.e., are positive). Thus, higher scores relative to baseline indicate more positive outcomes.
Measured: 3 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted1 Jul 2022
- Study start29 Jun 2022
- Primary completion11 May 2023
- Study completion22 Sep 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for DepressionStudies of the same condition, open and under way.
- 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 2
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Investigator
- Enrolment
- 275 participants (actual)
Sponsor and investigators
- Lead sponsor
- Indiana University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Lorenzo Lorenzo-Luaces, Indiana University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05441111
- Sponsor's protocol ID
- 11997
- Acronym
- COMET-DWM
- Status last verified
- May 2024
- First submitted
- 28 Jun 2022
- Last updated
- 7 May 2024
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Undecided: Data will be made available upon request.
Study at a glance
From the registry record, last updated by the sponsor on 7 May 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Combining Guided Self-help Approaches for Common Mental Disorders
- ClinicalTrials.gov ID
- NCT05441111
- Acronym / sponsor ID
- COMET-DWM / 11997
- Conditions
- Depression, Anxiety, Emotion Regulation
- Phase
- Phase 2
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 275 participants (actual)
- Lead sponsor
- Indiana UniversityUniversity, hospital or other
- Study start
- 29 Jun 2022 (actual)
- Primary completion
- 11 May 2023 (actual)
- Study completion
- 22 Sep 2023 (actual)
- First posted
- 1 Jul 2022 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The purpose of this study is to test the feasibility and efficacy of combining a single session intervention, COMET, with a self-help intervention, Doing what matters in times of stress. In step I, all individuals receive COMET. In Step II, all individuals receive Doing what matters in times of stress but are randomized 1:1 to guided (Doing what matters in times of stress with paraprofessional support) vs. unguided self-help (Doing what matters in times of stress with no support).
Detailed description
The first page participants will see is the informed consent document describing the study, delineating risks/benefits, payment, who to contact with problems, etc. Once participants have read through the informed consent, those who wish to participate will be taken to the survey battery.
The baseline survey should take about 15 minutes to complete. Individuals who score at least a 6 on the Kessler Psychological Distress Scale (K6) are eligible to participate. After participants are deemed eligible, they will be randomized to one of 2 conditions: guided self-help bibliotherapy or unguided self-help bibliotherapy. Participants who qualify and are randomized to the guided self-help condition will provide their phone number, email, address, whether they would like the Doing what matters in times of stress book to also be mailed to them, what their preferred method of initial contact is, and a list of timeframes in which they would have the privacy to be contacted by the research team. Participants who qualify and are randomized to the unguided self-help condition will provide their phone number, email, address, and confirm whether they would like the Doing what matters in times of stress book to also be mailed to them. Participants who do not qualify will be thanked for their time and receive the link to the book so they can use it on their own time if they wish.
After filling out their contact information, eligible participants will be taken directly to the Common Elements Toolbox (COMET) intervention. The COMET intervention will be delivered via Qualtrics and will include the following modules: cognitive restructuring (labeled "flexible thinking"), behavioral activation (labeled "positive activities"), gratitude, and self-compassion. The total time for completing the COMET intervention is around 45 minutes, which means the total approximate time for completing the entire baseline assessment (survey + COMET) is around 60 minutes.
For participants in the guided self-help condition, within 1 week of completing the baseline assessment a member of the research team will either email participants to schedule a time to call, or call eligible participants to explain the study in more detail, and answer any questions they may have. Participants will be sent a welcome email with the Doing what matters in times of stress book, a copy of the informed consent, and a participation guide. Each participant will receive a unique Zoom Health link to use for participation. These calls will not be recorded. This initial call will also serve to introduce the participant to the Doing what matters in times of stress book, create a plan for using the book, and schedule the remaining calls. The welcome call should take up to 30 minutes.
For participants in the unguided condition, within 1 week of completing the baseline assessment they will be emailed a copy of the book, the informed consent statement, the Making a Plan Worksheet, and a participation guide.
The next phase of the study involves participants using the Doing what matters in times of stress book either on its own or with guided interaction over video or phone calls. Each participant in the guided condition will meet weekly with a Research Assistant (RA) who will be trained to the therapeutic material and supportive accountability model. The supportive accountability model frames the relationship in self-help treatments as one in which the helper facilitates the participant's acquisition of skills by being supportive and promoting adherence to the material. This is different than the working alliance in individual therapy in which the patient and therapist work together on a mutually agreed-upon goal in that the relationship in guided self-help puts the emphasis on participants working on their own goals. To be clear, the RA will not be acting as a therapist - their role is only to help participants read through the book. The goal of these weekly guided interactions will be to provide supportive accountability and promote adherence to the intervention. The guided interactions will focus on how the participant interacts with the self-help material (i.e. how the participant feels about the material, goal setting, and performance monitoring). Guidance in the context of self-help has proven to increase treatment adherence compared to unguided self-administered treatment. This weekly guided self-help will be provided for 6 weeks. During this time the participant and trained RA will meet once a week for 3-6 weeks (depending on what the participant prefers). We will send out a reminder email the day before each meeting. Participants in the unguided condition will follow the same procedures, except they will not receive guidance.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (investigator)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| COMET + guided self-help bibliotherapy | Experimental | Behavioral: Common Elements Toolbox, Behavioral: Doing What Matters in Times of Stress: An Illustrated Guide, Behavioral: Guided self-helpParticipants are given access to a single session intervention the Common Elements Toolbox (COMET) and, a week after, are given access to the World Health Organization's (WHO) "Doing what matters in times of stress: An illustrated guide" (https://www.who.int/publications/i/item/9789240003927) virtually (i.e., as a pdf) and/or in print. Each participant is assigned an "eCoach" -- an undergraduate, post-baccalaureate, or graduate research assistant -- who will meet with the participant for a 60-minute welcome call describing the intervention and 3-6 sessions of guidance focused on promoting adherence to the manual and using skills in everyday life. |
| COMET + unguided self-help bibliotherapy | Active comparator | Behavioral: Common Elements Toolbox, Behavioral: Doing What Matters in Times of Stress: An Illustrated GuideParticipants are given access to a single session intervention the Common Elements Toolbox (COMET) and, a week after, are given access to the World Health Organization's (WHO) "Doing what matters in times of stress: An illustrated guide" (https://www.who.int/publications/i/item/9789240003927) virtually (i.e., as a pdf) and/or in print. Participants are left to read the book on their own (i.e., without an eCoach) |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (2 listed)
- At least mild distress: K6 score ≥ 6
- Having reasonably regular access to the internet or a telephone
Key exclusion criteria (1 listed)
- Suicidality: on the Patient Health Questionnaire 9 (PHQ9) item 9 ("thoughts that you would be better off dead, or of hurting yourself ") ≥ 2 ("more than half the days")
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 |
|---|---|---|
| Common Elements ToolboxAlso: COMET, Single-session interventionCOMET consists of the following modules: cognitive restructuring (labeled "flexible thinking"), behavioral activation (labeled "positive activities"), gratitude, and self-compassion. Participants complete these COMET modules by themselves. The format is reading psychoeducational along with completing specific activities | Behavioural | COMET + guided self-help bibliotherapy, COMET + unguided self-help bibliotherapy |
| Doing What Matters in Times of Stress: An Illustrated GuideAlso: Self-help PlusFrom the WHO's website: Doing What Matters in Times of Stress: An Illustrated Guide is a stress management guide for coping with adversity. The guide aims to equip people with practical skills to help cope with stress. A few minutes each day are enough to practice the self-help techniques. The guide can be used alone or with the accompanying audio exercises. Informed by evidence and extensive field testing, the guide is for anyone who experiences stress, wherever they live and whatever their circumstances. | Behavioural | COMET + guided self-help bibliotherapy, COMET + unguided self-help bibliotherapy |
| Guided self-helpParticipants in the guided self-help condition are assigned an "eCoach" who provides emotional support as well as who promote adherence to the intervention | Behavioural | COMET + guided self-help bibliotherapy |
Primary outcome
6-week change in Kessler 6 Psychological Distress Scale (K6)
Time frame: 6 weeks
Changes in K6 from baseline to Week 6. The K6 is a measure of distress and the measure is scored on a scale of 0 - 24 where higher scores indicate higher distress (i.e., are negative). Thus, lower scores relative to baseline indicate more positive outcomes.
6-week change in the WHO 5 Well-being Index (WHO-5)
Time frame: 6 weeks
Changes in WHO-5 from baseline to Week 6. The WHO-5 is a measure of well-being and the measure is scored on a scale of 0 - 100 where higher scores indicate higher satisfaction with life (i.e., are positive). Thus, higher scores relative to baseline indicate more positive outcomes.
4 secondary outcomes
6-week change in Emotion Regulation Scale (ERQ) - Reappraisal subscale
Time frame: 6 weeks
6-week change in the Emotion Regulation Scale (ERQ) - Suppression subscale
Time frame: 6 weeks
3-month change in Kessler 6 Psychological Distress Scale (K6; 0 - 24)
Time frame: 3 months
3-month change in the WHO 5 Well-being Index (WHO-5)
Time frame: 3 months
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 7 May 2024.
- Individual participant dataSharing planned: Undecided. Data will be made available upon request.
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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.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 2 study testing Common Elements Toolbox, Doing What Matters in Times of Stress: An Illustrated Guide and Guided self-help in people with Depression and Anxiety, run by Indiana University 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 2 inclusion and 1 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 7 May 2024. 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 phase mean?
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?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
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?
6-week change in Kessler 6 Psychological Distress Scale (K6) (time frame: 6 weeks). The study lists 2 primary outcomes in all. 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 7 May 2024.