Open Access

Emily Bralee, Mohammod Mostazir, Fiona C. Warren, Alexandra Newbold, Claire Hulme, Timothy Cranston, Benjamin Aas, Holly Bear, Cristina Botella, Felix Burkhardt, Thomas Ehring, Mina Fazel, Johnny R. J. Fontaine, Mads Frost, Azucena Garcia-Palacios, Ellen Greimel, Christiane Hößle, Arpine Hovasapian, Veerle E. I. Huyghe, Nanna Iversen, Kostas Karpouzis, Johanna Löchner, Guadalupe Molinari, Reinhard Pekrun, Belinda Platt, Tabea Rosenkranz, Klaus R. Scherer, Katja Schlegel, Björn W. Schuller, Gerd Schulte-Korne, Carlos Suso-Ribera, Varinka Voigt, Maria Voss, Edward R. Watkins

• Objective: To explore which cognitive behavioral therapy (CBT) self-help app usage predicted depression during a selective prevention trial. Method: A recent controlled trial (ECoWeB-PREVENT) randomized young people aged 16–22, at increased risk for depression because of elevated worry/rumination, negative appraisals, and/or rejection sensitivity but without past or current history of major depression, to apps that provided self-monitoring, self-monitoring plus CBT self-help, or self-monitoring plus emotional competency self-help. Self-help included coping strategies for moment-by-moment use (Tools) and self-learning/planning exercises (Challenges). On the primary outcome (depression, Patient Health Questionnaire-9 [PHQ-9]) at 3-months follow-up (primary endpoint), only the CBT app outperformed self-monitoring. In this secondary analysis, only data from participants who used the CBT or self-monitoring apps at least once were analyzed to test what app use predicted change in depressionObjective: To explore which cognitive behavioral therapy (CBT) self-help app usage predicted depression during a selective prevention trial. Method: A recent controlled trial (ECoWeB-PREVENT) randomized young people aged 16–22, at increased risk for depression because of elevated worry/rumination, negative appraisals, and/or rejection sensitivity but without past or current history of major depression, to apps that provided self-monitoring, self-monitoring plus CBT self-help, or self-monitoring plus emotional competency self-help. Self-help included coping strategies for moment-by-moment use (Tools) and self-learning/planning exercises (Challenges). On the primary outcome (depression, Patient Health Questionnaire-9 [PHQ-9]) at 3-months follow-up (primary endpoint), only the CBT app outperformed self-monitoring. In this secondary analysis, only data from participants who used the CBT or self-monitoring apps at least once were analyzed to test what app use predicted change in depression from baseline to 3 months. Results: Of the original 1,262 participants (79% female), 558 were included (CBT, baseline, n = 273, PHQ-9: M = 7.48, SD = 3.9; 3 months, N = 163, PHQ-9: M = 8.83, SD = 4.92; self-monitoring, baseline, n = 285, PHQ-9: M = 7.45, SD = 4.26; 3 months, N = 183, PHQ-9: M = 7.48, SD = 3.9). Neither total app use, self-monitoring, nor use of Tools predicted change in depression (all ps > .05). Frequency of use of Challenges predicted lower depression symptoms and caseness at 3 months (β = −0.28, 95% CI [−0.53, −0.03], p = .029). Specifically, the use of behavioral activation challenges mediated the effects of the CBT app on depression over 3 months (β = −0.59, 95% CI [−1.13, −0.05], p = .03). Conclusions: Brief psychoeducation about behavioral activation principles in an app may protect young people from depression over 3 months, even when only used once.…