Smartphone-Supported versus Full Behavioural Activation for Depression: A Randomised Controlled Trial

PLoS One. 2015 May 26;10(5):e0126559. doi: 10.1371/journal.pone.0126559. eCollection 2015.


Background: There is need for more cost and time effective treatments for depression. This is the first randomised controlled trial in which a blended treatment--including four face-to-face sessions and a smartphone application--was compared against a full behavioural treatment. Hence, the aim of the current paper was to examine whether a blended smartphone treatment was non-inferior to a full behavioural activation treatment for depression.

Methods: This was a randomised controlled non-inferiority trial (NCT01819025) comparing a blended treatment (n=46) against a full ten-session treatment (n=47) for people suffering from major depression. Primary outcome measure was the BDI-II, that was administered at pre- and post-treatment, as well as six months after the treatment.

Results: Results showed significant improvements in both groups across time on the primary outcome measure (within-group Cohen's d=1.35; CI [-0.82, 3.52] to d=1.47; CI [-0.41, 3.35]; between group d=-0.13 CI [-2.37, 2.09] and d=-0.10 CI [-2.53, 2.33]). At the same time, the blended treatment reduced the therapist time with an average of 47%.

Conclusions: We could not establish whether the blended treatment was non-inferior to a full BA treatment. Nevertheless, this study points to that the blended treatment approach could possibly treat nearly twice as many patients suffering from depression by using a smartphone application as add-on. More studies are needed before we can suggest that the blended treatment method is a promising cost-effective alternative to regular face-to-face treatment for depression.

Trial registration: Cognitive Behavioral Therapy Treatment of Depression With Smartphone Support NCT01819025.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anxiety / psychology
  • Cognitive Behavioral Therapy*
  • Demography
  • Depression / psychology
  • Depression / therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Compliance
  • Patient Dropouts
  • Psychiatric Status Rating Scales
  • Smartphone*
  • Time Factors
  • Treatment Outcome
  • Young Adult

Associated data


Grant support

This paper was supported by the Swedish Research Council: 2011-2476 (, as well as by the European Community’s Seventh Framework Programme (FP7): 603098 ( Wemind Psykiatri Stockholm provided support in the form of salaries for author OM, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of the authors are articulated in the author contributions’ section.