Randomized trial of digital mental health treatment for symptoms of depression and anxiety in breast cancer survivors

Psychological distress in breast cancer survivors (BCSs) is highly prevalent. Access to treatment is limited by barriers, including a lack of phychotherapists. The scalable, publicly accessible digital mental health treatment (DMHT) is an 8-week self-guided, fully automated suite of 5 clinically focused applications. A randomized trial among 313 BCSs across 44 US states evaluated the efficacy of DMHT for reducing symptoms of depression and anxiety. Adult women within 5 years of receiving a breast cancer diagnosis (stage I-III), who had a smartphone with a data plan, and had elevated symptoms of depression or anxiety, were randomized 2:1 to receive either the DMHT (IntelliCare) or a patient education program. Patients in the DMHT group who had suboptimal engagement based on week 1 use were randomized 1:1 to receive additional human coaching or no coaching. Patients in the DMHT group reported significantly greater reduction in anxiety but not depression compared to the patients in the control arm. Human coaching versus no coaching increased the number of days of application use. The authors conclude that these findings indicate that BCSs with symptoms of anxiety may benefit from a scalable and accessible DMHT program.