Smartphone training improves long-term symptoms of depression

A brief smartphone-based training programme completed by patients with depression alongside their inpatient treatment can lead to long-term reduction in depressive symptoms. This is the finding of a study conducted by psychologists at the University of Münster. The results have now been published in the journal JMIR mHealth and uHealth.

In this randomised clinical trial, 75 inpatients diagnosed with depression – divided into an experimental and a control group – completed a brief cognitive training programme on a smartphone in addition to their standard therapy. The training comprised six 15-minute sessions over a two-week period and was designed to modify automatic responses to social stimuli by systematically training approach and avoidance tendencies. Participants in the experimental group learned to perform approach movements by pulling the smartphone closer when viewing smiling faces, and avoidance movements by pushing the smartphone away when viewing faces with negative emotional expressions. Participants in the control group completed a non-specific version of the task in which the movements were not systematically paired with facial expressions.

Both groups showed substantial symptom improvement immediately following treatment, though no difference between the active and control participants was evident at that time. Six months later, a clear advantage emerged for the experimental group: these patients reported significantly lower depressive symptoms compared to the control group.

“Our findings suggest that the effects of the training may unfold over time, possibly as the learned approach tendencies are transferred into real-life social interactions. For example, this might occur when a person begins to re-engage with potentially rewarding activities with friends, or simply responds to another person’s smile with a smile of their own,” explains Dr Maximilian Blomberg, first author of the study and research associate in the Clinical Psychology and Translational Psychotherapy Unit at the University of Münster.

Potential mechanisms may involve the gradual translation of automated behavioural patterns toward positive social stimuli into actual social behaviour. Social withdrawal tendencies are considered a significant maintaining factor in depression, as they limit experiences of positive social reinforcement. “By promoting approach behaviour toward positive faces, the training may foster more potentially rewarding social experiences and thereby contribute to lasting symptom improvement,” Maximilian Blomberg notes.

“Furthermore, the training may strengthen the ability to seek out and process positive information in one’s environment, even when experiencing negative moods, a process often impaired in depression,” adds Prof Timo Brockmeyer, principal investigator of the study. “This form of information processing can help disrupt vicious cycles of low mood, negative thinking, and social withdrawal.” In earlier work, Timo Brockmeyer and his colleagues had already shown that such mood-incongruent information processing was associated with more favourable long-term outcomes in depression. Neurobiological evidence from previous studies supports these findings, suggesting that approach-avoidance training can normalise the brain’s reward sensitivity to positive social cues.

This investigation is the first randomised clinical trial to examine the efficacy of a fully smartphone-based approach-avoidance bias modification training for depression. The training was easily integrated into inpatient treatment, required no additional technical equipment and was completed independently by patients. The researchers emphasise that larger multicentre studies are needed to replicate the findings and to better understand the underlying mechanisms. Future research may also explore whether such interventions could be beneficial following discharge or in outpatient settings.

“If our findings are confirmed, simple digital training modules could in the future help reduce relapse rates after therapy and enhance the long-term effectiveness of treatment,” concludes Timo Brockmeyer.

Original publication
Blomberg, M., Zech, H., Kluge, M., Böhmert, N., Platte, H., & Brockmeyer, T. Smartphone-Based Approach–Avoidance Bias Modification Training for Depression: A Randomized Clinical Trial. JMIR mHealth and uHealth. doi:10.2196/69033

Further information

• Original publication in JMIR mHealth and uHealth
• Clinical Psychology and Translational Psychotherapy Unit, University of Münster (only in German)