title: Efficacy of a Web-based, crowdsourced peer-to-peer cognitive reappraisal platform for depression: randomized controlled trial.
abstract: BACKGROUND
  Self-guided, Web-based interventions for depression show promising results but suffer from high attrition and low user engagement. Online peer support networks can be highly engaging, but they show mixed results and lack evidence-based content.
  
  
  OBJECTIVE
  Our aim was to introduce and evaluate a novel Web-based, peer-to-peer cognitive reappraisal platform designed to promote evidence-based techniques, with the hypotheses that (1) repeated use of the platform increases reappraisal and reduces depression and (2) that the social, crowdsourced interactions enhance engagement.
  
  
  METHODS
  Participants aged 18-35 were recruited online and were randomly assigned to the treatment group, "Panoply" (n=84), or an active control group, online expressive writing (n=82). Both are fully automated Web-based platforms. Participants were asked to use their assigned platform for a minimum of 25 minutes per week for 3 weeks. Both platforms involved posting descriptions of stressful thoughts and situations. Participants on the Panoply platform additionally received crowdsourced reappraisal support immediately after submitting a post (median response time=9 minutes). Panoply participants could also practice reappraising stressful situations submitted by other users. Online questionnaires administered at baseline and 3 weeks assessed depression symptoms, reappraisal, and perseverative thinking. Engagement was assessed through self-report measures, session data, and activity levels.
  
  
  RESULTS
  The Panoply platform produced significant improvements from pre to post for depression (P=.001), reappraisal (P<.001), and perseverative thinking (P<.001). The expressive writing platform yielded significant pre to post improvements for depression (P=.02) and perseverative thinking (P<.001), but not reappraisal (P=.45). The two groups did not diverge significantly at post-test on measures of depression or perseverative thinking, though Panoply users had significantly higher reappraisal scores (P=.02) than expressive writing. We also found significant group by treatment interactions. Individuals with elevated depression symptoms showed greater comparative benefit from Panoply for depression (P=.02) and perseverative thinking (P=.008). Individuals with baseline reappraisal deficits showed greater comparative benefit from Panoply for depression (P=.002) and perseverative thinking (P=.002). Changes in reappraisal mediated the effects of Panoply, but not the expressive writing platform, for both outcomes of depression (ab=-1.04, SE 0.58, 95% CI -2.67 to -.12) and perseverative thinking (ab=-1.02, SE 0.61, 95% CI -2.88 to -.20). Dropout rates were similar for the two platforms; however, Panoply yielded significantly more usage activity (P<.001) and significantly greater user experience scores (P<.001).
  
  
  CONCLUSIONS
  Panoply engaged its users and was especially helpful for depressed individuals and for those who might ordinarily underutilize reappraisal techniques. Further investigation is needed to examine the long-term effects of such a platform and whether the benefits generalize to a more diverse population of users.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02302248; https://clinicaltrials.gov/ct2/show/NCT02302248 (Archived by WebCite at http://www.webcitation.org/6Wtkj6CXU).
authors.affiliation: MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, United States. rmorris@media.mit.edu.
authors.forename: Robert R
authors.identifier: http://orcid.org/0000-0001-5794-8490
authors.initials: RR
authors.lastname: Morris
authors.forename: Stephen M
authors.identifier: http://orcid.org/0000-0002-1003-0399
authors.initials: SM
authors.lastname: Schueller
authors.forename: Rosalind W
authors.identifier: http://orcid.org/0000-0002-5661-0022
authors.initials: RW
authors.lastname: Picard
mesh_terms: D000293:Adolescent; D000328:Adult; D063045:Crowdsourcing / Q000379:methods*; D003863:Depression / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Web-based intervention; cognitive behavioral therapy; crowdsourcing; depression; mental health; randomized controlled trial; social networks
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