Using High-Risk Adolescents′ Voices to Develop a Comprehensible Cognitive Behavioral Therapy–Based Text-Message Program

ABSTRACT

At-risk adolescents' comprehension of, and preferences for, the content of a text-message (SMS) delivered, cognitive behavioral therapy (CBT)–based depression prevention intervention was investigated using two qualitative studies. Adolescents with depressive symptoms and a history of peer violence were recruited from an urban emergency department. Forty-one participants completed semi-structured qualitative interviews. Thematic analysis using deductive and inductive codes were used to capture a priori and emerging themes. Five major themes were identified: CBT-based messages resonated with at-risk adolescents; high levels of peer violence, comorbid symptoms, and prior exposure to the mental health system were variables affecting preferred content; participants endorsed emotional regulation messages, but found mindfulness content difficult to understand via SMS; cognitive awareness and restructuring content was most acceptable when framed by self-efficacy content; adolescent participants generated applicable CBT content in their own voices. Overall, CBT-informed content was able to be distilled into 160-character text messages without losing its comprehensibility.

KEYWORDS:

• adolescent
• mobile health
• text messaging/SMS
• depression prevention
• qualitative

Acknowledgments

We acknowledge Christina Sales, Cathy Nam, Eve Purdy, Alexandra Pierszak, Shubh Agrawal, Adele Levine, Gerianne Connell, Louise Breen, and Isabel Platt for their dedication to patient recruitment and Sarah Bowman for her assistance with coding.

Additional information

Funding

This research was funded by the Society for Academic Emergency Medicine Research Training Grant, University Emergency Medicine Foundation, NIMH (grant K23 MH095866), and NICHD (grant K24 HD062645).