Self-Monitoring Program for MDD Lacks Human Touch

August 26, 2016

Which patients are most likely to find a computer-based program helpful?


Can a computer-based self-monitoring program make a difference for persons with major depression? A randomized, controlled trial of a pilot program called Help4Mood says yes for some patients, but most study participants were put off by the program’s mechanized approach.1

The program was designed to support patients between visits to their care provider, allowing them to self-monitor mood, thoughts, activity, and speech and retrain thinking patterns using elements of cognitive behavioral therapy. The pilot study was conducted by a multicenter team from the United Kingdom, Romania, and Spain.

The self-report tools in Help4Mood include those for mood, sleep, thoughts, and behaviors. Users are able to select short, medium, and long sessions each time they access the system. Patients also input data from a worn or carried accelerometer, which measures daily physical activity. A voice recognition component flags affect.

Patients are expected to log onto the computer application several times a week-ideally daily-and engage with a virtual agent that talks them through exercises, is personalized in appearance and manner, and has the ability to vary responses and facial expressions in reaction to users’ input. The program also provides regular patient progress summaries to the user’s care provider and crisis intervention resources.

The aim of the pilot study was to evaluate Help4Mood use and acceptability among patients with depression and to explore whether a clinical trial would be feasible in regard to trial recruitment and retention. Of those recruited, 27 patients with MDD met inclusion criteria and were randomized to either 4 weeks of Help4Mood in addition to treatment as usual (TAU; n = 13) or TAU alone (n = 14); however, follow-up data were available only for 21 patients (12, Help4Mood; 9, TAU), which were represented in the outcome analysis.

Self-report tools in Help4Mood include those for mood, sleep, thoughts, and behaviors.

Although none of patients randomized to Help4Mood used the program every day, half used it regularly, defined as more than 10 times during the study period. Acceptability varied. Whereas some users appreciated the emotional responsiveness of the system, others found it to be repetitive.

Despite the variation in session length, participants reported becoming bored with the sameness of tasks that they were presented with and requested a more customizable experience, including more content, such as educational resources.

The researchers concluded that study participants generally found Help4Mood to be inconvenient or inappropriate for its intended daily use. Post hoc treatment analysis, however, showed that patients who regularly used the system achieved meaningful improvement in symptoms.

A median change of 8 points was recorded in Beck Depression Inventory II scores. They also stated that the study findings suggest that Help4Mood is acceptable to some patients and further research may be in order to better identify best candidates for the program.


1. Burton C, Szentagotai Tatar A, McKinstry B, et al. Pilot randomised controlled trial of Help4Mood, an embodied virtual agent-based system to support treatment of depression. J Telemed Telecare. 2015 Oct 9. [Epub ahead of print]