(PS2-C58) An Entrée or Sampler Approach? A Randomized Controlled Trial of Two Approaches to Cognitive-behavioral Interventions

Introduction: Interventions that provide guidance on how to use cognitive-behavioral skills have been shown to be efficacious in treating depression. However, it is unknown if interventions providing a deep dive into one skill (i.e., an entrée approach) or interventions providing an introduction into a variety of skills (i.e., a sampler approach) are of greater use. To compare these approaches, we created a series of online cognitive-behavioral videos intended to help those with elevated depressive symptoms.

Method: A total of 657 participants with PHQ-9 scores of 10 or above were randomly assigned to the entrée, sampler, or no-intervention control condition. Outcome measures included depressive symptoms, coping skill usage, coping skill quality, and loneliness. The entrée approach focused on building one skill, while the sampler condition introduced three different skills over an intervention of the same length. Possible approaches included teaching cognitive skills (i.e., identifying and evaluating thoughts), behavioral skills (i.e., scheduling and planning activities), or interpersonal skills (i.e., developing assertive responses). One week after completing the intervention, participants were asked to complete outcome measures again. We conducted a series of ANCOVAs to examine differences between the entrée, sampler, and control conditions.

Results: The average QIDS score at baseline was 13.95 (SD = 4.35), indicating moderate depression. No significant differences in symptoms of depression, coping skill usage, or loneliness were found across conditions. However, those assigned to the entrée condition were significantly more likely to drop out (66.29%), compared to the sampler condition (54.86%) and the control condition (33.83%). Moderation analysis suggested that, for those with higher depressive symptoms, the sampler condition was associated with greater coping skill usage at the one-week follow-up than the entrée condition. Contrary to expectations, those with a greater preference for using multiple skills endorsed significantly higher use of coping skills in the entrée condition. The reverse was also true, in that the sampler outperformed the entrée condition among those with a greater preference for using one skill.

Discussion: Overall, we did not find differences between the entrée and sampler conditions on the primary outcomes we tested. We did, however, find several differences that suggest a sampling of various techniques may improve retention in a video-based CBT for depression intervention.