Open Access Highly Accessed Study protocol

Disrupting the rhythm of depression using Mobile Cognitive Therapy for recurrent depression: randomized controlled trial design and protocol

Claudi LH Bockting1*, Gemma D Kok1, Lillian van der Kamp2, Filip Smit23, Evelien van Valen4, Robert Schoevers5, Harm van Marwijk6, Pim Cuijpers7, Heleen Riper3, Jack Dekker78 and Aaron T Beck9

Author Affiliations

1 Department of Clinical and Experimental Psychology, Groningen University, Groningen, The Netherlands

2 Centre of Prevention and Early Intervention, Trimbos Institute (Netherlands Institute of Mental health and Addiction), Utrecht, The Netherlands

3 Department of Epidemiology and Biostatistics, VU University medical centre, Amsterdam, The Netherlands

4 Netherlands Center for Occupational Diseases, Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

5 Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands

6 Department of General Practice and the EMGO Institute for Health and Care Research (EMGO+), VU University medical centre, Amsterdam, The Netherlands

7 Department of Clinical Psychology of the Vrije Universiteit, Amsterdam, The Netherlands

8 Mental Health Care Center Arkin/PuntP, Amsterdam, The Netherlands

9 Department of Psychiatry, University of Pennsylvania, Philadelphia, USA

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BMC Psychiatry 2011, 11:12  doi:10.1186/1471-244X-11-12

Published: 14 January 2011



Major depressive disorder (MDD) is projected to rank second on a list of 15 major diseases in terms of burden in 2030. The major contribution of MDD to disability and health care costs is largely due to its highly recurrent nature. Accordingly, efforts to reduce the disabling effects of this chronic condition should shift to preventing recurrence, especially in patients at high risk of recurrence. Given its high prevalence and the fact that interventions are necessary during the remitted phase, new approaches are needed to prevent relapse in depression.


The best established effective and available psychological intervention is cognitive therapy. However, it is costly and not available for most patients. Therefore, we will compare the effectiveness and cost-effectiveness of self-management supported by online CT accompanied by SMS based tele-monitoring of depressive symptomatology, i.e. Mobile Cognitive Therapy (M-CT) versus treatment as us usual (TAU). Remitted patients (n = 268) with at least two previous depressive episodes will be recruited and randomized over (1) M-CT in addition to TAU versus (2) TAU alone, with follow-ups at 3, 12, and 24 months. Randomization will be stratified for number of previous episodes and type of treatment as usual. Primary outcome is time until relapse/recurrence over 24 months using DSM-IV-TR criteria as assessed by the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID). For the economic evaluation the balance between costs and health outcomes will be compared across strategies using a societal perspective.


Internet-based interventions might be helpful in empowering patients to become their own disease managers in this lifelong recurrent disorder. This is, as far as we are aware of, the first study that examines the (cost) effectiveness of an E-mental health program using SMS monitoring of symptoms with therapist support to prevent relapse in remitted recurrently depressed patients.

Trial registration

Netherlands Trial Register (NTR): NTR2503