StayWell is a 60-day CBT/DBT-based text messaging intervention which leverages reinforcement learning algorithms to support mental health. Participants were randomly assigned to receiving personalized messaging (adaptive arm), static messaging (random arm) or mood-monitoring only messages (control arm). A diverse sample of 1121 adults participated in a fully remote trial between December 2021 and July 2022. Across study arms, participants showed a 25% reduction in depression symptoms (PHQ-8) and 24% reduction in anxiety symptoms (GAD-7) following the intervention. We did not find statistically significant differences in PHQ-8 and GAD-7 reductions between intervention arms. Participants in the control arm had higher mood-monitoring messages response rates than those in other conditions. Finally, post-hoc exploratory analysis assessing outcomes by condition indicated that patients with minimal to mild depression symptoms (PHQ-8 < 10) benefitted from the reinforcement learning algorithm. The results of this trial suggest that StayWell is a promising text-messaging intervention to achieve reductions in depression and anxiety among diverse populations.

The StayWell at Home intervention, a 60-day text-messaging program based on Cognitive Behavioral Therapy (CBT) principles, was developed to help adults cope with the adverse effects of the global pandemic. Participants in StayWell at Home were found to show reduced depressive and anxiety symptoms after participation. However, it remains unclear whether the intervention improved mood and which intervention components were most effective at improving user mood during the pandemic. Thus, utilizing a micro-randomized trial (MRT) design, we examined two intervention components to inform the mechanisms of action that improve mood: 1) text messages delivering CBT-informed coping strategies (i.e., behavioral activation, other coping skills, or social support); 2) time at which messages were sent. Data from two independent trials of StayWell are included in this paper. The first trial included 303 adults aged 18 or older, and the second included 266 adults aged 18 or older. Participants were recruited via online platforms (e.g., Facebook ads) and partnerships with community-based agencies aiming to reach diverse populations, including low-income individuals and people of color. The results of this paper indicate that participating in the program improved and sustained self-reported mood ratings among participants. We did not find significant differences between the type of message delivered and mood ratings. On the other hand, the results from Phase 1 indicated that delivering any type of message in the 3 pm-6 pm time window improved mood significantly over sending a message in the 9 am-12 pm time window. The StayWell at Home program increases in mood ratings appeared more pronounced during the first two to three weeks of the intervention and were maintained for the remainder of the study period. The current paper provides evidence that low-burden text-message interventions may effectively address behavioral health concerns among diverse communities.