Digital Intervention to Treat Anxiety and Depression Among Persons Receiving Treatment for Opioid Use Disorder

NCT05047627 | Completed Results DMC

• 1 other identifier: AWD00010555
• Study Type: interventional
• Target: 63
• Locations: 1 country
• Sites: 1

Brief Summary

The majority of opioid users meet criteria for anxiety and depressive disorders, but most substance use disorder treatment programs do not offer treatment for co-occurring mental health problems. Anxiety and depression may also be directly linked to opioid use itself. Although treatments have been developed for anxiety and depressive symptoms for opioid users within face-to-face settings, few treatment facilities offer these in-person interventions due to their high cost and time burden. Given the deficits in research on treatments for anxiety and depression among those with opioid use disorder, the current research will examine the efficacy of a digital intervention designed to treat anxiety and depressive symptoms by augmenting the state of the science medication-based opioid use disorder treatment. Over the course of the proposed study, the research team will design and test the feasibility and acceptability of a standalone mobile intervention designed to treat persons receiving medication treatment for opioid use disorder. Participants receiving medication treatment for opioid use disorder will be randomized to receive a digital intervention to treat anxiety and depression or care as usual for a total of four weeks. The overarching goal of the proposed work is to test the feasibility and acceptability of the proposed mobile intervention. The Investigators will also explore the preliminary efficacy by examining reductions in anxiety and depressive symptoms and opioid cravings and use. This work could lead to a low-cost scalable solution to augment gold-standard treatment as usual in opioid use disorder by decreasing levels of comorbidity of anxiety and depressive disorders, thereby ultimately improving the outcomes of opioid use disorder itself.

Conditions

Opioid-use Disorder; Anxiety Disorders; Depressive Disorder

Outcome Measures

Primary Outcomes (3)

• Change in Anxiety Symptoms as Assessed by Generalized Anxiety Disorder- Q-IV Scale

  Assesses anxiety symptoms. Possible GAD-Q-IV scores range from 0 to 12, with higher scores representing greater GAD symptom severity

  From Baseline to 4 weeks (post-intervention) and from Baseline to 8 weeks (follow-up).

• Change in Depressive Symptoms as Assessed by Patient Health Questionnaire-9

  Assesses depressive symptoms, the PHQ-9 score can range from 0 to 27, since each of the 9 items can be scored from 0 (not at all) to 3 (nearly every day)

  From Baseline to 4 weeks (post-intervention) and from Baseline to 8 weeks (follow-up).

• Change in Likelihood of a Positive Urine Screen for Opioids (MOP)

  This outcome measures the change in the likelihood of a positive urine drug screen (UDS) for opioids (MOP). The result of each UDS was coded as a binary variable (0 = negative test, 1 = positive test). The reported data are the beta coefficients (estimated mean change) from a robust linear mixed-effects model, which are presented on a unitless scale. A negative value indicates a reduction in the likelihood of testing positive and represents a better outcome.

  From Baseline to 4 weeks (post-intervention) and from Baseline to 8 weeks (follow-up).

Secondary Outcomes (2)

• Change in Opioid Use Disorder Severity as Measured by the Rapid Opioid Dependence Screen (RODS)

  From Baseline to 4 weeks (post-intervention) and from Baseline to 8 weeks (follow-up).

• Change in Opioid Craving as Measured by the Opioid Craving Scale (OCS)

  From Baseline to 4 weeks (post-intervention) and from Baseline to 8 weeks (follow-up).

Study Arms (2)

Smartphone Digital Intervention Group

EXPERIMENTAL

The Smartphone Digital Intervention Group is the experimental group. Participants randomized to this group will download the smartphone intervention and be asked to use the intervention four times per week for four weeks ( 16 digital sessions). The smartphone digital intervention will also continuously collect passive sensing data. The smartphone digital intervention will be designed to treat anxiety and depression by providing informational videos to help participants treat these symptoms. These videos include information about physical activity, muscle relaxation, and other proven helpful interventions to help with anxiety and depression.

Behavioral: Smartphone-Based Digital Intervention

Wait list Control Condition

NO INTERVENTION

The wait list control condition will not receive the digital intervention treatment for the duration of the study. They will still provide urine samples during the study. Participants assigned to this condition will be able to access the digital intervention after their participation in the study.

Interventions

Smartphone-Based Digital Intervention BEHAVIORAL

The digital intervention will be a prototype, and the current trial will be used to continue to both develop and refine the intervention. The current intervention will be based on a combination of cognitive-behavioral principles. As with prior research, the mobile platform will be delivered via Qualtrics, a HIPAA compliant and mobile-friendly platform. The cognitive-behavioral therapy will be primarily based on components with strongest support in digital interventions. The app will continuously collect passive sensing data on patterns in 1) sleep duration and quality;(2) light (3) location; (4) movement (5) social contact including duration and frequency of incoming and outcoming calls and text messages; (6) screen time; and (7) heart rate variability; (8) sound levels captured through passively collected smartphone The platform will deliver interactive interventions where participants will view texts and images, and it will also allow user interaction.

Smartphone Digital Intervention Group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Adults (age 18 or older)
• fluent in English
• able to provide informed consent
• meet current criteria for OUD (as defined by a Rapid Opioid Dependence Screen)
• are receiving methadone, buprenorphine, and/or naltrexone for OUD
• meet current criteria for an anxiety and/or depressive disorder (based on the Patient Health Questionnaire and the Generalized Anxiety Disorder Questionnaire).

You may not qualify if:

• active suicidality
• psychosis
• bipolar disorder

Sponsors & Collaborators

• Trustees of Dartmouth College: lead

Study Sites (1)

Center For Technology and Behavioral Health

Lebanon, New Hampshire, 03766, United States

Location

Related Publications (34)

• Applebaum AJ, Bullis JR, Traeger LN, O'cleirigh C, Otto MW, Pollack MH, Safren SA. Rates of mood and anxiety disorders and contributors to continued heroin use in methadone maintenance patients: A comparison by HIV status. Neurobehav HIV Med. 2010 Aug 10;2010(2):49-57. doi: 10.2147/NBHIV.S12371.

  PMID: 24062619 BACKGROUND

• Barry DT, Beitel M, Breuer T, Cutter CJ, Savant J, Peters S, Schottenfeld RS, Rounsaville BJ. Group-based strategies for stress reduction in methadone maintenance treatment: what do patients want? J Addict Med. 2011 Sep;5(3):181-7. doi: 10.1097/ADM.0b013e3181ee77cl.

  PMID: 21841430 BACKGROUND

• Bartoli F, Carra G, Brambilla G, Carretta D, Crocamo C, Neufeind J, Baldacchino A, Humphris G, Clerici M. Association between depression and non-fatal overdoses among drug users: a systematic review and meta-analysis. Drug Alcohol Depend. 2014 Jan 1;134:12-21. doi: 10.1016/j.drugalcdep.2013.10.007. Epub 2013 Oct 24.

  PMID: 24210424 BACKGROUND

• Blume, A. W., Schmaling, K. B., & Marlatt, G. A. (2000). Revisiting the self-medication hypothesis from a behavioral perspective. Cognitive and Behavioral Practice, 7(4), 379-384. https://doi.org/10.1016/S1077-7229(00)80048-6

  BACKGROUND

• Borkovec TD, Newman MG, Pincus AL, Lytle R. A component analysis of cognitive-behavioral therapy for generalized anxiety disorder and the role of interpersonal problems. J Consult Clin Psychol. 2002 Apr;70(2):288-98.

  PMID: 11952187 BACKGROUND

• Childress AR, Ehrman R, McLellan AT, MacRae J, Natale M, O'Brien CP. Can induced moods trigger drug-related responses in opiate abuse patients? J Subst Abuse Treat. 1994 Jan-Feb;11(1):17-23. doi: 10.1016/0740-5472(94)90060-4.

  PMID: 8201629 BACKGROUND

• Cunningham JA, Hendershot CS, Kay-Lambkin F, Neighbors C, Griffiths KM, Bennett K, Bennett A, Godinho A, Schell C. Does providing a brief internet intervention for hazardous alcohol use to people seeking online help for depression reduce both alcohol use and depression symptoms among participants with these co-occurring disorders? Study protocol for a randomised controlled trial. BMJ Open. 2018 Jul 19;8(7):e022412. doi: 10.1136/bmjopen-2018-022412.

  PMID: 30030322 BACKGROUND

• Deady M, Mills KL, Teesson M, Kay-Lambkin F. An Online Intervention for Co-Occurring Depression and Problematic Alcohol Use in Young People: Primary Outcomes From a Randomized Controlled Trial. J Med Internet Res. 2016 Mar 23;18(3):e71. doi: 10.2196/jmir.5178.

  PMID: 27009465 BACKGROUND

• Firth J, Torous J, Nicholas J, Carney R, Pratap A, Rosenbaum S, Sarris J. The efficacy of smartphone-based mental health interventions for depressive symptoms: a meta-analysis of randomized controlled trials. World Psychiatry. 2017 Oct;16(3):287-298. doi: 10.1002/wps.20472.

  PMID: 28941113 BACKGROUND

• Firth J, Torous J, Nicholas J, Carney R, Rosenbaum S, Sarris J. Can smartphone mental health interventions reduce symptoms of anxiety? A meta-analysis of randomized controlled trials. J Affect Disord. 2017 Aug 15;218:15-22. doi: 10.1016/j.jad.2017.04.046. Epub 2017 Apr 25.

  PMID: 28456072 BACKGROUND

• Hassan AN, Howe AS, Samokhvalov AV, Le Foll B, George TP. Management of mood and anxiety disorders in patients receiving opioid agonist therapy: Review and meta-analysis. Am J Addict. 2017 Sep;26(6):551-563. doi: 10.1111/ajad.12581. Epub 2017 Jul 4.

  PMID: 28675762 BACKGROUND

• Hogarth L, Hardy L, Bakou A, Mahlberg J, Weidemann G, Cashel S, Moustafa AA. Negative Mood Induction Increases Choice of Heroin Versus Food Pictures in Opiate-Dependent Individuals: Correlation With Self-Medication Coping Motives and Subjective Reactivity. Front Psychiatry. 2019 May 15;10:274. doi: 10.3389/fpsyt.2019.00274. eCollection 2019.

  PMID: 31156470 BACKGROUND

• Hyman SM, Fox H, Hong KI, Doebrick C, Sinha R. Stress and drug-cue-induced craving in opioid-dependent individuals in naltrexone treatment. Exp Clin Psychopharmacol. 2007 Apr;15(2):134-43. doi: 10.1037/1064-1297.15.2.134.

  PMID: 17469937 BACKGROUND

• Kay-Lambkin FJ, Baker AL, Lewin TJ, Carr VJ. Computer-based psychological treatment for comorbid depression and problematic alcohol and/or cannabis use: a randomized controlled trial of clinical efficacy. Addiction. 2009 Mar;104(3):378-88. doi: 10.1111/j.1360-0443.2008.02444.x.

  PMID: 19207345 BACKGROUND

• Kenardy JA, Dow MG, Johnston DW, Newman MG, Thomson A, Taylor CB. A comparison of delivery methods of cognitive-behavioral therapy for panic disorder: an international multicenter trial. J Consult Clin Psychol. 2003 Dec;71(6):1068-75. doi: 10.1037/0022-006X.71.6.1068.

  PMID: 14622082 BACKGROUND

• Kosten TR, Rounsaville BJ, Kleber HD. A 2.5-year follow-up of depression, life crises, and treatment effects on abstinence among opioid addicts. Arch Gen Psychiatry. 1986 Aug;43(8):733-8. doi: 10.1001/archpsyc.1986.01800080019003.

  PMID: 3729667 BACKGROUND

• Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606-13. doi: 10.1046/j.1525-1497.2001.016009606.x.

  PMID: 11556941 BACKGROUND

• Kroenke, Kurt, & Spitzer, R. L. (2002). The PHQ-9: A new depression diagnostic and severity measure. Psychiatric Annals, 32(9), 509-515. https://doi.org/10.3928/0048-5713-20020901-06

  BACKGROUND

• Krupnick JL, Green BL, Amdur R, Alaoui A, Belouali A, Roberge E, Cueva D, Roberts M, Melnikoff E, Dutton MA. An Internet-based writing intervention for PTSD in veterans: A feasibility and pilot effectiveness trial. Psychol Trauma. 2017 Jul;9(4):461-470. doi: 10.1037/tra0000176. Epub 2016 Sep 8.

  PMID: 27607767 BACKGROUND

• Lange A, Rietdijk D, Hudcovicova M, van de Ven JP, Schrieken B, Emmelkamp PM. Interapy: a controlled randomized trial of the standardized treatment of posttraumatic stress through the internet. J Consult Clin Psychol. 2003 Oct;71(5):901-9. doi: 10.1037/0022-006X.71.5.901.

  PMID: 14516238 BACKGROUND

• Levin ME, Navarro C, Cruz RA, Haeger J. Comparing in-the-moment skill coaching effects from tailored versus non-tailored acceptance and commitment therapy mobile apps in a non-clinical sample. Cogn Behav Ther. 2019 May;48(3):200-216. doi: 10.1080/16506073.2018.1503706. Epub 2018 Aug 17.

  PMID: 30117784 BACKGROUND

• Maloney E, Degenhardt L, Darke S, Nelson EC. Are non-fatal opioid overdoses misclassified suicide attempts? Comparing the associated correlates. Addict Behav. 2009 Sep;34(9):723-9. doi: 10.1016/j.addbeh.2009.04.011. Epub 2009 May 3.

  PMID: 19447563 BACKGROUND

• Marshall BDL, Green TC, Elston B, Yedinak JL, Hadland SE, Clark MA. The Effectiveness of Internet- and Field-Based Methods to Recruit Young Adults Who Use Prescription Opioids Nonmedically. Subst Use Misuse. 2018 Aug 24;53(10):1688-1699. doi: 10.1080/10826084.2018.1425725. Epub 2018 Jan 24.

  PMID: 29364768 BACKGROUND

• McHugh RK, Fitzmaurice GM, Carroll KM, Griffin ML, Hill KP, Wasan AD, Weiss RD. Assessing craving and its relationship to subsequent prescription opioid use among treatment-seeking prescription opioid dependent patients. Drug Alcohol Depend. 2014 Dec 1;145:121-6. doi: 10.1016/j.drugalcdep.2014.10.002. Epub 2014 Oct 16.

  PMID: 25454409 BACKGROUND

• Moore MT, Anderson NL, Barnes JM, Haigh EA, Fresco DM. Using the GAD-Q-IV to identify generalized anxiety disorder in psychiatric treatment seeking and primary care medical samples. J Anxiety Disord. 2014 Jan;28(1):25-30. doi: 10.1016/j.janxdis.2013.10.009. Epub 2013 Nov 20.

  PMID: 24334213 BACKGROUND

• Newman, M. G., Zuellig, A. R., Kachin, K. E., Constantino, M. J., Przeworski, A., Erickson, T., & Cashman-McGrath, L. (2002). Preliminary reliability and validity of the Generalized Anxiety Disorder Questionnaire-IV: A revised self-report diagnostic measure of generalized anxiety disorder. Behavior Therapy, 33(2), 215-233. https://doi.org/10.1016/S0005-7894(02)80026-0

  BACKGROUND

• Pani PP, Vacca R, Trogu E, Amato L, Davoli M. Pharmacological treatment for depression during opioid agonist treatment for opioid dependence. Cochrane Database Syst Rev. 2010 Sep 8;(9):CD008373. doi: 10.1002/14651858.CD008373.pub2.

  PMID: 20824876 BACKGROUND

• Stathopoulou G, Pollack MH, Otto MW. Anxiety sensitivity moderates drug cravings in response to induced negative affect in opioid dependent outpatients. Addict Behav. 2018 Sep;84:75-78. doi: 10.1016/j.addbeh.2018.03.020. Epub 2018 Mar 13. No abstract available.

  PMID: 29631093 BACKGROUND

• Stein MD, Santiago Rivera OJ, Anderson BJ, Bailey GL. Perceived need for depression treatment among persons entering inpatient opioid detoxification. Am J Addict. 2017 Jun;26(4):395-399. doi: 10.1111/ajad.12554. Epub 2017 Apr 28.

  PMID: 28453912 BACKGROUND

• Walker J, Burke K, Wanat M, Fisher R, Fielding J, Mulick A, Puntis S, Sharpe J, Esposti MD, Harriss E, Frost C, Sharpe M. The prevalence of depression in general hospital inpatients: a systematic review and meta-analysis of interview-based studies. Psychol Med. 2018 Oct;48(14):2285-2298. doi: 10.1017/S0033291718000624. Epub 2018 Mar 26.

  PMID: 29576041 BACKGROUND

• Watkins KE, Hunter SB, Wenzel SL, Tu W, Paddock SM, Griffin A, Ebener P. Prevalence and characteristics of clients with co-occurring disorders in outpatient substance abuse treatment. Am J Drug Alcohol Abuse. 2004 Nov;30(4):749-64. doi: 10.1081/ada-200037538.

  PMID: 15624547 BACKGROUND

• Wickersham JA, Azar MM, Cannon CM, Altice FL, Springer SA. Validation of a Brief Measure of Opioid Dependence: The Rapid Opioid Dependence Screen (RODS). J Correct Health Care. 2015 Jan;21(1):12-26. doi: 10.1177/1078345814557513.

  PMID: 25559628 BACKGROUND

• Wilhelm S, Weingarden H, Ladis I, Braddick V, Shin J, Jacobson NC. Cognitive-Behavioral Therapy in the Digital Age: Presidential Address. Behav Ther. 2020 Jan;51(1):1-14. doi: 10.1016/j.beth.2019.08.001. Epub 2019 Aug 8.

  PMID: 32005328 BACKGROUND

• Gratz, K.L., Roemer, L. Multidimensional Assessment of Emotion Regulation and Dysregulation: Development, Factor Structure, and Initial Validation of the Difficulties in Emotion Regulation Scale. J Psychopathol Behav Assess 30, 315 (2008). https://doi.org/10.1007/s10862-008-9102-4

  BACKGROUND

MeSH Terms

Conditions

Opioid-Related Disorders; Anxiety Disorders; Depressive Disorder

Condition Hierarchy (Ancestors)

Narcotic-Related Disorders; Substance-Related Disorders; Chemically-Induced Disorders; Mental Disorders; Mood Disorders

Results Point of Contact

• Title: Nicholas Jacobson
• Organization: Dartmouth College

Nicholas.C.Jacobson@dartmouth.edu

(603) 646-7037

Study Officials

• Nicholas C Jacobson, PhD

  Dartmouth College

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: August 13, 2021
• First Posted: September 17, 2021
• Study Start: September 15, 2021
• Primary Completion: December 31, 2022
• Study Completion: March 1, 2023
• Last Updated: November 5, 2025
• Results First Posted: November 5, 2025

Record last verified: 2025-10

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)