Despite high depression prevalence rates, evidence-based treatment is not widely available (Kessler et al., 2005; Olfson et al., 2016). Treatment access disparities are most pronounced among underserved and underrepresented groups, including individuals experiencing economic disadvantage, Black, Indigenous, and Other People of Color, and rural residents. These persistent treatment access disparities represent a significant social justice issue and public health concern that require innovative, community-engaged approaches to successfully address.
Cognitive behavioral therapy (CBT), the gold standard psychosocial depression treatment, is effective when delivered individually, in groups, and via technology-assisted approaches (e.g., Hofmann et al., 2012; Andrews et al., 2018). Increasing evidence suggests the potential to leverage technology in acceptable ways to increase access to CBT, and the COVID-19 pandemic has exacerbated this need. Currently available technology-assisted CBT programs (T-CBT) are text-heavy, academic in nature, and often use jargon that limits treatment engagement (Waller & Gilbody, 2009). Further, existing T-CBT programs offer a one-size-fits all approach and do not allow for customization for specific client groups, settings, or contexts (Twomey et al., 2017). The inability to tailor existing T-CBT interventions further limits treatment engagement. The challenge of engaging individuals in T-CBT is further demonstrated by research suggesting poor treatment adherence and completion among T-CBT users (e.g., Fernandez et al., 2015).
In order to address current limitations with T-CBT programs, researchers at the University of Michigan School of Social Work developed Entertain Me Well, an entertaining, customizable T-CBT for depression. Entertain Me Well offers three key innovations: 1) the use of a character-driven storyline to illustrate core CBT principles and strategies in an entertaining, engaging way, 2) the ability to quickly and easily customize images, text, examples, and vignettes for specific client groups, settings, and contexts at low-cost, and 3) the use of simple, straightforward language to introduce CBT content and strategies (Weaver et al., under review). Taken together, these innovations led to the creation of a T-CBT that is entertaining, flexible, accessible, and inclusive.
This symposium introduces Entertain Me Well and its key innovations and presents three intervention studies in which community-engaged approaches were used to tailor and test our new T-CBT for depression among diverse, underserved populations, including individuals receiving dialysis treatment, rural residents, and young adult cancer survivors. The studies presented are in different phases of development and testing and include different methods of delivering Entertain Me Well, based on client needs and settings. The symposium closes with a discussion related to the utility of Entertain Me Well as a way to disseminate CBT and increase access to needed depression treatment among underserved and underrepresented groups.