{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T16:04:41Z","timestamp":1784563481642,"version":"3.55.0"},"reference-count":58,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Psychological distress in breast cancer survivors (BCS) is highly prevalent. Access to treatment is limited by barriers, including a lack of psychotherapists.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the efficacy of a scalable, publicly accessible digital mental health treatment (DMHT) for reducing symptoms of depression and anxiety in BCS and the effect of human coaching on engagement among BCS with initially low engagement.<\/jats:p>\n <\/jats:sec>\n \n Design, Settings, and Participants<\/jats:title>\n This randomized clinical trial followed the SMART (Sequential, Multiple Assignment, Randomized Trial) design and was conducted in the US between September 2021 and January 2024. Adult women who were within 5 years of receiving a breast cancer diagnosis (stage I-III), had a smartphone with a data plan, and had elevated symptoms of depression or anxiety were eligible for inclusion. Participants completed self-reported questionnaires at baseline, 8-week postintervention period, and 6-month and 12-month follow-up periods. Participants were randomized 2:1 to either the DMHT (IntelliCare) or the patient education program. Data analysis was based on intention-to-treat principle.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n The DMHT program is an 8-week self-guided, fully automated suite of 5 clinically focused applications. Participants in the DMHT group were classified as having optimal or suboptimal engagement based on week 1 use. Those with suboptimal engagement were subsequently randomized 1:1 to receive additional coaching or no coaching. The patient education program is an active control condition consisting of 8 weeks of use of a psychoeducational application and no human support.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Primary outcomes were symptoms of anxiety (self-assessed using the 7-item Generalized Anxiety Disorder) and depression (self-assessed using the 8-item Patient Health Questionnaire). Secondary outcomes were number of days of application use and number of application sessions.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 313 women (mean [SD] age, 51.62 [10.51] years) were enrolled and assigned to the DMHT program (n\u2009=\u2009209) or the patient education program (n\u2009=\u2009104). Primary analyses included 272 participants. Participants in both DMHT and patient education programs showed significantly reduced symptoms of both depression (Cohen\n d<\/jats:italic>\n \u2009=\u2009\u22120.60 at the 8-week, \u22121.03 at the 6-month, and \u22121.13 at the 12-month assessment) and anxiety (Cohen\n d<\/jats:italic>\n \u2009=\u2009\u22120.68 at the 8-week, \u22120.80 at the 6-month, and \u22120.85 at the 12-month assessment) from baseline. Compared with participants in the patient education group, those in the DMHT group showed significantly greater reductions in symptoms of anxiety (average marginal effect [AME]\u2009=\u2009\u22121.43;\n z<\/jats:italic>\n \u2009=\u2009\u22122.65 [95% CI, \u22122.49 to \u22120.38];\n P<\/jats:italic>\n \u2009=\u2009.01) but not for symptoms of depression (AME\u2009=\u2009\u22120.98;\n z<\/jats:italic>\n \u2009=\u2009\u22121.89 [95% CI, \u22121.99 to 0.04];\n P<\/jats:italic>\n \u2009=\u2009.06). Compared with participants with suboptimal engagement who did not receive coaching, those who received coaching used the intervention for a significantly greater number of days (mean [SD], 27.48 [0.94] vs 24.04 [1.16] days;\n P<\/jats:italic>\n \u2009=\u2009.02).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This randomized trial found that BCS can benefit from a DMHT program, particularly for reducing anxiety. Coaching may promote consistent engagement with a DMHT for those with difficulty engaging initially.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT04583891<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.23871","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T15:30:33Z","timestamp":1784561433000},"page":"e2623871","source":"Crossref","is-referenced-by-count":0,"title":["Digital Mental Health Treatment and Symptoms of Depression and Anxiety in Breast Cancer Survivors"],"prefix":"10.1001","volume":"9","author":[{"given":"Philip I.","family":"Chow","sequence":"first","affiliation":[{"name":"Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville"},{"name":"University of Virginia Comprehensive Cancer Center, 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Charlottesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Orange","sequence":"additional","affiliation":[{"name":"Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee M.","family":"Ritterband","sequence":"additional","affiliation":[{"name":"Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville"},{"name":"University of Virginia Comprehensive Cancer Center, Charlottesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David C.","family":"Mohr","sequence":"additional","affiliation":[{"name":"Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, 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