scholarly journals The Functionality of Mobile Apps for Anxiety: Systematic Search and Analysis of Engagement and Tailoring Features

10.2196/26712 ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. e26712
Author(s):  
Andreas Balaskas ◽  
Stephen M Schueller ◽  
Anna L Cox ◽  
Gavin Doherty
Keyword(s):  
Behavioral Therapy ◽  
Mobile Apps ◽  
Systematic Search ◽  
Cognitive Behavioral ◽  
Sensor Data ◽  
User Engagement ◽  
Attrition Rates ◽  
Self Monitoring ◽  
Goal Selection ◽  
Low Intensity

Background A range of mobile apps for anxiety have been developed in response to the high prevalence of anxiety disorders. Although the number of publicly available apps for anxiety is increasing, attrition rates among mobile apps are high. These apps must be engaging and relevant to end users to be effective; thus, engagement features and the ability to tailor delivery to the needs of individual users are key. However, our understanding of the functionality of these apps concerning engagement and tailoring features is limited. Objective The aim of this study is to review how cognitive behavioral elements are delivered by anxiety apps and their functionalities to support user engagement and tailoring based on user needs. Methods A systematic search for anxiety apps described as being based on cognitive behavioral therapy (CBT) was conducted on Android and iPhone marketplaces. Apps were included if they mentioned the use of CBT for anxiety-related disorders. We identified 597 apps, of which 36 met the inclusion criteria and were reviewed through direct use. Results Cognitive behavioral apps for anxiety incorporate a variety of functionalities, offer several engagement features, and integrate low-intensity CBT exercises. However, the provision of features to support engagement is highly uneven, and support is provided only for low-intensity CBT treatment. Cognitive behavioral elements combine various modalities to deliver intervention content and support the interactive delivery of these elements. Options for personalization are limited and restricted to goal selection upon beginning use or based on self-monitoring entries. Apps do not appear to provide individualized content to users based on their input. Conclusions Engagement and tailoring features can be significantly expanded in existing apps, which make limited use of social features and clinical support and do not use sophisticated features such as personalization based on sensor data. To guide the evolution of these interventions, further research is needed to explore the effectiveness of different types of engagement features and approaches to tailoring therapeutic content.

scholarly journals The Functionality of Mobile Apps for Anxiety: Systematic Search and Analysis of Engagement and Tailoring Features (Preprint)

2020 ◽  
Author(s):  
Andreas Balaskas ◽  
Stephen M Schueller ◽  
Anna L Cox ◽  
Gavin Doherty
Keyword(s):  
Behavioral Therapy ◽  
Mobile Apps ◽  
Systematic Search ◽  
Cognitive Behavioral ◽  
Sensor Data ◽  
User Engagement ◽  
Attrition Rates ◽  
Self Monitoring ◽  
Goal Selection ◽  
Low Intensity

BACKGROUND A range of mobile apps for anxiety have been developed in response to the high prevalence of anxiety disorders. Although the number of publicly available apps for anxiety is increasing, attrition rates among mobile apps are high. These apps must be engaging and relevant to end users to be effective; thus, engagement features and the ability to tailor delivery to the needs of individual users are key. However, our understanding of the functionality of these apps concerning engagement and tailoring features is limited. OBJECTIVE The aim of this study is to review how cognitive behavioral elements are delivered by anxiety apps and their functionalities to support user engagement and tailoring based on user needs. METHODS A systematic search for anxiety apps described as being based on cognitive behavioral therapy (CBT) was conducted on Android and iPhone marketplaces. Apps were included if they mentioned the use of CBT for anxiety-related disorders. We identified 597 apps, of which 36 met the inclusion criteria and were reviewed through direct use. RESULTS Cognitive behavioral apps for anxiety incorporate a variety of functionalities, offer several engagement features, and integrate low-intensity CBT exercises. However, the provision of features to support engagement is highly uneven, and support is provided only for low-intensity CBT treatment. Cognitive behavioral elements combine various modalities to deliver intervention content and support the interactive delivery of these elements. Options for personalization are limited and restricted to goal selection upon beginning use or based on self-monitoring entries. Apps do not appear to provide individualized content to users based on their input. CONCLUSIONS Engagement and tailoring features can be significantly expanded in existing apps, which make limited use of social features and clinical support and do not use sophisticated features such as personalization based on sensor data. To guide the evolution of these interventions, further research is needed to explore the effectiveness of different types of engagement features and approaches to tailoring therapeutic content.

Low-Intensity Cognitive Behavioral Therapy

2017 ◽  
Vol 2 (1) ◽  
pp. 31-36
Author(s):  
Pascal Wabnitz ◽  
Michael Schulz ◽  
Michael Löhr ◽  
André Nienaber
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Low Intensity

scholarly journals Low-intensity Cognitive Behavioral Therapy for Stuttering in Adults

2020 ◽  
Vol 123 (5) ◽  
pp. 363-370
Author(s):  
Shuta Tomisato ◽  
Yasuto Yada ◽  
Sae Shiraisi ◽  
Koichiro Wasano
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Low Intensity

scholarly journals The Implementation and Effectiveness of Digital Cognitive Behavioral Therapy for Insomnia in Primary Care: A Pilot Study

2021 ◽  
Vol 2 ◽  
pp. 263348952110536
Author(s):  
Eric D.A. Hermes ◽  
Robert A. Rosenheck ◽  
Laura Burrone ◽  
Greg Dante ◽  
Carrie Lukens ◽  
...  
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Cognitive Behavioral Therapy ◽  
Clinical Outcomes ◽  
Implementation Strategy ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Low Intensity ◽  
Phone Calls ◽  
Insomnia Severity

Background Digital interventions delivering Cognitive Behavioral Therapy for insomnia (Digital CBTi) may increase utilization of effective care for a common and serious condition. A low-intensity implementation strategy may facilitate digital CBTi use in healthcare settings. This pilot study assessed the feasibility of implementing a digital CBTi in Veterans Health Administration (VA) primary care through iterative modifications to a low-intensity implementation strategy, while evaluating clinical outcomes of a specific digital CBTi program. Methods A self-directed digital CBTi was implemented in the primary care clinics of a single VA facility using a cohort trial design that iteratively modified an implementation strategy over three 8-month phases. The phase 1 implementation strategy included (1) provider education; (2) point-of-care information via pamphlets; and (3) provider referral to digital CBTi through phone calls or messages. Phases 2 and 3 maintained these activities, while (1) adding a clinic-based coach who performed initial patient education and follow-up support contacts, (2) providing additional recruitment pathways, and (3) integrating the referral mechanism into provider workflow. Implementation outcomes included provider adoption, patient adoption, and acceptability. Clinical outcomes (insomnia severity, depression severity, and sedative hypnotic use) were compared among enrollees at baseline and 10 weeks. Results Across all phases 66 providers (48.9%) made 153 referrals, representing 0.38% of unique clinic patients. Of referrals, 77 (50.3%) enrolled in the study, 45 (29.4%) engaged in the program, and 24 (15.7%) completed it. Provider and patient adoption did not differ meaningfully across phases. Among enrollees, digital CBTi was acceptable and the Insomnia Severity Index decreased by 4.3 points (t = 6.41, p < 0.001) and 13 (18.6%) reached remission. The mean number of weakly sedative-hypnotic doses decreased by 2.2 (35.5%) (t = 2.39, p < 0.02). Conclusions Digital CBTi implementation in VA primary care is feasible using low-intensity implementation strategy, resulting in improved clinical outcomes for users. However, iterative implementation strategy modifications did not improve adoption. The trial was registered at clinicaltrials.gov (NCT03151083).

scholarly journals Optimizing Smartphone-Delivered Cognitive Behavioral Therapy for Body Dysmorphic Disorder Using Passive Smartphone Data: Initial Insights From an Open Pilot Trial

10.2196/16350 ◽  
2020 ◽  
Vol 8 (6) ◽  
pp. e16350
Author(s):  
Hilary Weingarden ◽  
Aleksandar Matic ◽  
Roger Garriga Calleja ◽  
Jennifer L Greenberg ◽  
Oliver Harrison ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Symptom Severity ◽  
Body Dysmorphic Disorder ◽  
Behavioral Therapy ◽  
Pilot Trial ◽  
Cognitive Behavioral ◽  
Sensor Data ◽  
Mobility Patterns ◽  
Insight Into ◽  
Open Pilot

Background Smartphone-delivered cognitive behavioral therapy (CBT) is becoming more common, but research on the topic remains in its infancy. Little is known about how people typically engage with smartphone CBT or which engagement and mobility patterns may optimize treatment. Passive smartphone data offer a unique opportunity to gain insight into these knowledge gaps. Objective This study aimed to examine passive smartphone data across a pilot course of smartphone CBT for body dysmorphic disorder (BDD), a psychiatric illness characterized by a preoccupation with a perceived defect in physical appearance, to inform hypothesis generation and the design of subsequent, larger trials. Methods A total of 10 adults with primary diagnoses of BDD were recruited nationally and completed telehealth clinician assessments with a reliable evaluator. In a 12-week open pilot trial of smartphone CBT, we initially characterized natural patterns of engagement with the treatment and tested how engagement and mobility patterns across treatment corresponded with treatment response. Results Most participants interacted briefly and frequently with smartphone-delivered treatment. More frequent app usage (r=–0.57), as opposed to greater usage duration (r=–0.084), correlated strongly with response. GPS-detected time at home, a potential digital marker of avoidance, decreased across treatment and correlated moderately with BDD severity (r=0.49). Conclusions The sample was small in this pilot study; thus, results should be used to inform the hypotheses and design of subsequent trials. The results provide initial evidence that frequent (even if brief) practice of CBT skills may optimize response to smartphone CBT and that mobility patterns may serve as useful passive markers of symptom severity. This is one of the first studies to examine the value that passively collected sensor data may contribute to understanding and optimizing users’ response to smartphone CBT. With further validation, the results can inform how to enhance smartphone CBT design.

Low-Intensity Cognitive Behavioral Therapy (LI-CBT) – Eine Einführung in Konzepte und Rahmenbedingungen

2017 ◽  
Vol 67 (08) ◽  
pp. 362-368 ◽  
Author(s):  
Pascal Wabnitz ◽  
Michael Löhr ◽  
André Nienaber ◽  
Bruno Hemkendreis ◽  
Klaus Kronmüller ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Collaborative Care ◽  
Behavioral Therapy ◽  
Kognitive Verhaltenstherapie ◽  
Stepped Care ◽  
Cognitive Behavioral ◽  
Low Intensity

ZusammenfassungDie Bezeichnung Low-Intensity Cognitive Behavioral Therapie (LI-CBT) (in der Übersetzung etwa „niedrigintensive kognitive Verhaltenstherapie“) beschreibt Versorgungsangebote, die das Ziel verfolgen, den Zugang zu evidenzbasierten psychologischen Therapien zu verbessern. Dies wird erreicht indem (1) die Kontaktzeit zwischen Therapeut und Patient reduziert wird, (2) Fachkräfte mit speziellem Training aber ohne langjährige psychotherapeutische Qualifikation und (3) Interventionen mit variabler Intensität eingesetzt werden. Gestufte (Stepped-care) und berufsgruppen-vernetzende (Collaborative-care) Versorgungsstrukturen bilden den strukturellen Rahmen für eine erfolgreiche Umsetzung von LI-CBT. Während sich international großangelegte Forschungs- und Praxisprojekte diesem Thema widmen, liegt die Entwicklung in Deutschland deutlich zurück. Gerade vor dem Hintergrund wachsender Bedarfe und Inanspruchnahmen sowie der Zielsetzung von politischer Seite, neue Versorgungsformen zu entwickeln, stellte das Konzept LI-CBT daher einen vielversprechenden Ansatz dar.

scholarly journals A meta-analysis of low-intensity cognitive behavioral therapy-based interventions for dementia caregivers

2018 ◽  
Vol 31 (07) ◽  
pp. 961-976 ◽  
Author(s):  
Laura Kaddour ◽  
Naoko Kishita ◽  
Anthony Schaller
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Meta Analysis ◽  
Cognitive Behavioral ◽  
Medium Effect ◽  
Outcome Variable ◽  
Progressive Dementia ◽  
Dementia Caregivers ◽  
Low Intensity ◽  
As Stress

ABSTRACTObjectives:This study aimed to review the effectiveness of low-intensity cognitive behavioral therapy (CBT)–based interventions for informal dementia caregivers when compared to non-active control conditions.Design:Literature searches were conducted in databases of published (PsycINFO, MEDLINE, CINAHL, Scopus) and unpublished (Open Grey, ISRCTN registry, ClinicalTrials.gov, ProQuest) literature. Individual meta-analyses were conducted for each outcome variable. Pooled intervention effect estimates were calculated as Hedge’sgusing a random-effects model.Included studies:Studies examining the effect of low-intensity CBT-based interventions for informal caregivers for people with any progressive dementia were included. Randomized controlled trials and controlled clinical trials were included.Measurements:Outcomes included the psychological variables of anxiety, depression, burden, and distress (defined as stress or strain).Results:A total of five studies reported anxiety outcomes, 12 reported on depression, three reported on burden, and six reported distress outcomes. Results demonstrated a significant effect of low-intensity CBT-based interventions in reducing all examined psychological difficulties. Small effect sizes were found for anxiety (g= 0.35), depression (g= 0.27), and distress (g= 0.33). A medium effect was found for burden (g= 0.53).Conclusions:The results provide initial support for low-intensity CBT-based interventions for dementia caregivers. Clinical implications and research recommendations are explored. Strengths and limitations of the study are discussed.

scholarly journals Cognitive and Behavioral Skills Exercises Completed by Patients with Major Depression During Smartphone Cognitive Behavioral Therapy: Secondary Analysis of a Randomized Controlled Trial (Preprint)

2017 ◽  
Author(s):  
Toshi A Furukawa ◽  
Masaru Horikoshi ◽  
Hirokazu Fujita ◽  
Naohisa Tsujino ◽  
Ran Jinnin ◽  
...  
Keyword(s):  
Behavioral Activation ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Cognitive Restructuring ◽  
Cognitive Behavioral ◽  
Depression Severity ◽  
Behavioral Skills ◽  
Self Monitoring ◽  
Randomized Controlled

BACKGROUND A strong and growing body of evidence has demonstrated the effectiveness of cognitive behavioral therapy (CBT), either face-to-face, in person, or as self-help via the Internet, for depression. However, CBT is a complex intervention consisting of several putatively effective components, and how each component may or may not contribute to the overall effectiveness of CBT is poorly understood. OBJECTIVE The aim of this study was to investigate how the users of smartphone CBT use and benefit from various components of the program. METHODS This is a secondary analysis from a 9-week, single-blind, randomized controlled trial that has demonstrated the effectiveness of adjunctive use of smartphone CBT (Kokoro-App) over antidepressant pharmacotherapy alone among patients with drug-resistant major depressive disorder (total n=164, standardized mean difference in depression severity at week 9=0.40, J Med Internet Res). Kokoro-App consists of three cognitive behavioral skills of self-monitoring, behavioral activation, and cognitive restructuring, with corresponding worksheets to fill in. All activities of the participants learning each session of the program and completing each worksheet were uploaded onto Kokoro-Web, which each patient could use for self-check. We examined what use characteristics differentiated the more successful users of the CBT app from the less successful ones, split at the median of change in depression severity. RESULTS A total of 81 patients with major depression were allocated to the smartphone CBT. On average, they completed 7.0 (standard deviation [SD] 1.4) out of 8 sessions of the program; it took them 10.8 (SD 4.2) days to complete one session, during which they spent 62 min (SD 96) on the app. There were no statistically significant differences in the number of sessions completed, time spent for the program, or the number of completed self-monitoring worksheets between the beneficiaries and the nonbeneficiaries. However, the former completed more behavioral activation tasks, engaged in different types of activities, and also filled in more cognitive restructuring worksheets than the latter. Activities such as “test-drive a new car,” “go to a coffee shop after lunch,” or “call up an old friend” were found to be particularly rewarding. All cognitive restructuring strategies were found to significantly decrease the distress level, with “What would be your advice to a friend who has a similar problem?” found more helpful than some other strategies. CONCLUSIONS The CBT program offered via smartphone and connected to the remote server is not only effective in alleviating depression but also opens a new avenue in gathering information of what and how each participant may utilize the program. The activities and strategies found useful in this analysis will provide valuable information in brush-ups of the program itself and of mobile health (mHealth) in general. CLINICALTRIAL Japanese Clinical Trials Registry UMIN CTR 000013693; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ ctr_view.cgi?recptno=R000015984 (Archived by WebCite at http://www.webcitation.org/6u6pxVwik)

scholarly journals Using Mobile Health Gamification to Facilitate Cognitive Behavioral Therapy Skills Practice in Child Anxiety Treatment: Open Clinical Trial (Preprint)

2017 ◽  
Author(s):  
Gede Pramana ◽  
Bambang Parmanto ◽  
James Lomas ◽  
Oliver Lindhiem ◽  
Philip C Kendall ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cognitive Behavioral Therapy ◽  
Mobile Health ◽  
Behavioral Therapy ◽  
Child Anxiety ◽  
Cognitive Behavioral ◽  
User Engagement ◽  
Significance Level ◽  
Anxiety Treatment

BACKGROUND Cognitive behavioral therapy is an efficacious treatment for child anxiety disorders. Although efficacious, many children (40%-50%) do not show a significant reduction in symptoms or full recovery from primary anxiety diagnoses. One possibility is that they are unwilling to learn and practice cognitive behavioral therapy skills beyond therapy sessions. This can occur for a variety of reasons, including a lack of motivation, forgetfulness, and a lack of cognitive behavioral therapy skills understanding. Mobile health (mHealth) gamification provides a potential solution to improve cognitive behavioral therapy efficacy by delivering more engaging and interactive strategies to facilitate cognitive behavioral therapy skills practice in everyday lives (in vivo). OBJECTIVE The goal of this project was to redesign an existing mHealth system called SmartCAT (Smartphone-enhanced Child Anxiety Treatment) so as to increase user engagement, retention, and learning facilitation by integrating gamification techniques and interactive features. Furthermore, this project assessed the effectiveness of gamification in improving user engagement and retention throughout posttreatment. METHODS We redesigned and implemented the SmartCAT system consisting of a smartphone app for children and an integrated clinician portal. The gamified app contains (1) a series of interactive games and activities to reinforce skill understanding, (2) an in vivo skills coach that cues the participant to use cognitive behavioral therapy skills during real-world emotional experiences, (3) a home challenge module to encourage home-based exposure tasks, (4) a digital reward system that contains digital points and trophies, and (5) a therapist-patient messaging interface. Therapists used a secure Web-based portal connected to the app to set up required activities for each session, receive or send messages, manage participant rewards and challenges, and view data and figures summarizing the app usage. The system was implemented as an adjunctive component to brief cognitive behavioral therapy in an open clinical trial. To evaluate the effectiveness of gamification, we compared the app usage data at posttreatment with the earlier version of SmartCAT without gamification. RESULTS Gamified SmartCAT was used frequently throughout treatment. On average, patients spent 35.59 min on the app (SD 64.18) completing 13.00 activities between each therapy session (SD 12.61). At the 0.10 significance level, the app usage of the gamified system (median 68.00) was higher than that of the earlier, nongamified SmartCAT version (median 37.00, U=76.00, P<.01). The amount of time spent on the gamified system (median 173.15) was significantly different from that of the earlier version (median 120.73, U=173.00, P=.06). CONCLUSIONS The gamified system showed good acceptability, usefulness, and engagement among anxious children receiving brief cognitive behavioral therapy treatment. Integrating an mHealth gamification platform within treatment for anxious children seems to increase involvement in shorter treatment. Further study is needed to evaluate increase in involvement in full-length treatment.

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