Accepted for/Published in: JMIR Formative Research
Date Submitted: Nov 23, 2020
Date Accepted: Aug 1, 2021
A Mobile App to Enhance Behavioral Activation Treatment for Substance Use: App Design, Use, and Integration into Treatment in the Context of a Randomized Controlled Trial
ABSTRACT
Background:
Group-based formats typical in low-resourced substance use treatment settings result in little individual attention to help reinforce and guide skill usage, which may contribute to poor post-treatment outcomes. Smartphone apps offer a convenient, user-friendly, and potentially cost effective tool that can extend the reach of effective substance use treatments. Aiming to increase engagement in treatment skills outside clinician-administered sessions, a smartphone app was developed and integrated into a group-based, brief behavioral activation treatment for substance use.
Objective:
1) Describe the features of the app and its use and integration into treatment; 2) Report the participant self-reported feasibility and acceptability of the app; and 3) Discuss challenges and provide recommendations for future smartphone app integration into behavioral treatments for substance use.
Methods:
N=56 individuals recruited from an intensive outpatient substance use disorder (SUD) treatment received the smartphone-enhanced behavioral activation treatment, The Life Enhancement Treatment for Substance Use (LETS ACT). Self-reported weekly app usage and reasons for nonuse were assessed at post treatment and 1 and 3 month follow-ups. T-tests and Chi-square tests compared self-reported use of each app component and overall app use over time.
Results:
Participant feedback suggested that the integration of the smartphone app into LETS ACT was feasible and well-accepted, and participants found the app useful for planning value-based activities outside of sessions. Self-reported app engagement decreased over the follow-up period: 72% of participants reported using the app at post-treatment, decreasing to 69% at the 1-month follow-up and 37% at the 3-month follow-up. Participants reported forgetting to use the app as a primary reason for non-use.
Conclusions:
The current study provides support for the feasibility and acceptability of a smartphone-enhanced BA treatment, offering promise for future research testing the integration of technology into substance use treatment. Design decisions to streamline smartphone integration into treatment are discussed. Clinical Trial: Technology Enhanced Behavioral Activation Treatment for Substance Use, NCT02707887, https://clinicaltrials.gov/ct2/show/NCT02707887
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