JMIR Publications

ABSTRACT

Background:

Smartphone app-based therapies offer clear promise for reducing the gap in available mental healthcare for people at risk for or suffering with mental illness. To this end, as smartphone ownership has become widespread, app-based therapies have become increasingly common. However, the research on app-based therapies lags behind. In particular, while experts suggest that human support may be critical for increasing engagement and effectiveness, we have little systematic knowledge about the role that human support plays in app-based therapy. It is critical to address these open questions in order to optimally design and scale these interventions.

Objective:

The purpose of the present study was to provide a scoping review of the use of human support or coaching in app-based cognitive behavioral therapy for emotional disorders, identify critical knowledge gaps, and offer recommendations for future research. Cognitive behavioral therapy is the most well-researched treatment for a wide range of concerns and understood to be particularly well-suited to digital implementations given its structured, skill-based approach.

Methods:

We conducted systematic searches of three databases (PubMed, PsycINFO, and Embase). Broadly, eligible manuscripts described a cognitive behavioral intervention delivered via smartphone app whose primary target was an emotional disorder or problem and which included some level of human involvement or support (“coaching”). All records were reviewed by two authors. Information regarding (a) the qualifications and training of coaches, (b) stated purpose and content of the coaching, (c) method and frequency of communication with users, and (d) relationship between coaching and outcomes was recorded.

Results:

Of the 2,341 titles returned by the searches, 56 manuscripts were eligible for inclusion. This review found significant heterogeneity across all of the dimensions of coaching considered as well as considerable missing information in the published manuscripts. Moreover, few studies had qualitatively or quantitatively evaluated how level of coaching impacts treatment engagement or outcomes. Although users tend to self-report that coaching improves their engagement and outcomes, there is limited and mixed supporting quantitative evidence at present.

Conclusions:

Digital mental health is a young but rapidly expanding field with great potential to improve the reach of evidence-based care. Researchers across the reviewed manuscripts offered numerous new, creative models for connecting with users involved in these treatments. With the relative infancy of these treatment approaches, however, this review found that the field has yet to develop standards or consensus for implementing coaching protocols, let alone measuring and reporting on the impact. We conclude that coaching remains a significant hole in the growing digital mental health literature and lay out recommendations for future data collection, reporting, experimentation, and analysis.