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Use of “Therapy in Your Pocket”: Patterns of Skills Review in Smartphone Cognitive Behavioral Therapy for Depression
Emily E. Bernstein;
Katharine E Daniel;
Peyton E. Miyares;
Susanne Hoeppner;
Kate H. Bentley;
Ivar Snorrason;
Lauren B. Fisher;
Jennifer L. Greenberg;
Hilary Weingarden;
Oliver Harrison;
Sabine Wilhelm
ABSTRACT
Background:
Smartphones could enhance access to effective cognitive behavioral therapy (CBT). Users may frequently and flexibly access bite-size CBT content on personal devices, review and practice skills, and thereby achieve better outcomes.
Objective:
We explored the distribution of actual interactions participants had with therapeutic content in a trial of smartphone CBT for depression and whether interactions were within assigned treatment modules or revisits to prior module content (i.e., between-module interactions).
Methods:
We examined the association between number of within- and between-module interactions and baseline and end-of-treatment symptom severity during an 8-week, single-arm open trial of a therapist-guided CBT for depression mobile health application.
Results:
Interactions were more frequent early in treatment and modestly declined in later stages. Within modules, most participants consistently made more interactions than required to progress to the next module and tended to return to all types of content rather than focus on one skill. By contrast, only 15 of 26 participants ever revisited prior module content (Median number of revisits = 1, Mode = 0). More revisits were associated with more severe end-of-treatment symptom severity.
Conclusions:
Results suggest that frequency of use is an insufficient metric of engagement, lacking the nuance of what users are engaging with and when during treatment. This lens is essential for developing personalized recommendations and yielding better treatment outcomes. Clinical Trial: ClinicalTrials.gov NCT05386329; https://clinicaltrials.gov/study/NCT05386329?term=NCT05386329
Citation
Please cite as:
Bernstein EE, Daniel KE, Miyares PE, Hoeppner S, Bentley KH, Snorrason I, Fisher LB, Greenberg JL, Weingarden H, Harrison O, Wilhelm S
Patterns of Skills Review in Smartphone Cognitive Behavioral Therapy for Depression: Observational Study of Intervention Content Use