Accepted for/Published in: JMIR Formative Research
Date Submitted: Dec 2, 2024
Date Accepted: Apr 11, 2025
Just-in-time Delivery of Cognitive Behavior Therapy Based Exercises: A Single Case Experimental Design with Random Multiple Baselines
ABSTRACT
Background:
Just-in-time adaptive interventions (JITAIs) are a promising approach in mental health care. Typically, a smartphone application (app) is programmed to assess users’ psychological states in daily life; when a particular state is detected, the app prompts users to engage in specific behaviors. JITAIs are thought to be a promising approach – yet, scarce evidence is available in the literature.
Objective:
We implemented this scheme as an online intervention for daily stress management, based on cognitive behavioral therapy (CBT), and evaluated its feasibility and efficacy using a single-case experimental design.
Methods:
Eight Japanese adults (community sample: four women; mean age = 37.6 years, SD = 13.1) were recruited. An AB phase design with multiple random baselines was used. Throughout the study period (28 days), participants were prompted to indicate their momentary levels of stress using a smartphone thrice a day. The length of the baseline phase was randomly permuted across participants (7-14 days), and the remaining period was used as the intervention phase (14-21 days), where CBT-based exercises (e.g., breath control, mindfulness, and relaxation) were offered depending on the reported levels of stress.
Results:
Approximately 70 % of the participants perceived the intervention to be useful and helpful. A randomization test detected a statistically significant decrease in the reported levels of stress after the onset of the intervention (P=0.004), although this effect was marginal when tested separately for each participant. Multilevel model analysis detected a significant acute reduction in the momentary level of stress right after completing an CBT-based exercise (P=0.03, Cohen’s dz=0.58). Also, a significant reduction in depressive rumination was observed in the postintervention assessment (P=0.01, Cohen’s dz = 1.17).
Conclusions:
The intervention was feasible and effective in reducing subjective stress (and rumination) in the study sample, although more evidence should be collected to draw robust conclusions. Clinical Trial: OSF: https://osf.io/3b5tp/?view_only=822e6357a8f442409285921e4b15e060
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