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Law M, Pickering I, Bartlett E, Sebaratnam G, Varghese C, Gharibans A, O'Grady G, Andrews CN, Calder S. Cognitive behavioural therapy-based interventions for gastroduodenal disorders of gut-brain interaction: A systematic review. J Psychosom Res 2023; 175:111516. [PMID: 37832277 DOI: 10.1016/j.jpsychores.2023.111516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE Cognitive behavioural therapy (CBT) is increasingly used to manage Disorders of Gut-Brain Interaction (DGBIs). This systematic review aimed to review the evidence for the effectiveness of CBT-based interventions for patients with gastroduodenal DGBIs. METHODS Medline, Embase, PubMed, Cochrane Central, and Scopus were searched in July 2022. Studies were included if they investigated the effects of a CBT-based intervention on gastrointestinal symptoms and/or psychological outcomes pre- and post-intervention in patients with gastroduodenal DGBIs. Case studies, studies not in English, and studies with patients under 18 years were excluded. Results were synthesised narratively, and standardised effect sizes were calculated where possible. RESULTS Nine studies (seven RCTs and two pre/post studies) were identified, with data reported in 10 articles (total N = 602). The studies investigated patients with functional dyspepsia (n = 7), rumination syndrome (n = 1), and supragastric belching (n = 1). The studies had heterogeneous interventions, methodologies, and outcomes, precluding meta-analysis, as well as a moderate-high risk of bias and high drop-outs rates. Findings demonstrated decreased gastrointestinal symptoms and improved anxiety, depression, and quality of life, from pre- to post-intervention, with medium to large effect sizes for symptoms and small to large effect sizes for psychological outcomes. Efficacy was maintained at follow-up, up to one year later. CONCLUSIONS This review suggests promising evidence that CBT effectively improves gastrointestinal symptoms and psychological outcomes in patients with gastroduodenal DGBIs. However, heterogeneity, risk of bias, and lack of statistical reporting were noted, indicating the need for more robust research and standardisation.
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Affiliation(s)
- Mikaela Law
- The Department of Surgery, The University of Auckland, New Zealand; Alimetry Ltd., Auckland, New Zealand
| | - Isabella Pickering
- Alimetry Ltd., Auckland, New Zealand; The Department of Psychological Medicine, The University of Auckland, New Zealand
| | | | | | - Chris Varghese
- The Department of Surgery, The University of Auckland, New Zealand
| | - Armen Gharibans
- The Department of Surgery, The University of Auckland, New Zealand; Alimetry Ltd., Auckland, New Zealand
| | - Greg O'Grady
- The Department of Surgery, The University of Auckland, New Zealand; Alimetry Ltd., Auckland, New Zealand
| | - Christopher N Andrews
- Alimetry Ltd., Auckland, New Zealand; The Division of Gastroenterology, Cumming School of Medicine, University of Calgary, Canada
| | - Stefan Calder
- The Department of Surgery, The University of Auckland, New Zealand; Alimetry Ltd., Auckland, New Zealand.
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Perret S, Alon N, Carpenter-Song E, Myrick K, Thompson K, Li S, Sharma K, Torous J. Standardising the role of a digital navigator in behavioural health: a systematic review. Lancet Digit Health 2023; 5:e925-e932. [PMID: 38000876 DOI: 10.1016/s2589-7500(23)00152-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 11/26/2023]
Abstract
As the number and availability of digital mental health tools increases, patients and clinicians see benefit only when these tools are engaging and well integrated into care. Digital navigators-ie, members of health-care teams who are dedicated to supporting patient use of digital resources-offer one solution and continue to be piloted in behavioural health; however, little is known about the core features of this position. The aims of this systematic review were to assess how digital navigators are implemented in behavioural health, and to provide a standardised definition of this position. In January, 2023, we conducted a systematic literature search resulting in 48 articles included in this systematic review. Results showed high heterogeneity between four attributes of digital navigators: training specifications, educational background, frequency of communication, and method of communication with patients. Reported effect sizes for depression and anxiety were medium to large, but could not be synthesised due to study heterogeneity and small study sample size. This systematic review was registered with PROSPERO (CRD42023391696). Results suggest that digital navigator support can probably increase access to, engagement with, and clinical integration of digital health technology, with standards for training and defined responsibilities now emerging.
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Affiliation(s)
- Sarah Perret
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Noy Alon
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Keris Myrick
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kennedy Thompson
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sunnie Li
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Karuna Sharma
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - John Torous
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Greywoode R, Szigethy E. Behavioral Digital Therapeutics in Gastrointestinal Conditions: Where Are We Now and Where Should We Go? Gastroenterol Clin North Am 2022; 51:741-752. [PMID: 36375993 DOI: 10.1016/j.gtc.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Behavioral digital therapeutics represents a diverse range of health technology tools that can offer beneficial options for patients with gastrointestinal disorders, particularly with the shortage of mental health providers. Challenges to the uptake of behavioral digital interventions exist and can be addressed with mobile device applications, improved interoperability of technology platforms, and flexible integration into clinical practice.
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Affiliation(s)
- Ruby Greywoode
- Division of Gastroenterology, Einstein-Montefiore Medical Center, 111 East 210th St, Bronx, NY 10467, USA
| | - Eva Szigethy
- University of Pittsburgh, 3708 Fifth Avenue, Pittsburgh, PA 15213, USA.
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Szigethy EM, Silfee V, Marroquin MA, Pavlick AN, Wallace ML, Williams KR, Hoberman AM. A Digital Cognitive-Behavioral Intervention for Depression and Anxiety Among Adolescents and Young Adults. Psychiatr Serv 2022; 74:437-440. [PMID: 36164775 DOI: 10.1176/appi.ps.202200045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Adolescents and young adults frequently experience anxiety and depression. The authors evaluated engagement in and effects of a coach-enhanced digital cognitive-behavioral intervention (dCBI; RxWell) targeting emotional distress in this age group. The dCBI app was prescribed to 506 adolescents and young adults at 35 pediatric practices; 278 enrolled in the app, of whom 58% engaged and 63% messaged their coach. Patients completed monthly General Anxiety Disorder-7 and eight-item Patient Health Questionnaire assessments, and a subset completed qualitative interviews. The dCBI app was associated with a significant reduction in anxiety and depression at 1 and 3 months. A dCBI is feasible as part of routine pediatric care and associated with reduced emotional distress.
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Affiliation(s)
- Eva M Szigethy
- Departments of Psychiatry (Szigethy, Marroquin, Pavlick, Wallace) and Pediatrics (Szigethy, Hoberman), University of Pittsburgh, Pittsburgh; UPMC Insurance Services Division (Silfee) and UPMC Center for High Value Health Care (Williams), Pittsburgh
| | - Valerie Silfee
- Departments of Psychiatry (Szigethy, Marroquin, Pavlick, Wallace) and Pediatrics (Szigethy, Hoberman), University of Pittsburgh, Pittsburgh; UPMC Insurance Services Division (Silfee) and UPMC Center for High Value Health Care (Williams), Pittsburgh
| | - Maria A Marroquin
- Departments of Psychiatry (Szigethy, Marroquin, Pavlick, Wallace) and Pediatrics (Szigethy, Hoberman), University of Pittsburgh, Pittsburgh; UPMC Insurance Services Division (Silfee) and UPMC Center for High Value Health Care (Williams), Pittsburgh
| | - Alexa N Pavlick
- Departments of Psychiatry (Szigethy, Marroquin, Pavlick, Wallace) and Pediatrics (Szigethy, Hoberman), University of Pittsburgh, Pittsburgh; UPMC Insurance Services Division (Silfee) and UPMC Center for High Value Health Care (Williams), Pittsburgh
| | - Meredith L Wallace
- Departments of Psychiatry (Szigethy, Marroquin, Pavlick, Wallace) and Pediatrics (Szigethy, Hoberman), University of Pittsburgh, Pittsburgh; UPMC Insurance Services Division (Silfee) and UPMC Center for High Value Health Care (Williams), Pittsburgh
| | - Kelly R Williams
- Departments of Psychiatry (Szigethy, Marroquin, Pavlick, Wallace) and Pediatrics (Szigethy, Hoberman), University of Pittsburgh, Pittsburgh; UPMC Insurance Services Division (Silfee) and UPMC Center for High Value Health Care (Williams), Pittsburgh
| | - Alejandro M Hoberman
- Departments of Psychiatry (Szigethy, Marroquin, Pavlick, Wallace) and Pediatrics (Szigethy, Hoberman), University of Pittsburgh, Pittsburgh; UPMC Insurance Services Division (Silfee) and UPMC Center for High Value Health Care (Williams), Pittsburgh
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Serio C, Gabarda A, Uyar-Morency F, Silfee V, Ludwig J, Szigethy E, Butterworth S. Strengthening the Impact of Digital Cognitive Behavioral Interventions through a Dual Intervention: Proficient Motivational Interviewing-based Health Coaching Plus In-Application Techniques (Preprint). JMIR Form Res 2021; 6:e34552. [PMID: 35544323 PMCID: PMC9133992 DOI: 10.2196/34552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/10/2022] [Accepted: 02/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background The COVID-19 pandemic has accelerated the adoption of digital tools to support individuals struggling with their mental health. The use of a digital intervention plus human coaching (“dual” intervention) is gaining momentum in increasing overall engagement in digital cognitive behavioral interventions (dCBIs). However, there is limited insight into the methodologies and coaching models used by those deploying dual interventions. To achieve a deeper understanding, we need to identify and promote effective engagement that leads to clinical outcomes versus simply monitoring engagement metrics. Motivational interviewing (MI) is a collaborative, goal-oriented communication approach that pays particular attention to the language of change and is an effective engagement approach to help people manage mental health issues. However, this approach has been traditionally used for in-person or telephonic interventions, and less is known about the application of MI to digital interventions. Objective We sought to provide a dual intervention approach and address multiple factors across two levels of engagement to operationalize a dCBI that combined cognitive behavioral therapy–based techniques and MI-based interactions between the digital health coach (DHC) and user. Methods We reviewed hundreds of digital exchanges between DHCs and users to identify and improve training and quality assurance activities for digital interventions. Results We tested five hypotheses and found that: (1) users of a dual digital behavioral health intervention had greater engagement levels than users of a noncoached intervention (P<.001); (2) DHCs with a demonstrated competency in applying MI to digital messages had more engaged users, as measured by the DHC-to-user message exchange ratio (P<.001); (3) the DHC-to-user message exchange ratio was correlated with more engagement in app activities (r=0.28, 95% CI 0.23-0.33); (4) DHCs with demonstrated MI proficiency elicited a greater amount of “change talk” from users than did DHCs without MI proficiency (H=25.12, P<.001); and (5) users who were engaged by DHCs with MI proficiency had better clinical outcomes compared to users engaged by DHCs without MI proficiency (P=.02). Conclusions To our knowledge, this pilot was the first of its kind to test the application of MI to digital coaching protocols, and it demonstrated the value of MI proficiency in digital health coaching for enhanced engagement and health improvement. Further research is needed to establish coaching models in dCBIs that incorporate MI to promote effective engagement and optimize positive behavioral outcomes.
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Affiliation(s)
- Catherine Serio
- UPMC Health Plan, Pittsburgh, PA, United States
- Happify Health, New York, NY, United States
| | | | | | | | | | - Eva Szigethy
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
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