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Klein A, Hagen A, Rahemenia J, de Gier E, Rapee R, Nauta M, de Bruin E, Biesters J, van Rijswijk L, Bexkens A, Baartmans J, Mobach L, Zimmermann R, Krause K, Bögels S, Ollendick T, Schneider S. Combining one-session treatment with a homework program including app-based technology to enhance the treatment of childhood specific phobias: A study protocol of a multicenter pragmatic randomized controlled trial. Contemp Clin Trials Commun 2024; 41:101346. [PMID: 39188411 PMCID: PMC11345506 DOI: 10.1016/j.conctc.2024.101346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 07/24/2024] [Accepted: 07/27/2024] [Indexed: 08/28/2024] Open
Abstract
Introduction Childhood specific phobias are among the most common and earliest onset mental disorders with a lifetime prevalence of more than ten percent. Brief intensive cognitive behavioral therapy (CBT) programs such as the One-Session Treatment (OST) are found to be effective in the remission of the specific phobias following treatment, but there is still room for improvement. The goal of the current study is to examine whether the long-term efficacy of OST increases by using a homework program supported by an app specifically designed for children; the Kids Beat Anxiety (KibA) homework program. Methods Children aged between 7 and 14 years with a specific phobia receive OST preceded by a three-week baseline phase to control for time-effects. Directly following OST, children are randomized to either a four-week homework period supported by an app (OST + app), or standard One-Session Treatment with a four-week homework period that is only supported by therapist instructions (OST-only). Primary outcome variables are diagnosis and severity of the specific phobia. Secondary outcomes include behavioral avoidance, self-reported fear, and functional impairment. Data will be analyzed based on intention-to-treat and per protocol samples using mixed-effects multilevel linear models. Ethics and dissemination The current study was approved by the METC of the Academic Medical Center, Amsterdam, The Netherlands (number: NL72697.018.20) and the Ethical Committee of the Ruhr University, Bochum, Germany (number: 663). Results of this trial will be published in peer-reviewed journals. Trial registration The study was pre-registered at the Dutch Trial Register, number: NL 9216.
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Affiliation(s)
- A.M. Klein
- Developmental and Educational Psychology, Leiden University, the Netherlands
| | - A. Hagen
- Developmental and Educational Psychology, Leiden University, the Netherlands
| | - J. Rahemenia
- Developmental and Educational Psychology, Leiden University, the Netherlands
| | | | - R.M. Rapee
- Centre for Emotional Health, Macquarie University, Australia
| | - M. Nauta
- Faculty of Behavioral and Social Sciences, University of Groningen, the Netherlands
- Accare Child Study Center, Groningen, the Netherlands
| | - E. de Bruin
- UvA Minds, Amsterdam, the Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, the Netherlands
| | | | | | - A. Bexkens
- Developmental and Educational Psychology, Leiden University, the Netherlands
| | | | - L. Mobach
- Developmental Psychology, University of Amsterdam, the Netherlands
| | - R. Zimmermann
- Mental Health Research and Treatment Center (FBZ), Ruhr University Bochum, Germany
| | - K. Krause
- Mental Health Research and Treatment Center (FBZ), Ruhr University Bochum, Germany
| | - S.M. Bögels
- Developmental Psychology, University of Amsterdam, the Netherlands
| | - T.H. Ollendick
- Child Study Center, Department of Psychology, Virginia Tech, USA
| | - S. Schneider
- Mental Health Research and Treatment Center (FBZ), Ruhr University Bochum, Germany
- German Center for Mental Health (DZPG), Germany
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Heinz MV, Lekkas D, Abreu V, Lee C, Marsch LA, Jacobson NC. Evaluating a mobile app's effects on depression and anxiety in medication-treated opioid use disorder. NPJ MENTAL HEALTH RESEARCH 2024; 3:43. [PMID: 39349617 PMCID: PMC11443057 DOI: 10.1038/s44184-024-00086-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 09/09/2024] [Indexed: 10/04/2024]
Abstract
Depression and anxiety frequently co-occur with opioid use disorder (OUD) yet are often overlooked in standard OUD treatments. This study evaluated the feasibility, acceptability, and preliminary effectiveness of a mobile application designed to address these symptoms in individuals receiving medications for OUD (MOUD). A randomized controlled trial recruited N = 63 adults with OUD who received MOUD and screened positive for moderate depression or generalized anxiety. Participants were randomized to an app-based digital intervention or treatment-as-usual for 4 weeks, and completed follow-ups at 4 and 8 weeks. Primary outcomes were self-reported severity measures for depression and generalized anxiety, and urine drug screens (UDS). Secondary outcomes included self-reported OUD severity, craving intensity, and digital biomarkers derived from passive smartphone sensors. The application was well-received (median app rating = 4/5 stars). The intervention group showed significant reductions in depressive and generalized anxiety symptoms post-intervention and at 8 weeks follow-up (d > 0.70), with large (d = 0.78) and moderate (d = 0.38) effect sizes, respectively, compared to controls. Both groups exhibited substantial decreases in self-reported severity of opioid use symptoms (d > 2.50). UDS suggested similar between-group adherence to MOUD, with a marginal decrease in opioid (MOP) use in the intervention group and increase in controls, yielding medium between group effect sizes (d = 0.44). Passive sensor data suggested significant increases in social connectedness in the intervention group, evidenced by a significant rise in incoming and outgoing calls and text connections. Initial evidence supports the feasibility and acceptability of a digital intervention for treating anxiety and depressive symptoms in persons receiving MOUD. While underpowered to confidently determine statistical significance beyond directionality, the intervention showed promise in reducing depressive and anxiety symptoms, suggesting its potential as a cost-effective and scalable adjunctive therapy alongside standard OUD treatment. Due to the preliminary nature of this pilot study, further research with sample sizes permitting greater statistical power is needed to confirm findings and explore long-term effects.
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Affiliation(s)
- Michael V Heinz
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
| | - Damien Lekkas
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
- Quantitative Biomedical Sciences Program, Dartmouth College, Hanover, NH, USA
| | - Veronica Abreu
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Camilla Lee
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Nicholas C Jacobson
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Quantitative Biomedical Sciences Program, Dartmouth College, Hanover, NH, USA
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
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Copland RR, Hanke S, Rogers A, Mpaltadoros L, Lazarou I, Zeltsi A, Nikolopoulos S, MacDonald TM, Mackenzie IS. The Digital Platform and Its Emerging Role in Decentralized Clinical Trials. J Med Internet Res 2024; 26:e47882. [PMID: 39226549 PMCID: PMC11408899 DOI: 10.2196/47882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 10/11/2023] [Accepted: 07/09/2024] [Indexed: 09/05/2024] Open
Abstract
Decentralized clinical trials (DCTs) are becoming increasingly popular. Digital clinical trial platforms are software environments where users complete designated clinical trial tasks, providing investigators and trial participants with efficient tools to support trial activities and streamline trial processes. In particular, digital platforms with a modular architecture lend themselves to DCTs, where individual trial activities can correspond to specific platform modules. While design features can allow users to customize their platform experience, the real strengths of digital platforms for DCTs are enabling centralized data capture and remote monitoring of trial participants and in using digital technologies to streamline workflows and improve trial management. When selecting a platform for use in a DCT, sponsors and investigators must consider the specific trial requirements. All digital platforms are limited in their functionality and technical capabilities. Integrating additional functional modules into a central platform may solve these challenges, but few commercial platforms are open to integrating third-party components. The lack of common data standardization protocols for clinical trials will likely limit the development of one-size-fits-all digital platforms for DCTs. This viewpoint summarizes the current role of digital platforms in supporting decentralized trial activities, including a discussion of the potential benefits and challenges of digital platforms for investigators and participants. We will highlight the role of the digital platform in the development of DCTs and emphasize where existing technology is functionally limiting. Finally, we will discuss the concept of the ideal fully integrated and unified DCT and the obstacles developers must address before it can be realized.
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Affiliation(s)
- Rachel R Copland
- MEMO Research, School of Medicine, University of Dundee, Dundee, United Kingdom
| | | | - Amy Rogers
- MEMO Research, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Lampros Mpaltadoros
- Information Technologies Institute, Centre for Research & Technology Hellas, Thessaloniki, Greece
| | - Ioulietta Lazarou
- Information Technologies Institute, Centre for Research & Technology Hellas, Thessaloniki, Greece
| | - Alexandra Zeltsi
- Information Technologies Institute, Centre for Research & Technology Hellas, Thessaloniki, Greece
| | - Spiros Nikolopoulos
- Information Technologies Institute, Centre for Research & Technology Hellas, Thessaloniki, Greece
| | - Thomas M MacDonald
- MEMO Research, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Isla S Mackenzie
- MEMO Research, School of Medicine, University of Dundee, Dundee, United Kingdom
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Weintraub MJ, Merranko JA, Ichinose MC, Denenny DM, Walshaw PD, Morgan-Fleming G, Brown RD, Arevian AC, Miklowitz DJ. Behavioral skill practice as a predictor of mood and family functioning in adolescents with bipolar and depressive mood disorders: Results of a 6-month randomized trial of family-focused therapy. Bipolar Disord 2024. [PMID: 39054264 DOI: 10.1111/bdi.13466] [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: 07/27/2024]
Abstract
OBJECTIVE Behavioral interventions require considerable practice of treatment skills in between therapy sessions. The effects of these treatments may vary with the degree to which patients are able to implement these practices. In offspring of parents with bipolar and major depressive disorders, we examined whether youth who frequently practiced communication and problem-solving skills between family-focused therapy (FFT) sessions had less severe mood symptoms and better psychosocial functioning over 6 months than youth who practiced less frequently. METHODS We randomly assigned offspring (ages 12-19) of parents with mood disorders to 12 sessions of FFT plus a mobile app that encouraged the practice of communication, problem-solving and mood management skills (FFT-MyCoachConnect [MCC] condition) or 12 sessions of FFT with an app that only allowed for tracking of symptoms and stress (FFT-Track condition). Independent evaluators assessed youths' mood and psychosocial functioning at 9-week intervals over 27 weeks. Clinicians rated participants' between-session skill practice at each FFT session. RESULTS FFT-MCC was associated with more frequent skill practice than FFT-Track over 18 weeks of treatment. Skill practice was associated with reductions in youths' mood instability and perceptions of family conflict over 27 weeks in both app conditions. Skill practice mediated the effects of app condition on youths' mood instability and family functioning. CONCLUSIONS Mobile applications as adjuncts to family therapy for youth with mood disorders can help increase skill practice. These findings provide preliminary causal evidence for behavioral skill practice improving mood symptoms and family functioning among youth with mood disorders.
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Affiliation(s)
- Marc J Weintraub
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - John A Merranko
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Megan C Ichinose
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Danielle M Denenny
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Patricia D Walshaw
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Georga Morgan-Fleming
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Robin D Brown
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | | | - David J Miklowitz
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at University of California, Los Angeles, California, USA
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Postma MR, Vrancken S, Daemen M, Meulen IHVD, Volbragt N, Delespaul P, Haan LD, Pluijm MVD, Breedvelt JJF, Gaag MVD, Lindauer R, Berg DVD, Bockting C, Amelsvoort TV, Schwannauer M, Doi L, Reininghaus U. Working mechanisms of the use and acceptability of ecological momentary interventions: a realist evaluation of a guided self-help ecological momentary intervention targeting self-esteem. BMC Public Health 2024; 24:1633. [PMID: 38898412 PMCID: PMC11186172 DOI: 10.1186/s12889-024-19143-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 06/14/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Technology improves accessibility of psychological interventions for youth. An ecological momentary intervention (EMI) is a digital intervention geared toward intervening in daily life to enhance the generalizability and ecological validity, and to be able to intervene in moments most needed. Identifying working mechanisms of the use of ecological momentary interventions might generate insights to improve interventions. METHODS The present study investigates the working mechanisms of the use and acceptability of an ecological momentary intervention, named SELFIE, targeting self-esteem in youth exposed to childhood trauma, and evaluates under what circumstances these mechanisms of use and acceptability do or do not come into play. A realist evaluation approach was used for developing initial program theories (data: expert interviews and a stakeholders focus group), and subsequently testing (data: 15 interviews with participants, a focus group with therapists, debriefing questionnaire), and refining them. RESULTS The SELFIE intervention is offered through a smartphone application enabling constant availability of the intervention and thereby increasing accessibility and feasibility. When the intervention was offered on their personal smartphone, this enhanced a sense of privacy and less hesitance in engaging with the app, leading to increased disclosure and active participation. Further, the smartphone application facilitates the practice of skills in daily life, supporting the repeated practice of exercises in different situations leading to the generalizability of the effect. Buffering against technical malfunction seemed important to decrease its possible negative effects. CONCLUSIONS This study enhanced our understanding of possible working mechanisms in EMIs, such as the constant availability supporting increased accessibility and feasibility, for which the use of the personal smartphone was experienced as a facilitating context. Hereby, the current study contributes to relatively limited research in this field. For the field to move forward, mechanisms of use, and acceptability of EMIs need to be understood. It is strongly recommended that alongside efficacy trials of an EMI on specific target mechanisms, a process evaluation is conducted investigating the working mechanisms of use. TRIAL REGISTRATION The current paper reports on a realist evaluation within the SELFIE trial (Netherlands Trial Register NL7129 (NTR7475)).
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Affiliation(s)
- Mary Rose Postma
- Department of Psychiatry and Neuropychology, School for Mental Health and Neuroscience, Maastricht University, Vijverdalseweg 1, Maastricht, 6226 NB, the Netherlands.
- Mondriaan Mental Health Center, Heerlen, The Netherlands.
| | | | - Maud Daemen
- Department of Psychiatry and Neuropychology, School for Mental Health and Neuroscience, Maastricht University, Vijverdalseweg 1, Maastricht, 6226 NB, the Netherlands
| | | | - Nele Volbragt
- Department of Psychiatry and Neuropychology, School for Mental Health and Neuroscience, Maastricht University, Vijverdalseweg 1, Maastricht, 6226 NB, the Netherlands
| | - Philippe Delespaul
- Department of Psychiatry and Neuropychology, School for Mental Health and Neuroscience, Maastricht University, Vijverdalseweg 1, Maastricht, 6226 NB, the Netherlands
- Mondriaan Mental Health Center, Heerlen, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam Public Health, Amsterdam University Medical Centers (location AMC), Amsterdam, The Netherlands
| | - Marieke van der Pluijm
- Department of Psychiatry, Amsterdam Public Health, Amsterdam University Medical Centers (location AMC), Amsterdam, The Netherlands
| | - Josefien Johanna Froukje Breedvelt
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, London, UK
| | - Mark van der Gaag
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - Ramon Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, location Academic Medical Center, Amsterdam, The Netherlands
- Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
| | - David van den Berg
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
- Parnassia Academy, The Hague, The Netherlands
| | - Claudi Bockting
- Department of Psychiatry, Amsterdam Public Health, Amsterdam University Medical Centers (location AMC), Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropychology, School for Mental Health and Neuroscience, Maastricht University, Vijverdalseweg 1, Maastricht, 6226 NB, the Netherlands
- Mondriaan Mental Health Center, Heerlen, The Netherlands
| | | | - Lawrence Doi
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Ulrich Reininghaus
- Department of Public Mental Health, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
- ESRC Centre for Society and Mental Health and Social Epidemiology Research Group, King's College London, London, UK
- Health Service and Population Research Department, Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Klein AM, Hagen A, Mobach L, Zimmermann R, Baartmans JMD, Rahemenia J, de Gier E, Schneider S, Ollendick TH. The Importance of Practicing at Home During and Following Cognitive Behavioral Therapy for Childhood Anxiety Disorders: A Conceptual Review and New Directions to Enhance Homework Using Mhealth Technology. Clin Child Fam Psychol Rev 2024; 27:602-625. [PMID: 38616213 PMCID: PMC11222243 DOI: 10.1007/s10567-024-00476-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/16/2024]
Abstract
Practicing newly acquired skills in different contexts is considered a crucial aspect of Cognitive Behavioral Therapy (CBT) for anxiety disorders (Peris et al. J Am Acad Child Adolesc Psychiatry 56:1043-1052, 2017; Stewart et al. Prof Psychol Res Pract 47:303-311, 2016). Learning to cope with feared stimuli in different situations allows for generalization of learned skills, and experiencing non-occurrence of the feared outcome helps in developing non-catastrophic associations that may enhance treatment outcomes (Bandarian-Balooch et al. J Behav Ther Exp Psychiatry 47:138-144, 2015; Cammin-Nowak et al. J Clin Psychol 69:616-629, 2013; Kendall et al. Cogn Behav Pract 12:136-148, 2005; Tiwari et al. J Clin Child Adolesc Psychol 42:34-43, 2013). To optimize treatment outcome, homework is often integrated into CBT protocols for childhood anxiety disorders during and following treatment. Nevertheless, practicing at home can be challenging, with low motivation, lack of time, and insufficient self-guidance often listed as reasons for low adherence (Tang and Kreindler, JMIR Mental Health 4:e20, 2017). This conceptual review provides an overview of (1) how existing CBT childhood programs incorporate homework, and empirical evidence for the importance of homework practice, (2) evidence-based key elements of practice, and (3) how mHealth apps could potentially enhance practice at home, including an example of the development and application of such an app. This review therefore sets the stage for new directions in developing more effective and engaging CBT-based homework programs for childhood anxiety disorders.
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Affiliation(s)
- Anke M Klein
- Developmental and Educational Psychology, Leiden University, Leiden, The Netherlands.
| | - Annelieke Hagen
- Developmental and Educational Psychology, Leiden University, Leiden, The Netherlands
| | - Lynn Mobach
- Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Pro Persona Institute for Integrated Mental Health Care, Wolfheze, The Netherlands
| | - Robin Zimmermann
- Mental Health Research and Treatment Center (FBZ), Ruhr University, Bochum, Germany
| | | | - Jasmin Rahemenia
- Developmental and Educational Psychology, Leiden University, Leiden, The Netherlands
| | | | - Silvia Schneider
- Mental Health Research and Treatment Center (FBZ), Ruhr University, Bochum, Germany
| | - Thomas H Ollendick
- Department of Psychology, Child Study Center, Virginia Tech, Blacksburg, USA
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Cheng C, Ebrahimi OV. Gamification: a Novel Approach to Mental Health Promotion. Curr Psychiatry Rep 2023; 25:577-586. [PMID: 37801212 PMCID: PMC10654169 DOI: 10.1007/s11920-023-01453-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE OF REVIEW Gamification has emerged as a novel technique for improving mental health and enhancing treatment effectiveness. This paper provides an overview of gamification approaches to mental health intervention, identifies factors that may be related to variations in treatment effectiveness, and discusses possible strategies for tailoring gamified interventions to clients' needs. RECENT FINDINGS Recent research has documented the potential of gamified mental health interventions for bolstering mental wellness and mitigating psychological symptoms. However, their effectiveness may vary depending on study design-related factors and gender-specific considerations. Literature reviews have also identified yet-to-be resolved issues surrounding the possible strengths and weaknesses of the personalization versus standardization of gamification, as well as the potential benefits of gamification for increasing engagement versus the potential risks of over-engagement and behavioral addiction to gamified components. This review highlights the need for careful planning and execution of gamified mental health interventions to optimize their effectiveness and suitability for meeting clients' individual needs and preferences.
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Affiliation(s)
- Cecilia Cheng
- Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong, China.
| | - Omid V Ebrahimi
- Department of Clinical Psychology, University of Oslo, Oslo, Norway
- Research Institute, Modum Bad Psychiatric Hospital, Vikersund, Norway
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Eghdami S, Ahmadkhaniha HR, Baradaran HR, Hirbod-Mobarakeh A. Ecological momentary interventions for smoking cessation: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1431-1445. [PMID: 37269310 DOI: 10.1007/s00127-023-02503-2] [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: 12/07/2022] [Accepted: 05/25/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Tobacco use is an important cause of preventable mortality and morbidity worldwide. Only 7% of smokers successfully quit annually, despite numerous evidence-based smoking cessation treatments. An important reason for failure is barriers to accessing appropriate smoking cessation interventions, which can be minimized by technology-delivered interventions, such as ecological momentary interventions. Ecological momentary interventions provide the right type and intensity of treatment in real time, based on ecological momentary assessments of relevant variables. The aim of this review was to assess the effectiveness of ecological momentary interventions in smoking cessation. METHODS We searched MEDLINE, Scopus, CENTRAL, psychINFO, and ProQuest without applying any filters on 19 September, 2022. One author screened search results for obvious irrelevant and duplicate studies. The remaining studies were independently reviewed by two authors to exclude irrelevant studies, and then they extracted data from the included studies. We collated study findings, transformed data into a common rubric, and calculated a weighted treatment effect across studies using Review Manager 5. FINDINGS We analyzed 10 studies with a total of 2391 participants. Assessment methods included exhaled CO analyzers, bidirectional SMS, data input in apps, and hand movement detection. Interventions were based on acceptance and commitment therapy and cognitive behavioral therapy. Smoking abstinence was significantly higher in participants of intervention groups compared to control groups (RR = 1.24; 95% CI 1.07-1.44, P = 0.004; I2 = 0%). CONCLUSION Ecological momentary intervention is a novel area of research in behavioral science. The results of this systematic review based on the available literature suggest that these interventions could be beneficial for smoking cessation.
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Affiliation(s)
- Shayan Eghdami
- Research Committee, School of Medicine, Iran University of Medical Sciences, Hemat Highway, Next to Milad Tower, Tehran, 14535, Iran.
| | - Hamid R Ahmadkhaniha
- Research Center for Addiction and Risky Behaviors, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid R Baradaran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Armin Hirbod-Mobarakeh
- Research Center for Addiction and Risky Behaviors, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Hirbod Psychiatric and Psychologic Club (BAVAR), Tehran, Iran
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9
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Cheng P, Santarossa S, Kalmbach D, Sagong C, Hu K, Drake C. Patient perspectives on facilitators and barriers to equitable engagement with digital CBT-I. Sleep Health 2023; 9:571-578. [PMID: 37625947 PMCID: PMC10592026 DOI: 10.1016/j.sleh.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 03/14/2023] [Accepted: 07/08/2023] [Indexed: 08/27/2023]
Abstract
STUDY OBJECTIVES Digital cognitive behavioral therapy for insomnia has significant advantages for dissemination and scalability vs. in-person cognitive behavioral therapy for insomnia and is, therefore, well-positioned to be the first-line intervention for insomnia. However, only about half of patients remit following digital cognitive behavioral therapy for insomnia. Evidence suggests that treatment engagement is a critical driver of digital cognitive behavioral therapy for insomnia effectiveness, and barriers to engagement disproportionately impact people from under-resourced communities. For digital cognitive behavioral therapy for insomnia to be effective and scalable, we need to identify facilitators and barriers to digital cognitive behavioral therapy for insomnia engagement. METHODS Responses from an exit survey about participant experiences with digital cognitive behavioral therapy for insomnia were analyzed using mixed methods. The survey included quantitative measures of treatment engagement and a free-response item, which was coded and analyzed for themes using both inductive and deductive approaches. RESULTS Analyses revealed five themes that were relevant for engagement: (1) digital person-to-person components, (2) type and extent of information, (3) user's sense of autonomy, (4) app functionality, and (5) importance of tailored content. Facilitators included enjoyment of digital cognitive behavioral therapy for insomnia elements, particularly those that enhanced a sense of connection (eg, a digital therapist avatar); content presented clearly and at an appropriate pace; and smooth app functionality. Barriers included desire for additional human support, perception that digital cognitive behavioral therapy for insomnia did not account for clinical complexities, and factors that interfered with implementation of key treatment recommendations. CONCLUSION Many barriers and facilitators are influenced by health literacy and technological literacy. Those with access to health and technological literacy are better equipped to engage with digital cognitive behavioral therapy for insomnia. Recommendations for adaptations and enhancements are discussed.
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Timmons AC, Duong JB, Fiallo NS, Lee T, Vo HPQ, Ahle MW, Comer JS, Brewer LC, Frazier SL, Chaspari T. A Call to Action on Assessing and Mitigating Bias in Artificial Intelligence Applications for Mental Health. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023; 18:1062-1096. [PMID: 36490369 PMCID: PMC10250563 DOI: 10.1177/17456916221134490] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Advances in computer science and data-analytic methods are driving a new era in mental health research and application. Artificial intelligence (AI) technologies hold the potential to enhance the assessment, diagnosis, and treatment of people experiencing mental health problems and to increase the reach and impact of mental health care. However, AI applications will not mitigate mental health disparities if they are built from historical data that reflect underlying social biases and inequities. AI models biased against sensitive classes could reinforce and even perpetuate existing inequities if these models create legacies that differentially impact who is diagnosed and treated, and how effectively. The current article reviews the health-equity implications of applying AI to mental health problems, outlines state-of-the-art methods for assessing and mitigating algorithmic bias, and presents a call to action to guide the development of fair-aware AI in psychological science.
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Affiliation(s)
- Adela C. Timmons
- University of Texas at Austin Institute for Mental Health Research
- Colliga Apps Corporation
| | | | | | | | | | | | | | - LaPrincess C. Brewer
- Department of Cardiovascular Medicine, May Clinic College of Medicine, Rochester, Minnesota, United States
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota, United States
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11
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Xie H. A scoping review of gamification for mental health in children: Uncovering its key features and impact. Arch Psychiatr Nurs 2022; 41:132-143. [PMID: 36428041 DOI: 10.1016/j.apnu.2022.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/26/2022] [Accepted: 07/03/2022] [Indexed: 11/30/2022]
Abstract
Mental health conditions in children and adolescents have wide-ranging effects, limiting opportunities for future productive lives. While there has been an upsurge of interest in using games for learning, gamification to optimize health outcomes is worth reviewing when this approach to address mental health conditions is in its infancy. A literature search was conducted with two hundred and fifteen articles involving participants up to 19 years of age with diagnosable mental health conditions, involving the concept of game design elements to motivate health in the context of comparing gamification and non-gamification approaches were retrieved after employing Boolean operators and pre-determined search strategies. Literature of participants with addiction to alcohol or substance use and organic brain issues were excluded as their mental health recovery differed regardless of gamification impact. Findings, extracted from 8 included articles following rigorous screening and critical appraisal, showed that gamification to relieve mental health symptoms were conducted via mobile devices or computers. Key features of the games involved applications or video where players with mental health conditions took on roles in a virtual world with narratives. Real-life knowledge and skills to manage the symptoms of mental health conditions were learned in the process as players leveled up in the game. Only one study utilized gamification platforms that could detect breathing changes but it was shown to be only helpful towards relief of anxiety symptoms. Nevertheless, the potential for gamification for mental health outcomes remains promising.
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Affiliation(s)
- Huiting Xie
- Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore.
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12
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Kriegshauser KD, Sexton CC, Bozsik FM, Blossom JB, Wiese AD, Adams Larsen M, Hale LR. The Feasibility of a Family-Focused CBT Skills Self-Help App. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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App-enhanced transdiagnostic CBT for adolescents with mood or psychotic spectrum disorders. J Affect Disord 2022; 311:319-326. [PMID: 35594972 PMCID: PMC9728252 DOI: 10.1016/j.jad.2022.05.094] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/25/2022] [Accepted: 05/15/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Although transdiagnostic forms of cognitive-behavioral therapy (CBT) have been evaluated in individuals with depressive and anxiety disorders, few studies have examined their suitability for more severe disorders, such as recurrent or persistent major depressive disorder, bipolar disorder, or psychotic spectrum disorders. This study examined the acceptability and initial efficacy of an app-enhanced Unified Protocol for Adolescents [UP-A] when including youth with more severe mood disorders or psychotic spectrum disorders. METHODS We first adapted a mobile application (app), based on user-centered feedback from adolescents and their parents, to assist participants in reviewing session content, practicing skills learned in previous treatment sessions, and monitoring symptomatic progress. A total of 24 adolescents (M age = 15.2 years, SD = 1.6) with mood or psychotic spectrum disorders and their parents then participated in an open trial of the app-enhanced group treatment given over 9 weekly sessions. RESULTS Adolescent participants and their parents rated the group treatment and mobile app as acceptable and useful. We observed significant improvements over the 9-week treatment in adolescents' depressive symptoms, attenuated psychotic symptoms, and global functioning. The frequency with which adolescents used the mobile app between sessions was positively related to symptomatic and functional gains. CONCLUSIONS Initial findings suggest the acceptability and feasibility of a mobile app that enabled adolescent participants and their parents to review session content and practice treatment skills. Findings also indicated improvements in psychiatric and functional outcomes among the adolescent participants over the course of the app-enhanced treatment. Randomized clinical trials are needed to evaluate the efficacy of app-enhanced CBT in improving symptoms and functioning in adolescents with mood or psychotic spectrum disorders.
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14
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Ferrari M, Sabetti J, McIlwaine SV, Fazeli S, Sadati SMH, Shah JL, Archie S, Boydell KM, Lal S, Henderson J, Alvarez-Jimenez M, Andersson N, Nielsen RKL, Reynolds JA, Iyer SN. Gaming My Way to Recovery: A Systematic Scoping Review of Digital Game Interventions for Young People's Mental Health Treatment and Promotion. Front Digit Health 2022; 4:814248. [PMID: 35465647 PMCID: PMC9021794 DOI: 10.3389/fdgth.2022.814248] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
Nearly all young people use the internet daily. Many youth with mental health concerns, especially since the Covid-19 pandemic, are using this route to seek help, whether through digital mental health treatment, illness prevention tools, or supports for mental wellbeing. Videogames also have wide appeal among young people, including those who receive mental health services. This review identifies the literature on videogame interventions for young people, ages 12-29, and maps the data on game use by those with mental health and substance use problems, focusing on evidence for the capacity of games to support treatment in youth mental health services; how stakeholders are involved in developing or evaluating games; and any potential harms and ethical remedies identified. A systematic scoping review methodology was used to identify and assess relevant studies. A search of multiple databases identified a total of 8,733 articles. They were screened, and 49 studies testing 32 digital games retained. An adapted stepped care model, including four levels, or steps, based on illness manifestation and severity, was used as a conceptual framework for organizing target populations, mental health conditions and corresponding digital games, and study results. The 49 selected studies included: 10 studies (20.4%) on mental health promotion/prevention or education for undiagnosed youth (Step 0: 7 games); 6 studies (12.2%) on at-risk groups or suspected mental problems (Step 1: 5 games); 24 studies (49.0%) on mild to moderate mental conditions (Steps 2-3: 16 games); and 9 studies (18.4%) focused on severe and complex mental conditions (Step 4: 7 games). Two interventions were played by youth at more than one level of illness severity: the SPARX game (Steps 1, 2-3, 4) and Dojo (Steps 2-3 and 4), bringing the total game count to 35 with these repetitions. Findings support the potential integration of digital games in youth services based on study outcomes, user satisfaction, relatively high program retention rates and the potential usefulness of most games for mental health treatment or promotion/prevention. Most studies included stakeholder feedback, and involvement ratings were very high for seven games. Potential harms were not addressed in this body of research. This review provides an important initial repository and evaluation of videogames for use in clinical settings concerned with youth mental health.
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Affiliation(s)
- Manuela Ferrari
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
- *Correspondence: Manuela Ferrari
| | - Judith Sabetti
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Sarah V. McIlwaine
- Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Sahar Fazeli
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - S. M. Hani Sadati
- Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Integrated Studies in Education, McGill University, Montreal, QC, Canada
| | - Jai L. Shah
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Suzanne Archie
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Katherine M. Boydell
- Black Dog Institute and School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Shalini Lal
- Douglas Mental Health University Institute, Montreal, QC, Canada
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Health Innovation and Evaluation Hub, Université de Montréal Hospital Research Centre, Montreal, QC, Canada
| | | | - Mario Alvarez-Jimenez
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Neil Andersson
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | | | | | - Srividya N. Iyer
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
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15
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Denecke K, Schmid N, Nüssli S. Implementation of Cognitive Behavioral Therapy in e-Mental Health Apps: Literature Review. J Med Internet Res 2022; 24:e27791. [PMID: 35266875 PMCID: PMC8949700 DOI: 10.2196/27791] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 07/27/2021] [Accepted: 12/28/2021] [Indexed: 12/24/2022] Open
Abstract
Background To address the matter of limited resources for treating individuals with mental disorders, e–mental health has gained interest in recent years. More specifically, mobile health (mHealth) apps have been suggested as electronic mental health interventions accompanied by cognitive behavioral therapy (CBT). Objective This study aims to identify the therapeutic aspects of CBT that have been implemented in existing mHealth apps and the technologies used. From these, we aim to derive research gaps that should be addressed in the future. Methods Three databases were screened for studies on mHealth apps in the context of mental disorders that implement techniques of CBT: PubMed, IEEE Xplore, and ACM Digital Library. The studies were independently selected by 2 reviewers, who then extracted data from the included studies. Data on CBT techniques and their technical implementation in mHealth apps were synthesized narratively. Results Of the 530 retrieved citations, 34 (6.4%) studies were included in this review. mHealth apps for CBT exploit two groups of technologies: technologies that implement CBT techniques for cognitive restructuring, behavioral activation, and problem solving (exposure is not yet realized in mHealth apps) and technologies that aim to increase user experience, adherence, and engagement. The synergy of these technologies enables patients to self-manage and self-monitor their mental state and access relevant information on their mental illness, which helps them cope with mental health problems and allows self-treatment. Conclusions There are CBT techniques that can be implemented in mHealth apps. Additional research is needed on the efficacy of the mHealth interventions and their side effects, including inequalities because of the digital divide, addictive internet behavior, lack of trust in mHealth, anonymity issues, risks and biases for user groups and social contexts, and ethical implications. Further research is also required to integrate and test psychological theories to improve the impact of mHealth and adherence to the e–mental health interventions.
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Affiliation(s)
- Kerstin Denecke
- Institute for Medical Informatics, Bern University of Applied Sciences, Biel, Switzerland
| | | | - Stephan Nüssli
- Institute for Medical Informatics, Bern University of Applied Sciences, Biel, Switzerland
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16
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Leong QY, Sridhar S, Blasiak A, Tadeo X, Yeo G, Remus A, Ho D. Characteristics of Mobile Health Platforms for Depression and Anxiety: Content Analysis Through a Systematic Review of the Literature and Systematic Search of Two App Stores. J Med Internet Res 2022; 24:e27388. [PMID: 35119370 PMCID: PMC8857696 DOI: 10.2196/27388] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 06/05/2021] [Accepted: 11/08/2021] [Indexed: 12/20/2022] Open
Abstract
Background Mobile health (mHealth) platforms show promise in the management of mental health conditions such as anxiety and depression. This has resulted in an abundance of mHealth platforms available for research or commercial use. Objective The objective of this review is to characterize the current state of mHealth platforms designed for anxiety or depression that are available for research, commercial use, or both. Methods A systematic review was conducted using a two-pronged approach: searching relevant literature with prespecified search terms to identify platforms in published research and simultaneously searching 2 major app stores—Google Play Store and Apple App Store—to identify commercially available platforms. Key characteristics of the mHealth platforms were synthesized, such as platform name, targeted condition, targeted group, purpose, technology type, intervention type, commercial availability, and regulatory information. Results The literature and app store searches yielded 169 and 179 mHealth platforms, respectively. Most platforms developed for research purposes were designed for depression (116/169, 68.6%), whereas the app store search reported a higher number of platforms developed for anxiety (Android: 58/179, 32.4%; iOS: 27/179, 15.1%). The most common purpose of platforms in both searches was treatment (literature search: 122/169, 72.2%; app store search: 129/179, 72.1%). With regard to the types of intervention, cognitive behavioral therapy and referral to care or counseling emerged as the most popular options offered by the platforms identified in the literature and app store searches, respectively. Most platforms from both searches did not have a specific target age group. In addition, most platforms found in app stores lacked clinical and real-world evidence, and a small number of platforms found in the published research were available commercially. Conclusions A considerable number of mHealth platforms designed for anxiety or depression are available for research, commercial use, or both. The characteristics of these mHealth platforms greatly vary. Future efforts should focus on assessing the quality—utility, safety, and effectiveness—of the existing platforms and providing developers, from both commercial and research sectors, a reporting guideline for their platform description and a regulatory framework to facilitate the development, validation, and deployment of effective mHealth platforms.
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Affiliation(s)
- Qiao Ying Leong
- N.1 Institute for Health, National University of Singapore, Singapore, Singapore.,The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shreya Sridhar
- N.1 Institute for Health, National University of Singapore, Singapore, Singapore
| | - Agata Blasiak
- N.1 Institute for Health, National University of Singapore, Singapore, Singapore.,The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Biomedical Engineering, NUS Engineering, National University of Singapore, Singapore, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xavier Tadeo
- N.1 Institute for Health, National University of Singapore, Singapore, Singapore.,The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - GeckHong Yeo
- N.1 Institute for Health, National University of Singapore, Singapore, Singapore.,The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Alexandria Remus
- N.1 Institute for Health, National University of Singapore, Singapore, Singapore.,The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Biomedical Engineering, NUS Engineering, National University of Singapore, Singapore, Singapore
| | - Dean Ho
- N.1 Institute for Health, National University of Singapore, Singapore, Singapore.,The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Biomedical Engineering, NUS Engineering, National University of Singapore, Singapore, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Health District @ Queenstown, Singapore, Singapore
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17
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Rasouli S, Gupta G, Nilsen E, Dautenhahn K. Potential Applications of Social Robots in Robot-Assisted Interventions for Social Anxiety. Int J Soc Robot 2022; 14:1-32. [PMID: 35096198 PMCID: PMC8787185 DOI: 10.1007/s12369-021-00851-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 12/31/2022]
Abstract
AbstractSocial anxiety disorder or social phobia is a condition characterized by debilitating fear and avoidance of different social situations. We provide an overview of social anxiety and evidence-based behavioural and cognitive treatment approaches for this condition. However, treatment avoidance and attrition are high in this clinical population, which calls for innovative approaches, including computer-based interventions, that could minimize barriers to treatment and enhance treatment effectiveness. After reviewing existing assistive technologies for mental health interventions, we provide an overview of how social robots have been used in many clinical interventions. We then propose to integrate social robots in conventional behavioural and cognitive therapies for both children and adults who struggle with social anxiety. We categorize the different therapeutic roles that social robots can potentially play in activities rooted in conventional therapies for social anxiety and oriented towards symptom reduction, social skills development, and improvement in overall quality of life. We discuss possible applications of robots in this context through four scenarios. These scenarios are meant as ‘food for thought’ for the research community which we hope will inspire future research. We discuss risks and concerns for using social robots in clinical practice. This article concludes by highlighting the potential advantages as well as limitations of integrating social robots in conventional interventions to improve accessibility and standard of care as well as outlining future steps in relation to this research direction. Clearly recognizing the need for future empirical work in this area, we propose that social robots may be an effective component in robot-assisted interventions for social anxiety, not replacing, but complementing the work of clinicians. We hope that this article will spark new research, and research collaborations in the highly interdisciplinary field of robot-assisted interventions for social anxiety.
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Affiliation(s)
- Samira Rasouli
- Department of Electrical and Computer Engineering, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1 Canada
| | - Garima Gupta
- Department of Psychology, University of Waterloo, Waterloo, Ontario Canada
| | - Elizabeth Nilsen
- Department of Psychology, University of Waterloo, Waterloo, Ontario Canada
| | - Kerstin Dautenhahn
- Department of Electrical and Computer Engineering, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1 Canada
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Ontario Canada
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18
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Lockwood J, Williams L, Martin JL, Rathee M, Hill C. Effectiveness, User Engagement and Experience, and Safety of a Mobile App (Lumi Nova) Delivering Exposure-Based Cognitive Behavioral Therapy Strategies to Manage Anxiety in Children via Immersive Gaming Technology: Preliminary Evaluation Study. JMIR Ment Health 2022; 9:e29008. [PMID: 35072644 PMCID: PMC8822420 DOI: 10.2196/29008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Childhood anxiety disorders are a prevalent mental health problem that can be treated effectively with cognitive behavioral therapy, in which exposure is a key component; however, access to treatment is poor. Mobile-based apps on smartphones or tablets may facilitate the delivery of evidence-based therapy for child anxiety, thereby overcoming the access and engagement barriers of traditional treatment. Apps that deliver therapeutic content via immersive gaming technology could offer an effective, highly engaging, and flexible treatment proposition. OBJECTIVE In this paper, we aim to describe a preliminary multi-method evaluation of Lumi Nova, a mobile app intervention targeting mild to moderate anxiety problems in children aged 7-12 years using exposure therapy delivered via an immersive game. The primary objective is to evaluate the effectiveness, user engagement and experience, and safety of the beta version of Lumi Nova. METHODS Lumi Nova was co-designed with children, parents, teachers, clinicians, game industry experts, and academic partnerships. In total, 120 community-based children with mild to moderate anxiety and their guardians were enrolled to participate in an 8-week pilot study. The outcome measures captured the app's effectiveness (anxiety symptoms, child-identified goal-based outcomes, and functional impairment), user engagement (game play data and ease-of-use ratings), and safety (mood ratings and adverse events). The outcome measures before and after the intervention were available for 30 children (age: mean 9.8, SD 1.7 years; girls: 18/30, 60%; White: 24/30, 80%). Additional game play data were automatically generated for 67 children (age: mean 9.6, SD 1.53 years; girls: 35/67, 52%; White: 42/67, 63%). Postintervention open-response data from 53% (16/30) of guardians relating to the primary objectives were also examined. RESULTS Playing Lumi Nova was effective in reducing anxiety symptom severity over the 8-week period of game play (t29=2.79; P=.009; Cohen d=0.35) and making progress toward treatment goals (z=2.43; P=.02), but there were no improvements in relation to functional impairment. Children found it easy to play the game and engaged safely with therapeutic content. However, the positive effects were small, and there were limitations to the game play data. CONCLUSIONS This preliminary study provides initial evidence that an immersive mobile game app may safely benefit children experiencing mild to moderate anxiety. It also demonstrates the value of the rigorous evaluation of digital interventions during the development process to rapidly improve readiness for full market launch.
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Affiliation(s)
- Joanna Lockwood
- National Institute of Health Research MindTech MedTech Co-operative, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Laura Williams
- National Institute of Health Research MindTech MedTech Co-operative, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Jennifer L Martin
- National Institute of Health Research MindTech MedTech Co-operative, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | - Claire Hill
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, United Kingdom
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19
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Bettis AH, Burke TA, Nesi J, Liu RT. Digital Technologies for Emotion-Regulation Assessment and Intervention: A Conceptual Review. Clin Psychol Sci 2022; 10:3-26. [PMID: 35174006 PMCID: PMC8846444 DOI: 10.1177/21677026211011982] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
The ability to regulate emotions in response to stress is central to healthy development. While early research in emotion regulation predominantly employed static, self-report measurement, the past decade has seen a shift in focus toward understanding the dynamic nature of regulation processes. This is reflected in recent refinements in the definition of emotion regulation, which emphasize the importance of the ability to flexibly adapt regulation efforts across contexts. The latest proliferation of digital technologies employed in mental health research offers the opportunity to capture the state- and context-sensitive nature of emotion regulation. In this conceptual review, we examine the use of digital technologies (ecological momentary assessment; wearable and smartphone technology, physical activity, acoustic data, visual data, and geo-location; smart home technology; virtual reality; social media) in the assessment of emotion regulation and describe their application to interventions. We also discuss challenges and ethical considerations, and outline areas for future research.
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Affiliation(s)
| | | | | | - Richard T Liu
- Harvard Medical School
- Massachusetts General Hospital
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20
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Martinez RG, van Dyk IS, Kroll JL, Emerson ND, Bursch B. Recommendations for building telemental health relationships with youth: A systematic review and resource for clinicians. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2022; 7:349-362. [PMID: 36248612 PMCID: PMC9562612 DOI: 10.1080/23794925.2021.1970050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Ruben G. Martinez
- Department of Psychiatry & Biobehavioral Sciences, UCLA Jane & Terry Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA
| | - Ilana Seager van Dyk
- Department of Social & Behavioral Science, Yale School of Public Health, New Haven, CT
| | - Juliet L. Kroll
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TC
| | - Natacha D. Emerson
- Department of Psychiatry & Biobehavioral Sciences, UCLA Jane & Terry Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA
| | - Brenda Bursch
- Department of Psychiatry & Biobehavioral Sciences, UCLA Jane & Terry Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA,Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA
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21
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Leenaraj B, Arayaphan W, Intawong K, Puritat K. A gamified mobile application for first-year student orientation to promote library services. JOURNAL OF LIBRARIANSHIP AND INFORMATION SCIENCE 2021. [DOI: 10.1177/09610006211067273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study proposes a mobile application as a new approach for first-year student orientation to promote knowledge of library services using the gamification concept. The application is based on mobile devices with GPS to locate students, allowing them to catch, collect, and battle monsters around the library with questions on library service instructions. To evaluate the learning effectiveness of the approach, we performed a comparative experiment in which the control group used e-learning, while the experimental group used the mobile application of the CMU Journey. We evaluated the pre-and post-test scores, delayed 1-month post-test scores, and intrinsic motivation based on the IMI questionnaire. The results demonstrated that the preference for gamified experience among students can enhance knowledge retention and intrinsic motivation compared to other groups.
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22
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Martinez K, Menéndez-Menéndez MI, Bustillo A. Awareness, Prevention, Detection, and Therapy Applications for Depression and Anxiety in Serious Games for Children and Adolescents: Systematic Review. JMIR Serious Games 2021; 9:e30482. [PMID: 34927589 PMCID: PMC8726021 DOI: 10.2196/30482] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/28/2021] [Accepted: 09/10/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Depression and anxiety in children and adolescents are major health problems worldwide. In recent years, serious games research has advanced in the development of tools to address these mental health conditions. However, there has not been an extensive analysis of these games, their tendencies, and capacities. OBJECTIVE This review aims to gather the most current serious games, published from 2015 to 2020, with a new approach focusing on their applications: awareness, prevention, detection, and therapy. The purpose is also to analyze the implementation, development, and evaluation of these tools to obtain trends, strengths, and weaknesses for future research lines. METHODS The identification of the serious games through a literature search was conducted on the databases PubMed, Scopus, Wiley, Taylor and Francis, Springer, PsycINFO, PsycArticles, Web of Science, and Science Direct. The identified records were screened to include only the manuscripts meeting these criteria: a serious game for PC, smartphone, or virtual reality; developed by research teams; targeting only depression or anxiety or both; aiming specifically at children or adolescents. RESULTS A total of 34 studies have been found that developed serious games for PC, smartphone, and virtual reality devices and tested them in children and adolescents. Most of the games address both conditions and are applied in prevention and therapy. Nevertheless, there is a trend that anxiety is targeted more in childhood and depression targeted more in adolescence. Regarding design, the game genres arcade minigames, adventure worlds, and social simulations are used, in this order. For implementation, these serious games usually require sessions of 1 hour and are most often played using a PC. Moreover, the common evaluation tools are normalized questionnaires that measure acquisition of skills or reduction of symptoms. Most studies collect and compare these data before and after the participants play. CONCLUSIONS The results show that more awareness and detection games are needed, as well as games that mix the awareness, prevention, detection, and therapy applications. In addition, games for depression and anxiety should equally target all age ranges. For future research, the development and evaluation of serious games should be standardized, so the implementation of serious games as tools would advance. The games should always offer support while playing, in addition to collecting data on participant behavior during the game to better analyze their learning. Furthermore, there is an open line regarding the use of virtual reality for these games due to the capabilities offered by this technology.
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Affiliation(s)
- Kim Martinez
- Department of History, Geography and Communication, University of Burgos, Burgos, Spain
| | | | - Andres Bustillo
- Department of Computer Engineering, University of Burgos, Burgos, Spain
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23
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Moczygemba LR, Thurman W, Tormey K, Hudzik A, Welton-Arndt L, Kim E. GPS Mobile Health Intervention Among People Experiencing Homelessness: Pre-Post Study. JMIR Mhealth Uhealth 2021; 9:e25553. [PMID: 34730550 PMCID: PMC8600433 DOI: 10.2196/25553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 05/27/2021] [Accepted: 08/06/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND People experiencing homelessness are at risk for gaps in care after an emergency department (ED) or hospital visit, which leads to increased use, poor health outcomes, and high health care costs. Most people experiencing homelessness have a mobile phone of some type, which makes mobile health (mHealth) interventions a feasible way to connect a person experiencing homelessness with providers. OBJECTIVE This study aims to investigate the accuracy, acceptability, and preliminary outcomes of a GPS-enabled mHealth (GPS-mHealth) intervention designed to alert community health paramedics when people experiencing homelessness are in the ED or hospital. METHODS This study was a pre-post design with baseline and 4-month postenrollment assessments. People experiencing homelessness, taking at least 2 medications for chronic conditions, scoring at least 10 on the Patient Health Questionnaire-9, and having at least 2 ED or hospital visits in the previous 6 months were eligible. Participants were issued a study smartphone with a GPS app programmed to alert a community health paramedic when a participant entered an ED or hospital. For each alert, community health paramedics followed up via telephone to assess care coordination needs. Participants also received a daily email to assess medication adherence. GPS alerts were compared with ED and hospital data from the local health information exchange (HIE) to assess accuracy. Paired t tests compared scores on the Patient Health Questionnaire-9, Medical Outcomes Study Social Support Survey, and Adherence Starts with Knowledge-12 adherence survey at baseline and exit. Semistructured exit interviews examined the perceptions and benefits of the intervention. RESULTS In total, 30 participants were enrolled; the mean age was 44.1 (SD 9.7) years. Most participants were male (20/30, 67%), White (17/30, 57%), and not working (19/30, 63%). Only 19% (3/16) of the ED or hospital visit alerts aligned with HIE data, mainly because of patients not having the smartphone with them during the visit, the smartphone being off, and gaps in GPS technology. There was a significant difference in depressive symptoms between baseline (mean 16.9, SD 5.8) and exit (mean 12.7, SD 8.2; t19=2.9; P=.009) and a significant difference in adherence barriers between baseline (mean 2.4, SD 1.4) and exit (mean 1.5, SD 1.5; t17=2.47; P=.03). Participants agreed that the app was easy to use (mean 4.4/5, SD 1.0, with 5=strongly agree), and the email helped them remember to take their medications (mean 4.6/5, SD 0.6). Qualitative data indicated that unlimited smartphone access allowed participants to meet social needs and maintain contact with case managers, health care providers, family, and friends. CONCLUSIONS mHealth interventions are acceptable to people experiencing homelessness. HIE data provided more accurate ED and hospital visit information; however, unlimited access to reliable communication provided benefits to participants beyond the study purpose of improving care coordination.
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Affiliation(s)
- Leticia R Moczygemba
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, TX, United States
| | - Whitney Thurman
- School of Nursing, University of Texas at Austin, Austin, TX, United States
| | - Kyler Tormey
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, TX, United States
| | - Anthony Hudzik
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, TX, United States
| | - Lauren Welton-Arndt
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, TX, United States
| | - Elizabeth Kim
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, TX, United States
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Adolescent Perspectives on How an Adjunctive Mobile App for Social Anxiety Treatment Impacts Treatment Engagement in Telehealth Group Therapy. SOCIAL SCIENCES-BASEL 2021. [DOI: 10.3390/socsci10100397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adjunctive mobile mental health apps to supplement mental health treatment have been growing in recent years given their ability to address treatment engagement barriers. However, few studies have explicitly examined how these mobile apps impact treatment engagement, and even fewer have investigated this topic through adolescents’ perspectives. To this end, we conducted semi-structured interviews with five adolescents who used an adjunctive mobile mental health app in combination with telehealth cognitive behavioral group therapy for social anxiety. Using a multidimensional framework of treatment engagement, we elicited their perspectives on how the app impacted their engagement in telehealth group therapy and gathered their suggestions for improving the app. Using a consensual qualitative research approach, we learned that adolescents felt the app increased their comfort with others in therapy and their expectations about the effectiveness of mental health apps. They also indicated that the app prepared them for in-session participation and facilitated out-of-session skills practice. Adolescents had valuable suggestions such as adding app features to facilitate social connectedness between group members and adding appointment reminders in the app. This preliminary study highlights implications for future adjunctive mobile mental health app developers and researchers to increase adolescents’ treatment engagement in mental health services.
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Balaskas A, Schueller SM, Cox AL, Doherty G. The Functionality of Mobile Apps for Anxiety: Systematic Search and Analysis of Engagement and Tailoring Features. JMIR Mhealth Uhealth 2021; 9:e26712. [PMID: 34612833 PMCID: PMC8529472 DOI: 10.2196/26712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/02/2021] [Accepted: 07/15/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND A range of mobile apps for anxiety have been developed in response to the high prevalence of anxiety disorders. Although the number of publicly available apps for anxiety is increasing, attrition rates among mobile apps are high. These apps must be engaging and relevant to end users to be effective; thus, engagement features and the ability to tailor delivery to the needs of individual users are key. However, our understanding of the functionality of these apps concerning engagement and tailoring features is limited. OBJECTIVE The aim of this study is to review how cognitive behavioral elements are delivered by anxiety apps and their functionalities to support user engagement and tailoring based on user needs. METHODS A systematic search for anxiety apps described as being based on cognitive behavioral therapy (CBT) was conducted on Android and iPhone marketplaces. Apps were included if they mentioned the use of CBT for anxiety-related disorders. We identified 597 apps, of which 36 met the inclusion criteria and were reviewed through direct use. RESULTS Cognitive behavioral apps for anxiety incorporate a variety of functionalities, offer several engagement features, and integrate low-intensity CBT exercises. However, the provision of features to support engagement is highly uneven, and support is provided only for low-intensity CBT treatment. Cognitive behavioral elements combine various modalities to deliver intervention content and support the interactive delivery of these elements. Options for personalization are limited and restricted to goal selection upon beginning use or based on self-monitoring entries. Apps do not appear to provide individualized content to users based on their input. CONCLUSIONS Engagement and tailoring features can be significantly expanded in existing apps, which make limited use of social features and clinical support and do not use sophisticated features such as personalization based on sensor data. To guide the evolution of these interventions, further research is needed to explore the effectiveness of different types of engagement features and approaches to tailoring therapeutic content.
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Affiliation(s)
- Andreas Balaskas
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Stephen M Schueller
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States.,Department of Informatics, University of California, Irvine, Irvine, CA, United States
| | - Anna L Cox
- UCL Interaction Centre, University College London, London, United Kingdom
| | - Gavin Doherty
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
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Kim S, Park Y, Ackerman MK. Designing an Indoor Air Quality Monitoring App for Asthma Management in Children: User-Centered Design Approach. JMIR Form Res 2021; 5:e27447. [PMID: 34550080 PMCID: PMC8495576 DOI: 10.2196/27447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/15/2021] [Accepted: 05/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Indoor air pollution is a well-known risk factor that triggers and exacerbates asthma, the most common pediatric chronic disease. Using a mobile app to monitor indoor air quality could be promising in engaging children in keeping their indoor air quality clean and healthy as secondary environmental prevention for asthma management. However, no app is available to allow children to monitor, assess, and improve their indoor air quality. OBJECTIVE This study aims to design a mobile app that encourages children to monitor indoor air quality and track their asthma conditions through a user-centered, iterative design approach. METHODS We reviewed existing apps for indoor air quality monitoring or asthma management for children and conducted two sets of semistructured interviews with 12 children with asthma. We then iteratively created prototypes and evaluated and revised them. RESULTS Participants raised a series of outstanding questions on the prototype features and content that described their needs and perspectives, which informed the final designs. Following the identified requirements and recommendations, we developed two versions of the app: AirBuddy for presenting concrete information for indoor air quality and AirPet for gamifying the practice of monitoring indoor air quality. CONCLUSIONS By following an iterative, user-centered design process, we developed two versions of an app to encourage children with asthma to monitor indoor air quality and track their asthma condition. The user-centered design approach revealed two crucial aspects that require deeper consideration when creating a child-friendly app, including balancing brevity and expressivity and considering the longitudinal effects of gamification. As a next step, we plan to conduct a longitudinal deployment study to evaluate the real-world effects of our apps.
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Affiliation(s)
- Sunyoung Kim
- School of Communication and Information, Rutgers University, New Brunswick, NJ, United States
| | - Yunoh Park
- Department of Computer Science, Rutgers University, New Brunswick, NJ, United States
| | - Matthew K Ackerman
- School of Communication and Information, Rutgers University, New Brunswick, NJ, United States
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Warsinsky S, Schmidt-Kraepelin M, Rank S, Thiebes S, Sunyaev A. Conceptual Ambiguity Surrounding Gamification and Serious Games in Health Care: Literature Review and Development of Game-Based Intervention Reporting Guidelines (GAMING). J Med Internet Res 2021; 23:e30390. [PMID: 34505840 PMCID: PMC8463952 DOI: 10.2196/30390] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In health care, the use of game-based interventions to increase motivation, engagement, and overall sustainability of health behaviors is steadily becoming more common. The most prevalent types of game-based interventions in health care research are gamification and serious games. Various researchers have discussed substantial conceptual differences between these 2 concepts, supported by empirical studies showing differences in the effects on specific health behaviors. However, researchers also frequently report cases in which terms related to these 2 concepts are used ambiguously or even interchangeably. It remains unclear to what extent existing health care research explicitly distinguishes between gamification and serious games and whether it draws on existing conceptual considerations to do so. OBJECTIVE This study aims to address this lack of knowledge by capturing the current state of conceptualizations of gamification and serious games in health care research. Furthermore, we aim to provide tools for researchers to disambiguate the reporting of game-based interventions. METHODS We used a 2-step research approach. First, we conducted a systematic literature review of 206 studies, published in the Journal of Medical Internet Research and its sister journals, containing terms related to gamification, serious games, or both. We analyzed their conceptualizations of gamification and serious games, as well as the distinctions between the two concepts. Second, based on the literature review findings, we developed a set of guidelines for researchers reporting on game-based interventions and evaluated them with a group of 9 experts from the field. RESULTS Our results show that less than half of the concept mentions are accompanied by an explicit definition. To distinguish between the 2 concepts, we identified four common approaches: implicit distinction, synonymous use of terms, serious games as a type of gamified system, and distinction based on the full game dimension. Our Game-Based Intervention Reporting Guidelines (GAMING) consist of 25 items grouped into four topics: conceptual focus, contribution, mindfulness about related concepts, and individual concept definitions. CONCLUSIONS Conceptualizations of gamification and serious games in health care literature are strongly heterogeneous, leading to conceptual ambiguity. Following the GAMING can support authors in rigorous reporting on study results of game-based interventions.
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Affiliation(s)
- Simon Warsinsky
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | | | - Sascha Rank
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Scott Thiebes
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Ali Sunyaev
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Germany
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Ecological momentary interventions for mental health: A scoping review. PLoS One 2021; 16:e0248152. [PMID: 33705457 PMCID: PMC7951936 DOI: 10.1371/journal.pone.0248152] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 02/19/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The development of mobile computing technology has enabled the delivery of psychological interventions while people go about their everyday lives. The original visions of the potential of these "ecological momentary interventions" were presented over a decade ago, and the widespread adoption of smartphones in the intervening years has led to a variety of research studies exploring the feasibility of these aspirations. However, there is a dearth of research describing the different dimensions, characteristics, and features of these interventions, as constructed. OBJECTIVE To provide an overview of the definitions given for "ecological momentary interventions" in the treatment of common mental health disorders, and describe the set of technological and interaction possibilities which have been used in the design of these interventions. METHODS A systematic search identified relevant literature published between 2009 and 2020 in the PubMed, PsycInfo, and ACM Guide to the Computing Literature databases. Following screening, data were extracted from eligible articles using a standardized extraction worksheet. Selected articles were then thematically categorized. RESULTS The search identified 583 articles of which 64 met the inclusion criteria. The interventions target a range of mental health problems, with diverse aims, intervention designs and evaluation approaches. The studies employed a variety of features for intervention delivery, but recent research is overwhelmingly comprised of studies based on smartphone apps (30 of 42 papers that described an intervention). Twenty two studies employed sensors for the collection of data in order to provide just-in-time support or predict psychological states. CONCLUSIONS With the shift towards smartphone apps, the vision for EMIs has begun to be realised. Recent years have seen increased exploration of the use of sensors and machine learning, but the role of humans in the delivery of EMI is also varied. The variety of capabilities exhibited by EMIs motivates development of a more precise vocabulary for capturing both automatic and human tailoring of these interventions.
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Wu A, Scult MA, Barnes ED, Betancourt JA, Falk A, Gunning FM. Smartphone apps for depression and anxiety: a systematic review and meta-analysis of techniques to increase engagement. NPJ Digit Med 2021; 4:20. [PMID: 33574573 PMCID: PMC7878769 DOI: 10.1038/s41746-021-00386-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/24/2020] [Indexed: 01/30/2023] Open
Abstract
Meta-analyses have shown that digital mental health apps can be efficacious in reducing symptoms of depression and anxiety. However, real-world usage of apps is typically not sustained over time, and no studies systematically examine which features increase sustained engagement with apps or the relationship between engagement features and clinical efficacy. We conducted a systematic search of the literature to identify empirical studies that (1) investigate standalone apps for depression and/or anxiety in symptomatic participants and (2) report at least one measure of engagement. Features intended to increase engagement were categorized using the persuasive system design (PSD) framework and principles of behavioral economics. Twenty-five studies with 4159 participants were included in the analysis. PSD features were commonly used, whereas behavioral economics techniques were not. Smartphone apps were efficacious in treating symptoms of anxiety and depression in randomized controlled trials, with overall small-to-medium effects (g = 0.2888, SE = 0.0999, z(15) = 2.89, p = 0.0119, Q(df = 14) = 41.93, p < 0.0001, I2 = 66.6%), and apps that employed a greater number of engagement features as compared to the control condition had larger effect sizes (β = 0.0450, SE = 0.0164, t(15) = 2.7344, p = 0.0161). We observed an unexpected negative association between PSD features and engagement, as measured by completion rate (β = -0.0293, SE = 0.0121, t(17) = 02.4142, p = 0.0281). Overall, PSD features show promise for augmenting app efficacy, though engagement, as reflected in study completion, may not be the primary factor driving this association. The results suggest that expanding the use of PSD features in mental health apps may increase clinical benefits and that other techniques, such as those informed by behavioral economics, are employed infrequently.
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Affiliation(s)
- Ashley Wu
- MD Program, Weill Cornell Medicine, New York, NY, USA
| | - Matthew A Scult
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.
| | - Emily D Barnes
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | | | - Avital Falk
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Faith M Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.
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Stubberud A, Linde M, Brenner E, Heier M, Olsen A, Aamodt AH, Gravdahl GB, Tronvik E. Self‐administered biofeedback treatment app for pediatric migraine: A randomized pilot study. Brain Behav 2020. [PMCID: PMC7882181 DOI: 10.1002/brb3.1974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective To investigate the effect size, safety, and tolerability of a therapist‐independent biofeedback treatment app among adolescent with migraine. Materials and Methods This was a prospective, 3:1 ratio randomized, sham‐controlled, double‐blind, pilot study with 16 adolescents diagnosed with migraine randomized to eight weeks of biofeedback treatment (n = 12) or sham biofeedback (n = 4), carried out at two university hospitals in Norway. The prespecified and primary objective of the study was to observe changes in outcomes within the active treatment group. The sham control group was included in a minor ratio primarily to evaluate its feasibility. The primary outcome was change in headache frequency. A modified intention to treat analysis was performed, including participants completing at least seven biofeedback sessions in weeks 1–4 (n = 12 vs. n = 4) and weeks 5–8 (n = 7 vs. n = 2). Results Adherence was poor with 40% (136/336) of planned biofeedback sessions completed during weeks 5–8. Within the biofeedback group, a not statistically significant reduction in headache frequency was observed at weeks 1–4 (2.92 days/month, 95% CI −1.00 to 6.84, p = .145) and weeks 5–8 (1.85 days/month, 95% CI −2.01 to 5.72, p = .395). The biofeedback group experienced a median of one fewer headache days/month versus sham that did not reach significance (95% CI −4.0 to 9.0, p = .760). Conclusions We observed a small reduction in headache frequency in the active treatment group. Findings were likely undermined by low adherence and underpowered analyses but indicate that a therapist‐independent biofeedback treatment app has the potential to be an effective, tolerable, and inexpensive treatment option.
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Affiliation(s)
- Anker Stubberud
- Department of Neuromedicine and Movement ScienceNTNU Norwegian University of Science and TechnologyTrondheimNorway
| | - Mattias Linde
- Department of Neuromedicine and Movement ScienceNTNU Norwegian University of Science and TechnologyTrondheimNorway
- Norwegian Advisory Unit on Headaches, Department of NeurologySt. Olavs HospitalTrondheimNorway
| | - Eiliv Brenner
- Department of Neuromedicine and Movement ScienceNTNU Norwegian University of Science and TechnologyTrondheimNorway
- Norwegian Advisory Unit on Headaches, Department of NeurologySt. Olavs HospitalTrondheimNorway
| | - Martin Heier
- Department of Clinical Neuroscience for ChildrenOslo University HospitalOsloNorway
| | - Alexander Olsen
- Department of PsychologyNTNU Norwegian University of Science and TechnologyTrondheimNorway
- Department of Physical Medicine and RehabilitationSt. Olavs HospitalTrondheimNorway
| | | | - Gøril B. Gravdahl
- Department of Neuromedicine and Movement ScienceNTNU Norwegian University of Science and TechnologyTrondheimNorway
- Norwegian Advisory Unit on Headaches, Department of NeurologySt. Olavs HospitalTrondheimNorway
| | - Erling Tronvik
- Department of Neuromedicine and Movement ScienceNTNU Norwegian University of Science and TechnologyTrondheimNorway
- Norwegian Advisory Unit on Headaches, Department of NeurologySt. Olavs HospitalTrondheimNorway
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Richardson PA, Harrison LE, Heathcote LC, Rush G, Shear D, Lalloo C, Hood K, Wicksell RK, Stinson J, Simons LE. mHealth for pediatric chronic pain: state of the art and future directions. Expert Rev Neurother 2020; 20:1177-1187. [PMID: 32881587 PMCID: PMC7657989 DOI: 10.1080/14737175.2020.1819792] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Chronic pain conditions are common among children and engender cascading effects across social, emotional, and behavioral domains for the child and family. Mobile health (mHealth) describes the practice of delivering healthcare via mobile devices and may be an ideal solution to increase access and reach of evidence-based behavioral health interventions. AREAS COVERED The aim of this narrative review is to present a state-of-the-art overview of evidence-based mHealth efforts within the field of pediatric chronic pain and consider new and promising directions for study. Given the nascent nature of the field, published mHealth interventions in all stages of development are discussed. Literature was identified through a non-systematic search in PubMed and Google Scholar, and a review of reference lists of papers that were identified as particularly relevant or foundational (within and outside of the chronic pain literature). EXPERT OPINION mHealth is a promising interventional modality with early evidence suggesting it is primed to enhance behavioral health delivery and patient outcomes. There are many exciting future directions to be explored including drawing inspiration from digital health technology to generate new ways of thinking about the optimal treatment of pediatric chronic pain.
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Affiliation(s)
- Patricia A. Richardson
- Departments of Pediatric Psychology and Pediatric Pain and Palliative Medicine, Helen DeVos Children’s Hospital, Grand Rapids, MI, USA
- Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - Lauren E. Harrison
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Lauren C. Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Gillian Rush
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Deborah Shear
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Chitra Lalloo
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Canada
- Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
| | - Korey Hood
- Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Rikard K. Wicksell
- Department of Clinical Neuroscience, Division for Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer Stinson
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Canada
- Lawrence S. Bloomberg, Faculty of Nursing, The University of Toronto, Toronto, Canada
| | - Laura E. Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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Regidor N, Ausín B. Tecnologías de información y comunicación (TIC) aplicadas al tratamiento de los problemas de ansiedad. CLÍNICA CONTEMPORÁNEA 2020. [DOI: 10.5093/cc2020a8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Edridge C, Wolpert M, Deighton J, Edbrooke-Childs J. An mHealth Intervention (ReZone) to Help Young People Self-Manage Overwhelming Feelings: Cluster-Randomized Controlled Trial. J Med Internet Res 2020; 22:e14223. [PMID: 32716299 PMCID: PMC7418005 DOI: 10.2196/14223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/31/2019] [Accepted: 03/23/2020] [Indexed: 11/25/2022] Open
Abstract
Background Mental health difficulties in young people are increasing, and there is a need for evidence on the effectiveness of digital interventions to increase opportunities for supporting mental health in young people. Such studies are complicated due to issues of implementation and adoption, outcome measurement, and appropriate study designs. Objective The objective of this study was to examine the effectiveness of an mHealth intervention (ReZone) in reducing mental health difficulties in young people. Methods The cluster-randomized controlled trial enrolled 409 participants aged 10-15 years, and classes were allocated to ReZone or management as usual. Self-reported questionnaires were completed at baseline and 3-month follow-up. Results There were no significant differences between the ReZone condition and management as usual in the self-reported outcome measures. However, there were 3467 usage sessions, which corresponds to 16.9 times per student (total of 205 students) in classes allocated to ReZone. Conclusions It is essential to publish studies that do not show significant differences, as these findings can still contribute to the literature, help in learning, and inform the direction of future work. The results reported in this paper could be due to a range of reasons, including whether ReZone has the scope to impact change or limitations related to the setting, context, and appropriateness of an RCT. The findings of this study suggest that ReZone was implemented and adopted. International Registered Report Identifier (IRRID) RR2-10.2196/resprot.7019
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Affiliation(s)
- Chloe Edridge
- Clinical, Educational and Health Psychology, University College London, London, United Kingdom.,Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Miranda Wolpert
- Clinical, Educational and Health Psychology, University College London, London, United Kingdom.,Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Jessica Deighton
- Clinical, Educational and Health Psychology, University College London, London, United Kingdom.,Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Julian Edbrooke-Childs
- Clinical, Educational and Health Psychology, University College London, London, United Kingdom.,Anna Freud National Centre for Children and Families, London, United Kingdom
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Miralles I, Granell C, Díaz-Sanahuja L, Van Woensel W, Bretón-López J, Mira A, Castilla D, Casteleyn S. Smartphone Apps for the Treatment of Mental Disorders: Systematic Review. JMIR Mhealth Uhealth 2020; 8:e14897. [PMID: 32238332 PMCID: PMC7163422 DOI: 10.2196/14897] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 12/05/2019] [Accepted: 01/20/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Smartphone apps are an increasingly popular means for delivering psychological interventions to patients suffering from a mental disorder. In line with this popularity, there is a need to analyze and summarize the state of the art, both from a psychological and technical perspective. OBJECTIVE This study aimed to systematically review the literature on the use of smartphones for psychological interventions. Our systematic review has the following objectives: (1) analyze the coverage of mental disorders in research articles per year; (2) study the types of assessment in research articles per mental disorder per year; (3) map the use of advanced technical features, such as sensors, and novel software features, such as personalization and social media, per mental disorder; (4) provide an overview of smartphone apps per mental disorder; and (5) provide an overview of the key characteristics of empirical assessments with rigorous designs (ie, randomized controlled trials [RCTs]). METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews were followed. We performed searches in Scopus, Web of Science, American Psychological Association PsycNET, and Medical Literature Analysis and Retrieval System Online, covering a period of 6 years (2013-2018). We included papers that described the use of smartphone apps to deliver psychological interventions for known mental disorders. We formed multidisciplinary teams, comprising experts in psychology and computer science, to select and classify articles based on psychological and technical features. RESULTS We found 158 articles that met the inclusion criteria. We observed an increasing interest in smartphone-based interventions over time. Most research targeted disorders with high prevalence, that is, depressive (31/158,19.6%) and anxiety disorders (18/158, 11.4%). Of the total, 72.7% (115/158) of the papers focused on six mental disorders: depression, anxiety, trauma and stressor-related, substance-related and addiction, schizophrenia spectrum, and other psychotic disorders, or a combination of disorders. More than half of known mental disorders were not or very scarcely (<3%) represented. An increasing number of studies were dedicated to assessing clinical effects, but RCTs were still a minority (25/158, 15.8%). From a technical viewpoint, interventions were leveraging the improved modalities (screen and sound) and interactivity of smartphones but only sparingly leveraged their truly novel capabilities, such as sensors, alternative delivery paradigms, and analytical methods. CONCLUSIONS There is a need for designing interventions for the full breadth of mental disorders, rather than primarily focusing on most prevalent disorders. We further contend that an increasingly systematic focus, that is, involving RCTs, is needed to improve the robustness and trustworthiness of assessments. Regarding technical aspects, we argue that further exploration and innovative use of the novel capabilities of smartphones are needed to fully realize their potential for the treatment of mental health disorders.
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Affiliation(s)
| | | | | | | | - Juana Bretón-López
- Universitat Jaume I, Castellón de la Plana, Spain
- CIBER of Physiopathology of Obesity and Nutrition CIBERobn, Castellón, Spain
| | - Adriana Mira
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
| | - Diana Castilla
- CIBER of Physiopathology of Obesity and Nutrition CIBERobn, Castellón, Spain
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
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Silk JS, Pramana G, Sequeira SL, Lindhiem O, Kendall PC, Rosen D, Parmanto B. Using a Smartphone App and Clinician Portal to Enhance Brief Cognitive Behavioral Therapy for Childhood Anxiety Disorders. Behav Ther 2020; 51:69-84. [PMID: 32005341 PMCID: PMC6995786 DOI: 10.1016/j.beth.2019.05.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 12/15/2022]
Abstract
Cognitive behavioral therapy (CBT) is an efficacious treatment for child anxiety disorders, but 40%-50% of youth do not respond fully to treatment, and time commitments for standard CBT can be prohibitive for some families and lead to long waiting lists for trained CBT therapists in the community. SmartCAT 2.0 is an adjunctive mobile health program designed to improve and shorten CBT treatment for anxiety disorders in youth by providing them with the opportunity to practice CBT skills outside of session using an interactive and gamified interface. It consists of an app and an integrated clinician portal connected to the app for secure 2-way communication with the therapist. The goal of the present study was to evaluate SmartCAT 2.0 in an open trial to establish usability, feasibility, acceptability, and preliminary efficacy of brief (8 sessions) CBT combined with SmartCAT. We also explored changes in CBT skills targeted by the app. Participants were 34 youth (ages 9-14) who met DSM-5 criteria for generalized, separation, and/or social anxiety disorder. Results demonstrated strong feasibility and usability of the app/portal and high satisfaction with the intervention. Youth used the app an average of 12 times between each therapy session (M = 5.8 mins per day). At posttreatment, 67% of youth no longer met diagnostic criteria for an anxiety disorder, with this percentage increasing to 86% at 2-month follow-up. Youth showed reduced symptom severity over time across raters and also improved from pre- to posttreatment in CBT skills targeted by the app, demonstrating better emotion identification and thought challenging and reductions in avoidance. Findings support the feasibility of combining brief CBT with SmartCAT. Although not a controlled trial, when benchmarked against the literature, the current findings suggest that SmartCAT may enhance the utility of brief CBT for childhood anxiety disorders.
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Affiliation(s)
- Jennifer S. Silk
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Gede Pramana
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA
| | | | - Oliver Lindhiem
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | | | - Dana Rosen
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Bambang Parmanto
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA
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Christie GI, Shepherd M, Merry SN, Hopkins S, Knightly S, Stasiak K. Gamifying CBT to deliver emotional health treatment to young people on smartphones. Internet Interv 2019; 18:100286. [PMID: 31890633 PMCID: PMC6926322 DOI: 10.1016/j.invent.2019.100286] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 09/27/2019] [Accepted: 10/05/2019] [Indexed: 12/11/2022] Open
Abstract
mHealth interventions promise the economic delivery of evidence-based mental health treatments like cognitive behavioural therapy (CBT) to populations that struggle to access health services, such as adolescents and in New Zealand, Māori and Pasifika youth. Unfortunately engagement with digital therapies is poor; modularisation and gamification have potential to increase their appeal. Gamifying CBT involves selecting suitable interventions, adapting them to a digital format while applying gamification principles. We describe the design and development of Quest - Te Whitianga, an app that encourages the user to learn CBT skills via a series of activities and games. A variety of approaches including consultation with clinicians, reference to best-practice literature, focus groups and interactive workshops with youth were used to inform the co-design process. Clinicians worked iteratively with experienced game designers to co-create a youth CBT digital intervention. The Quest modular app is set on an ocean and the user travels between islands to learn six evidence-based skills. These include a relaxation/mindfulness activity, activity planning, a gratitude journal plus problem solving and communication skills training. We describe the theoretical and design aspects of each module detailing the gamified features that aim to increase user engagement. In the near future we will be testing the app and the principles discussed in this paper via a randomised-controlled trial.
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Affiliation(s)
- Grant I. Christie
- Department of Psychological Medicine, Faculty of Medical & Health Science, University of Auckland, New Zealand,Corresponding author.
| | - Matthew Shepherd
- Department of Psychological Medicine, Faculty of Medical & Health Science, University of Auckland, New Zealand
| | - Sally N. Merry
- Department of Psychological Medicine, Faculty of Medical & Health Science, University of Auckland, New Zealand
| | - Sarah Hopkins
- Department of Psychological Medicine, Faculty of Medical & Health Science, University of Auckland, New Zealand
| | | | - Karolina Stasiak
- Department of Psychological Medicine, Faculty of Medical & Health Science, University of Auckland, New Zealand
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Tuerk PW, Schaeffer CM, McGuire JF, Adams Larsen M, Capobianco N, Piacentini J. Adapting Evidence-Based Treatments for Digital Technologies: a Critical Review of Functions, Tools, and the Use of Branded Solutions. Curr Psychiatry Rep 2019; 21:106. [PMID: 31584124 DOI: 10.1007/s11920-019-1092-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE OF REVIEW We provide a critical review of digital technologies in evidence-based treatments (EBTs) for mental health with a focus on the functions technologies are intended to serve. The review highlights issues related to clarity of purpose, usability, and assumptions related to EBT technology integration, branding, and packaging. RECENT FINDINGS Developers continue to use technology in creative ways, often combining multiple functions to convey existing EBTs or to create new technology-enabled EBTs. Developers have a strong preference for creating and investigating whole-source, branded solutions related to specific EBTs, in comparison to developing or investigating technology tools related to specific components of behavior change, or developing specific clinical protocols that can be delivered via existing technologies. Default assumptions that new applications are required for each individual EBT, that EBTs are best served by the use of only one technology solution rather than multiple tools, and that an EBT-specific technology product should include or convey all portions of an EBT slow scientific progress and increase risk of usability issues that negatively impact uptake. We contend that a purposeful, functions-based approach should guide the selection, development, and application of technology in support of EBT delivery.
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Affiliation(s)
- Peter W Tuerk
- Sheila C. Johnson Center for Clinical Services, University of Virginia, Charlottesville, VA, USA.
- Department of Human Services, University of Virginia, 417 Emmet St. South, Charlottesville, VA, 22904, USA.
| | - Cindy M Schaeffer
- Division of Child and Adolescent Psychiatry, University of Maryland-Baltimore, Baltimore, MD, USA
| | - Joseph F McGuire
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | | | - Nicole Capobianco
- Department of Human Services, University of Virginia, Charlottesville, VA, USA
| | - John Piacentini
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
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Tark R, Metelitsa M, Akkermann K, Saks K, Mikkel S, Haljas K. Usability, Acceptability, Feasibility, and Effectiveness of a Gamified Mobile Health Intervention (Triumf) for Pediatric Patients: Qualitative Study. JMIR Serious Games 2019; 7:e13776. [PMID: 31573904 PMCID: PMC6792029 DOI: 10.2196/13776] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/18/2019] [Accepted: 08/05/2019] [Indexed: 01/07/2023] Open
Abstract
Background Mental disorders are notably prevalent in children with chronic illnesses, whereas a lack of access to psychological support might lead to potential mental health problems or disruptions in treatment. Digitally delivered psychological interventions have shown promising results as a supportive treatment measure for improving health outcomes during chronic illness. Objective This study aimed to evaluate the usability, acceptability, and feasibility of providing psychological and treatment support in a clinical setting via a mobile game environment. In addition, the study aimed to evaluate the preliminary effectiveness of the mobile health game. Methods Patients aged 7 to 14 years with less than a year from their diagnosis were eligible to participate in the study. In total, 15 patients were invited to participate by their doctor. A total of 9 patients (age range: 7-12 years; mean age 9.1 years) completed the 60-day-long study in which the Triumf mobile health game was delivered as a digital intervention. In an engaging game environment, patients were offered psychological and treatment support, cognitive challenges, and disease-specific information. The fully digital intervention was followed by a qualitative interview conducted by a trained psychologist. The results of the interview were analyzed in conjunction with patient specific in-game qualitative data. Ethical approval was obtained to conduct the study. Results Patients positively perceived the game, resulting in high usability and acceptability evaluations. Participants unanimously described the game as easy to use and engaging in terms of gamified activities, while also providing beneficial and trustworthy information. Furthermore, the overall positive evaluation was emphasized by an observed tendency to carry on gaming post study culmination (67%, 10/15). Psychological support and mini games were the most often used components of the game, simultaneously the participants also highlighted the education module as one of the most preferred. On average, the patients sought and received psychological support or education on 66.6 occasions during the 60-day intervention. Participants spent the most time collecting items from the city environment (on average 15.6 days, SD 8.1), indicative of exploratory behavior, based on the quantitative in-game collected data. During the intervention period, we observed a statistically significant decrease in general health problems (P=.003) and saw a trend toward a decrease in depression and anxiety symptoms. Conclusions This study demonstrated that a game environment could be a promising medium for delivering comprehensive supportive care to pediatric patients with cancer alongside standard treatment, with potential application across a variety of chronic conditions. Importantly, the results indicate that the study protocol was feasible with modifications to randomized controlled trials, and the game could be considered applicable in a clinical context. By giving an empirical evaluation of delivering psychological support via the game environment, our work stands to inform future mobile health interventions.
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Affiliation(s)
- Riin Tark
- Institute of Psychology, University of Tartu, Tartu, Estonia.,Triumf Research OU, Tartu, Estonia
| | - Mait Metelitsa
- Institute of Psychology, University of Tartu, Tartu, Estonia.,Triumf Research OU, Tartu, Estonia
| | | | - Kadri Saks
- Department of Oncology and Hematology, Clinic of Pediatrics, Tallinn Children's Hospital, Tallinn, Estonia
| | - Sirje Mikkel
- Department of Hematology and Bone Marrow Transplantation, Clinic of Hematology and Oncology, Tartu University Hospital, Tartu, Estonia
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Gonsalves PP, Hodgson ES, Kumar A, Aurora T, Chandak Y, Sharma R, Michelson D, Patel V. Design and Development of the " POD Adventures" Smartphone Game: A Blended Problem-Solving Intervention for Adolescent Mental Health in India. Front Public Health 2019; 7:238. [PMID: 31508404 PMCID: PMC6716539 DOI: 10.3389/fpubh.2019.00238] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/08/2019] [Indexed: 12/11/2022] Open
Abstract
Introduction: Digital technology platforms offer unparalleled opportunities to reach vulnerable adolescents at scale and overcome many barriers that exist around conventional service provision. This paper describes the design and development of POD Adventures, a blended problem-solving game-based intervention for adolescents with or at risk of anxiety, depression and conduct difficulties in India. This intervention was developed as part of the PRemIum for ADolEscents (PRIDE) research programme, which aims to establish a suite of transdiagnostic psychological interventions organized around a stepped care system in Indian secondary schools. Methods and Materials: Intervention development followed a person-centered approach consisting of four iterative activities: (i) review of recent context-specific evidence on mental health needs and preferences for the target population of school-going Indian adolescents, including a multiple stakeholder analysis of school counseling priorities and pilot studies of a brief problem-solving intervention; (ii) new focus group discussions with N = 46 student participants and N = 8 service providers; (iii) co-design workshops with N = 22 student participants and N = 8 service providers; and (iv) user-testing with N = 50 student participants. Participants were aged 12-17 years and recruited from local schools in New Delhi and Goa, including a subgroup with self-identified mental health needs (N = 6). Results: Formative data from existing primary sources, new focus groups and co-design workshops supported a blended format for delivering a brief problem-solving intervention, with counselors supporting use of a game-based app on "offline" smartphones. User-testing with prototypes identified a need for simplification of language, use of concrete examples of concepts and practice elements to enhance engagement. There were also indications that participants most valued relatability and interactivity within real-world stories with judicious support from an in-app guide. The final prototype comprised a set of interactive and gamified vignettes and a structured set of problem-solving questions to consolidate and generalize learning while encouraging real-world application. Discussion: Findings shaped the design of POD Adventures and its delivery as an open-access blended intervention for secondary school students with a felt need for psychological support, consistent with an early intervention paradigm. A randomized controlled trial is planned to evaluate processes and impacts of POD Adventures when delivered for help-seeking students in low-resource school settings.
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Affiliation(s)
| | | | | | | | | | | | - Daniel Michelson
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Vikram Patel
- Sangath, New Delhi, India
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
- Harvard TH Chan School of Public Health, Boston, MA, United States
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Cheng VWS, Davenport T, Johnson D, Vella K, Hickie IB. Gamification in Apps and Technologies for Improving Mental Health and Well-Being: Systematic Review. JMIR Ment Health 2019; 6:e13717. [PMID: 31244479 PMCID: PMC6617915 DOI: 10.2196/13717] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/22/2019] [Accepted: 05/29/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND There is little research on the application of gamification to mental health and well-being. Furthermore, usage of gamification-related terminology is inconsistent. Current applications of gamification for health and well-being have also been critiqued for adopting a behaviorist approach that relies on positive reinforcement and extrinsic motivators. OBJECTIVE This study aimed to analyze current applications of gamification for mental health and well-being by answering 3 research questions (RQs). RQ1: which gamification elements are most commonly applied to apps and technologies for improving mental health and well-being? RQ2: which mental health and well-being domains are most commonly targeted by these gamified apps and technologies? RQ3: what reasons do researchers give for applying gamification to these apps and technologies? A systematic review of the literature was conducted to answer these questions. METHODS We searched ACM Digital Library, CINAHL, Cochrane Library, EMBASE, IEEE Explore, JMIR, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science for qualifying papers published between the years 2013 and 2018. To answer RQ1 and RQ2, papers were coded for gamification elements and mental health and well-being domains according to existing taxonomies in the game studies and medical literature. During the coding process, it was necessary to adapt our coding frame and revise these taxonomies. Thematic analysis was conducted to answer RQ3. RESULTS The search and screening process identified 70 qualifying papers that collectively reported on 50 apps and technologies. The most commonly observed gamification elements were levels or progress feedback, points or scoring, rewards or prizes, narrative or theme, personalization, and customization; the least commonly observed elements were artificial assistance, unlockable content, social cooperation, exploratory or open-world approach, artificial challenge, and randomness. The most commonly observed mental health and well-being domains were anxiety disorders and well-being, whereas the least commonly observed domains were conduct disorder and bipolar disorders. Researchers' justification for applying gamification to improving mental health and well-being was coded in 59% (41/70) of the papers and was broadly divided into 2 themes: (1) promoting engagement and (2) enhancing an intervention's intended effects. CONCLUSIONS Our findings suggest that the current application of gamification to apps and technologies for improving mental health and well-being does not align with the trend of positive reinforcement critiqued in the greater health and well-being literature. We also observed overlap between the most commonly used gamification techniques and existing behavior change frameworks. Results also suggest that the application of gamification is not driven by health behavior change theory, and that many researchers may treat gamification as a black box without consideration for its underlying mechanisms. We call for the inclusion of more comprehensive and explicit descriptions of how gamification is applied and the standardization of applied games terminology within and across fields.
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Affiliation(s)
| | - Tracey Davenport
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Daniel Johnson
- Queensland University of Technology, Brisbane, Australia
| | - Kellie Vella
- Queensland University of Technology, Brisbane, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
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Improving RNN Performance by Modelling Informative Missingness with Combined Indicators. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9081623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Daily questionnaires from mobile applications allow large amounts of data to be collected with relative ease. However, these data almost always suffer from missing data, be it due to unanswered questions, or simply skipping the survey some days. These missing data need to be addressed before the data can be used for inferential or predictive purposes. Several strategies for dealing with missing data are available, but most are prohibitively computationally intensive for larger models, such as a recurrent neural network (RNN). Perhaps even more important, few methods allow for data that are missing not at random (MNAR). Hence, we propose a simple strategy for dealing with missing data in longitudinal surveys from mobile applications, using a long-term-short-term-memory (LSTM) network with a count of the missing values in each survey entry and a lagged response variable included in the input. We then propose additional simplifications for padding the days a user has skipped the survey entirely. Finally, we compare our strategy with previously suggested methods on a large daily survey with data that are MNAR and conclude that our method worked best, both in terms of prediction accuracy and computational cost.
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43
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Wray TB, Pérez AE, Celio MA, Carr DJ, Adia AC, Monti PM. Exploring the Use of Smartphone Geofencing to Study Characteristics of Alcohol Drinking Locations in High-Risk Gay and Bisexual Men. Alcohol Clin Exp Res 2019; 43:900-906. [PMID: 30802318 DOI: 10.1111/acer.13991] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/14/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Geofencing offers new opportunities to study how specific environments affect alcohol use and related behavior. In this study, we examined the feasibility of using geofencing to examine social/environmental factors related to alcohol use and sexual perceptions in a sample of gay and bisexual men (GBM) who engage in heavy drinking and high-risk sex. METHODS HIV-negative GBM (N = 76) completed ecological momentary assessments for 30 days via a smartphone application and were prompted to complete surveys when inside general geofences set around popular bars and clubs. A subset (N = 45) were also asked to complete surveys when inside personal geofences, which participants set themselves by identifying locations where they typically drank heavily. RESULTS Approximately 49% of participants received a survey prompted by a general geofence. Among those who identified at least 1 personal drinking location, 62.2% received a personal geofence-prompted survey. Of the 175 total location-based surveys, 40.2% occurred when participants were not at the location that was intended to be captured. Participants reported being most able to openly express themselves at gay bars/clubs and private residences, but these locations were also more "sexualized" than general bars/clubs. Participants did not drink more heavily at gay bars/clubs, but did when in locations with more intoxicated patrons or guests. CONCLUSIONS Geofencing has the potential to improve the validity of studies exploring environmental influences on drinking. However, the high number of "false-positive" prompts we observed suggests that geofences should be used carefully until improvements in precision are more widely available.
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Affiliation(s)
- Tyler B Wray
- Department of Behavioral and Social Sciences , Brown University School of Public Health, Providence, Rhode Island
| | - Ashley E Pérez
- Department of Social and Behavioral Sciences , University of California, San Francisco, San Francisco, California
| | - Mark A Celio
- Department of Behavioral and Social Sciences , Brown University School of Public Health, Providence, Rhode Island
| | - Daniel J Carr
- Department of Behavioral and Social Sciences , Brown University School of Public Health, Providence, Rhode Island
| | - Alexander C Adia
- Department of Behavioral and Social Sciences , Brown University School of Public Health, Providence, Rhode Island
| | - Peter M Monti
- Department of Behavioral and Social Sciences , Brown University School of Public Health, Providence, Rhode Island
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Yeager CM, Benight CC. If we build it, will they come? Issues of engagement with digital health interventions for trauma recovery. Mhealth 2018; 4:37. [PMID: 30363749 PMCID: PMC6182033 DOI: 10.21037/mhealth.2018.08.04] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/17/2018] [Indexed: 12/12/2022] Open
Abstract
Exposure to traumatic events is extremely common with nearly 75% reported to have experienced one or more traumatic events worldwide. A significant number of those exposed will develop posttraumatic stress disorder (PTSD) along with depression, anxiety, and substance use disorders. Globally, trauma-related mental health disorders are the leading cause of global disability burden, and many of these disorders are caused, or worsened, by exposure to wars, natural and human-caused disasters, and other traumatic events. Significant barriers to treatment exist including logistical, geographical, financial, stigma, and other attitudinal challenges. One opportune approach to overcoming these barriers is the provision of mental health interventions via technology that can be readily standardized for wide dissemination of evidence-based care. However, engagement with technology-based interventions is a concern and limited participation and high attrition rates are common. This may be especially true for trauma survivors who often experience symptoms of avoidance and hyperarousal. Engagement is regarded as an essential component of intervention efficacy and has been demonstrated to be associated with more positive clinical outcomes, yet theoretically based research in this area is sparse. This review focuses on the complex issue of engagement with digital health interventions (DHIs). Specifically, we review the conceptualization and measurement of engagement, predictors of engagement, and importantly, the relationship of engagement with intervention effectiveness. Finally, a theoretically based model of engagement is proposed that considers the unique challenges of trauma recovery. This review is not intended to provide a systematic or exhaustive set of recommendations, rather it is intended to highlight the challenges of engagement research including its definition, measurement, and modeling. Future engagement research that includes valid and reliable measures of engagement will enable consistent exploration of engagement predictors that can then inform methods for increasing engagement and, ultimately, intervention effectiveness.
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Affiliation(s)
- Carolyn M. Yeager
- Psychology Department, University of Colorado Colorado Springs, Colorado Springs, CO 80918, USA
- Trauma, Health, & Hazards Center, University of Colorado Colorado Springs, Colorado Springs, CO 80918, USA
| | - Charles C. Benight
- Psychology Department, University of Colorado Colorado Springs, Colorado Springs, CO 80918, USA
- Trauma, Health, & Hazards Center, University of Colorado Colorado Springs, Colorado Springs, CO 80918, USA
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