Examining effectiveness of tailorable computer-assisted therapy programmes for substance misuse: Programme usage and clinical outcomes data from Breaking Free Online

Abstract

Rationale: When evaluating complex, tailorable digital behavioural interventions, additional approaches may be required alongside established methodologies such as randomised controlled trials (RCTs). Research evaluating computer-assisted therapy (CAT) programme for substance misuse, Breaking Free Online (BFO), is informed by Medical Research Council (MRC) guidance recommending examining 'mechanisms of action' of individual intervention strategies, which is relevant when evaluating digital interventions with content that may evolve over time. Aims: To report findings from examination of mechanisms of action of tailoring advice within the BFO programme and outcomes from specific intervention strategies. Methodology: Analysis of variance and linear regressions were used to assess intervention completion data, and psychometric and clinical outcomes, for 2311 service users accessing drug and alcohol treatment services across the UK. Results: Tailoring advice provided to users appeared to prompt them to prioritise completion of intervention strategies associated with their areas of highest biopsychosocial impairment. Completion of specific intervention strategies within BFO were associated with specific clinical outcomes, with a dose response also being found. Mechanisms of action analyses revealed the primacy of cognitions, with cognitive restructuring strategies being associated with improvements in mental health, severity of substance dependence, quality of life and global biopsychosocial functioning. Conclusions: The MRC framework provides an evolved research paradigm within the field of digital behavioural change. By assessing baseline profiles of need, BFO can target the most appropriate clinical content for individual users. Mechanisms of action research can be used to inform modifications to BFO to continually update clinical content and the technology platform.

Understanding eHealth Cognitive Behavioral Therapy Targeting Substance Use: Realist Review (Preprint)

“…Eight CMOcs from five unique programs met the inclusion criteria and were included in the final synthesis. Table 1 summarizes the eight CMOcs that were included from the reviewed literature regarding eCBT interventions [20][21][22][23][24][25][26][27][28][29][30][31] . The study setting, which includes how and where the study was carried out, is an important part of the intervention context.…”

Protocol for a randomized controlled trial of the Breaking Free Online Health and Justice program for substance misuse in prison settings

“…Other published research has examined mechanisms of action of BFO in a sample of participants engaging with the program in community-based treatment settings (Elison et al 2017c) which has demonstrated the primacy of cognitive change to instigating behavioral change. Completion of cognitive restructuring strategies in the program has been demonstrated to be associated with multiple aspects of behavioral and biopsychosocial improvements.…”

“…As only the first 5 items of the WHOQoL-BREF are being used, reliability and validity analyses will be conducted on data generated from these 5 items. Internal reliability which will be examined using Cronbach’s alpha, and concurrent validity will be examined by correlating scores on the 5 WHOQoL-BREF items against scores on the other measures included in the study measuring constructs related to quality of life.Biopsychosocial functioning: This will be measured using the Recovery Progression Measure (RPM; Elison et al 2016a, b; Elison et al 2017a, b, c, d), which is a 36-item measure comprising 6 ‘impact slider’, 11-point Likert scale items each measuring level of severity of impairment in the following 6 domains of functioning; difficult situations, negative thoughts, emotions, unhelpful behaviors, physical sensations, lifestyle. In addition, the RPM contains 30 dichotomous ‘yes/no’ response items measuring presence or absence of specific biopsychosocial issues within each of the 6 domains.…”

“…Biopsychosocial functioning: This will be measured using the Recovery Progression Measure (RPM; Elison et al 2016a, b; Elison et al 2017a, b, c, d), which is a 36-item measure comprising 6 ‘impact slider’, 11-point Likert scale items each measuring level of severity of impairment in the following 6 domains of functioning; difficult situations, negative thoughts, emotions, unhelpful behaviors, physical sensations, lifestyle. In addition, the RPM contains 30 dichotomous ‘yes/no’ response items measuring presence or absence of specific biopsychosocial issues within each of the 6 domains.…”

“…Research examining the effectiveness of the program (Elison et al 2015a, b; Elison et al 2014a, b; Elison et al 2017d) has demonstrated significant reductions in substance dependence and use, and significant improvements in mental health and broader psychosocial functioning. Examination of the mechanisms of action of BFO has demonstrated that users follow tailoring advice provided by the program, that the program exhibits a ‘dose-response’, and that completion of cognitive restructuring strategies in the program underpins changes to broader biopsychosocial functioning (Elison et al 2017c).…”