Supporting Homework Compliance in Cognitive Behavioural Therapy: Essential Features of Mobile Apps

Tang, Wei; Kreindler, David

doi:10.2196/mental.5283

Cited by 85 publications

(51 citation statements)

References 95 publications

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“…With 76% of UK and 81% of US adults owning a smartphone [15,16], there is a strong argument for the potential of apps to help in providing flexible access to mental health support [17,18]. Studies have been conducted focusing on the development of mobile apps to support mental health [19-28], and more detailed reviews and analyses of existing research are also available [4,29-31].…”

Section: Introductionmentioning

confidence: 99%

User Experience of Cognitive Behavioral Therapy Apps for Depression: An Analysis of App Functionality and User Reviews

Stawarz¹,

Preist²,

Tallon³

et al. 2018

J Med Internet Res

178

137

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BackgroundHundreds of mental health apps are available to the general public. With increasing pressures on health care systems, they offer a potential way for people to support their mental health and well-being. However, although many are highly rated by users, few are evidence-based. Equally, our understanding of what makes apps engaging and valuable to users is limited.ObjectiveThe aim of this paper was to analyze functionality and user opinions of mobile apps purporting to support cognitive behavioral therapy for depression and to explore key factors that have an impact on user experience and support engagement.MethodsWe systematically identified apps described as being based on cognitive behavioral therapy for depression. We then conducted 2 studies. In the first, we analyzed the therapeutic functionality of apps. This corroborated existing work on apps’ fidelity to cognitive behavioral therapy theory, but we also extended prior work by examining features designed to support user engagement. Engagement features found in cognitive behavioral therapy apps for depression were compared with those found in a larger group of apps that support mental well-being in a more general sense. Our second study involved a more detailed examination of user experience, through a thematic analysis of publicly available user reviews of cognitive behavioral therapy apps for depression.ResultsWe identified 31 apps that purport to be based on cognitive behavioral therapy for depression. Functionality analysis (study 1) showed that they offered an eclectic mix of features, including many not based on cognitive behavioral therapy practice. Cognitive behavioral therapy apps used less varied engagement features compared with 253 other mental well-being apps. The analysis of 1287 user reviews of cognitive behavioral therapy apps for depression (study 2) showed that apps are used in a wide range of contexts, both replacing and augmenting therapy, and allowing users to play an active role in supporting their mental health and well-being. Users, including health professionals, valued and used apps that incorporated both core cognitive behavioral therapy and non-cognitive behavioral therapy elements, but concerns were also expressed regarding the unsupervised use of apps. Positivity was seen as important to engagement, for example, in the context of automatic thoughts, users expressed a preference to capture not just negative but also positive ones. Privacy, security, and trust were crucial to the user experience.ConclusionsCognitive behavioral therapy apps for depression need to improve with respect to incorporating evidence-based cognitive behavioral therapy elements. Equally, a positive user experience is dependent on other design factors, including consideration of varying contexts of use. App designers should be able to clearly identify the therapeutic basis of their apps, but they should also draw on evidence-based strategies to support a positive and engaging user experience. The most effective apps are likely to strike a balance be...

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Section: Introductionmentioning

confidence: 99%

User Experience of Cognitive Behavioral Therapy Apps for Depression: An Analysis of App Functionality and User Reviews

Stawarz¹,

Preist²,

Tallon³

et al. 2018

J Med Internet Res

178

137

View full text Add to dashboard Cite

show abstract

“…The smartphone’s facility for establishing, rewarding and reinforcing behavioural change is also cited as a significant advantage of this technology in the context of mental health 6. Tang and Kreindler suggest that mobile applications may support homework compliance for CBT treatment when the application is congruent with therapy, fosters learning, incorporates guided therapy, inspires connection building, emphasises completion and is population specific 7. This is especially important in the care of men with mental illness, with evidence suggesting that males may be particularly responsive to therapies that reward planned behaviours 8…”

Section: Introductionmentioning

confidence: 99%

A qualitative study of a blended therapy using problem solving therapy with a customised smartphone app in men who present to hospital with intentional self-harm

Mackie

Dunn

MacLean

et al. 2017

Evid Based Mental Health

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backgroundBlended therapy describes the use of computerised therapy combined with face-to-face therapy to extend the depth, range and nature of the face-to-face therapy. We wanted to develop a treatment manual for a randomised trial of blended therapy combining face-to-face problem solving and a smartphone app in men who present to hospital with self-harm. Objective To develop a treatment manual and to describe the experience of receiving and delivering a blended therapy. Methods After completion of the blended therapy, semistructured qualitative interviews were conducted with participants to describe their experience of the treatment. Two independent coders analysed the material using a thematic, grounded theory approach. Findings Seven men were enrolled in the study, and six completed the qualitative interviews. The two main themes identified were of trust and connection. Participants attended 85% of their appointments. conclusions In the treatment manual, we emphasised the themes of trust and connection by allowing time to discuss the app in the face-to-face to sessions, ensuring that therapists are familiar with the app and know how to respond to technical queries. Identification of trust and connection generates novel questions about the importance of the therapeutic alliance with technology rather than with people. clinical implications Clinicians and app developers need to pay attention to the therapeutic relationship with technology as trust and good communication can be easily damaged, resulting in disengagement with the app. Blended therapy may result in increased adherence to face-to-face sessions. trial registration number NCT02718248 bAckgrOund Blended therapy is the integration of internet-based treatment and psychotherapy in the treatment of psychiatric disorders. It has been described as 'any possible combination of regular face-to-face treatments and web-based interventions'.1 Several systematic reviews have examined the partial replacement of face-to-face therapy with web-based technologies.2-4 Yet there have been few descriptions of instances where internet-based therapies supplement or augment face-to-face therapy to create a new treatment rather than simply replacing face-to-face treatment with variable degrees of inperson support. This approach to blended therapy attempts to increase the depth, reach and nature of traditional face-to-face treatment.A 2016 review of mental health smartphone applications recommended the integration of cognitive behavioural therapy (CBT)-based features when developing applications.5 The smartphone's facility for establishing, rewarding and reinforcing behavioural change is also cited as a significant advantage of this technology in the context of mental health.6 Tang and Kreindler suggest that mobile applications may support homework compliance for CBT treatment when the application is congruent with therapy, fosters learning, incorporates guided therapy, inspires connection building, emphasises completion and is population specific.7 This is especial...

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“…One suggestion was the use of communication technologies. Although interventions in the form of Computerised CBT (cCBT) are now being trialled for a range of mental health conditions (Andersson et al, 2014;Menon et al, 2017;Tang & Kreindler, 2017), providing follow-up or relapse prevention has not been a focus of this medium. However, this approach has been utilised as a relapse prevention method to maintain smoking abstinence in individuals with Post Traumatic Stress Disorder, with promising preliminary results (Hicks et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Intensive Cognitive Behavioural Therapy for Obsessive Compulsive Disorder: Perspectives of Service Users

Jfa¹,

S²,

Gregory³

et al. 2020

Preprint

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Background: The National Institute for Health and Care Excellence (NICE) recommend an intensive version of treatment for service users who have not responded to > 2 treatments for Obsessive Compulsive Disorder (OCD). The views of service users for whom this format of treatment is recommended are unknown. Method: Thirty semi-structured telephone interviews were conducted with participants with OCD. All participants had previously undertaken > 2 unsuccessful courses of CBT. Interviews were analysed using reflexive thematic analysis. Results: Participants reported that an intensive format may provide the time required to tackle important aspects of therapy that were not achieved or tackled during weekly CBT (e.g. in-session ERP). Individual preference is seen to play an important role and consequently an intensive format will not be well-suited to all who have experienced previous CBT failure. Four themes were identified: 1) Continuity and momentum, 2) Hmm, yes, but…: reservations about intensive CBT, 3) The fortune is in the follow-up, and 4) Understanding individual preference. Conclusion: Findings support the NICE recommendation. Participants with OCD who had experienced multiple CBT failures perceived intensive CBT to be broadly acceptable with potential therapeutic advantages. Reservations related to the possibility of relapse after therapy were expressed. Clinical implications and future research directions are discussed.

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Supporting Homework Compliance in Cognitive Behavioural Therapy: Essential Features of Mobile Apps

Cited by 85 publications

References 95 publications

User Experience of Cognitive Behavioral Therapy Apps for Depression: An Analysis of App Functionality and User Reviews

User Experience of Cognitive Behavioral Therapy Apps for Depression: An Analysis of App Functionality and User Reviews

A qualitative study of a blended therapy using problem solving therapy with a customised smartphone app in men who present to hospital with intentional self-harm

Intensive Cognitive Behavioural Therapy for Obsessive Compulsive Disorder: Perspectives of Service Users

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