Two Novel Cognitive Behavioral Therapy–Based Mobile Apps for Agoraphobia: Randomized Controlled Trial

Christoforou, Marina; Fonseca, Jose Andres Saez; Tsakanikos, Elias

doi:10.2196/jmir.7747

Cited by 48 publications

(50 citation statements)

References 49 publications

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“…Data retention was not related to recruitment source or participant characteristics measured, with the exception that men were less likely to provide outcome data than women. This gender difference in outcome data retention is consistent with some previous eHealth studies [ 26 , 60 ], though results are mixed [ 3 , 57 , 61 ]. Reasons for this discrepancy are unclear and are beyond the scope of the present study.…”

Section: Discussionsupporting

confidence: 91%

Participant Recruitment and Retention in Remote eHealth Intervention Trials: Methods and Lessons Learned From a Large Randomized Controlled Trial of Two Web-Based Smoking Interventions

Watson¹,

Mull²,

Heffner³

et al. 2018

J Med Internet Res

113

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BackgroundDespite having many advantages, online eHealth trials are not without challenges—notably, participant recruitment, and outcome data retention. Moreover, publications from these trials rarely provide detailed information on the methods used for recruitment and retention or discuss implications of the methods for future studies.ObjectiveTo address this need for empirical guidance regarding recruitment and outcome data retention planning, we aim to describe the methods and lessons learned from the recruitment and retention procedures used in a large randomized trial of 2 Web-based smoking cessation interventions.MethodsTo ensure a demographically and geographically diverse participant sample, we used the recruitment strategies (1) traditional, (2) Web-based, and (3) online survey panel methods and adaptively modified each in response to recruitment success. At baseline, participants indicated how they heard about the study and answered demographic questions. To maximize trial retention at each of the 3-, 6-, and 12-month assessment points, 4 survey modalities (first Web, followed by phone, mail, and postcard) were sequentially timed over a 30-day period. Participants received US $25 for submitting their responses, regardless of modality, and received an additional US $10 bonus for completing the Web survey within 24h of electronic notification.ResultsWe randomized 2637 smokers in 16 months and achieved 88% retention at 12-months. Participants (79.26% female, 72.60% Caucasian) were recruited from all 50 states. The majority of participants were recruited through Facebook (49.43%), followed by the survey panel (20.85%), free internet sources (14.54%), traditional media (11.34%), and Google ads (3.84%). Descriptively, participant demographics varied by recruitment source. Of the completed follow-up surveys, most were completed by Web (92%). Retention rates did not vary by recruitment source.ConclusionsContinuous monitoring and refinement of multiple recruitment methods, particularly of online advertising campaigns, allowed us to maximize the effectiveness of recruitment strategies in recruiting a large, diverse sample of smokers. Likewise, offering multiple follow-up survey modalities in sequential order along with time-dependent bonus incentives enabled us to obtain outcome data from a very high level of enrolled participants for the duration of the trial protocol. These strategies may be similarly useful in other trials.Trial RegistrationClinicalTrials.gov NCT01812278; https://clinicaltrials.gov/ct2/show/NCT01812278 (Archived by WebCite at http://www.webcitation.org/71gy5GLvO)

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Section: Discussionsupporting

confidence: 91%

Participant Recruitment and Retention in Remote eHealth Intervention Trials: Methods and Lessons Learned From a Large Randomized Controlled Trial of Two Web-Based Smoking Interventions

Watson¹,

Mull²,

Heffner³

et al. 2018

J Med Internet Res

113

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“…A variety of study designs were employed to investigate the effects of EMIs: two-, three-, or four-armed randomised control trials (RCT) (12 studies [30][31][32][33][34][35][36][37][38][39][40][41]) as well as a non-randomised trial with a control group (1 study [42]) for between-group comparisons, or case studies and one-group-only studies (11 studies [43-53]) for within-group or intra-individual comparisons (See Table 1). Control conditions were selected based on the research questions of a given study.…”

Section: Study Design and Control Conditionsmentioning

confidence: 99%

“…For instance, reflection and cognitive restructuring were presented in a fabular comic story of the main character who suffered from depression [41]. A similar solution was employed in Agoraphobia free app, which was game-based and presented a virtual character who needed to meet the virtual therapist to work on reflection and cognitive restructuring [33]. Relaxation and meditation exercises were delivered via audio and video tools [49,53].…”

Section: Study Design and Control Conditionsmentioning

confidence: 99%

Standalone smartphone CBT-based Ecological Momentary Interventions to increase mental health - a narrative review

Ma¹,

Shanahan²,

Rohde³

et al. 2020

Preprint

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Introduction: A growing number of psychological interventions are delivered via smartphone with the aim to increase the efficacy and effectiveness of these treatments and provide scalable access to interventions for improving mental health. Most of the scientifically tested apps are based on cognitive behavioural therapy principles which are considered as a gold standard for the treatment of many mental health problems.Objective: This review aimed to investigate standalone smartphone-based ‘ecological momentary interventions’ (EMIs) to improve mental health, that were built based on principles derived from cognitive behavioural therapy (CBT).Methods: We searched MEDLINE, PsycINFO, Embase and PubMed databases for peer-reviewed studies published between 1st January 2007 and 15th January 2020. We included studies with a focus on standalone app-based approaches to improve mental health and their feasibility, and/or efficacy and/or effectiveness. Both within- and between-group designs and studies with both healthy and clinical samples were included. Blended interventions, e.g., app-based treatments in combination with psychotherapy, were not included. Selected studies were evaluated in terms of their design, i.e., choice of the control condition, sample characteristics, EMI content, EMI delivery characteristics, feasibility, efficacy and effectiveness. The latter was defined in terms of improvement in primary outcomes used in the studies.Results: A total of 26 studies were selected. The results show that EMIs based on CBT principles can be successfully delivered, significantly increase well-being among users, and reduce mental health symptoms. Standalone EMIs were rated as helpful (m=70.8%), and outcomes were satisfying by users (m=72.6%). Conclusions: Study quality was heterogeneous, and feasibility was often not reported in the reviewed studies, hence limiting the conclusions that can be drawn from the existing data. Together, the studies show that EMIs may help increase mental health and thus support individuals in their daily life. Such EMIs provide readily available, scalable and evidence-based mental health support. These characteristics appear crucial in the context of a global crisis, such as the COVID-19 pandemic, but may also help reduce personal and economic costs of mental health impairment beyond this situation or in the context of potential future pandemics.

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“…Similarly however, these have found only very limited coverage in literature. We found a few individual studies, for example, utilizing a mobile virtual reality (VR) system to help patients coping with agoraphobia by guiding an avatar through real-life simulations in a game-based setting [133]. Beyond exposure-type therapies, Repetto et al (2013) [143] utilize VR techniques to cope with generalized anxiety disorders, leveraging bio-feedback to regulate features of the virtual world (e.g., current heart rate).…”

Section: Discussionmentioning

confidence: 99%

“…Notwithstanding, even this rather conservative transition to smartphones has led to interventions out of reach for classic mobile phones. Exploiting larger screen resolutions and multimedia capabilities, one finds examples of multimodal learning materials using both audio and video guides [133,167], using pictures [83, 86-88, 117, 129], audio [83,87,88,117], music [86][87][88] and video [83,88,156]. Leveraging the improved connectivity and ubiquity of smartphones, some authors offer access to entire online libraries of learning materials [127,167]; others utilize in-app prompting as intervention techniques, e.g., sending reminders to use the app [87,103,104,118,159], motivational messages [70] or messages from the therapist [90,163].…”

Section: Coverage Of Technical Dimensionsmentioning

confidence: 99%

Analysis and Development of a Platform for Generating Context-Aware Apps for Mental Health

Tena¹

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This work gathers a research carried out on the use of context-aware technologies in their application to the field of mental health. It begins by performing a deep state of the art of mobile technologies used in psychological interventions and extracting the characteristics and disorders most discussed in the literature; It continues to propose a series of considerations to take into account in the development of this type of technologies to increase its chances of success, focusing on three areas of study: Context, Mental Health and the Technology itself; The next contribution is the process of developing a platform that allows therapists to create their own mobile applications with geolocation to customize their own intervention tools without the need for high technical knowledge, the development is based on the learning obtained in the first two contributions, it is described as an intervention example a hypothetical case of depression; Finally, the platform is validated with three patients suffering from two different disorders: Panic disorder and agoraphobia; and gambling disorder.

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Two Novel Cognitive Behavioral Therapy–Based Mobile Apps for Agoraphobia: Randomized Controlled Trial

Cited by 48 publications

References 49 publications

Participant Recruitment and Retention in Remote eHealth Intervention Trials: Methods and Lessons Learned From a Large Randomized Controlled Trial of Two Web-Based Smoking Interventions

Participant Recruitment and Retention in Remote eHealth Intervention Trials: Methods and Lessons Learned From a Large Randomized Controlled Trial of Two Web-Based Smoking Interventions

Standalone smartphone CBT-based Ecological Momentary Interventions to increase mental health - a narrative review

Analysis and Development of a Platform for Generating Context-Aware Apps for Mental Health

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