SOURCE: Global Medical Education
Guest Commentary by M. Zachary Rosenthal, PhD, and Marcus Rodriguez, MA
Guest Commentary by M. Zachary Rosenthal, PhD, and Marcus Rodriguez, MA
GME Research Review is a monthly newsletter where internationally recognized experts select, summarize, and provide a clinical commentary on the latest published research in psychiatry. Each summary has been derived from the relevant article’s abstract and the clinical commentary has been provided by our expert.
REVIEW INCLUDES:
- A Smartphone-Based Intervention with Diaries and Therapist-Feedback to Reduce Catastrophizing and Increase Functioning in Women with Chronic Widespread Pain: Randomized Controlled Trial
- Behavioral Activation Versus Mindfulness-Based Guided Self-Help Treatment Administered Through a Smartphone Application: A Randomised Controlled Trial
- The Smartphone Psychology Manifesto
- The Feasibility and Validity of Ambulatory Self-report of Psychotic Symptoms Using a Smartphone Software Application
- A Pilot Study of the DBT Coach: An Interactive Mobile Phone Application for Individuals with Borderline Personality Disorder and Substance Use Disorder
A Smartphone-Based Intervention with Diaries and Therapist-Feedback to Reduce Catastrophizing and Increase Functioning in Women with Chronic Widespread Pain: Randomized Controlled Trial
Kristjánsdóttir J, Fors ÓB, Eide EA, et al
Med Int Res. 2013;15(1).
Objective
This study examined the efficacy of a web-based CBT-grounded intervention delivered through smartphones. Specifically, researchers in Norway conducted a randomized controlled trial (RCT) to investigate the efficacy of a smartphone delivered intervention based on Acceptance and Commitment Therapy (ACT) principles following an inpatient chronic pain program.
Conclusions
The present findings suggest this personalized web-based smartphone delivered intervention can change psychological processes related to Acceptance and Commitment principles among chronic pain patients. However, booster sessions may be needed to enhance prolonged effects. Providing immediate, situational feedback close to the moment dysfunctional thoughts (e.g., catastrophizing) and behaviors (e.g., avoidance) occur may help to increase patients’ self-management skills and alleviate their somatic complaints
Clinical Commentary
It is important for clinical scientists to develop accessible and cost-effective psychological interventions, as it is unlikely that clinicians will be able to serve all clients in need with traditional face-to-face interventions, particularly in developing countries. The present study makes a valuable contribution to the growing body of literature exploring ways that mobile technologies can be leveraged to facilitate this work. ACT has been shown to be an efficacious treatment for a variety of mental health problems (Strosahl et al., 2004). This study was an initial evaluation of a new platform for the delivery of an ACT-based intervention (Hayes et al., 1999) for patients suffering from chronic pain. The intervention made use of technology through four principal elements: Electronic diaries (where participants registered activities, emotions and pain cognitions three times daily using the smartphone), individualized written situational feedbacks (from clinicians), access to a website with information, and audio files with mindfulness exercises installed on the smartphone and available at the website. The implications of the present findings have potential to extend beyond rehabilitation programs for chronic pain patients. The generalizability of the results is reduced by several factors, including the withdrawal rate of 30% in the intervention group and the response rates (below 70%) at both follow-ups. Replication studies are needed, including the application of this intervention to populations with different mental health problems (e.g., depression, anxiety, or disordered eating). Note: Kristjánsdóttir and colleagues also published results of an 11-month follow-up of this randomized trial.
Kristjánsdóttir J, Fors ÓB, Eide EA, et al
Med Int Res. 2013;15(1).
Objective
This study examined the efficacy of a web-based CBT-grounded intervention delivered through smartphones. Specifically, researchers in Norway conducted a randomized controlled trial (RCT) to investigate the efficacy of a smartphone delivered intervention based on Acceptance and Commitment Therapy (ACT) principles following an inpatient chronic pain program.
Conclusions
The present findings suggest this personalized web-based smartphone delivered intervention can change psychological processes related to Acceptance and Commitment principles among chronic pain patients. However, booster sessions may be needed to enhance prolonged effects. Providing immediate, situational feedback close to the moment dysfunctional thoughts (e.g., catastrophizing) and behaviors (e.g., avoidance) occur may help to increase patients’ self-management skills and alleviate their somatic complaints
Clinical Commentary
It is important for clinical scientists to develop accessible and cost-effective psychological interventions, as it is unlikely that clinicians will be able to serve all clients in need with traditional face-to-face interventions, particularly in developing countries. The present study makes a valuable contribution to the growing body of literature exploring ways that mobile technologies can be leveraged to facilitate this work. ACT has been shown to be an efficacious treatment for a variety of mental health problems (Strosahl et al., 2004). This study was an initial evaluation of a new platform for the delivery of an ACT-based intervention (Hayes et al., 1999) for patients suffering from chronic pain. The intervention made use of technology through four principal elements: Electronic diaries (where participants registered activities, emotions and pain cognitions three times daily using the smartphone), individualized written situational feedbacks (from clinicians), access to a website with information, and audio files with mindfulness exercises installed on the smartphone and available at the website. The implications of the present findings have potential to extend beyond rehabilitation programs for chronic pain patients. The generalizability of the results is reduced by several factors, including the withdrawal rate of 30% in the intervention group and the response rates (below 70%) at both follow-ups. Replication studies are needed, including the application of this intervention to populations with different mental health problems (e.g., depression, anxiety, or disordered eating). Note: Kristjánsdóttir and colleagues also published results of an 11-month follow-up of this randomized trial.
Behavioral Activation Versus Mindfulness-Based Guided Self-Help Treatment Administered Through a Smartphone Application: A Randomised Controlled Trial Ly KH, Trüschel A, Jarl L, et al
BMJ Open. 2014;4(1):e003440.
Objective
The aim of this study was to evaluate the effectiveness of two smartphone-delivered treatments, one based on behavioral Activation (BA) and the other based on mindfulness. Both BA and mindfulness have strong empirical bases. However, the present study is the first to compare these treatments when delivered entirely via an application on participants’ personal smartphones.
Conclusions
When analyzing data from the whole sample (i.e., averaging across different levels of depression severity), the two interventions did not differ significantly from one another in terms of their efficacy. However, BA worked significantly better for participants with higher severity of depression (as measured by the PHQ-9), whereas mindfulness worked significantly better for participants with lower initial severity (as measured by both the BDI-II and the PHQ-9).
Clinical Commentary
This study is one of the first to perform a randomized controlled trial comparing two evidence-based treatments delivered via smartphone applications. In contrast with results from Cuijpers et al.’s (2010) meta-analyses, BA was found to be comparable in efficacy to the alternative treatment for depression. These findings’ study suggest that BA might work better for a more severely depressed population, whereas mindfulness might work better for a mildly depressed population. Most importantly, the results from this study demonstrate the potential for mild-to-moderate MDD to be treated effectively among a non-treatment-seeking population by means of a smartphone application. Using mobile technology to disseminate interventions has potential to reach a broader group of people, since this platform attracts less attention and allows users to interact with a personal device without fear of judgment or stigma (Boschen & Casey, 2008). Future studies are needed to control for the different components of these treatments, because based on the present findings it is impossible to determine which parts of the treatments were effective.
BMJ Open. 2014;4(1):e003440.
Objective
The aim of this study was to evaluate the effectiveness of two smartphone-delivered treatments, one based on behavioral Activation (BA) and the other based on mindfulness. Both BA and mindfulness have strong empirical bases. However, the present study is the first to compare these treatments when delivered entirely via an application on participants’ personal smartphones.
Conclusions
When analyzing data from the whole sample (i.e., averaging across different levels of depression severity), the two interventions did not differ significantly from one another in terms of their efficacy. However, BA worked significantly better for participants with higher severity of depression (as measured by the PHQ-9), whereas mindfulness worked significantly better for participants with lower initial severity (as measured by both the BDI-II and the PHQ-9).
Clinical Commentary
This study is one of the first to perform a randomized controlled trial comparing two evidence-based treatments delivered via smartphone applications. In contrast with results from Cuijpers et al.’s (2010) meta-analyses, BA was found to be comparable in efficacy to the alternative treatment for depression. These findings’ study suggest that BA might work better for a more severely depressed population, whereas mindfulness might work better for a mildly depressed population. Most importantly, the results from this study demonstrate the potential for mild-to-moderate MDD to be treated effectively among a non-treatment-seeking population by means of a smartphone application. Using mobile technology to disseminate interventions has potential to reach a broader group of people, since this platform attracts less attention and allows users to interact with a personal device without fear of judgment or stigma (Boschen & Casey, 2008). Future studies are needed to control for the different components of these treatments, because based on the present findings it is impossible to determine which parts of the treatments were effective.
The Smartphone Psychology Manifesto
Miller G.
Perspectives on Psychological Science. 2012;7(3):221-237.
Objective
This article includes five parts: (1) A review of previous behavioral research using mobile electronic devices, (2) an outline of what smartphones can do now and may be able to do in the near future, (3) an illustration of how a smartphone study could work given current technology, (4) a discussion of limitations and challenges of smartphone research, and (5) a comparison of smartphones to other more traditional research methods.
Conclusion
Smartphone assessment methods have significant advantages over traditional research methods. However, for some research questions field study and laboratory settings will remain more useful than smartphones (e.g., perception and cognition experiments that demand high contextual control or bio sampling).
Clinical Commentary
Smartphones are powerful tools, and they are carried around by billions of people all around the world. Although they were not designed for psychological research, but they can be used for that purpose, and Miller (2012) argues they will ultimately revolutionize the way we conduct and think about research in our field. Adapting to this new era in psychological research (e.g., learning app development skills and advanced statistical analytic methods) will not be easy, especially considering the dizzying rates of technological progress. However, Miller (2012) argues it is well worth it, considering the potential payoff. Perhaps the most exciting aspect of smartphone-based research is the ability to collect data from vast amounts of people, across the planet, relatively easily. As smartphones become ever more versatile and powerful they will increase our capacity to run perceptually and behaviorally rich experiments. Moreover, smartphones will also allow us to gather precise, objective, sustained, ecologically valid field observations of real-world behavior in real time. Miller (2012) challenges readers to think about how this new technology is going to change our research questions, theories, and models of behavior change, funding sources, and even career tracks.
Miller G.
Perspectives on Psychological Science. 2012;7(3):221-237.
Objective
This article includes five parts: (1) A review of previous behavioral research using mobile electronic devices, (2) an outline of what smartphones can do now and may be able to do in the near future, (3) an illustration of how a smartphone study could work given current technology, (4) a discussion of limitations and challenges of smartphone research, and (5) a comparison of smartphones to other more traditional research methods.
Conclusion
Smartphone assessment methods have significant advantages over traditional research methods. However, for some research questions field study and laboratory settings will remain more useful than smartphones (e.g., perception and cognition experiments that demand high contextual control or bio sampling).
Clinical Commentary
Smartphones are powerful tools, and they are carried around by billions of people all around the world. Although they were not designed for psychological research, but they can be used for that purpose, and Miller (2012) argues they will ultimately revolutionize the way we conduct and think about research in our field. Adapting to this new era in psychological research (e.g., learning app development skills and advanced statistical analytic methods) will not be easy, especially considering the dizzying rates of technological progress. However, Miller (2012) argues it is well worth it, considering the potential payoff. Perhaps the most exciting aspect of smartphone-based research is the ability to collect data from vast amounts of people, across the planet, relatively easily. As smartphones become ever more versatile and powerful they will increase our capacity to run perceptually and behaviorally rich experiments. Moreover, smartphones will also allow us to gather precise, objective, sustained, ecologically valid field observations of real-world behavior in real time. Miller (2012) challenges readers to think about how this new technology is going to change our research questions, theories, and models of behavior change, funding sources, and even career tracks.
The Feasibility and Validity of Ambulatory Self-report of Psychotic Symptoms Using a Smartphone Software Application
Palmier-Claus JE, Ainsworth J, Machin M, et al
BMC Psychiatry. 2012;12(1):172.
Objective
Ambulatory, real-time, smartphone-based self-report assessment devices may have advantages over semi-structured interviews for assessing psychotic symptoms. The present study has two primary aims: (1) To assess the validity of using a smartphone-based monitoring system for the assessment of psychosis, compared to a gold-standard structured interview assessment method, and (2) to examine compliance to the procedure among individuals suffering with psychotic symptoms of varying severity.
Conclusions
Results from the present study suggest that ambulatory monitoring of symptoms several times daily using smartphone applications represents a feasible and valid way of assessing psychotic symptoms for clinical and research purposes. This smartphone-based monitoring system shows promise and should be studied further.
Clinical Commentary
The present study aims to assess the validity, acceptability, and feasibility of using a smartphone-based monitoring system for assessing psychosis Future studies concerning the implementation of new technologies among potential users are needed. Kilbourne et al. [43] described a useful framework called Replicating Effective Programs (REP) for implementing health care interventions. Insights from the Technology Acceptance Model (TAM; Venkatesh & Davis, 2000) should also be considered throughout the implementation process. Palmier-Claus et al.’s (2012) research is important, as traditional face-to-face assessments have significant limitations, including recall bias, averaging (e.g., overlooking potential variability in the number, type and intensity of psychotic symptoms in different contexts), variable interrater reliability, and insensitivity to change. This study lays the groundwork to be able to develop future interventions to help individuals with psychotic symptoms. Further evaluation is required over longer assessment periods, in clinical trials and service settings.
Palmier-Claus JE, Ainsworth J, Machin M, et al
BMC Psychiatry. 2012;12(1):172.
Objective
Ambulatory, real-time, smartphone-based self-report assessment devices may have advantages over semi-structured interviews for assessing psychotic symptoms. The present study has two primary aims: (1) To assess the validity of using a smartphone-based monitoring system for the assessment of psychosis, compared to a gold-standard structured interview assessment method, and (2) to examine compliance to the procedure among individuals suffering with psychotic symptoms of varying severity.
Conclusions
Results from the present study suggest that ambulatory monitoring of symptoms several times daily using smartphone applications represents a feasible and valid way of assessing psychotic symptoms for clinical and research purposes. This smartphone-based monitoring system shows promise and should be studied further.
Clinical Commentary
The present study aims to assess the validity, acceptability, and feasibility of using a smartphone-based monitoring system for assessing psychosis Future studies concerning the implementation of new technologies among potential users are needed. Kilbourne et al. [43] described a useful framework called Replicating Effective Programs (REP) for implementing health care interventions. Insights from the Technology Acceptance Model (TAM; Venkatesh & Davis, 2000) should also be considered throughout the implementation process. Palmier-Claus et al.’s (2012) research is important, as traditional face-to-face assessments have significant limitations, including recall bias, averaging (e.g., overlooking potential variability in the number, type and intensity of psychotic symptoms in different contexts), variable interrater reliability, and insensitivity to change. This study lays the groundwork to be able to develop future interventions to help individuals with psychotic symptoms. Further evaluation is required over longer assessment periods, in clinical trials and service settings.
A Pilot Study of the DBT Coach: An Interactive Mobile Phone Application for Individuals with Borderline Personality Disorder and Substance Use Disorder
Rizvi SL, Dimeff LA, Skutch J, et al
Behavior Therapy, 2011;42(4):589-600.
Objective
The aim of this study was to develop and test the feasibility of the DBT coach, a smartphone application designed to enhance generalization of a specific dialectical behavioral therapy (DBT) skill (opposite action) among individuals with borderline personality disorder (BPD) and comorbid substance use disorders (SUD).
Conclusions
The present findings suggest that DBT coach, a smartphone application which offers in vivo (OA) skills coaching, may be a useful tool for increasing DBT skills use and adaptive coping behaviors, while reducing urges to use substances and levels of symptomatology.
Clinical Commentary
There is a significant body of literature that suggests DBT is an effective approach to the treatment of BPD and BPD with comorbid SUD. This study builds on this line of research to examine how mobile technology can be used to help DBT clients with BPD-SUD generalize newly acquired skills to the natural settings where they most often experience urges to engage in maladaptive behavior (e.g., substance use or abuse). Although there were numerous limitations to this small feasibility pilot trial which used a quasi-experimental design, the present findings are encouraging. Results suggest that, when used as an adjunct to DBT, the smartphone application DBT coach has the potential to decrease emotional intensity, urges to use substances, and overall distress. More generally, the present research supports the use of mobile-phone based psychological interventions for facilitating skills generalization, behavior change, and symptom-reduction. This study also contributes to this field by developing the Satisfaction and Usability Scale, which can be adopted in future research to evaluate the acceptability of smartphone application-based interventions
Rizvi SL, Dimeff LA, Skutch J, et al
Behavior Therapy, 2011;42(4):589-600.
Objective
The aim of this study was to develop and test the feasibility of the DBT coach, a smartphone application designed to enhance generalization of a specific dialectical behavioral therapy (DBT) skill (opposite action) among individuals with borderline personality disorder (BPD) and comorbid substance use disorders (SUD).
Conclusions
The present findings suggest that DBT coach, a smartphone application which offers in vivo (OA) skills coaching, may be a useful tool for increasing DBT skills use and adaptive coping behaviors, while reducing urges to use substances and levels of symptomatology.
Clinical Commentary
There is a significant body of literature that suggests DBT is an effective approach to the treatment of BPD and BPD with comorbid SUD. This study builds on this line of research to examine how mobile technology can be used to help DBT clients with BPD-SUD generalize newly acquired skills to the natural settings where they most often experience urges to engage in maladaptive behavior (e.g., substance use or abuse). Although there were numerous limitations to this small feasibility pilot trial which used a quasi-experimental design, the present findings are encouraging. Results suggest that, when used as an adjunct to DBT, the smartphone application DBT coach has the potential to decrease emotional intensity, urges to use substances, and overall distress. More generally, the present research supports the use of mobile-phone based psychological interventions for facilitating skills generalization, behavior change, and symptom-reduction. This study also contributes to this field by developing the Satisfaction and Usability Scale, which can be adopted in future research to evaluate the acceptability of smartphone application-based interventions
