A Virtual Hope Box: Randomized Controlled Trial of a Smartphone App for Emotional Regulation and Coping With Distress

Bush, Nigel; Smolenski, Derek J.; Denneson, Lauren M.; Williams, Holly B.; Thomas, Elissa K.; Dobscha, Steven K.

doi:10.1176/appi.ps.201600283

Cited by 105 publications

(132 citation statements)

References 29 publications

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“…Although several smartphone CBT apps have been experimented among general population participants with elevated self-reported symptoms [ 27 - 33 ], Kokoro-app is the first smartphone CBT app to prove to be effective in a RCT in comparison with an alternative treatment for patients suffering from clinically diagnosed major depression. Advantages of smartphone CBT include high accessibility, efficiency, and affordability.…”

Section: Discussionmentioning

confidence: 99%

“…However, few apps have demonstrated quality [ 22 , 23 ] and no randomized controlled trial (RCT) has yet proved the benefits of a smartphone app in comparison with a control condition in the treatment of clinically diagnosed major depressive disorder. Several trials have examined the use of smartphone to monitor symptoms [ 24 - 26 ] or smartphone apps applying the CBT principles, but only among participants recruited from the general population who had reported elevated levels of depressive symptoms on self-reports [ 27 - 33 ]. A few have examined participants with diagnosed major depression, but only against active controls.…”

Section: Introductionmentioning

confidence: 99%

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Smartphone Cognitive Behavioral Therapy as an Adjunct to Pharmacotherapy for Refractory Depression: Randomized Controlled Trial

Mantani¹,

Kato²,

Furukawa³

et al. 2017

J Med Internet Res

142

159

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BackgroundIn the treatment of major depression, antidepressants are effective but not curative. Cognitive behavioral therapy (CBT) is also effective, alone or in combination with pharmacotherapy, but accessibility is a problem.ObjectiveThe aim is to evaluate the effectiveness of a smartphone CBT app as adjunctive therapy among patients with antidepressant-resistant major depression.MethodsA multisite, assessor-masked, parallel-group randomized controlled trial was conducted in 20 psychiatric clinics and hospitals in Japan. Participants were eligible if they had a primary diagnosis of major depression and were antidepressant-refractory after taking one or more antidepressants at an adequate dosage for four or more weeks. After a 1-week run-in in which participants started the medication switch and had access to the welcome session of the app, patients were randomized to medication switch alone or to medication switch plus smartphone CBT app via the centralized Web system. The smartphone app, called Kokoro-app (“kokoro” means “mind” in Japanese), included sessions on self-monitoring, behavioral activation, and cognitive restructuring presented by cartoon characters. The primary outcome was depression severity as assessed by masked telephone assessors with the Patient Health Questionnaire-9 (PHQ-9) at week 9. The secondary outcomes included the Beck Depression Inventory-II (BDI-II) and Frequency, Intensity, and Burden of Side Effects Ratings (FIBSER).ResultsIn the total sample (N=164), 81 participants were allocated to the smartphone CBT in addition to medication change and 83 to medication change alone. In the former group, all but one participant (80/81, 99%) completed at least half, and 71 (88%) completed at least six of eight sessions. In the intention-to-treat analysis, patients allocated the CBT app scored 2.48 points (95% CI 1.23-3.72, P<.001; standardized mean difference 0.40) lower on PHQ-9 than the control at week 9. The former group also scored 4.1 points (95% CI 1.5-6.6, P=.002) lower on BDI-II and 0.76 points (95% CI –0.05 to 1.58, P=.07) lower on FIBSER. In the per-protocol sample (comfortable with the smartphone app, still symptomatic, and adherent to medication with mild or less side effects after run-in), the intervention group (n=60) scored 1.72 points (95% CI 0.25-3.18, P=.02) lower on PHQ-9, 3.2 points (95% CI –0.01 to 6.3, P=.05) lower on BDI-II, and 0.75 points (95% CI 0.03-1.47, P=.04) lower on FIBSER than the control (n=57). The treatment benefits were maintained up to week 17.ConclusionsThis is the first study to demonstrate the effectiveness of a smartphone CBT in the treatment of clinically diagnosed depression. Given the merits of the mobile mental health intervention, including accessibility, affordability, quality control, and effectiveness, it is clinically worthwhile to consider adjunctive use of a smartphone CBT app when treating patients with antidepressant-resistant depression. Research into its effectiveness in wider clinical contexts is warranted.Trial RegistrationJapanese Clinic...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Smartphone Cognitive Behavioral Therapy as an Adjunct to Pharmacotherapy for Refractory Depression: Randomized Controlled Trial

Mantani¹,

Kato²,

Furukawa³

et al. 2017

J Med Internet Res

142

159

View full text Add to dashboard Cite

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“…68,69 For instance, the Virtual Hope Box, a smartphone app, aims to instill reasons for living and improve coping skills in veterans at risk for suicide. 70 Conscientiousness may also be enhanced through existing cognitive interventions. 71 Two cognitive techniques, mental contrasting (i.e., imagining future goals and challenges which must be addressed to achieve goals) and implementation intentions (i.e., outlining potential scenarios that may arise during pursuit of goal), have been developed to facilitate goal pursuit, an important aspect of conscientiousness.…”

Section: Discussionmentioning

confidence: 99%

Purpose in Life and Conscientiousness Protect Against the Development of Suicidal Ideation in U.S. Military Veterans With PTSD and MDD: Results From the National Health and Resilience in Veterans Study

et al. 2019

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Background:Although several studies have examined risk factors for suicidal ideation among veterans, little is known about risk and protective factors for suicidal ideation in high-risk veteran samples. Thus, this study examined a broad range of risk and protective factors associated with the development of suicidal ideation in a high-risk sample of U.S. veterans who screened positive for current posttraumatic stress disorder (PTSD) and/or major depressive disorder (MDD). Methods: Data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative, prospective cohort study of U.S. veterans. Veterans completed self-report measures to screen for PTSD and MDD and to assess for risk and protective factors. The sample included 222 veterans with PTSD and/or MDD who did not endorse suicidal ideation at baseline and completed at least one assessment over a seven-year follow-up period. A multivariable binary logistic regression analysis was conducted to examine baseline factors associated with incident suicidal ideation. Results: Nearly one in three (27.1%) of veterans with PTSD and/or MDD developed suicidal ideation over the seven-year follow-up period. Non-Caucasian race and lower scores on measures of purpose in life, conscientiousness, and frequency of religious service attendance were independently associated with incident suicidal ideation. Lower purpose in life (52.3%) and conscientiousness (33.2%) explained the vast majority of variance in incident suicidal ideation. Conclusion: Nearly 30% of veterans with PTSD and/or MDD who did not endorse suicidal ideation at baseline developed suicidal ideation over a seven-year period. Prevention and treatment efforts designed to bolster purpose in life and conscientiousness may help mitigate risk for suicidal ideation in this high-risk population.

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“…However, in one of these studies participants were more divided around whether the service benefited their psychological health, and suicidal thoughts or behavior (40%–60% felt the service was helpful in these areas; Berrouiguet et al., ). For mobile phone apps, participants typically found these helpful or were satisfied with the content (e.g., 84%–89%; Bush et al., , ; McManama O'Brien et al., ), and would consider using the apps again (e.g., 83%–94%; Bush et al., , ; Rizvi et al., ; Stallard et al., ). In one study, helpfulness ratings were more ambivalent ( M rating = 2.46 of 5) but higher when participants were specifically asked if the app would be helpful for SB ( M rating = 3.23 of 5; Rizvi et al., ).…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of the Evidence Supporting Mobile‐ and Internet‐Based Psychological Interventions For Self‐Harm

Arshad

Farhat-Ul-Ain

Gauntlett

et al. 2019

Suicide & Life Threat Behav

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Objectives Internet‐ and mobile phone‐based psychological interventions have the potential to overcome many of the barriers associated with accessing traditional face‐to‐face therapy. Self‐injurious thoughts and behaviors (STB) are prevalent global health problems that may benefit from Internet‐ and mobile‐based interventions. We provide a systematic review and meta‐analysis of studies evaluating mobile‐ and Internet‐based interventions for STB, including nonsuicidal self‐injury (NSSI). Methods Online databases (PsycINFO, Web of Science, Medline) were searched up to March 2019 for single‐arm and controlled trials of Internet‐ or mobile‐based interventions for STB. The potential for bias was assessed using the Cochrane risk of bias tool. Results Twenty‐two eligible trials were identified. The research was limited by a lack of controlled designs and small samples. Evidence supports the acceptability of interventions. There is preliminary evidence that these interventions are associated with a decline in STB. A meta‐analysis suggested a positive treatment effect on suicidal ideation when compared to treatment as usual, but not when trials with active controls were also considered. Conclusions Overall, Internet‐ and mobile‐based interventions show promise and further controlled trials are warranted, focusing on behavioral outcomes (NSSI, suicidal behavior). This review was preregistered with PROSPERO (CRD42017074065).

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A Virtual Hope Box: Randomized Controlled Trial of a Smartphone App for Emotional Regulation and Coping With Distress

Abstract: The VHB is a demonstrably useful accessory to treatment-an easily accessible tool that can increase stress coping skills. Because the app is easily disseminated across a large population, it is likely to have broad, positive utility in behavioral health care.

Cited by 105 publications

References 29 publications

Smartphone Cognitive Behavioral Therapy as an Adjunct to Pharmacotherapy for Refractory Depression: Randomized Controlled Trial

Smartphone Cognitive Behavioral Therapy as an Adjunct to Pharmacotherapy for Refractory Depression: Randomized Controlled Trial

Purpose in Life and Conscientiousness Protect Against the Development of Suicidal Ideation in U.S. Military Veterans With PTSD and MDD: Results From the National Health and Resilience in Veterans Study

A Systematic Review of the Evidence Supporting Mobile‐ and Internet‐Based Psychological Interventions For Self‐Harm

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