Can Brief, Daily Training Using a Mobile App Help Change Maladaptive Beliefs? Crossover Randomized Controlled Trial

Roncero, María; Belloch, Amparo; Doron, Guy

doi:10.2196/11443

Cited by 37 publications

(42 citation statements)

References 56 publications

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“…The CORE intervention is a smartphone app that uses the GGtude platform, a system designed to increase the cognitive flexibility of individuals struggling with a range of mental health problems through brief daily training [44][45][46][47]. CORE was specifically designed to help counteract dysfunctional thoughts in multiple domains that are relevant to the subjective experience of having SMI.…”

Section: Intervention Descriptionmentioning

confidence: 99%

“…The CORE intervention builds on a digital cognitive training strategy that has been previously demonstrated to reduce dysfunctional self-talk and increase resilience in community-based subclinical groups [44][45][46]. The app included modules focused on countering maladaptive beliefs in common mental health domains (eg, self-esteem, distinguishing thoughts from feelings, social anxiety, and catastrophizing) as well as modules specifically designed for people with SMI (eg, stigma related to mental illness, threat perception and persecutory ideation, hopelessness, strengths-based recovery, self-care, and treatment seeking).…”

Section: Principal Findingsmentioning

confidence: 99%

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A Smartphone Intervention for People With Serious Mental Illness: Fully Remote Randomized Controlled Trial of CORE

Ben‐Zeev¹,

Chander²,

Tauscher³

et al. 2021

J Med Internet Res

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Background People with serious mental illness (SMI) have significant unmet mental health needs. Development and testing of digital interventions that can alleviate the suffering of people with SMI is a public health priority. Objective The aim of this study is to conduct a fully remote randomized waitlist-controlled trial of CORE, a smartphone intervention that comprises daily exercises designed to promote reassessment of dysfunctional beliefs in multiple domains. Methods Individuals were recruited via the web using Google and Facebook advertisements. Enrolled participants were randomized into either active intervention or waitlist control groups. Participants completed the Beck Depression Inventory-Second Edition (BDI-II), Generalized Anxiety Disorder-7 (GAD-7), Hamilton Program for Schizophrenia Voices, Green Paranoid Thought Scale, Recovery Assessment Scale (RAS), Rosenberg Self-Esteem Scale (RSES), Friendship Scale, and Sheehan Disability Scale (SDS) at baseline (T1), 30-day (T2), and 60-day (T3) assessment points. Participants in the active group used CORE from T1 to T2, and participants in the waitlist group used CORE from T2 to T3. Both groups completed usability and accessibility measures after they concluded their intervention periods. Results Overall, 315 individuals from 45 states participated in this study. The sample comprised individuals with self-reported bipolar disorder (111/315, 35.2%), major depressive disorder (136/315, 43.2%), and schizophrenia or schizoaffective disorder (68/315, 21.6%) who displayed moderate to severe symptoms and disability levels at baseline. Participants rated CORE as highly usable and acceptable. Intent-to-treat analyses showed significant treatment×time interactions for the BDI-II (F1,313=13.38; P<.001), GAD-7 (F1,313=5.87; P=.01), RAS (F1,313=23.42; P<.001), RSES (F1,313=19.28; P<.001), and SDS (F1,313=10.73; P=.001). Large effects were observed for the BDI-II (d=0.58), RAS (d=0.61), and RSES (d=0.64); a moderate effect size was observed for the SDS (d=0.44), and a small effect size was observed for the GAD-7 (d=0.20). Similar changes in outcome measures were later observed in the waitlist control group participants following crossover after they received CORE (T2 to T3). Approximately 41.5% (64/154) of participants in the active group and 60.2% (97/161) of participants in the waitlist group were retained at T2, and 33.1% (51/154) of participants in the active group and 40.3% (65/161) of participants in the waitlist group were retained at T3. Conclusions We successfully recruited, screened, randomized, treated, and assessed a geographically dispersed sample of participants with SMI entirely via the web, demonstrating that fully remote clinical trials are feasible in this population; however, study retention remains challenging. CORE showed promise as a usable, acceptable, and effective tool for reducing the severity of psychiatric symptoms and disability while improving recovery and self-esteem. Rapid adoption and real-world dissemination of evidence-based mobile health interventions such as CORE are needed if we are to shorten the science-to-service gap and address the significant unmet mental health needs of people with SMI during the COVID-19 pandemic and beyond. Trial Registration ClinicalTrials.gov NCT04068467; https://clinicaltrials.gov/ct2/show/NCT04068467

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Section: Intervention Descriptionmentioning

confidence: 99%

Section: Principal Findingsmentioning

confidence: 99%

A Smartphone Intervention for People With Serious Mental Illness: Fully Remote Randomized Controlled Trial of CORE

Ben‐Zeev¹,

Chander²,

Tauscher³

et al. 2021

J Med Internet Res

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“…GGtude is a CBT-based mobile application platform that provides various modules to cope with maladaptive beliefs that are associated with different psychological difficulties (e.g., OCD, depression, low self-esteem, body image distress). A growing body of evidence including five RCTs has indicated that using the GGtude platform is associated with significant reductions in maladaptive beliefs and psychopathological symptoms ( Aboody et al, 2020 , Ben-Zeev et al, 2021 , Cerea et al, 2020 ; Cerea, Ghisi, Bottesi, Manoli, Carraro, & Doron, 2021; Giraldo-O'Meara and Doron, 2020 , Roncero et al, 2018 , Roncero et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Cognitive Training via a Mobile Application to Reduce Obsessive-Compulsive-Related Distress and Cognitions During the COVID-19 Outbreaks: A Randomized Controlled Trial Using a Subclinical Cohort

et al. 2022

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Obsessive-compulsive disorder (OCD) is a persistent psychiatric disorder causing significant impairment in functioning. The COVID-19 pandemic has exacerbated OCD-related symptoms and interrupted access to treatment. Recent research suggests mHealth apps are promising tools for coping with OCD symptoms. This randomized controlled trial evaluated the effects of a CBT-based mobile application designed to reduce OCD symptoms and cognitions in community participants considered at high-risk of developing OCD symptoms. Following initial screening ( n =924), fifty-five community participants scoring 2 standard deviations above the OCI-R mean were randomized into two groups. In the immediate-app use group (iApp; n =25), participants started using the application at baseline (T0), 4min a day, for 12 days (T0 - T1). Participants in the delayed-app group (dApp; n =20) started using the mobile application at T1 (crossover) and used the app for the following 12 consecutive days (T1 - T2). Intention to treat analyses indicated that using the app for 12 consecutive days was associated with large effect-size reductions (Cohen’s d ranging from .87 to 2.73) in OCD symptoms and maladaptive cognitions in the iApp group (from T0 to T1) and dApp group (from T1 to T2). These reductions were maintained at follow-up. Our findings underscore the usefulness of brief, low-intensity, portable interventions in reducing OCD symptoms and cognitions during the pandemic.

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“…Examples may include perspective taking (e.g., “Do you judge your friends based on their child's value?”) or testing of catastrophic expectations regarding the impact of the child's characteristics on oneself (e.g., “I can't accept my child's physical flaws”; “I can't tolerate the embarrassment caused by my child's ignorance”) using planned exposure exercises. Homework tasks relating to ROCD beliefs and self‐vulnerabilities could include training with evidenced based mobile applications specifically designed for such tasks (e.g., GG relationship doubts [GGRO]; Roncero, Belloch, & Doron, 2018, 2019). Parents' child‐value contingencies should be explored, such that the client understands the link between perceptions of the child's behaviours and characteristics, and one's own feelings of self‐worth.…”

Section: Discussionmentioning

confidence: 99%

“Why do I obsess about my child's flaws?”: Assessing the role of parental self‐vulnerabilities in parent–child relationship obsessive compulsive disorder (ROCD) symptoms

Levy

Tibi

Szepsenwol

et al. 2020

Clinical Psychologist

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Objective Relationship obsessive compulsive disorder (ROCD) is a manifestation of obsessive compulsive disorder (OCD) that refers to obsessions, doubts, and compulsive behaviours focusing on one's relationship and relationship partner. ROCD symptoms occur in various types of relationships including parent–child dyads, involving obsessional preoccupations with the perceived flaws of one's child (parent–child ROCD symptoms). Such preoccupations have been shown to be associated with decreased mood and significant parental distress. We examined the double self‐vulnerability hypothesis—that the co‐occurrence of parental contingency of self in specific domains (i.e., intelligence and appearance) and child‐value contingent self‐worth would be associated with increased parent–child ROCD symptoms. Method A total of 175 parents participated in the study and completed self‐report questionnaires to assess ROCD and depressive symptoms and parental self‐contingencies. We used linear regression with simple slope analyses to estimate interaction effects. Results Parents whose self‐worth were strongly dependent on their child's perceived value showed higher parent–child ROCD symptoms, particularly when co‐occurring with parental intelligence and appearance self‐contingencies. These findings were maintained when controlling for depression symptoms, parental age, and gender. Conclusions Results supported the double self‐vulnerability hypothesis suggesting that parents with child‐value and domain‐relevant self‐vulnerabilities might be susceptible to child‐related obsessions. More research is needed to further explore susceptibility of vulnerable parents to the development and maintenance of parent–child ROCD symptoms.

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Can Brief, Daily Training Using a Mobile App Help Change Maladaptive Beliefs? Crossover Randomized Controlled Trial

Cited by 37 publications

References 56 publications

A Smartphone Intervention for People With Serious Mental Illness: Fully Remote Randomized Controlled Trial of CORE

A Smartphone Intervention for People With Serious Mental Illness: Fully Remote Randomized Controlled Trial of CORE

Cognitive Training via a Mobile Application to Reduce Obsessive-Compulsive-Related Distress and Cognitions During the COVID-19 Outbreaks: A Randomized Controlled Trial Using a Subclinical Cohort

“Why do I obsess about my child's flaws?”: Assessing the role of parental self‐vulnerabilities in parent–child relationship obsessive compulsive disorder (ROCD) symptoms

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