Preliminary Results From a Randomized Controlled Study for an App-Based Cognitive Behavioral Therapy Program for Depression and Anxiety in Cancer Patients

Abstract

Cancer patients experience various psychological and social difficulties, the most common being depression and anxiety. The purpose of this study was to develop and evaluate the effectiveness of an app-based cognitive behavioral therapy program for depression and anxiety in cancer patients. For this purpose, 63 participants who met the inclusion criteria were randomly assigned to either a mobile-application-based cognitive behavioral therapy program (HARUToday), a simple information-provision mobile-application-based program (HARUCard), or a waitlist control group. Self-report questionnaires including the Beck Depression Inventory, State-Trait Anxiety Inventory, Health-Related Quality of Life Scale, Dysfunctional Attitude Scale, and two computer tasks including the dot-probe task and the Implicit Association Test, were administered before and after 66 days of intervention. The results showed that the Beck Depression Inventory and State-Trait Anxiety Inventory scores of the cognitive behavioral therapy program (HARUToday) group decreased significantly after the intervention compared to the attention control (HARUCard) and waitlist control groups. However, there were no significant changes in scores of the Health-Related Quality of Life Scale and Dysfunctional Attitude Scale, and the two computer tasks. Such results suggest that a mobile-application-based cognitive behavioral therapy program may be an effective intervention for alleviating depression and anxiety, but not the general quality of life of cancer patients. Taking into consideration that psychosocial problems may not the topmost priority for cancer patients who are facing a chronic and possibly mortal disease, a mobile-application cognitive behavioral therapy program may be a possible solution for the alleviation of depression and anxiety in cancer patients who have many restraints in terms of time and space.

Can mHealth interventions improve quality of life of cancer patients? A systematic review and meta-analysis

“…In women with incurable cancer and with elevated anxiety symptoms, a tablet-delivered CBT program (intervention) and health education program (control group) delivered via tablet computers were associated with a significant improvement in the FACT-General questionnaire scores, yet without a statistically significant between-group differences ( Greer et al, 2019 ). Ham and colleagues found a similar between-group improvement of the SF-36 total score in cancer patients randomized to either a mobile-application-based CBT ( HARUToday ), a waitlist control group, or an attention control group ( Ham et al, 2019 ). Another RCT found that cancer patients randomized to either an Internet-based mindfulness-based cognitive therapy or a face-to-face mindfulness based cognitive therapy had improved mental health, but not physical health, when compared to cancer patients who received treatment as usual ( Compen et al, 2018 ).…”

“… ( Park et al, 2019 ) Republic of Korea Lung cancer 90 / 54% women / 55.1 ± 8.7 years Pre-post App delivered physical rehabilitation program (Smart Aftercare app) None 12 weeks EORTC QLQ-C30 90% Improved role, emotional and social functioning, fatigue, appetite, diarrhea ( Trinh et al, 2018 ) Canada Prostate cancer 46 / all men / 73.2 ± 7.3 years Pre-post Accelerometer, wrist-worn activity tracker and Web based application None 12 weeks FACT-General 91% Improved emotional well-being ( Lozano-Lozano et al, 2019 ) Spain Breast cancer (Overweight/obese) 80 / all women / age 59 ± 9 years Pre-post Healthy eating and physical activity feedback app (BENECA) None 8 weeks EORT QLQ-C30 73% Improved global health, physical, emotional, social and cognitive functioning, fatigue, dyspnea, insomnia Cognitive behavioral therapy / behavioral change (6 studies) ( Greer et al, 2019 ) USA Incurable cancer (patients with high anxiety) 145 / 74% women / mean age: 56 ± 11 years RCT CBT (tablet based) Health education program 12 weeks FACT-G - QOL improved in both patient groups. ( Ham et al, 2019 ) South Korea Different cancer types …”

“…We identified 17 RCTs ( Willems et al, 2017 ; Mendoza et al, 2017 ; Graetz et al, 2018 ; Ferrante et al, 2018 ; Admiraal et al, 2017 ; Compen et al, 2018 ; Frensham et al, 2018 ; Galiano-Castillo et al, 2016 ; Greer et al, 2019 ; Ham et al, 2019 ; Ji et al, 2019 ; Kubo et al, 2019 ; Rosen et al, 2018 ; Uhm et al, 2017 ; Urech et al, 2018 ; Yang et al, 2019 ; Zhu et al, 2018 ) and 8 pre-post design studies ( Børøsund et al, 2019 ; Cheong et al, 2018 ; Lozano-Lozano et al, 2019 ; McCarroll et al, 2015 ; Pappot et al, 2019 ; Park et al, 2019 ; Pope et al, 2019 ; Trinh et al, 2018 ). Nine studies (5 RCTs and 4 pre-post designs) tested physical activity / rehab / fitness interventions ( Mendoza et al, 2017 ; Frensham et al, 2018 ; Galiano-Castillo et al, 2016 ; Ji et al, 2019 ; Uhm et al, 2017 ; Cheong et al, 2018 ; Lozano-Lozano et al, 2019 ; Park et al, 2019 ; Trinh et al, 2018 ), six studies – CBT interventions (4 RCTs and 2 pre-post designs) ( McCarthy et al, 2018 ; Willems et al, 2017 ; Compen et al, 2018 ; Greer et al, 2019 ; Greer et al, 2019 ; Ham et al, 2019 ; Børøsund et al, 2019 ), three studies - mindfulness/stress management interventions (3 RCTs) ( Kubo et al, 2019 ; Rosen et al, 2018 ; Urech et al, 2018 ), two studies - social support (1 RCT and 1 pre-post design) ( Zhu et al, 2018 ; Pappot et al, 2019 ), two studies - information/psychoeducation (2 RCTs) ( Graetz et al, 2018 ; Admiraal et al, 2017 ), two studies – weight management (1 RCT and 1 pre-post design) ( Ferrante et al, 2018 ;…”

Impact of Smartphone App–Based Psychological Interventions for Reducing Depressive Symptoms in People With Depression: Systematic Literature Review and Meta-analysis of Randomized Controlled Trials

“…All trials consisted of individually RCTs. In all, 25 % (3/12) of the trials included people with mild to moderate depression [ 34 , 39 , 41 ], 17% (2/12) of the trials included people with mild to severe depression [ 33 , 40 ], 42% (5/12) of the trials included people with moderate to severe depression [ 35 , 36 , 42 - 44 ], 8% (1/12) of the trials included people with a diagnosis of major depression [ 38 ], and 8% (1/12) of the trials included people with a self-reported need for help with their depressive symptoms [ 37 ]. The total combined sample size for all included trials was 2859 participants.…”

Aplicações da Terapia Cognitivo-Comportamental em pacientes oncológicos: Uma Revisão Integrativa

“…Ainda sobre a ansiedade, os estudos realizados porAubin et al (2019) eHam et al (2019) obtiveram dados significativos em relação ao uso da TCC em formato on-line, por meio de aplicativos móveis, com melhora em relação à ansiedade nos grupos da intervenção.Em se tratando da questão da depressão, constatou-se que o estudo deGreer et al (2012) apresenta contribuições consideráveis na redução dos sintomas depressivos, da mesma forma que os estudos de Mejía-Castrejón e Landra-Ramírez (2014) eHam et al (2019) demonstram que a TCC foi útil na redução da depressão. Um dado interessante sobre o estudo deHam et al (2019) é que os achados foram coletados em uma grande variedade de estágios e tipos de câncer.…”