Preventing relapse with personalized smart‐messaging after cognitive behavioural therapy: A proof‐of‐concept evaluation

Abstract

Objectives. Cognitive behavioural therapy (CBT) can improve symptoms of anxiety and depression, but also reduces the risk of future relapse after therapy completion. However, current CBT relapse prevention methods are resource-intensive and can be limited in clinical practice. This paper investigates a personalized means of reducing relapse using smart-messaging in two settings: research and routine care.Design. Study 1 presents a cohort study comparing a cohort of smart-messaging users versus non-users. Study 2 presents time series follow-up data from a case series of smartmessaging users from clinical practice.Methods. Fifteen of 56 CBT completers who participated in a trial for the treatment of health anxiety wrote advice they would want if in future they were doing well, experiencing early warning signs of relapse, or experiencing full relapse. Following CBT, participants received weekly text-message requests to rate their well-being. Dependent upon their response, participants received tailored advice they had written, appropriate to the wellbeing level reported after recovery from health anxiety. Smart-messaging was also trialled in a routine practice sample of 14 CBT completers with anxiety and depression.Results. Across a 12-month follow-up, participants receiving smart-messaging showed greater health improvements than those who did not. Well-being scores showed stability between CBT completion and 6-month follow-up among routine care patients.Conclusions. These findings suggest that a low-intensity, personalized relapse prevention method can have a clinical benefit following CBT for common mental health problems. Practitioner pointsPost-treatment outcomes may be improved using personalized smart-messaging to prevent relapse following cognitive behavioural therapy (CBT) for health anxiety.

Adaptive Elements in Internet-Delivered Psychological Treatment Systems: Systematic Review

“…Based on our findings, the communication media used to administer internet-facilitated interventions to patients can be classified into three categories: web apps, mobile apps, and computer games. A significant number of the included studies were based on web apps [ 11 , 14 , 24 , 39 , 43 , 49 , 50 , 52 , 54 , 56 , 63 ], followed by mobile apps [ 13 , 32 , 41 , 49 , 50 , 55 , 60 , 61 ] and a game-based intervention [ 53 ]. There was only one paper that applied both web and mobile technologies for internet-based intervention.…”

“…Another notable observation is that several studies (11/31, 35%) used feedbacks as adaptive elements. Numerous studies described the process of adaptive feedback in different forms, including sending personalized motivational messages [ 43 ], tailored messages by therapists [ 11 , 13 , 54 ], and providing general support [ 14 ]. In contrast, a few studies aimed to adapt reminders and alerts by sending an email or SMS text message or making a phone call [ 24 , 48 , 50 ].…”

“…In general, this systematic review shows that tailoring interventions according to patients’ needs and preferences has a positive effect on user adherence and hence treatment outcomes. Several studies reported that the personalization of interventions [ 13 , 32 , 39 , 41 , 43 , 47 , 50 - 52 , 54 , 56 , 59 ] and assessments [ 42 , 45 , 46 ] increased user adherence. Similarly, a study by Coyle et al [ 53 ] reported that a personalized system provided a higher degree of user satisfaction.…”

Simple Mobile technology health management tool for people with severe mental illness: a randomised controlled feasibility trial

“…To our knowledge, this is the rst randomised-controlled trial to investigate the clinical utilities of a 'Simple-Telehealth' (Florence) text-messaging technology to assist the mental health care of patients with severe and enduring mental illness. Preliminary evidence from small cohort and case studies suggest that "Florence is a low-cost, low-risk innovation with a strong track record" [30]; studies reported bene ts on self-management, recovery outcomes and treatment adherence, predominantly in the management of physical long-term conditions such as hypertension and diabetes [31], but also more recently for patients with mental health problems following psychotherapy [32]. Other studies provided preliminary evidence for the effectiveness of more complex text-messaging interventions that incorporated Cognitive Behaviour Therapy techniques to target medication adherence and psychotic symptoms [33] or used an 'Early Warning Signs Questionnaire' for relapse prevention [34].…”

Acceptance and commitment therapy for young brain tumour survivors: study protocol for an acceptability and feasibility trial

“…Personalised, targeted smart messaging may improve retention in psychological therapy and outcomes after the completion of therapy. 36 37 Therefore, relapse prevention plans will be organised into brief weekly reminders that can be sent as text messages after therapy has finished. The messages received will be tailored to participant-reported well-being each week, with messages specific to times when they are doing well, experiencing early warning signs of relapse or experiencing full relapse.…”