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Fuhrmann LM, Weisel KK, Harrer M, Kulke JK, Baumeister H, Cuijpers P, Ebert DD, Berking M. Additive effects of adjunctive app-based interventions for mental disorders - A systematic review and meta-analysis of randomised controlled trials. Internet Interv 2024; 35:100703. [PMID: 38225971 PMCID: PMC10788289 DOI: 10.1016/j.invent.2023.100703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 12/11/2023] [Accepted: 12/17/2023] [Indexed: 01/17/2024] Open
Abstract
Background It is uncertain whether app-based interventions add value to existing mental health care. Objective To examine the incremental effects of app-based interventions when used as adjunct to mental health interventions. Methods We searched PubMed, PsycINFO, Scopus, Web of Science, and Cochrane Library databases on September 15th, 2023, for randomised controlled trials (RCTs) on mental health interventions with an adjunct app-based intervention compared to the same intervention-only arm for adults with mental disorders or respective clinically relevant symptomatology. We conducted meta-analyses on symptoms of different mental disorders at postintervention. PROSPERO, CRD42018098545. Results We identified 46 RCTs (4869 participants). Thirty-two adjunctive app-based interventions passively or actively monitored symptoms and behaviour, and in 13 interventions, the monitored data were sent to a therapist. We found additive effects on symptoms of depression (g = 0.17; 95 % CI 0.02 to 0.33; k = 7 comparisons), anxiety (g = 0.80; 95 % CI 0.06 to 1.54; k = 3), mania (g = 0.2; 95 % CI 0.02 to 0.38; k = 4), smoking cessation (g = 0.43; 95 % CI 0.29 to 0.58; k = 10), and alcohol use (g = 0.23; 95 % CI 0.08 to 0.39; k = 7). No significant effects were found on symptoms of depression within a bipolar disorder (g = -0.07; 95 % CI -0.37 to 0.23, k = 4) and eating disorders (g = -0.02; 95 % CI -0.44 to 0.4, k = 3). Studies on depression, mania, smoking, and alcohol use had a low heterogeneity between the trials. For other mental disorders, only single studies were identified. Only ten studies had a low risk of bias, and 25 studies reported insufficient statistical power. Discussion App-based interventions may be used to enhance mental health interventions to further reduce symptoms of depression, anxiety, mania, smoking, and alcohol use. However, the effects were small, except for anxiety, and limited due to study quality. Further high-quality research with larger sample sizes is warranted to better understand how app-based interventions can be most effectively combined with established interventions to improve outcomes.
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Affiliation(s)
- Lukas M. Fuhrmann
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Kiona K. Weisel
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Mathias Harrer
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Psychology and Digital Mental Health Care, Technical University Munich, Munich, Germany
| | - Jennifer K. Kulke
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Psychology and Digital Mental Health Care, Technical University Munich, Munich, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - David D. Ebert
- Department of Psychology and Digital Mental Health Care, Technical University Munich, Munich, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
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Conway FN, Kane H, Dorsainvil M, Kennedy P, Cance JD. Mobile resonance frequency breathing smartphone application to support recovery among people with opioid use disorder: Study protocol for feasibility study. PLoS One 2024; 19:e0296278. [PMID: 38295049 PMCID: PMC10829996 DOI: 10.1371/journal.pone.0296278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/05/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Experiencing drug cravings is an aspect of substance use disorders that frequently compromises the recovery efforts of people who use drugs. Most treatment approaches that address drug cravings either involve cognitive strategies or medication. Few interventions directly address the physiological aspects of craving, such as increased heart rate. Previous research has demonstrated that slow-paced breathing may be effective in managing drug cravings by manipulating an individual's heart rate. The purpose of this paper is to describe a study protocol for an intervention that offers resonance frequency breathing training for managing cravings via a smartphone application (app). METHODS This trial is registered in ClinicalTrials.gov (Identifier: NCT05830773). The intervention focuses on persons in recovery from opioid use disorder who receive services from the Texas Health and Human Service Commission Recovery Support Services division. Participants will be trained to use Camera Heart Rate Variability (CHRV), a resonance frequency breathing app. The CHRV app measures heart rate and the volumetric variations of blood circulation. When experiencing stress, anxiety, or cravings, participants will use the app to practice breathing exercises. Participants (N = 60) will also complete surveys at baseline, 4 weeks, and 8 weeks; the survey questions, covers demographic characteristics, personal trauma history, substance use experience, and utilization of substance use treatment services. The surveys will also include psychosocial measures of craving, stress, and anxiety to allow the study team to assess changes between baseline and study completion. Participants who complete the full 8-week intervention will be invited to participate in a 30-minute interview about their experience with the app. Interviews will provide details on implementation outcomes, including acceptability, appropriateness, and feasibility. CONCLUSION Many evidence-based interventions for opioid use require interpersonal communication with individuals in one's recovery network. However, individuals may be unable to engage others in their recovery network in the moments when they are experiencing cravings or stress- and anxiety-related triggers. Therefore, recovery support interventions that emphasize individual self-management of cravings, stress, and anxiety when they occur can empower individuals in recovery and enhance existing interventions.
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Affiliation(s)
- Fiona N. Conway
- Addiction Research Institute, Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas, United States of America
| | - Heather Kane
- RTI International, Durham, North Carolina, United States of America
| | | | - Patrick Kennedy
- Addiction Research Institute, Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas, United States of America
| | - Jessica D. Cance
- RTI International, Durham, North Carolina, United States of America
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Ruyak S, Roberts MH, Chambers S, Ma X, DiDomenico J, De La Garza R, Bakhireva LN. The effect of the COVID-19 pandemic on substance use patterns and physiological dysregulation in pregnant and postpartum women. Alcohol Clin Exp Res 2023; 47:1088-1099. [PMID: 37526587 PMCID: PMC10394275 DOI: 10.1111/acer.15077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/19/2023] [Accepted: 03/25/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND The SARS-CoV-2/COVID-19 pandemic has been associated with increased stress levels and higher alcohol use, including in pregnant and postpartum women. In the general population, alcohol use is associated with dysregulation in the autonomic nervous system (ANS), which is indexed by heart rate variability (HRV). The objectives of this study were to: (1) characterize changes in substance use during the SARS-CoV-2/COVID-19 pandemic via a baseline self-report survey followed by mobile ecological momentary assessment (mEMA) of substance use; and (2) examine the associations between momentary substance use and ambulatory HRV measures in pregnant and postpartum women. METHODS Pregnant and postpartum women were identified from the ENRICH-2 prospective cohort study. Participants were administered a baseline structured phone interview that included the Coronavirus Perinatal Experiences (COPE) survey and ascertained the prevalence of substance use. Over a 14-day period, momentary substance use was assessed three times daily, and HRV measurements were captured via wearable electronics. Associations between momentary substance use and HRV measures (root mean square of successive differences [RMSSD] and low frequency/high frequency [LF/HF] ratio) were examined using a mixed effects model that included within-subject (WS) and between-subject (BS) effects and adjusted for pregnancy status and participant age. RESULTS The sample included 49 pregnant and 22 postpartum women. From a combination of a baseline and 14-day mEMA surveys, 21.2% reported alcohol use, 16.9% reported marijuana use, and 8.5% reported nicotine use. WS effects for momentary alcohol use were associated with the RMSSD (β = -0.14; p = 0.005) and LF/HF ratio (β = 0.14; p = 0.01) when controlling for pregnancy status and maternal age. No significant associations were observed between HRV measures and instances of marijuana or nicotine use. CONCLUSIONS These findings highlight the negative effect of the SARS-CoV-2/COVID-19 pandemic on the psychological health of pregnant and postpartum women associated with substance use, and in turn, ANS dysregulation, which potentially puts some women at risk of developing a substance use disorder.
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Affiliation(s)
- Sharon Ruyak
- College of Nursing, University of New Mexico, Albuquerque, New Mexico, USA
| | - Melissa H Roberts
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, New Mexico, USA
| | - Stephanie Chambers
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Xingya Ma
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jared DiDomenico
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, New Mexico, USA
| | - Richard De La Garza
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Ludmila N Bakhireva
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, New Mexico, USA
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Bates ME, Eddie D, Lehrer PM, Nolan RP, Siepmann M. Editorial: Integrated cardiovascular and neural system processes as potential mechanisms of behavior change. Front Psychiatry 2023; 14:1175691. [PMID: 37032946 PMCID: PMC10074486 DOI: 10.3389/fpsyt.2023.1175691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 04/11/2023] Open
Affiliation(s)
- Marsha E. Bates
- Department of Kinesiology and Health, Center of Alcohol and Substance Use Studies, Rutgers University - New Brunswick, New Brunswick, NJ, United States
| | - David Eddie
- Recovery Research Institute and Psychiatry Department, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Paul M. Lehrer
- Department of Kinesiology and Health, Center of Alcohol and Substance Use Studies, Rutgers University - New Brunswick, New Brunswick, NJ, United States
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Robert P. Nolan
- Behavioural Cardiology Research Unit, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Martin Siepmann
- Clinic for Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Bates ME, Price JL, Leganes-Fonteneau M, Muzumdar N, Piersol K, Frazier I, Buckman JF. The Process of Heart Rate Variability, Resonance at 0.1 hz, and the Three Baroreflex Loops: A Tribute to Evgeny Vaschillo. Appl Psychophysiol Biofeedback 2022; 47:327-340. [PMID: 35536496 PMCID: PMC9088144 DOI: 10.1007/s10484-022-09544-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/04/2022] [Accepted: 04/22/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Marsha E. Bates
- Department of Kinesiology & Health, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
- Center of Alcohol & Substance Use Studies, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
| | - Julianne L. Price
- Department of Kinesiology & Health, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
- Center of Alcohol & Substance Use Studies, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
| | - Mateo Leganes-Fonteneau
- Department of Kinesiology & Health, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
- Center of Alcohol & Substance Use Studies, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
| | - Neel Muzumdar
- Department of Kinesiology & Health, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
- Center of Alcohol & Substance Use Studies, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
| | - Kelsey Piersol
- Department of Kinesiology & Health, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
- Center of Alcohol & Substance Use Studies, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
| | - Ian Frazier
- Department of Kinesiology & Health, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
- Center of Alcohol & Substance Use Studies, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
| | - Jennifer F. Buckman
- Department of Kinesiology & Health, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
- Center of Alcohol & Substance Use Studies, Rutgers University—New Brunswick, 08854 Piscataway, NJ United States
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Price JL, Bates ME, Pawlak AP, Uhouse SG, Todaro SM, Morgano J, Buckman JF. Use and perceived usefulness of a just-in-time resonance breathing intervention adjunct for substance use disorder: Contextual and physiological predictors. Front Psychiatry 2022; 13:945751. [PMID: 36159943 PMCID: PMC9490325 DOI: 10.3389/fpsyt.2022.945751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/29/2022] [Indexed: 11/20/2022] Open
Abstract
Craving for alcohol and other drugs is often described as a momentary hyperarousal state that interferes with one's ability to use top-down strategies. As such, it may be best interrupted 'in the moment' through bottom-up modulation. We recently reported that episodic resonance paced breathing (eRPB) delivered via mobile phone app as an add-on to outpatient treatment for substance use disorder (SUD) was effective at dampening craving over the course of an 8-week intervention (NCT#02579317). However, not all participants engaged with the eRPB app and there was high intra- and inter-individual variability in weekly ratings of usefulness. Here we examined baseline demographic, physiological, and psychiatric measures as well as time-varying exposure to positive, negative, and temptation craving triggers as predictors of frequency of eRPB app use and ratings of usefulness. Seventy-seven outpatient women were randomized to an eRPB (0.1 Hz) or a faster paced breathing sham (0.23 Hz) condition. Baseline measures were assessed within the first 3 weeks of treatment entry prior to randomization. App use frequency, ratings of usefulness, and trigger exposure were measured weekly throughout the intervention. Variables were entered into marginal means models with forward stepwise model selection and examined as predictors of use and usefulness. Frequent app use was associated with a lifetime alcohol use disorder (AUD) diagnosis (p = 0.026), higher ratings of usefulness (p < 0.001), and fewer exposures to positive triggers (e.g., celebration, socialization; p < 0.001). There was a trend-level association between frequency of app use and greater cardiovascular capacity at baseline (p = 0.088). Higher ratings of usefulness were associated with greater exposure to negative triggers (e.g,. loneliness, frustration; p < 0.001) and parasympathetic dysregulation at baseline (p = 0.05). A positive relationship between app use frequency and ratings of usefulness was present only in the eRPB group (p = 0.045). Matching ideal candidates and moments to an arousal modulation anti-craving intervention can help streamline screening and implementation of eRPB in the treatment of SUD. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT02579317, identifier NCT02579317.
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Affiliation(s)
- Julianne L. Price
- Cardiac Neuroscience Laboratory, Center of Alcohol and Substance Use Studies, Rutgers University—New Brunswick, Piscataway, NJ, United States
- Department of Kinesiology and Health, Rutgers University—New Brunswick, Piscataway, NJ, United States
| | - Marsha E. Bates
- Cardiac Neuroscience Laboratory, Center of Alcohol and Substance Use Studies, Rutgers University—New Brunswick, Piscataway, NJ, United States
- Department of Kinesiology and Health, Rutgers University—New Brunswick, Piscataway, NJ, United States
| | - Anthony P. Pawlak
- Cardiac Neuroscience Laboratory, Center of Alcohol and Substance Use Studies, Rutgers University—New Brunswick, Piscataway, NJ, United States
| | - Sarah Grace Uhouse
- Cardiac Neuroscience Laboratory, Center of Alcohol and Substance Use Studies, Rutgers University—New Brunswick, Piscataway, NJ, United States
- Department of Psychology, Rutgers University—New Brunswick, Piscataway, NJ, United States
| | - Sabrina M. Todaro
- Cardiac Neuroscience Laboratory, Center of Alcohol and Substance Use Studies, Rutgers University—New Brunswick, Piscataway, NJ, United States
- Department of Psychology, College of Health Sciences, University of Rhode Island, South Kingstown, RI, United States
| | - Julie Morgano
- Cardiac Neuroscience Laboratory, Center of Alcohol and Substance Use Studies, Rutgers University—New Brunswick, Piscataway, NJ, United States
| | - Jennifer F. Buckman
- Cardiac Neuroscience Laboratory, Center of Alcohol and Substance Use Studies, Rutgers University—New Brunswick, Piscataway, NJ, United States
- Department of Kinesiology and Health, Rutgers University—New Brunswick, Piscataway, NJ, United States
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