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LaFreniere LS, Newman MG. Savoring changes novel positive mindset targets of GAD treatment: Optimism, prioritizing positivity, kill-joy thinking, and worry mediation. Behav Res Ther 2024; 177:104541. [PMID: 38640622 DOI: 10.1016/j.brat.2024.104541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/21/2024]
Abstract
This study analyzed effects of savoring on unstudied positive mindset targets of generalized anxiety disorder (GAD) treatment (ClinicalTrials.gov: NCT05040061). 85 students with GAD were randomly assigned to one of two ecological momentary interventions (EMIs) on smartphone for seven days. The SkillJoy EMI promoted practices for savoring positive emotions. An active control EMI mirrored SkillJoy, yet did not include savoring or positive emotion. Optimism, worry, kill-joy thinking (lessening positive emotion with cognition), and prioritization of positive emotion activities and goals were assessed at pre-trial, eighth-day, post-trial, and 30th-day follow-up. Savoring was assessed pre-trial and fifth-day mid-trial. Longitudinal linear mixed models and simple slope analyses examined change between and within conditions. Bias-corrected bootstrapping path analysis examined mediation of worry change by increased savoring. SkillJoy led to significantly greater increases in both optimism and prioritizing positivity than the control from pre-trial to post-trial and pre-trial to follow-up. Both interventions significantly reduced kill-joy thinking at both timepoints with Skilljoy leading to marginally greater change at post-trial. Pre- to mid-trial increases in savoring mediated the relationships between treatment condition and reductions in worry at both post-trial and follow-up.
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Affiliation(s)
- Lucas S LaFreniere
- Department of Psychology, Skidmore College. United States; Department of Psychology, Pennsylvania State University. United States.
| | - Michelle G Newman
- Department of Psychology, Pennsylvania State University. United States
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Moitra E, Amaral TM, Benz MB, Cambow S, Elwy AR, Kunicki ZJ, Lu Z, Rafferty NS, Rabasco A, Rossi R, Schatten HT, Gaudiano BA. A Hybrid Type 1 trial of a multi-component mHealth intervention to improve post-hospital transitions of care for patients with serious mental illness: Study protocol. Contemp Clin Trials 2024; 139:107481. [PMID: 38431134 PMCID: PMC10960682 DOI: 10.1016/j.cct.2024.107481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/18/2023] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The transition from acute (e.g., psychiatric hospitalization) to outpatient care is associated with increased risk for rehospitalization, treatment disengagement, and suicide among people with serious mental illness (SMI). Mobile interventions (i.e., mHealth) have the potential to increase monitoring and improve coping post-acute care for this population. This protocol paper describes a Hybrid Type 1 effectiveness-implementation study, in which a randomized controlled trial will be conducted to determine the effectiveness of a multi-component mHealth intervention (tFOCUS) for improving outcomes for adults with SMI transitioning from acute to outpatient care. METHODS Adults meeting criteria for schizophrenia-spectrum or major mood disorders (n = 180) will be recruited from a psychiatric hospital and randomized to treatment-as-usual (TAU) plus standard discharge planning and aftercare (CHECK-IN) or TAU plus tFOCUS. tFOCUS is a 12-week intervention, consisting of: (a) a patient-facing mHealth smartphone app with daily self-assessment prompts and targeted coping strategies; (b) a clinician-facing web dashboard; and, (c) mHealth aftercare advisors, who will conduct brief post-hospital clinical calls with patients (e.g., safety concerns, treatment engagement) and encourage app use. Follow-ups will be conducted at 6-, 12-, and 24-weeks post-discharge to assess primary and secondary outcomes, as well as target mechanisms. We also will assess barriers and facilitators to future implementation of tFOCUS via qualitative interviews of stakeholders and input from a Community Advisory Board throughout the project. CONCLUSIONS Information gathered during this project, in combination with successful study outcomes, will inform a potential tFOCUS intervention scale-up across a range of psychiatric hospitals and healthcare systems. CLINICALTRIALS govregistration: NCT05703412.
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Affiliation(s)
- Ethan Moitra
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
| | - Toni M Amaral
- Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA
| | - Madeline B Benz
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA
| | - Simranjeet Cambow
- Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA
| | - A Rani Elwy
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Zachary J Kunicki
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Zhengduo Lu
- Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA
| | - Neil S Rafferty
- Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA
| | - Ana Rabasco
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA
| | - Rita Rossi
- Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA
| | - Heather T Schatten
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA
| | - Brandon A Gaudiano
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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Zainal NH, Tan HH, Hong RY, Newman MG. Is a brief mindfulness ecological momentary intervention more efficacious than a self-monitoring app for social anxiety disorder? A randomized controlled trial. J Anxiety Disord 2024; 104:102858. [PMID: 38657408 DOI: 10.1016/j.janxdis.2024.102858] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 03/10/2024] [Accepted: 03/11/2024] [Indexed: 04/26/2024]
Abstract
Despite their proliferation, limited knowledge exists regarding possible benefits of brief mindfulness ecological momentary interventions (MEMIs) for social anxiety disorder (SAD). Propositions that MEMIs could alleviate SAD symptoms and related clinical outcomes remain untested. This trial evaluated a 14-day MEMI for SAD. Participants with self-reported SAD were randomized to MEMI (n = 96) or self-monitoring app (SM; n = 95). Whereas MEMI instructed mindfulness exercises, SM prompted only self-monitoring five times daily for 14 days. Participants completed state-level self-reports of depression, anxiety, and mindfulness pre-post-mindfulness practice and SAD symptoms, worry, depression severity, repetitive negative thinking, and trait mindfulness at pre-randomization, post-intervention, and 1-month follow-up (1MFU). Hierarchical linear modeling was conducted. The MEMI yielded statistically significantly larger improvements in momentary depression, anxiety, and mindfulness (Cohen's d = -0.10-0.11). Although no between-group effects emerged in alleviating SAD fear and avoidance, excessive worry, depression severity, repetitive negative thinking, and trait mindfulness (-0.13-0.15), within-group effects were significantly small-to-large from pre-post and pre-1MFU (-4.62-0.67). A significant reduction in depression severity occurred in MEMI (-0.63--0.60) but not SM (-0.31--0.29). Brief MEMI and SM yielded nondifferent sustained effects on SAD, comorbid symptoms, and risk factors, highlighting its potential value within stepped-care delivery settings.
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Affiliation(s)
- Nur Hani Zainal
- Harvard Medical School (HMS), Department of Health Care Policy, USA; National University of Singapore (NUS), Department of Psychology, USA.
| | - Hui Han Tan
- National University of Singapore (NUS), Department of Psychology, USA
| | - Ryan Y Hong
- National University of Singapore (NUS), Department of Psychology, USA
| | - Michelle G Newman
- The Pennsylvania State University (PSU), Department of Psychology, USA
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Porras-Segovia A, De Granda-Beltrán AM, Gallardo C, Abascal-Peiró S, Barrigón ML, Artés-Rodríguez A, López-Castroman J, Courtet P, Baca-García E. Smartphone-based safety plan for suicidal crisis: The SmartCrisis 2.0 pilot study. J Psychiatr Res 2024; 169:284-291. [PMID: 38065053 DOI: 10.1016/j.jpsychires.2023.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 01/15/2024]
Abstract
Here we present the findings of the pilot phase of the SmartCrisis 2.0 Randomized Clinical Trial. This pilot study aimed to explore the feasibility and acceptability of a safety plan contained in a smartphone app. Our sample consisted patients with a history of recent suicidal behaviour who installed a smartphone-based safety plan. To explore the satisfaction with of the safety plan, two patient satisfaction surveys were conducted: one qualitative and one quantitative. To explore the objective use of the safety plan, we gained access to texts contained in the safety plans completed by the patients. Participation rate was 77%, while 48.9% patients completed both satisfaction surveys at the end of the pilot phase. N = 105 successfully installed the safety plan. In a scale from 1 to 10, users rated the usefulness of the security plan at 7.4, the usability at 8.9, the degree to which they would recommend it to others at 8.6 and the overall satisfaction with the project including evaluations at 9.6. The most widely completed tab was warning signs. Feeling sad or lonely was the warning sign most commonly reported by patients. The second most completed tab was internal coping strategies. Walking or practicing any other exercise was the strategy most commonly resorted to. Our smartphone-based safety plan appears to be a feasible intervention. Data obtained from this pilot study showed high participation rates and high acceptability by patients. This, together with the general satisfaction with the project, supports its implementation in the clinical practice.
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Affiliation(s)
- Alejandro Porras-Segovia
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain; Departamento de Psiquiatría, Hospital Rey Juan Carlos Móstoles, Madrid, Spain
| | | | - Claudia Gallardo
- Facultad de Psicología General Sanitaria, Universidad de Villanueva, Madrid, Spain
| | - Sofía Abascal-Peiró
- Departamento de Psiquiatría, Hospital Rey Juan Carlos Móstoles, Madrid, Spain
| | - María Luisa Barrigón
- Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Antonio Artés-Rodríguez
- Department of Signal Theory and Communications, Universidad Carlos III de Madrid, Leganés, Madrid, Spain
| | | | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Montpellier, France
| | - Enrique Baca-García
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain; Departamento de Psiquiatría, Hospital Rey Juan Carlos Móstoles, Madrid, Spain; Departamento de Psiquiatría, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; Department of Emergency Psychiatry and Acute Care, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Montpellier, France; Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain; Departamento de Psiquiatría, Hospital Central de Villalba Villalba, Madrid, Spain; Departamento de Psiquiatría, Hospital Universitario Infanta Elena Valdemoro, Madrid, Spain; CIBERSAM, Research Group CB/07/09/0025, Madrid, Spain.
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Marciniak MA, Shanahan L, Yuen KSL, Veer IM, Walter H, Tuescher O, Kobylińska D, Kalisch R, Hermans E, Binder H, Kleim B. Burst versus continuous delivery design in digital mental health interventions: Evidence from a randomized clinical trial. Digit Health 2024; 10:20552076241249267. [PMID: 38698832 PMCID: PMC11064753 DOI: 10.1177/20552076241249267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/08/2024] [Indexed: 05/05/2024] Open
Abstract
Objective Digital mental health interventions delivered via smartphone-based apps effectively treat various conditions; however, optimizing their efficacy while minimizing participant burden remains a key challenge. In this study, we investigated the potential benefits of a burst delivery design (i.e. interventions delivered only in pre-defined time intervals) in comparison to the continuous delivery of interventions. Methods We randomly assigned 93 participants to the continuous delivery (CD) or burst delivery (BD) group. The CD group engaged in ReApp, a mobile app that increases positive cognitive reappraisal with a consistent delivery schedule that provides five prompts per day throughout the 3-week-long study, while the BD group received five daily prompts only in the first and third weeks of the study. Results No significant differences were found between the groups in terms of adherence, mental health outcomes (specifically depressive and anxiety symptoms), level of perceived stress, and perceived helpfulness of intervention. The BD group showed a significantly decreased perceived difficulty of intervention over time. Conclusions The results suggest that the burst delivery may be as suitable for digital mental health interventions as the continuous delivery. The perceived difficulty of the intervention declined more steeply for the BD group, indicating that it improved the feasibility of the positive cognitive reappraisal intervention without hurting its efficacy. This outcome may inform the design of less burdensome interventions with improved outcomes in future research.
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Affiliation(s)
- Marta Anna Marciniak
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital (PUK), University of Zurich, Zurich, Switzerland
| | - Lilly Shanahan
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Kenneth S L Yuen
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Ilya Milos Veer
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands; Research Division of Mind and Brain, Department of Psychiatry and Psychotherapy CCM
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Henrik Walter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Oliver Tuescher
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
- Institute for Molecular Biology (IMB), Mainz, Germany
| | | | - Raffael Kalisch
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Erno Hermans
- Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands
| | - Harald Binder
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Freiburg Center for Data Analysis and Modelling, University of Freiburg, Freiburg, Germany
| | - Birgit Kleim
- Freiburg Center for Data Analysis and Modelling, University of Freiburg, Freiburg, Germany
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Darharaj M, Roshanpajouh M, Amini M, Shrier LA, Habibi Asgarabad M. The effectiveness of mobile-based ecological momentary motivational enhancement therapy in reducing craving and severity of cannabis use disorder: Study protocol for a randomized controlled trial. Internet Interv 2023; 34:100669. [PMID: 37746638 PMCID: PMC10514405 DOI: 10.1016/j.invent.2023.100669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/30/2023] [Accepted: 09/16/2023] [Indexed: 09/26/2023] Open
Abstract
Objective This study aims to investigate the effectiveness of Ecological Momentary Motivational Enhancement Therapy (EM-MET) in reducing craving and severity of Cannabis Use Disorder (CUD) among young adults. Methods This multicenter, single-blinded randomized controlled trial (RCT) will be conducted over a period of 11 weeks. Eighty patients with CUD will be randomly assigned to two equal-sized parallel groups, either the Motivational Enhancement Therapy (MET) group or the EM-MET group. All participants will receive four individual face-to-face sessions of MET (twice a week). The MET group will not receive any other treatments after these sessions; however, in the EM-MET group, the top triggers of patients will be assessed using mobile-based Ecological Momentary Assessment (EMA) five times a day within three weeks (after face-to-face sessions) and they will receive a call from the therapist who provides them with EM-MET (in the form of an emergency telephone helpline) as soon as they report experiencing triggers of cannabis use that are assessed using EMA in their everyday lives. Primary outcomes including CUD severity and the severity of craving will be evaluated using the Leeds Dependence Questionnaire and the Self-efficacy and Temptation Scale, respectively. These assessments will be conducted at pre-treatment, post-treatment, and a six-week follow-up. Discussion If proven feasible and effective, the results of this study will offer clinicians an evidence-based treatment approach to address craving and dependency in patients with CUD. Moreover, these patients will receive effective treatment in real time and in real life, when and where it is most needed. However, it is important to consider the limitations of this study, such as the specific population studied in Tehran, Iran, which may affect the generalizability of the results. Nevertheless, the implementation of Ecological Momentary Interventions (EMIs) in real-life settings holds promise for timely and effective treatment.Trial registration: This trial was registered in the Iranian Registry of Clinical Trials on 21 February 2023. Registry No. IRCT20221224056908N1.
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Affiliation(s)
- Mohammad Darharaj
- Addiction Department, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Roshanpajouh
- Addiction Department, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Amini
- Addiction Department, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Lydia A. Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Mojtaba Habibi Asgarabad
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
- Positive Youth Development Lab, Human Development & Family Sciences, Texas Tech University, TX, USA
- Center of Excellence in Cognitive Neuropsychology, Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
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Eghdami S, Ahmadkhaniha HR, Baradaran HR, Hirbod-Mobarakeh A. Ecological momentary interventions for smoking cessation: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1431-1445. [PMID: 37269310 DOI: 10.1007/s00127-023-02503-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/25/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Tobacco use is an important cause of preventable mortality and morbidity worldwide. Only 7% of smokers successfully quit annually, despite numerous evidence-based smoking cessation treatments. An important reason for failure is barriers to accessing appropriate smoking cessation interventions, which can be minimized by technology-delivered interventions, such as ecological momentary interventions. Ecological momentary interventions provide the right type and intensity of treatment in real time, based on ecological momentary assessments of relevant variables. The aim of this review was to assess the effectiveness of ecological momentary interventions in smoking cessation. METHODS We searched MEDLINE, Scopus, CENTRAL, psychINFO, and ProQuest without applying any filters on 19 September, 2022. One author screened search results for obvious irrelevant and duplicate studies. The remaining studies were independently reviewed by two authors to exclude irrelevant studies, and then they extracted data from the included studies. We collated study findings, transformed data into a common rubric, and calculated a weighted treatment effect across studies using Review Manager 5. FINDINGS We analyzed 10 studies with a total of 2391 participants. Assessment methods included exhaled CO analyzers, bidirectional SMS, data input in apps, and hand movement detection. Interventions were based on acceptance and commitment therapy and cognitive behavioral therapy. Smoking abstinence was significantly higher in participants of intervention groups compared to control groups (RR = 1.24; 95% CI 1.07-1.44, P = 0.004; I2 = 0%). CONCLUSION Ecological momentary intervention is a novel area of research in behavioral science. The results of this systematic review based on the available literature suggest that these interventions could be beneficial for smoking cessation.
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Affiliation(s)
- Shayan Eghdami
- Research Committee, School of Medicine, Iran University of Medical Sciences, Hemat Highway, Next to Milad Tower, Tehran, 14535, Iran.
| | - Hamid R Ahmadkhaniha
- Research Center for Addiction and Risky Behaviors, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid R Baradaran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Armin Hirbod-Mobarakeh
- Research Center for Addiction and Risky Behaviors, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Hirbod Psychiatric and Psychologic Club (BAVAR), Tehran, Iran
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Dowling NA, Rodda SN, Merkouris SS. Applying the Just-In-Time Adaptive Intervention Framework to the Development of Gambling Interventions. J Gambl Stud 2023:10.1007/s10899-023-10250-x. [PMID: 37659031 DOI: 10.1007/s10899-023-10250-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 09/05/2023]
Abstract
Just-In-Time Adaptive Interventions (JITAIs) are emerging "push" mHealth interventions that provide the right type, timing, and amount of support to address the dynamically-changing needs for each individual. Although JITAIs are well-suited to the delivery of interventions for the addictions, few are available to support gambling behaviour change. We therefore developed GamblingLess: In-The-Moment and Gambling Habit Hacker, two smartphone-delivered JITAIs that differ with respect to their target populations, theoretical underpinnings, and decision rules. We aim to describe the decisions, methods, and tools we used to design these two treatments, with a view to providing guidance to addiction researchers who wish to develop JITAIs in the future. Specifically, we describe how we applied a comprehensive, organising scientific framework to define the problem, define just-in-time in the context of the identified problem, and formulate the adaptation strategies. While JITAIs appear to be a promising design in addiction intervention science, we describe several key challenges that arose during development, particularly in relation to applying micro-randomised trials to their evaluation, and offer recommendations for future research. Issues including evaluation considerations, integrating on-demand intervention content, intervention optimisation, combining active and passive assessments, incorporating human facilitation, adding cost-effectiveness evaluations, and redevelopment as transdiagnostic interventions are discussed.
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Affiliation(s)
- Nicki A Dowling
- School of Psychology, Deakin University, Geelong, Australia.
- Melbourne Graduate School of Education, University of Melbourne, Parkville, Australia.
| | - Simone N Rodda
- School of Psychology, Deakin University, Geelong, Australia
- Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
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Bögemann SA, Riepenhausen A, Puhlmann LMC, Bar S, Hermsen EJC, Mituniewicz J, Reppmann ZC, Uściƚko A, van Leeuwen JMC, Wackerhagen C, Yuen KSL, Zerban M, Weermeijer J, Marciniak MA, Mor N, van Kraaij A, Köber G, Pooseh S, Koval P, Arias-Vásquez A, Binder H, De Raedt W, Kleim B, Myin-Germeys I, Roelofs K, Timmer J, Tüscher O, Hendler T, Kobylińska D, Veer IM, Kalisch R, Hermans EJ, Walter H. Investigating two mobile just-in-time adaptive interventions to foster psychological resilience: research protocol of the DynaM-INT study. BMC Psychol 2023; 11:245. [PMID: 37626397 PMCID: PMC10464364 DOI: 10.1186/s40359-023-01249-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/14/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Stress-related disorders such as anxiety and depression are highly prevalent and cause a tremendous burden for affected individuals and society. In order to improve prevention strategies, knowledge regarding resilience mechanisms and ways to boost them is highly needed. In the Dynamic Modelling of Resilience - interventional multicenter study (DynaM-INT), we will conduct a large-scale feasibility and preliminary efficacy test for two mobile- and wearable-based just-in-time adaptive interventions (JITAIs), designed to target putative resilience mechanisms. Deep participant phenotyping at baseline serves to identify individual predictors for intervention success in terms of target engagement and stress resilience. METHODS DynaM-INT aims to recruit N = 250 healthy but vulnerable young adults in the transition phase between adolescence and adulthood (18-27 years) across five research sites (Berlin, Mainz, Nijmegen, Tel Aviv, and Warsaw). Participants are included if they report at least three negative burdensome past life events and show increased levels of internalizing symptoms while not being affected by any major mental disorder. Participants are characterized in a multimodal baseline phase, which includes neuropsychological tests, neuroimaging, bio-samples, sociodemographic and psychological questionnaires, a video-recorded interview, as well as ecological momentary assessments (EMA) and ecological physiological assessments (EPA). Subsequently, participants are randomly assigned to one of two ecological momentary interventions (EMIs), targeting either positive cognitive reappraisal or reward sensitivity. During the following intervention phase, participants' stress responses are tracked using EMA and EPA, and JITAIs are triggered if an individually calibrated stress threshold is crossed. In a three-month-long follow-up phase, parts of the baseline characterization phase are repeated. Throughout the entire study, stressor exposure and mental health are regularly monitored to calculate stressor reactivity as a proxy for outcome resilience. The online monitoring questionnaires and the repetition of the baseline questionnaires also serve to assess target engagement. DISCUSSION The DynaM-INT study intends to advance the field of resilience research by feasibility-testing two new mechanistically targeted JITAIs that aim at increasing individual stress resilience and identifying predictors for successful intervention response. Determining these predictors is an important step toward future randomized controlled trials to establish the efficacy of these interventions.
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Grants
- 777084 European Union's Horizon 2020 research and innovation program
- 777084 European Union's Horizon 2020 research and innovation program
- 777084 European Union's Horizon 2020 research and innovation program
- 777084 European Union's Horizon 2020 research and innovation program
- 777084 European Union's Horizon 2020 research and innovation program
- 777084 European Union's Horizon 2020 research and innovation program
- 777084 European Union's Horizon 2020 research and innovation program
- 777084 European Union's Horizon 2020 research and innovation program
- 777084 European Union's Horizon 2020 research and innovation program
- 777084 European Union's Horizon 2020 research and innovation program
- 777084 European Union's Horizon 2020 research and innovation program
- 777084 European Union's Horizon 2020 research and innovation program
- 777084 European Union's Horizon 2020 research and innovation program
- 777084 European Union's Horizon 2020 research and innovation program
- 777084 European Union's Horizon 2020 research and innovation program
- 777084 European Union's Horizon 2020 research and innovation program
- DFG Grant CRC 1193, subprojects B01, C01, C04, Z03 Deutsche Forschungsgemeinschaft
- DFG Grant CRC 1193, subprojects B01, C01, C04, Z03 Deutsche Forschungsgemeinschaft
- 01KX2021 German Federal Ministry for Education and Research (BMBF) as part of the Network for University Medicine
- MARP program, DRZ program, Leibniz Institute for Resilience Research State of Rhineland-Palatinate, Germany
- MARP program, DRZ program, Leibniz Institute for Resilience Research State of Rhineland-Palatinate, Germany
- European Union’s Horizon 2020 research and innovation program
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Affiliation(s)
- S A Bögemann
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Kapittelweg 29, Nijmegen, 6525 EN, The Netherlands.
| | - A Riepenhausen
- Research Division of Mind and Brain, Department of Psychiatry and Neurosciences CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Faculty of Philosophy, Berlin School of Mind and Brain, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - L M C Puhlmann
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - S Bar
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - E J C Hermsen
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Kapittelweg 29, Nijmegen, 6525 EN, The Netherlands
| | - J Mituniewicz
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Z C Reppmann
- Research Division of Mind and Brain, Department of Psychiatry and Neurosciences CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - A Uściƚko
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - J M C van Leeuwen
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Kapittelweg 29, Nijmegen, 6525 EN, The Netherlands
| | - C Wackerhagen
- Research Division of Mind and Brain, Department of Psychiatry and Neurosciences CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - K S L Yuen
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - M Zerban
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - J Weermeijer
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Louvain, Belgium
| | - M A Marciniak
- Division of Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital (PUK), University of Zurich, Zurich, Switzerland
| | - N Mor
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A van Kraaij
- OnePlanet Research Center, Wageningen, The Netherlands
| | - G Köber
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Freiburg Center for Data Analysis and Modelling, University of Freiburg, Freiburg, Germany
| | - S Pooseh
- Freiburg Center for Data Analysis and Modelling, University of Freiburg, Freiburg, Germany
| | - P Koval
- Melbourne School of Psychological Sciences, The University of Melbourne, Vic, 3010, Australia
| | - A Arias-Vásquez
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Kapittelweg 29, Nijmegen, 6525 EN, The Netherlands
| | - H Binder
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Freiburg Center for Data Analysis and Modelling, University of Freiburg, Freiburg, Germany
| | - W De Raedt
- Life Sciences Department, Imec, Louvain, Belgium
| | - B Kleim
- Division of Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital (PUK), University of Zurich, Zurich, Switzerland
| | - I Myin-Germeys
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Louvain, Belgium
| | - K Roelofs
- Center for Cognitive Neuroimaging, Donders Institute for Brain Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - J Timmer
- Freiburg Center for Data Analysis and Modelling, University of Freiburg, Freiburg, Germany
- Institute of Physics, University of Freiburg, Freiburg, Germany
- Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - O Tüscher
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Department of Psychiatry and Psychotherapy, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - T Hendler
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- School of Psychological Science, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - D Kobylińska
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - I M Veer
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - R Kalisch
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - E J Hermans
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Kapittelweg 29, Nijmegen, 6525 EN, The Netherlands
| | - H Walter
- Research Division of Mind and Brain, Department of Psychiatry and Neurosciences CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Faculty of Philosophy, Berlin School of Mind and Brain, Humboldt-Universität Zu Berlin, Berlin, Germany
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10
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Gual-Montolio P, Suso-Ribera C, García-Palacios A, Castilla D, Zaragoza I, Bretón-López J. Enhancing Internet-based psychotherapy for adults with emotional disorders using ecological momentary assessments and interventions: Study protocol of a feasibility trial with "My EMI, Emotional Well-being" app. Internet Interv 2023; 31:100601. [PMID: 36686334 PMCID: PMC9852876 DOI: 10.1016/j.invent.2023.100601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Emotional disorders are the most frequent mental health problems globally. To ensure the dissemination of psychological treatments for these conditions, novel forms of delivery (e.g., Internet or mobile apps) and more scalable forms of psychotherapy (e.g., transdiagnostic interventions) have become increasingly popular. Research, however, shows that a significant number of patients, around 40 % according to some studies, do not respond to the interventions as expected (i.e., not-on-track patients). Ecological momentary assessments (EMAs) and ecological momentary interventions (EMIs) could simplify tailoring treatments to the patients' progress and rapidly respond to undesired outcomes during psychotherapy. Therefore, these would facilitate measurement-based care with little therapist involvement. This study aims to explore the feasibility of an app-based system called My EMI, Emotional Well-being for people with emotional disorders. According to daily EMAs, the app will provide personalized EMIs while participants receive a self-applied online transdiagnostic treatment. The app will be used as an add-tool to the online intervention to address emotion dysregulation, foster adherence, and reinforce contents. The current study describes the study protocol for this trial. METHOD AND ANALYSIS A single-group, open trial design will be used. Participants will be 30 adults suffering from emotional disorders. Primary outcomes will be app usability, acceptability, and response rates. Secondary outcomes will be either evaluated in Qualtrics at pre-treatment, post-treatment, and 3-month follow-up (depression and anxiety severity, and transdiagnostic dimensions of emotional disorders) or daily throughout the study with the app (EMAs of mood and five transdiagnostic mechanisms of therapeutic change). EMIs will consist of brief, evidence-based transdiagnostic CBT digital content (images, infographics, or videos) delivered just-in-time. Only if problems persist, short phone calls or episodic videocalls will be conducted. The Ethics Committee of the Jaume I University approved the study and all its procedures (CD/111/2021) in December 2021. DISCUSSION Identifying personalized and scalable interventions is paramount to improve mental health care, especially its accessibility, and to reduce the psychological distress of people with mental health problems. Feasibility data of the app (EMA and EMI system) supported by a self-applied online transdiagnostic intervention will be important to explore whether this modern approach is a real option to move forward personalized psychological interventions for persons with emotional disorders. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05109780. Registered 05 November 2021, https://clinicaltrials.gov/ct2/show/NCT05109780.
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Affiliation(s)
- Patricia Gual-Montolio
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, 12071 Castellon de la Plana, Spain
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, 12071 Castellon de la Plana, Spain,CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain,Corresponding author at: Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, 12071 Castellon de la Plana, Spain.
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, 12071 Castellon de la Plana, Spain,CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Diana Castilla
- Department of Personality, Assessment, and Psychological Treatments, Universidad de Valencia, 46010 Valencia, Spain,CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Irene Zaragoza
- Department of Personality, Assessment, and Psychological Treatments, Universidad de Valencia, 46010 Valencia, Spain,CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Juana Bretón-López
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, 12071 Castellon de la Plana, Spain,CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
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11
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Myin-Germeys I, van Aubel E, Vaessen T, Steinhart H, Klippel A, Lafit G, Viechtbauer W, Batink T, van Winkel R, van der Gaag M, van Amelsvoort T, Marcelis M, Schirmbeck F, de Haan L, Reininghaus U. Efficacy of Acceptance and Commitment Therapy in Daily Life in Early Psychosis: Results from the Multi-Center INTERACT Randomized Controlled Trial. Psychother Psychosom 2022; 91:411-423. [PMID: 35306502 DOI: 10.1159/000522274] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/22/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION/OBJECTIVE This study aimed to investigate efficacy of Acceptance and Commitment Therapy in Daily Life (ACT-DL), combining face-to-face therapy with an Ecological Momentary Intervention (EMI), in addition to treatment as usual (TAU) for psychotic distress, in comparison to TAU. METHODS Individuals aged 15-65 years with clinically established ultra-high risk or first episode of psychosis were randomly assigned to TAU or ACT-DL+TAU. ACT-DL+TAU consisted of 8 ACT-sessions augmented with an EMI-app. The primary outcome was psychotic distress assessed with the Comprehensive Assessment scale of At Risk Mental State (CAARMS) at post-intervention and 6- and 12-month follow-up. Secondary outcomes were functioning, symptom severity, and momentary psychotic distress. We performed multivariate mixed models according to intent-to-treat principles. RESULTS Between June 1, 2015 and December 31, 2018, 668 participants were referred, of whom 148 were randomized to ACT-DL+TAU (n = 71) or TAU (n = 77). One hundred and fifteen (78%) provided primary outcome data at least at one follow-up assessment. There was no evidence of greater reduction in the primary outcome measure CAARMS distress in ACT-DL+TAU compared to TAU (χ2(3) = 2.36; p = 0.50). However, out of the tested secondary outcomes, global functioning (χ2(3) = 9.05; p = 0.033), and negative symptoms (χ2(3) = 19.91; p<0.001) improved in ACT-DL+TAU compared to TAU, as did momentary psychotic distress (χ2(3) = 21.56; p < 0.001). CONCLUSIONS INTERACT did not support a significant effect of ACT-DL over TAU on the primary outcome measure of psychotic distress as assessed with the CAARMS. Although significant improvements were found for some secondary outcome measures, further replication studies are needed to confirm the strength and specificity of these effects.
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Affiliation(s)
- Inez Myin-Germeys
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Evelyne van Aubel
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Thomas Vaessen
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Henrietta Steinhart
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Annelie Klippel
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Faculty of Psychology, Open University, Heerlen, The Netherlands
| | - Ginette Lafit
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium.,Faculty of Psychology and Educational Sciences, Research Group of Quantitative Psychology and Individual Differences, KU Leuven, Leuven, Belgium
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Tim Batink
- Faculty of Psychology, Open University, Heerlen, The Netherlands
| | - Ruud van Winkel
- Department of Neurosciences, Psychiatry Research Group, Center for Clinical Psychiatry, KU Leuven, Leuven, Belgium
| | - Mark van der Gaag
- Department of Clinical Psychology, VU Amsterdam, Amsterdam, The Netherlands
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Machteld Marcelis
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, The Netherlands
| | - Frederike Schirmbeck
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,ESRC Centre for Society and Mental Health and Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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12
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Castilla D, Navarro-Haro MV, Suso-Ribera C, Díaz-García A, Zaragoza I, García-Palacios A. Ecological momentary intervention to enhance emotion regulation in healthcare workers via smartphone: a randomized controlled trial protocol. BMC Psychiatry 2022; 22:164. [PMID: 35248015 PMCID: PMC8897724 DOI: 10.1186/s12888-022-03800-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/19/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND CUIDA-TE is an APP that offers transdiagnostic cognitive behavioral therapy focused on enhancing emotion regulation. As a novelty, it incorporates ecological momentary interventions (EMI), which can provide psychological support in real time, when suffering arises. The main goal of the study is to evaluate the efficacy of CUIDA-TE to improve emotion regulation in healthcare workers, a population that has been particularly emotionally impacted by the COVID-19 pandemic. METHODS In this three-arm, randomized controlled trial (RCT) the study sample will be composed of a minimum of 174 healthcare workers. They will be randomly assigned to a 2-month EMI group (CUIDA-TE APP, n ≥ 58), a 2-month ecological momentary assessment (EMA) only group (MONITOR EMOCIONAL APP, n ≥ 58), or a wait-list control group (no daily monitoring nor intervention, n ≥ 58). CUIDA-TE will provide EMI if EMA reveals emotional problems, poor sleep quality/quantity, burnout, stress, or low perceived self-efficacy when regulating emotions. Depression will be the primary outcome. Secondary outcomes will include emotion regulation, quality of life, and resilience. Treatment acceptance and usability will also be measured. Primary and secondary outcomes will be obtained at pre- and post-intervention measurements, and at the 3-month follow-up for all groups. DISCUSSION To our knowledge, this is the first RCT that evaluates the efficacy of an APP-based EMI to improve emotion regulation skills in healthcare workers. This type of intervention might ultimately help disseminate treatments and reach a larger number of individuals than traditional face-to-face individual therapies. TRIAL REGISTRATION ClinicalTrial.gov : NCT04958941 Registered 7 Jun 2021. STUDY STATUS Participant recruitment has not started.
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Affiliation(s)
- Diana Castilla
- grid.5338.d0000 0001 2173 938XDepartment of Personality, Evaluation and Psychological Treatment, University of Valencia, Avenida Blasco Ibáñez, 21, 46010 Valencia, Spain ,grid.413448.e0000 0000 9314 1427CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), ISCIII CB06/03/0052, Instituto Salud Carlos III, 28029 Madrid, Spain
| | - María Vicenta Navarro-Haro
- Department of Psychology and Sociology, University of Zaragoza, Calle Atarazana, 4, 44003 C/ Ciudad Escolar, s/n, 44001, Teruel, Spain. .,Instituto de Investigación Sanitaria Aragón, Avenida de San Juan Bosco, 13, 50009, Zaragoza, Spain.
| | - Carlos Suso-Ribera
- grid.413448.e0000 0000 9314 1427CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), ISCIII CB06/03/0052, Instituto Salud Carlos III, 28029 Madrid, Spain ,grid.9612.c0000 0001 1957 9153Department of Basic Psychology, Clinical Psychology and Psychobiology, Universitat Jaume I, Avenida de Vicent Sos Baynat, s/n, 12071 Castellón de la Plana, Spain
| | - Amanda Díaz-García
- grid.11205.370000 0001 2152 8769Department of Psychology and Sociology, University of Zaragoza, Calle Atarazana, 4, 44003 C/ Ciudad Escolar, s/n, 44001 Teruel, Spain
| | - Irene Zaragoza
- grid.413448.e0000 0000 9314 1427CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), ISCIII CB06/03/0052, Instituto Salud Carlos III, 28029 Madrid, Spain
| | - Azucena García-Palacios
- grid.413448.e0000 0000 9314 1427CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), ISCIII CB06/03/0052, Instituto Salud Carlos III, 28029 Madrid, Spain ,grid.9612.c0000 0001 1957 9153Department of Basic Psychology, Clinical Psychology and Psychobiology, Universitat Jaume I, Avenida de Vicent Sos Baynat, s/n, 12071 Castellón de la Plana, Spain
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Daemen M, Postma MR, Lindauer R, Hoes-van der Meulen I, Nieman D, Delespaul P, Breedvelt JJF, van der Gaag M, Viechtbauer W, Schruers K, van den Berg D, Bockting C, van Amelsvoort T, Reininghaus U. Efficacy of a transdiagnostic ecological momentary intervention for improving self-esteem (SELFIE) in youth exposed to childhood adversity: study protocol for a multi-center randomized controlled trial. Trials 2021; 22:641. [PMID: 34538272 PMCID: PMC8449997 DOI: 10.1186/s13063-021-05585-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Targeting low self-esteem in youth exposed to childhood adversity is a promising strategy for preventing adult mental disorder, but psychological help remains difficult to access and accept for youth, calling for novel, youth-friendly approaches. Mobile Health (mHealth) and, most prominently, ecological momentary interventions (EMIs) provide a unique opportunity to deliver youth-friendly, personalized, real-time, guided self-help interventions. The aim of this study is to investigate the efficacy of a novel, accessible, transdiagnostic ecological momentary intervention for improving self-esteem ('SELFIE') in youth with prior exposure to childhood adversity. METHODS/DESIGN In a parallel-group, assessor-blind, multi-center randomized controlled trial, individuals aged 12-26 years with prior exposure to childhood adversity and low self-esteem will be randomly allocated to SELFIE in addition to treatment as usual (TAU) as the experimental condition or the control condition of TAU only, which will include access to all standard health care. SELFIE is a digital guided self-help intervention administered through a smartphone-based app to allow for interactive, personalized, real-time and real-world transfer of intervention components in individuals' daily lives, blended with three training sessions delivered by trained mental health professionals over a 6-week period. Outcomes will be assessed at baseline, post-intervention, and 6-month follow-up by blinded assessors. The primary outcome will be the level of self-esteem as measured with the Rosenberg Self-Esteem Scale (RSES). DISCUSSION The current study is the first to establish the efficacy of an EMI focusing on improving self-esteem transdiagnostically in youth exposed to childhood adversity. If this trial provides evidence on the efficacy of SELFIE, it has significant potential to contribute to minimizing the deleterious impact of childhood adversity and, thereby, preventing the development of mental disorder later in life. TRIAL REGISTRATION Netherlands Trial Register NL7129 (NTR7475 ). Registered on 9 November 2018.
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Affiliation(s)
- Maud Daemen
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Mary Rose Postma
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Mondriaan, Maastricht, The Netherlands
| | - Ramon Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, location Academic Medical Center, Amsterdam, The Netherlands
- Levvel, academic centre for child and adolescent psychiatry, Amsterdam, The Netherlands
| | | | - Dorien Nieman
- Department of Psychiatry, Amsterdam University Medical Centers (location AMC), Amsterdam, The Netherlands
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Josefien Johanna Froukje Breedvelt
- Department of Psychiatry, Amsterdam University Medical Centers (location AMC), Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
- Parnassia Academy, The Hague, The Netherlands
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Koen Schruers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Health Psychology, Faculty of Psychology, University of Leuven, Leuven, Belgium
| | - David van den Berg
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
- Parnassia Academy, The Hague, The Netherlands
| | - Claudi Bockting
- Department of Psychiatry, Amsterdam University Medical Centers (location AMC), Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Mondriaan, Maastricht, The Netherlands
| | - Ulrich Reininghaus
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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14
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Everitt N, Broadbent J, Richardson B, Smyth JM, Heron K, Teague S, Fuller-Tyszkiewicz M. Exploring the features of an app-based just-in-time intervention for depression. J Affect Disord 2021; 291:279-287. [PMID: 34058610 DOI: 10.1016/j.jad.2021.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/09/2021] [Accepted: 05/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Technological advancements make it possible to deliver depression interventions via smartphone applications ("Apps"), including those that deliver content "just-in-time" (e.g., in response to acute negative mood states). This study examined whether an app-based just-in-time intervention (ImproveYourMood+) decreased depressive symptoms, and whether the following features were related to symptom improvement: micro-intervention content, mood monitoring, and just-in-time prompts to use content. METHODS Participants (n = 235) from the general population who self-identified as wanting to improve their negative mood were randomised to a waitlist control group (n = 55) or one of three intervention groups: MoodTracker (monitoring-only, n = 58), ImproveYourMood (monitoring and content; n = 62), or ImproveYourMood+ (monitoring, content, and prompts; n = 60). The active intervention phase was 3 weeks. Depressive and anxiety symptoms, and negative automatic thoughts were assessed at baseline, immediately post-intervention, and one month following post-intervention. RESULTS Linear mixed modelling revealed greater declines over time in depressive and anxiety symptoms and negative automatic thoughts for the ImproveYourMood group (standardized mean differences [SMDs] ranged from .32 to .40) and improves for the ImproveYourMood+ group for negative automatic thoughts (SMDs ≥ .37) compared to the waitlist control group. No between-group differences were observed between the MoodTracker and control groups (SMDs = .04-.23). User experience appeared to be superior in more comprehensive/multi-modal versions. LIMITATIONS The study employed a naturalistic design, whereby participants self-selected to utilise the program, did not complete eligibility assessments, and did not receive compensation. The study therefore attained considerable drop-out rate (~50% by the follow-up timepoints), potentially reflecting the usage patterns of real-world mental health apps. CONCLUSIONS The findings suggest that micro-interventions can be an effective way to reduce depressive symptoms both in the moment and 1-2 months later. Integration of micro-interventions with full treatment programs is a viable next step in micro-intervention research.
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Affiliation(s)
| | | | | | - Joshua M Smyth
- Departments of Biobehavioral Health and of Medicine, The Pennsylvania State University, United States
| | - Kristin Heron
- Department of Psychology, Old Dominion University & Virginia Consortium Program in Clinical Psychology, United States
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Rauschenberg C, Hirjak D, Ganslandt T, Schulte-Strathaus JCC, Schick A, Meyer-Lindenberg A, Reininghaus U. [Digital forms of service delivery for personalized crisis resolution and home treatment]. Nervenarzt 2021; 93:279-287. [PMID: 33730181 PMCID: PMC7966885 DOI: 10.1007/s00115-021-01100-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 12/14/2022]
Abstract
Hintergrund Die stationsäquivalente psychiatrische Behandlung (StäB) wurde 2018 als Krankenhausleistung für Menschen eingeführt, die die Kriterien einer stationären Behandlung erfüllen. Die rasanten Fortschritte im Bereich der Informations- und Kommunikationstechnologie bieten neue Chancen für innovative digitale Versorgungsangebote wie telemedizinische, eHealth- oder mHealth-Verfahren. Ziel der Arbeit Diese Übersichtsarbeit soll einen umfassenden Überblick über neue digitale Versorgungsformen geben, die zur Personalisierung der StäB bei schweren psychischen Erkrankungen beitragen und somit klinische und soziale Outcomes verbessern sowie direkte und indirekte Kosten reduzieren könnten. Methode Diese Arbeit basiert auf einer selektiven Literaturrecherche (Narratives Review). Ergebnisse Es wurden vier primäre digitale Versorgungsformen identifiziert, die in der StäB gewinnbringend genutzt werden könnten: (1) Kommunikation, Behandlungskontinuität und -flexibilität durch Online-Chat und Videotelefonie, (2) Monitoring von Symptomen und Verhaltensweisen in Echtzeit durch Anwendung des ambulatorischen Assessments („ecological momentary assessment“ [EMA]), (3) Nutzung multimodaler EMA-Daten für die Generierung von personalisiertem Feedback über subjektives Erleben und Verhaltensmuster sowie (4) auf Person, Moment und Kontext zugeschnittene, adaptive ambulatorische Interventionen („ecological momentary interventions“ [EMIs]). Diskussion Digitale Versorgungsformen haben erhebliches Potenzial die Effektivität und Kosteneffektivität der StäB zu steigern. Ein wichtiger nächster Schritt besteht darin, die Anwendung dieser Versorgungsformen im Bereich der StäB zu modellieren und deren Qualität aus Sicht der Patient*innen, Sicherheit und initiale Prozess- und Ergebnisqualität sowie Implementierungsbedingungen sorgfältig zu untersuchen.
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Affiliation(s)
- Christian Rauschenberg
- Abteilung Public Mental Health, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Niederlande
| | - Dusan Hirjak
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Thomas Ganslandt
- Heinrich-Lanz-Zentrum für Personalisierte Medizin, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Julia C C Schulte-Strathaus
- Abteilung Public Mental Health, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Anita Schick
- Abteilung Public Mental Health, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Andreas Meyer-Lindenberg
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Ulrich Reininghaus
- Abteilung Public Mental Health, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland. .,ESRC Centre for Society and Mental Health, King's College London, London, Großbritannien. .,Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, Großbritannien.
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Vogel RI, Nagler RH, Ahmed RL, Brown K, Luo X, Martinson BC, Lazovich D. UVR-sensor wearable device intervention to improve sun behaviors and reduce sunburns in melanoma survivors: study protocol of a parallel-group randomized controlled trial. Trials 2020; 21:959. [PMID: 33228807 PMCID: PMC7682122 DOI: 10.1186/s13063-020-04881-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/06/2020] [Indexed: 02/03/2023] Open
Abstract
Background Individuals who have been diagnosed with melanoma have more than a 9-fold increased risk of developing another melanoma. Ultraviolet radiation (UVR) exposure following a melanoma diagnosis can be modified to reduce risk of a new melanoma diagnosis. Yet research shows that many melanoma survivors do not report optimal sun protection practices. The objective of this study is to evaluate the effectiveness of a UVR-sensor wearable device to improve sun protection behaviors and reduce sunburns in a randomized controlled trial (RCT) in melanoma survivors. Methods We will conduct an RCT among 368 melanoma survivors in two waves (Summer 2020, Summer 2021). This approach allows for adequate recruitment of the required sample and potential improvements to recruitment, compliance, and retention strategies between waves. The intervention includes an informational brochure about sun protection behaviors and a commercially available UVR-sensor wearable device (Shade), which accurately measures UVR. The device, along with its associated mobile application, measures and stores UVR exposure. As UVR exposure accumulates, the device provides notifications to increase sun protection action. Survivors in the control group receive the device and a separate mobile application that does not provide notifications or summary UVR exposure data. Participants will be asked to wear the device for 12 weeks. They will complete surveys about their sun behaviors at study entry, every 4 weeks during the intervention, and 1 year later. At the end of the intervention period, intervention and control groups will be compared for differences in a summary measure of sun protection habits and experience of a sunburn. We will also measure self-reported physical activity, depression, and anxiety to examine potential unintended negative consequences of the intervention. Discussion The study intervention will be completed Fall 2021, with anticipated results available in 2022. If this intervention improves sun protection behaviors in melanoma survivors, these findings would support expanding the use of this technology with other populations at high risk for melanoma. Trial registration ClinicalTrials.gov NCT03927742. Registered on April 15, 2019.
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Affiliation(s)
- Rachel I Vogel
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA. .,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
| | - Rebekah H Nagler
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.,Hubbard School of Journalism & Mass Communication, University of Minnesota, Minneapolis, MN, USA
| | - Rehana L Ahmed
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.,Department of Dermatology, University of Minnesota, Minneapolis, MN, USA
| | - Katherine Brown
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Xianghua Luo
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.,Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Brian C Martinson
- HealthPartners Institute, Bloomington, MN, USA.,Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health System, Minneapolis, MN, USA.,Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - DeAnn Lazovich
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Meinlschmidt G, Tegethoff M, Belardi A, Stalujanis E, Oh M, Jung EK, Kim HC, Yoo SS, Lee JH. Personalized prediction of smartphone-based psychotherapeutic micro-intervention success using machine learning. J Affect Disord 2020; 264:430-7. [PMID: 31787419 DOI: 10.1016/j.jad.2019.11.071] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/18/2019] [Accepted: 11/12/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Tailoring healthcare to patients' individual needs is a central goal of precision medicine. Combining smartphone-based interventions with machine learning approaches may help attaining this goal. The aim of our study was to explore the predictability of the success of smartphone-based psychotherapeutic micro-interventions in eliciting mood changes using machine learning. METHODS Participants conducted daily smartphone-based psychotherapeutic micro-interventions, guided by short video clips, for 13 consecutive days. Participants chose one of four intervention techniques used in psychotherapeutic approaches. Mood changes were assessed using the Multidimensional Mood State Questionnaire. Micro-intervention success was predicted using random forest (RF) tree-based mixed-effects logistic regression models. Data from 27 participants were used, totaling 324 micro-interventions, randomly split 100 times into training and test samples, using within-subject and between-subject sampling. RESULTS Mood improved from pre- to post-intervention in 137 sessions (initial success-rate: 42.3%). The RF approach resulted in predictions of micro-intervention success significantly better than the initial success-rate within and between subjects (positive predictive value: 0.732 (95%-CI: 0.607; 0.820) and 0.698 (95%-CI: 0.564; 0.805), respectively). Prediction quality was highest using the RF approach within subjects (rand accuracy: 0.75 (95%-CI: 0.641; 0.840), Matthew's correlation coefficient: 0.483 (95%-CI: 0.323; 0.723)). LIMITATIONS The RF approach does not allow firm conclusions about the exact contribution of each factor to the algorithm's predictions. We included a limited number of predictors and did not compare whether predictability differed between psychotherapeutic techniques. CONCLUSIONS Our findings may pave the way for translation and encourage scrutinizing personalized prediction in the psychotherapeutic context to improve treatment efficacy.
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Smith KE, Juarascio A. From Ecological Momentary Assessment (EMA) to Ecological Momentary Intervention (EMI): Past and Future Directions for Ambulatory Assessment and Interventions in Eating Disorders. Curr Psychiatry Rep 2019; 21:53. [PMID: 31161276 DOI: 10.1007/s11920-019-1046-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Ambulatory assessment methods, including ecological momentary assessment (EMA), have often been used in eating disorders (EDs) to assess the type, frequency, and temporal sequencing of ED symptoms occurring in naturalistic environments. Relatedly, growing research in EDs has explored the utility of ecological momentary interventions (EMIs) to target ED symptoms. The aims of the present review were to (1) synthesize recent literature pertaining to ambulatory assessment/EMA and EMI in EDs, and (2) identify relevant limitations and future directions in these domains. RECENT FINDINGS With respect to ambulatory assessment and EMA, there has been substantial growth in the expansion of constructs assessed with EMA, the exploration of state- vs. trait-level processes, integration of objective and passive assessment approaches, and consideration of methodological issues. The EMI literature in EDs also continues to grow, though most of the recent research focuses on mobile health (mHealth) technologies with relatively minimal EMI components that adapt to momentary contextual information. Despite these encouraging advances, there remain several promising areas of ambulatory assessment research and clinical applications in EDs going forward. These include integration of passive data collection, use of EMA in treatment evaluation and design, evaluation of dynamic system processes, inclusion of diverse samples, and development and evaluation of adaptive, tailored EMIs such as just-in-time adaptive interventions. While much remains to be learned in each of these domains, the continual growth in mobile technology has potential to facilitate and refine our understanding of the nature of ED psychopathology and ultimately improve intervention approaches.
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Affiliation(s)
- Kathryn E Smith
- Center for Bio-behavioral Research, Sanford Research, Fargo, ND, USA. .,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.
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Colombo D, Palacios AG, Alvarez JF, Patané A, Semonella M, Cipresso P, Kwiatkowska M, Riva G, Botella C. Current state and future directions of technology-based ecological momentary assessments and interventions for major depressive disorder: protocol for a systematic review. Syst Rev 2018; 7:233. [PMID: 30545415 PMCID: PMC6293509 DOI: 10.1186/s13643-018-0899-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 11/27/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Ecological momentary assessments (EMAs) and ecological momentary interventions (EMIs) represent a novel approach for the assessment and delivery of psychological support to depressed patients in daily life. Beyond the classical paper-and-pencil daily diaries, the more recent progresses in Information and Communication Technologies (ICT) enabled researchers to bring all the needed processes together in only one device, i.e., response signaling, repeated symptom collection, information storage, secure data transfer, and psychological support delivery. Despite evidence showing the feasibility and acceptability of these techniques, EMAs are only beginning to be applied in real clinical practice, whether the development of EMIs for clinically depressed patients is still very limited. The objective of this systematic review is to provide the state of the art of technology-based EMAs and EMIs for major depressive disorder (MDD), with the aim of leading the way to possible future directions for the clinical practice. METHODS We will conduct a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Data sources will include two bibliographic databases, PubMed and Web of Science (Web of Knowledge), supplemented by searches for unpublished or ongoing studies. Eligible studies will report data for adult (≥ 18 years old) with a primary (both current and past) diagnosis of MDD, defined by a valid criterion standard. We will consider studies adopting technology-based EMAs and EMIs for the investigation and/or assessment of depression and for the delivery of a psychological intervention. We will exclude studies adopting paper-and-pencil tools. DISCUSSION The proposed systematic review will provide new insights on the advantages and benefits of adopting technology-based EMAs and EMIs for MDD in the traditional clinical practice, taking into consideration both clinical and technological issues. The potential of using sensors and biosensors along with machine learning for affective modeling will also be discussed.
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Affiliation(s)
- Desirée Colombo
- Department of Basic Psychology, Clinic and Psychobiology, Universitat Jaume I, Av. Sos Baynat, s/n, 12071 Castellón, Spain
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Via Magnasco, 2, 20149 Milan, Italy
| | - Azucena Garcia Palacios
- Department of Basic Psychology, Clinic and Psychobiology, Universitat Jaume I, Av. Sos Baynat, s/n, 12071 Castellón, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
| | - Javier Fernandez Alvarez
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20100 Milan, Italy
| | - Andrea Patané
- Department of Computer Science, University of Oxford, Wolfson Building, Parks Rd, Oxford, OX1 3QD UK
| | - Michelle Semonella
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Via Magnasco, 2, 20149 Milan, Italy
| | - Pietro Cipresso
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Via Magnasco, 2, 20149 Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20100 Milan, Italy
| | - Marta Kwiatkowska
- Department of Computer Science, University of Oxford, Wolfson Building, Parks Rd, Oxford, OX1 3QD UK
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Via Magnasco, 2, 20149 Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20100 Milan, Italy
| | - Cristina Botella
- Department of Basic Psychology, Clinic and Psychobiology, Universitat Jaume I, Av. Sos Baynat, s/n, 12071 Castellón, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
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20
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Moody LN, Tegge AN, Poe LM, Koffarnus MN, Bickel WK. To drink or to drink less? Distinguishing between effects of implementation intentions on decisions to drink and how much to drink in treatment-seeking individuals with alcohol use disorder. Addict Behav 2018; 83:64-71. [PMID: 29153992 PMCID: PMC5945346 DOI: 10.1016/j.addbeh.2017.11.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 11/08/2017] [Accepted: 11/08/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION For many people with alcohol use disorders, alcohol drinking is a highly ingrained and automatized behavior with negative long-term health consequences. Implementation intentions, a behavioral intervention that links high-risk drinking situations with alternative, healthier responses, provide a means to intervene on habitual drinking behaviors. Here, a pilot treatment using implementation intentions was assessed with remote assessments and treatment prompts. METHODS Treatment-seeking individuals with alcohol use disorder between the ages of 18 and 65 were recruited from the community from October 2014 to November 2016. Participants (N=35) were quasi-randomly assigned to complete either active (n=18) or control (n=17) two-week implementation intention interventions. Active implementation intentions linked high-risk situations with alternative responses whereas the control condition selected situations and responses but did not link these together. Daily ecological momentary interventions of participant-tailored implementation intentions were delivered via text message. Alcohol consumption was assessed once daily with self-reported ecological momentary assessments (EMAs) of drinks consumed the previous day and thrice daily remotely submitted breathalyzer samples to assess reliability of self-reports. RESULTS On drinking days (80% of days), the active implementation intentions group reduced alcohol consumption during the intervention period compared to the control condition; however the difference between consumption was not observed at one-month follow-up. DISCUSSION The implementation intention intervention was associated with a 1.09 drink per day decrease in alcohol consumption on drinking days compared to a decrease of 0.29 drinks per day in the control condition. Future studies may combine implementation intentions with other treatments to help individuals to reduce alcohol consumption.
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Affiliation(s)
- Lara N Moody
- Virginia Tech Carilion Research Institute, Roanoke, VA, USA; Virginia Tech, Department of Psychology, Blacksburg, VA, USA
| | - Allison N Tegge
- Virginia Tech Carilion Research Institute, Roanoke, VA, USA; Virginia Tech, Department of Statistics, Blacksburg, VA, USA
| | - Lindsey M Poe
- Virginia Tech Carilion Research Institute, Roanoke, VA, USA
| | - Mikhail N Koffarnus
- Virginia Tech Carilion Research Institute, Roanoke, VA, USA; Virginia Tech, Department of Psychology, Blacksburg, VA, USA
| | - Warren K Bickel
- Virginia Tech Carilion Research Institute, Roanoke, VA, USA; Virginia Tech, Department of Psychology, Blacksburg, VA, USA.
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Bell IH, Fielding-Smith SF, Hayward M, Rossell SL, Lim MH, Farhall J, Thomas N. Smartphone-based ecological momentary assessment and intervention in a coping-focused intervention for hearing voices (SAVVy): study protocol for a pilot randomised controlled trial. Trials 2018; 19:262. [PMID: 29720208 PMCID: PMC5930938 DOI: 10.1186/s13063-018-2607-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/13/2018] [Indexed: 12/19/2022] Open
Abstract
Background Smartphone-based ecological momentary assessment and intervention (EMA/I) show promise for enhancing psychological treatments for psychosis. EMA has the potential to improve assessment and formulation of experiences which fluctuate day-to-day, and EMI may be used to prompt use of therapeutic strategies in daily life. The current study is an examination of these capabilities in the context of a brief, coping-focused intervention for distressing voice hearing experiences. Methods/design This is a rater-blinded, pilot randomised controlled trial comparing a four-session intervention in conjunction with use of smartphone EMA/I between sessions, versus treatment-as-usual. The recruitment target is 34 participants with persisting and distressing voice hearing experiences, recruited through a Voices Clinic based in Melbourne, Australia, and via wider advertising. Allocation will be made using minimisation procedure, balancing of the frequency of voices between groups. Assessments are completed at baseline and 8 weeks post-baseline. The primary outcomes of this trial will focus on feasibility and acceptability of the intervention and trial methodology, with secondary outcomes examining preliminary clinical effects related to overall voice severity, the emotional and functional impact of the voices, and emotional distress. Discussion This study offers a highly novel examination of specific smartphone capabilities and their integration with traditional psychological treatment for distressing voices. Such technology has potential to enhance psychological interventions and promote adaptation to distressing experiences. Trial registration Australian New Zealand Clinical Trial Registry, ACTRN12617000348358. Registered on 7 March 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2607-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Imogen H Bell
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia. .,Monash Alfred Psychiatry Research Centre, Melbourne, Australia.
| | - Sarah F Fielding-Smith
- Sussex Partnership NHS Foundation Trust, Worthing, UK.,School of Psychology, University of Sussex, Brighton, UK
| | - Mark Hayward
- Sussex Partnership NHS Foundation Trust, Worthing, UK.,School of Psychology, University of Sussex, Brighton, UK
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia.,Monash Alfred Psychiatry Research Centre, Melbourne, Australia.,Department of Psychiatry, St. Vincent's Hospital, Melbourne, Australia
| | - Michelle H Lim
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, Australia.,NorthWestern Mental Health, Melbourne Health, Melbourne, Australia
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia.,Monash Alfred Psychiatry Research Centre, Melbourne, Australia
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Inada S, Yoshiuchi K, Iizuka Y, Ohashi K, Kikuchi H, Yamamoto Y, Kadowaki T, Akabayashi A. Pilot Study for the Development of a Self-Care System for Type 2 Diabetes Patients Using a Personal Digital Assistant (PDA). Int J Behav Med 2017; 23:295-299. [PMID: 26780633 DOI: 10.1007/s12529-016-9535-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE The primary objective of the present pilot study was to investigate the feasibility and acceptability of the newly developed self-care system using personal digital assistance in patients with type 2 diabetes. The secondary objective was to investigate changes in daily calorie intake, body weight, and hemoglobin A1c after using the system for 6 months. METHOD The participants were nine outpatients with type 2 diabetes, aged 34-72 and living in Tokyo or surrounding prefectures. They were instructed to use the electronic food diary and to review the graphs of the total energy intake to control food intake under their own target value for 6 months. After they completed the study, the feasibility indicated by adherence rate for food recording and acceptability of the system rated with 6-point Likert scale from 1 (worst) to 6 (best) by the participants were investigated. RESULTS Seven participants out of nine completed the study protocol. The median adherence rate for food recording was 80.6 %. Regarding the acceptability, six patients rated 6 for desire to use the system while one rated 5. In addition, regarding improvement in self-care for diabetes, the median score was 5. Daily calorie intake, body weight, and HbA1c, however, did not change significantly over the 6-month period. CONCLUSION The newly developed self-care system might be feasible and acceptable in diabetes patients, which could be applied as an ecological momentary intervention tool, although there was some room to refine it to raise adherence.
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Affiliation(s)
- Shuji Inada
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Yoko Iizuka
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Ken Ohashi
- Department of Internal Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Japan
| | - Hiroe Kikuchi
- Department of Psychosomatic Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-higashimachi, Kodaira, Japan
| | - Yoshiharu Yamamoto
- Educational Physiology Laboratory, Graduate School of Education, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Takashi Kadowaki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Akira Akabayashi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
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Scott CK, Dennis ML, Gustafson DH. Using smartphones to decrease substance use via self-monitoring and recovery support: study protocol for a randomized control trial. Trials 2017; 18:374. [PMID: 28797307 DOI: 10.1186/s13063-017-2096-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/11/2017] [Indexed: 11/12/2022] Open
Abstract
Background Alcohol abuse, other substance use disorders, and risk behaviors associated with the human immunodeficiency virus (HIV) represent three of the top 10 modifiable causes of mortality in the US. Despite evidence that continuing care is effective in sustaining recovery from substance use disorders and associated behaviors, patients rarely receive it. Smartphone applications (apps) have been effective in delivering continuing care to patients almost anywhere and anytime. This study tests the effectiveness of two components of such apps: ongoing self-monitoring through Ecological Momentary Assessments (EMAs) and immediate recovery support through Ecological Momentary Interventions (EMIs). Methods/design The target population, adults enrolled in substance use disorder treatment (n = 400), are being recruited from treatment centers in Chicago and randomly assigned to one of four conditions upon discharge in a 2 × 2 factorial design. Participants receive (1) EMAs only, (2) EMIs only, (3) combined EMAs + EMIs, or (4) a control condition without EMA or EMI for 6 months. People in the experimental conditions receive smartphones with the apps (EMA and/or EMI) specific to their condition. Phones alert participants in the EMA and EMA + EMI conditions at five random times per day and present participants with questions about people, places, activities, and feelings that they experienced in the past 30 min and whether these factors make them want to use substances, support their recovery, or have no impact. Those in the EMI and EMA + EMI conditions have continual access to a suite of support services. In the EMA + EMI condition, participants are prompted to use the EMI(s) when responses to the EMA(s) indicate risk. All groups have access to recovery support as usual. The primary outcome is days of abstinence from alcohol and other drugs. Secondary outcomes are number of HIV risk behaviors and whether abstinence mediates the effects of EMA, EMI, or EMA + EMI on HIV risk behaviors. Discussion This project will enable the field to learn more about the effects of EMAs and EMIs on substance use disorders and HIV risk behaviors, an understanding that could potentially make treatment and recovery more effective and more widely accessible. Trial registration ClinicalTrials.gov, ID: NCT02132481. Registered on 5 May 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2096-z) contains supplementary material, which is available to authorized users.
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Boh B, Lemmens LH, Jansen A, Nederkoorn C, Kerkhofs V, Spanakis G, Weiss G, Roefs A. An Ecological Momentary Intervention for weight loss and healthy eating via smartphone and Internet: study protocol for a randomised controlled trial. Trials 2016; 17:154. [PMID: 27000058 DOI: 10.1186/s13063-016-1280-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/19/2016] [Indexed: 12/16/2022] Open
Abstract
Background Long-term weight loss maintenance is difficult to achieve. Effectiveness of obesity interventions could be increased by providing extended treatment, and by focusing on person-environment interactions. Ecological Momentary Intervention (EMI) can account for these two factors by allowing an indefinite extension of a treatment protocol in everyday life. EMI relies on observations in daily life to intervene by providing appropriate in-the-moment treatment. The Think Slim intervention is an EMI based on the principles of cognitive behavioural therapy (CBT), and its effectiveness will be investigated in the current study. Methods A randomised controlled trial (RCT) will be conducted. At least 134 overweight adults (body mass index (BMI) above 25 kg/m2) will be randomly assigned to an 8-week immediate intervention group (Diet + Think Slim intervention, n = 67) or to an 8-week diet-only control group (followed by the Think Slim intervention, n = 67). The Think Slim intervention consists of (1) an app-based EMI that estimates and intervenes when people are likely to overeat, based on Ecological Momentary Assessment data, and (2) ten online computerised CBT sessions which work in conjunction with an EMI module in the app. The primary outcome is BMI. Secondary outcomes include (1) scores on self-report questionnaires for dysfunctional thinking, eating styles, eating disorder pathology, general psychological symptomatology, and self-esteem, and (2) eating patterns, investigated via network analysis. Primary and secondary outcomes will be obtained at pre- and post-intervention measurements, and at 3- and 12-month follow-up measurements. Discussion This is the first EMI aimed at treating obesity via a cognitive approach, provided via a smartphone app and the Internet, in the context of an RCT. Trial registration This trial has been registered at the Netherlands Trial Register, part of the Dutch Cochrane Centre (NTR5473; registration date: 26 October 2015).
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