The Efficacy of a Smartphone-Based App on Stress Reduction: Randomized Controlled Trial

Background

Stress management in the workplace is essential for a healthy mental and physical state. Due to technological advancements, individually tailored therapy and online cognitive behavioral therapy (CBT) are on the rise.

Objective

This study analyzed the efficacy of a smartphone app based on third-wave CBT tailored to an individual.

Methods

A randomized controlled trial was conducted with 126 participants who were divided into 2 groups. The intervention group used the smartphone app BetterLife for 10 weeks, while the control group was placed on a waiting list for the same duration. The Perceived Stress Scale–10 (PSS), Korean Utrecht Work Engagement Scale–9 (UWES), World Health Organization Quality of Life Assessment (WHOQOL), Beck Depression Inventory–II (BDI), and Beck Anxiety Inventory (BAI) were administered at baseline and after 10 weeks to both groups.

Results

Of the 126 participants, 11 dropped out during the trial. A 2-way repeated measure analysis of covariance was conducted, controlling for baseline BDI. There were greater improvements in PSS (F=24.33, P<.001, η²=0.17) and UWESK scores (F=8.32, P=.0046, η²=0.06) in the intervention group than in the control group. WHOQOL scores exhibited statistically significant improvement in the intervention group in the overall quality of life (F=8.19, P=.0049, η²=0.06), physical health (F=8.87, P=.003, η²=0.07), psychological health (F=13.32, P<.001, η²=0.10), social relationships (F=19.43, P<.001, η²=0.14), and environmental domains (F=10.14, P=.002, η²=0.08) but not overall health (F=1.68, P=.20). BDI (F=7.17, P=.008, η²=0.06) and BAI (F=6.00, P=.02, η²=0.05) showed a statistically significant improvement in the intervention group, but this significance did not survive the Bonferroni correction (P<.005).

Conclusions

These results provide evidence that smartphone-based CBT is a viable option for reducing stress in the workplace.

Trial Registration

Clinical Research Information Service KCT0003231; https://cris.nih.go.kr/cris/search/detailSearch.do/15137

Development of a Web-Based, Guided Self-help, Acceptance and Commitment Therapy-Based Intervention for Weight Loss Maintenance: Evidence-, Theory-, and Person-Based Approach

Background

The long-term impact and cost-effectiveness of weight management programs depend on posttreatment weight maintenance. There is growing evidence that interventions based on third-wave cognitive behavioral therapy, particularly acceptance and commitment therapy (ACT), could improve long-term weight management; however, these interventions are typically delivered face-to-face by psychologists, which limits the scalability of these types of intervention.

Objective

The aim of this study is to use an evidence-, theory-, and person-based approach to develop an ACT-based intervention for weight loss maintenance that uses digital technology and nonspecialist guidance to minimize the resources needed for delivery at scale.

Methods

Intervention development was guided by the Medical Research Council framework for the development of complex interventions in health care, Intervention Mapping Protocol, and a person-based approach for enhancing the acceptability and feasibility of interventions. Work was conducted in two phases: phase 1 consisted of collating and analyzing existing and new primary evidence and phase 2 consisted of theoretical modeling and intervention development. Phase 1 included a synthesis of existing evidence on weight loss maintenance from previous research, a systematic review and network meta-analysis of third-wave cognitive behavioral therapy interventions for weight management, a qualitative interview study of experiences of weight loss maintenance, and the modeling of a justifiable cost for a weight loss maintenance program. Phase 2 included the iterative development of guiding principles, a logic model, and the intervention design and content. Target user and stakeholder panels were established to inform each phase of development, and user testing of successive iterations of the prototype intervention was conducted.

Results

This process resulted in a guided self-help ACT-based intervention called SWiM (Supporting Weight Management). SWiM is a 4-month program consisting of weekly web-based sessions for 13 consecutive weeks followed by a 4-week break for participants to reflect and practice their new skills and a final session at week 18. Each session consists of psychoeducational content, reflective exercises, and behavioral experiments. SWiM includes specific sessions on key determinants of weight loss maintenance, including developing skills to manage high-risk situations for lapses, creating new helpful habits, breaking old unhelpful habits, and learning to manage interpersonal relationships and their impact on weight management. A trained, nonspecialist coach provides guidance for the participants through the program with 4 scheduled 30-minute telephone calls and 3 further optional calls.

Conclusions

This comprehensive approach facilitated the development of an intervention that is based on scientific theory and evidence for supporting people with weight loss maintenance and is grounded in the experiences of the target users and the context in which it is intended to be delivered. The intervention will be refined based on the findings of a planned pilot randomized controlled trial.

Application of functional analytic psychotherapy to manage schizophrenia

INTRODUCTION

Cognitive behavioral therapy (CBT) and third-wave CBT approaches have been shown to ameliorate symptoms of schizophrenia. However, this study uses the functional analytic psychotherapy which focuses on the environmental causes of behavior which includes the client's present environment as well as his history of past interactions with it, to bring about a change in the client and reduce the symptoms. This therapy has never been used earlier with patients having schizophrenia in India; therefore, it was taken up for this study.

METHODOLOGY

A pre-post design with control group was used in the present study. Ten patients were taken. Positive and Negative Syndrome Scale for measuring symptoms of schizophrenia, Schizophrenia Quality of Life Scale for assessing quality of life, Coping Response Inventory-Adult form for assessing coping skills, Apathy Evaluation Scale-Clinician Version for assessing apathy, Family Adaptability and Cohesion Evaluation Scale for assessing perceived interpersonal relationship were used for assessment pre- and postintervention. Fifteen sessions were done with each patient within a period of 10 months at the rate of one session per week. Chi-square test, Wilcoxon signed-rank test, and Mann-Whitney U-test were used for the analysis of data.

RESULTS

Significant improvements were found in positive symptoms, general psychopathology, approach coping mechanisms, psychosocial and motivation domains in quality of life, and perceived cohesion in family among the patients postintervention.

CONCLUSION

Functional analytic psychotherapy is an effective method for treating patients having schizophrenia with the application of its specifically modified rules for use with patients having psychosis.