Can Brief, Daily Training Using a Mobile App Help Change Maladaptive Beliefs? Crossover Randomized Controlled Trial

María Roncero, Amparo Belloch, Guy Doron, María Roncero, Amparo Belloch, Guy Doron

Abstract

Background: Obsessive-compulsive disorder (OCD) is a disabling condition with a wide variety of clinical presentations including contamination fears, fear of harm, and relationship-related obsessions. Cognitive behavioral models of OCD suggest that OC symptoms result from catastrophic misinterpretations of commonly occurring intrusive experiences and associated dysfunctional strategies used to manage them. OCD-related maladaptive beliefs including inflated responsibility, importance and control of thoughts, perfectionism, and intolerance for uncertainty increase the likelihood of such misinterpretations.

Objective: Considering accumulating evidence suggesting that mobile health (mHealth) apps based on cognitive-behavioral principles may lead to significant reductions in psychopathological symptoms, we assessed the effectiveness of a novel cognitive training app (GGRO) designed to challenge OCD-related beliefs.

Methods: A total of 97 students were randomized to groups undertaking immediate-use (iApp) or delayed use (dApp) of GGRO. All participants were requested to complete Web-based assessments, with questionnaires relating to maladaptive beliefs, mood, and OC symptoms at baseline (T1), 15 days from baseline (T2), and 30 days from baseline (T3). Participants in iApp group started using the app at baseline and continued using the app for 15 consecutive days. They were then requested to stop using the app until T3. Participants in the dApp group were requested to wait for 15 days and only then start using the app (crossover) for 15 consecutive days.

Results: All participants used the app for a mean of 14.07 (SD 1.41) days with 2.94 levels per day. Consistent with previous findings, app use was associated with medium-large effect size reductions in both iApp (n=51) and dApp (n=46) groups. In the iApp group, all effects remained significant during the 15 days of follow-up. Analyses focusing on the first two assessment occasions revealed significant treatment × repeated measures interactions on maladaptive beliefs, several OC symptom measures, and self-esteem.

Conclusions: This study provides further evidence for the efficacy of GGRO as a mobile-delivered training exercise that is useful for reducing OCD-related beliefs and symptoms.

Trial registration: ClinicalTrials.gov NCT03571464; https://ichgcp.net/clinical-trials-registry/NCT03571464 (Archived by WebCite at http://www.webcitation.org/7675sYPsH).

Keywords: cognitive therapy; maladaptive beliefs; mobile apps; obsessive compulsive disorder; relationships.

Conflict of interest statement

Conflicts of Interest: GD is a codeveloper of GGRO. GD is also a cofounder of GGapps.net. GGRO is the subject of this evaluation and therefore has financial interest to GGapps.net.

©María Roncero, Amparo Belloch, Guy Doron. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 13.02.2019.

Figures

Figure 1
Figure 1
Study design with both groups. iApp: immediate-use App; dApp: delayed-use App.
Figure 2
Figure 2
GGRO screenshot.
Figure 3
Figure 3
CONSORT flow diagram of participants through the trial.
Figure 4
Figure 4
Graphs of the measures across T1, T2, and T3 for iApp and dApp groups. iApp: immediate-use App; dApp: delayed-use App; DASS: Depression, Anxiety, Stress Scale - Short version; OBQ: Obsessive Beliefs Questionnaire; OCI-R: Obsessive-Compulsive Inventory; PROCSI-Si: Partner-Related Obsessive-Compulsive Symptoms Inventory - 6-item version; ROCI-S: The Relationship Obsessive-Compulsive Inventory - Short version; SISE: The Single-Item Self-Esteem Scale.

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