A comparison between phone-based psychotherapy with and without text messaging support in between sessions for crisis patients

Gareth Furber, Gabrielle Margaret Jones, David Healey, Niranjan Bidargaddi, Gareth Furber, Gabrielle Margaret Jones, David Healey, Niranjan Bidargaddi

Abstract

Background: Few studies have tested whether individually tailored text messaging interventions have an effect on clinical outcomes when used to supplement traditional psychotherapy. This is despite the potential to improve outcomes through symptom monitoring, prompts for between-session activities, and psychoeducation.

Objective: The intent of the study was to explore the use of individually tailored between-session text messaging, or short message service (SMS), as an adjunct to telephone-based psychotherapy for consumers who present to the Emergency Department (ED) in situational and/or emotional crises.

Methods: Over a 4-month period, two therapists offered 68 prospective consumers of a telephone-based psychotherapy service individually tailored between-session text messaging alongside their telephone-based psychotherapy. Attendance and clinical outcomes (depression, anxiety, functional impairment) of those receiving messages were compared against a historical control group (n=157) who received telephone psychotherapy only.

Results: A total of 66% (45/68) of the consumers offered SMS accepted the intervention. A total of 432 messages were sent over the course of the trial, the majority involving some kind of psychoeducation or reminders to engage in therapy goals. There were no significant differences in clinical outcomes between consumers who received the SMS and those in the control group. There was a trend for participants in the intervention group to attend fewer sessions than those in the control group (mean 3.7, SD 1.9 vs mean 4.4, SD 2.3).

Conclusions: Both groups showed significant improvement over time. Individually tailored SMS were not found to improve clinical outcomes in consumers receiving telephone-based psychotherapy, but the study was underpowered, given the effect sizes noted and the significance level chosen. Given the ease of implementation and positive feedback from therapists and clients, individually tailored text messages should be explored further in future trials with a focus on enhancing the clinical impact of the tailored text messages, and utilizing designs with additional power to test for between-group effects.

Keywords: eHealth; mHealth; mental health services; mobile health; psychotherapy; short message service; telemedicine.

Conflict of interest statement

Conflicts of Interest: NB is a shareholder and founding member of goACT.

Figures

Figure 1
Figure 1
Flow of participants into the intervention group.
Figure 2
Figure 2
Flow of participants into the historical control group.
Figure 3
Figure 3
Proportion of intervention and control participants by number of sessions attended.

References

    1. Clough BA, Casey LM. Technological adjuncts to increase adherence to therapy: a review. Clin Psychol Rev. 2011 Jul;31(5):697–710. doi: 10.1016/j.cpr.2011.03.006.
    1. Proudfoot J. The future is in our hands: the role of mobile phones in the prevention and management of mental disorders. Aust N Z J Psychiatry. 2013 Feb;47(2):111–3. doi: 10.1177/0004867412471441.
    1. Luxton DD, McCann RA, Bush NE, Mishkind MC, Reger GM. mHealth for mental health: Integrating smartphone technology in behavioral healthcare. Professional Psychology: Research and Practice. 2011;42(6):505–512. doi: 10.1037/a0024485.
    1. Boschen MJ, Casey LM. The use of mobile telephones as adjuncts to cognitive behavioral psychotherapy. Professional Psychology: Research and Practice. 2008;39(5):546–552. doi: 10.1037/0735-7028.39.5.546.
    1. Clough BA, Casey LM. Technological adjuncts to enhance current psychotherapy practices: a review. Clin Psychol Rev. 2011 Apr;31(3):279–92. doi: 10.1016/j.cpr.2010.12.008.
    1. Harrison V, Proudfoot J, Wee PP, Parker G, Pavlovic DH, Manicavasagar V. Mobile mental health: review of the emerging field and proof of concept study. J Ment Health. 2011 Dec;20(6):509–24. doi: 10.3109/09638237.2011.608746.
    1. Preziosa A, Grassi A, Gaggioli A, Riva G. Therapeutic applications of the mobile phone. British Journal of Guidance & Counselling. 2009 Aug;37(3):313–325. doi: 10.1080/03069880902957031.
    1. Agyapong VIO, Farren CK, McLoughlin DM. Mobile phone text message interventions in psychiatry - what are the possibilities? CPSR. 2011 Feb 01;7(1):50–56. doi: 10.2174/157340011795945847.
    1. Spaniel F, Vohlídka P, Hrdlicka J, Kozený J, Novák T, Motlová L, Cermák J, Bednarík J, Novák D, Höschl C. ITAREPS: information technology aided relapse prevention programme in schizophrenia. Schizophr Res. 2008 Jan;98(1-3):312–7. doi: 10.1016/j.schres.2007.09.005.
    1. Kramer I, Simons CJ, Hartmann JA, Menne-Lothmann C, Viechtbauer W, Peeters F, Schruers K, van Bemmel Al, Myin-Germeys I, Delespaul P, van Os J, Wichers M. A therapeutic application of the experience sampling method in the treatment of depression: a randomized controlled trial. World Psychiatry. 2014 Feb;13(1):68–77. doi: 10.1002/wps.20090.
    1. Kauer SD, Reid SC, Crooke AHD, Khor A, Hearps SJC, Jorm AF, Sanci L, Patton G. Self-monitoring using mobile phones in the early stages of adolescent depression: randomized controlled trial. J Med Internet Res. 2012;14(3):e67. doi: 10.2196/jmir.1858.
    1. Reid Sc, Kauer Sd, Hearps Sj, Crooke Ah, Khor As, Sanci La, Patton Gc. A mobile phone application for the assessment and management of youth mental health problems in primary care: a randomised controlled trial. BMC Fam Pract. 2011;12:131. doi: 10.1186/1471-2296-12-131.
    1. Pijnenborg GH, Withaar FK, Brouwer WH, Timmerman ME, van den Bosch RJ, Evans JJ. The efficacy of SMS text messages to compensate for the effects of cognitive impairments in schizophrenia. Br J Clin Psychol. 2010 Jun;49(Pt 2):259–74. doi: 10.1348/014466509X467828.
    1. Montes JM, Medina E, Gomez-Beneyto M, Maurino J. A short message service (SMS)-based strategy for enhancing adherence to antipsychotic medication in schizophrenia. Psychiatry Res. 2012 Dec 30;200(2-3):89–95. doi: 10.1016/j.psychres.2012.07.034.
    1. Bauer S, Okon E, Meermann R, Kordy H. Technology-enhanced maintenance of treatment gains in eating disorders: efficacy of an intervention delivered via text messaging. J Consult Clin Psychol. 2012 Aug;80(4):700–6. doi: 10.1037/a0028030.
    1. Agyapong VI, Ahern S, McLoughlin DM, Farren CK. Supportive text messaging for depression and comorbid alcohol use disorder: single-blind randomised trial. J Affect Disord. 2012 Dec 10;141(2-3):168–76. doi: 10.1016/j.jad.2012.02.040.
    1. Marasinghe RB, Edirippulige S, Kavanagh D, Smith A, Jiffry Mt. Effect of mobile phone-based psychotherapy in suicide prevention: a randomized controlled trial in Sri Lanka. J Telemed Telecare. 2012 Apr;18(3):151–5. doi: 10.1258/jtt.2012.SFT107.
    1. Baer L, Minichiello WE, Jenike MA, Holland A. Use of a portable computer program to assist behavioral treatment in a case of obsessive compulsive disorder. J Behav Ther Exp Psychiatry. 1988 Sep;19(3):237–40.
    1. Kimhy D, Corcoran C. Use of Palm computer as an adjunct to cognitive-behavioural therapy with an ultra-high-risk patient: a case report. Early Interv Psychiatry. 2008 Nov;2(4):234–41. doi: 10.1111/j.1751-7893.2008.00083.x.
    1. Przeworski A, Newman MG. Palmtop computer-assisted group therapy for social phobia. J Clin Psychol. 2004 Feb;60(2):179–88. doi: 10.1002/jclp.10246.
    1. Norton M, Wonderlich SA, Myers T, Mitchell JE, Crosby RD. The use of palmtop computers in the treatment of bulimia nervosa. Eur Eat Disorders Rev. 2003 May;11(3):231–242. doi: 10.1002/erv.518.
    1. Newman MG, Consoli AJ, Taylor CB. A palmtop computer program for the treatment of generalized anxiety disorder. Behav Modif. 1999 Oct;23(4):597–619.
    1. Aguilera A, Muñoz RF. Text messaging as an adjunct to CBT in low-income populations: a usability and feasibility pilot study. Professional Psychology: Research and Practice. 2011;42(6):472–478. doi: 10.1037/a0025499.
    1. Rizvi SL, Dimeff LA, Skutch J, Carroll D, Linehan MM. A pilot study of the DBT coach: an interactive mobile phone application for individuals with borderline personality disorder and substance use disorder. Behav Ther. 2011 Dec;42(4):589–600. doi: 10.1016/j.beth.2011.01.003.
    1. Muench F, van Stolk-Cooke K, Morgenstern J, Kuerbis An, Markle K. Understanding messaging preferences to inform development of mobile goal-directed behavioral interventions. J Med Internet Res. 2014;16(2):e14. doi: 10.2196/jmir.2945.
    1. Owens C, Farrand P, Darvill R, Emmens T, Hewis E, Aitken P. Involving service users in intervention design: a participatory approach to developing a text-messaging intervention to reduce repetition of self-harm. Health Expect. 2011 Sep;14(3):285–95. doi: 10.1111/j.1369-7625.2010.00623.x.
    1. Fjeldsoe BS, Marshall AL, Miller YD. Behavior change interventions delivered by mobile telephone short-message service. Am J Prev Med. 2009 Feb;36(2):165–73. doi: 10.1016/j.amepre.2008.09.040.
    1. Cole-Lewis H, Kershaw T. Text messaging as a tool for behavior change in disease prevention and management. Epidemiol Rev. 2010 Apr;32(1):56–69. doi: 10.1093/epirev/mxq004.
    1. Wei J, Hollin I, Kachnowski S. A review of the use of mobile phone text messaging in clinical and healthy behaviour interventions. J Telemed Telecare. 2011;17(1):41–48. doi: 10.1258/jtt.2010.100322.
    1. Clark DM. Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: the IAPT experience. Int Rev Psychiatry. 2011 Aug;23(4):318–27. doi: 10.3109/09540261.2011.606803.
    1. Lovell K, Richards D. A recovery programme for depression. London: Rethink; 2008.
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606–13.
    1. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092–7. doi: 10.1001/archinte.166.10.1092.
    1. Mundt JC, Marks IM, Shear MK, Greist JH. The Work and Social Adjustment Scale: a simple measure of impairment in functioning. Br J Psychiatry. 2002 May;180:461–4.
    1. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007 May;39(2):175–91.
    1. Gyani A, Shafran R, Layard R, Clark DM. Enhancing recovery rates: lessons from year one of IAPT. Behav Res Ther. 2013 Sep;51(9):597–606. doi: 10.1016/j.brat.2013.06.004.
    1. Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, Eccles MP, Cane J, Wood CE. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013 Aug;46(1):81–95. doi: 10.1007/s12160-013-9486-6.
    1. Reese RJ, Norsworthy LA, Rowlands SR. Does a continuous feedback system improve psychotherapy outcome? Psychotherapy (Chic) 2009 Dec;46(4):418–31. doi: 10.1037/a0017901.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel