A Mobile Phone App Featuring Cue Exposure Therapy As Aftercare for Alcohol Use Disorders: An Investigator-Blinded Randomized Controlled Trial

Angelina Isabella Mellentin, Bent Nielsen, Anette Søgaard Nielsen, Fei Yu, Anna Mejldal, Dorthe Grüner Nielsen, Elsebeth Stenager, Angelina Isabella Mellentin, Bent Nielsen, Anette Søgaard Nielsen, Fei Yu, Anna Mejldal, Dorthe Grüner Nielsen, Elsebeth Stenager

Abstract

Background: Cue exposure therapy (CET) is a psychological approach developed to prepare individuals with alcohol use disorder (AUD) for confronting alcohol and associated stimuli in real life. CET has shown promise when treating AUD in group sessions, but it is unknown whether progressing from group sessions to using a mobile phone app is an effective delivery pathway.

Objective: The objectives of this study were to investigate (1) whether CET as aftercare would increase the effectiveness of primary treatment with cognitive behavior therapy, and (2) whether CET delivered through a mobile phone app would be similarly effective to CET via group sessions.

Methods: A total of 164 individuals with AUD were randomized to one of three groups: CET as group aftercare (CET group), CET as fully automated mobile phone app aftercare (CET app), or aftercare as usual. Study outcomes were assessed face-to-face at preaftercare, postaftercare, and again at 6 months after aftercare treatment. Generalized mixed models were used to compare the trajectories of the groups over time on drinking, cravings, and use of urge-specific coping skills (USCS).

Results: In all, 153 of 164 individuals (93%) completed assessments both at posttreatment and 6-month follow-up assessments. No differences in the trajectories of predicted means were found between the experimental groups (CET group and app) compared with aftercare as usual on drinking and craving outcomes over time. Both CET group (predicted mean difference 5.99, SE 2.59, z=2.31, P=.02) and the CET app (predicted mean difference 4.90, SE 2.26, z=2.31, P=.02) showed increased use of USCS compared to aftercare as usual at posttreatment, but this effect was reduced at the 6-month follow-up. No differences were detected between the two experimental CET groups on any outcomes.

Conclusions: CET with USCS delivered as aftercare either via group sessions or a mobile phone app did not increase the effectiveness of primary treatment. This suggests that CET with USCS may not be an effective psychological approach for the aftercare of individuals treated for AUD.

Trial registration: ClinicalTrials.gov NCT02298751; https://ichgcp.net/clinical-trials-registry/NCT02298751.

Keywords: aftercare; alcohol use disorder; cognitive behavior therapy; cue exposure therapy; mobile phone app; randomized controlled trial.

Conflict of interest statement

Conflicts of Interest: None declared.

©Angelina Isabella Mellentin, Bent Nielsen, Anette Søgaard Nielsen, Fei Yu, Anna Mejldal, Dorthe Grüner Nielsen, Elsebeth Stenager. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 16.08.2019.

Figures

Figure 1
Figure 1
Illustration of the mobile phone app for cue exposure therapy.
Figure 2
Figure 2
Primary outcomes by group allocation over time among individuals receiving cue exposure therapy (CET) as group aftercare or as a mobile phone app, or aftercare as usual.
Figure 3
Figure 3
Secondary outcomes by group allocation over time among individuals receiving cue exposure therapy (CET) as group aftercare or as a mobile phone app, or aftercare as usual. USCS: urge-specific coping skills (a lower score reflects less use or lower perceived effectiveness); VAS: visual analog scale (a lower score reflects fewer alcohol cravings).

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