Enhancing mental health literacy in obsessive-compulsive disorder and reducing stigma via smartphone: A randomized controlled trial protocol

Antonio Chaves, Sandra Arnáez, Diana Castilla, María Roncero, Gemma García-Soriano, Antonio Chaves, Sandra Arnáez, Diana Castilla, María Roncero, Gemma García-Soriano

Abstract

Background: Obsessive-compulsive disorder (OCD) is a disabling disorder that can be successfully treated. However, individuals with OCD do not seek or delay seeking treatment. This delay may be explained by poor mental health literacy and stigmatizing attitudes toward OCD in community. In order to work on these variables, a gamified mental health mobile application (app) called esTOCma has been developed. The purpose of this study is to describe the protocol for a study to test the efficacy of esTOCma, increasing mental health literacy and help-seeking intention, reducing the stigmatizing attitudes and social distance suffered by people with OCD, as well as the distress associated with obsessive-compulsive symptoms.

Methods: A randomized controlled trial with a crossover design with two conditions (immediate-use App group versus delayed-use App group) will be conducted on a non-clinical adult sample of the community of a minimum size of 200 participants. Participants in the immediate-use App group will start using the app at baseline until completion (10 days); whereas participants in the delayed-use App group will wait 10 days, and then start using the app until completion (10 days). The outcomes will be measured at four assessment points (baseline; 10 days from baseline; and 20 days from baseline; and after 3 months). The following instruments will be administered: Attribution Questionnaire, General Help-Seeking Questionnaire, Social Distance Scale, Mental Health Literacy, Psychoeducation Questionnaire, Social Desirability Scale, Single-Item Self-esteem Scale, and Obsessive-Compulsive Inventory-Revised.

Discussion: This protocol presents the first study to describe a randomized control trial of a mental health app focused on changing mental health literacy, stigmatizing attitudes, social distance and help-seeking intention associated with OCD. An app intervention of these characteristics is especially relevant nowadays as the COVID-19 pandemic has increased obsessive-compulsive symptoms and severity. An improvement in general knowledge about OCD and a reduction in stigma could be associated with earlier OCD detection and an increase in help-seeking intention, which could result in greater wellbeing. Moreover, normalizing intrusions and knowledge about the cognitive OCD model could serve as a protective variable in vulnerable individuals.

Trial registration: ClinicalTrials.gov identifier: NCT04777292. Registered February 23, 2021, https://ichgcp.net/clinical-trials-registry/NCT04777292.

Keywords: App; Help-seeking intention; Mental health literacy; OCD; RCT; Stigma.

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

© 2022 The Author(s).

Figures

Fig. 1
Fig. 1
Design flowchart.
Fig. 2
Fig. 2
Characters and other visual elements of esTOCma v.1.
Fig. 3
Fig. 3
esTOCma v.1 screenshots with examples of the different intervention approaches.

References

    1. Albert U., Barbaro F., Bramante S., Rosso G., De Ronchi D., Maina G. Duration of untreated illness and response to SRI treatment in obsessive-compulsive disorder. Eur. Psychiatry. 2019;58:19–26. doi: 10.1016/J.EURPSY.2019.01.017.
    1. Alonso P., Bertolín S., Segalàs J., Tubío-Fungueiriño M., Real E., Mar-Barrutia L., Fernández-Prieto M., Carvalho S., Carracedo A., Menchón J.M. How is COVID-19 affecting patients with obsessive-compulsive disorder? A longitudinal study on the initial phase of the pandemic in a Spanish cohort. Eur. Psychiatry. 2021;64(1):1–9. doi: 10.1192/j.eurpsy.2021.2214. e45.
    1. Belloch A., Cabedo E., Carrió C. Alianza ed; Madrid: 2011. TOC: obsesiones y compulsiones: tratamiento cognitivo; p. 408.
    1. Belloch A., del Valle G., Morillo C., Carrió C., Cabedo E. To seek advice or not to seek advice about the problem : the help-seeking dilemma for obsessive-compulsive disorder. Social Psychiatry and Psychiatric Epidemiology. 2009;44:257–264. doi: 10.1007/s00127-008-0423-0.
    1. Cavoukian A. Privacy by design. Identity Inf. Soc. 2010;3(2):1–12.
    1. Chaves A., Árnaez S., Belloch A., García-Soriano G. Resultados preliminares de un estudio exploratorio. VII Congreso Internacional En Contextos Psicológicos, Educativos y de La Salud. 2021. ¿Puede una aplicación móvil de e-salud disminuir el estigma asociado al Trastorno Obsesivo-Compulsivo y aumentar la intención de búsqueda de ayuda?
    1. Chaves A., Árnaez S., Castilla D., García-Soriano G. VII Congreso Internacional En Contextos Psicológicos, Educativos y de La Salud. 2021. Satisfacción y usabilidad de una app para luchar contra el estigma asociado al TOC y aumentar los conocimientos del mismo.
    1. Chaves A., Arnáez S., Roncero M., García-Soriano G. Teachers’ knowledge and stigmatizing attitudes associated with obsessive-compulsive disorder: effectiveness of a brief educational intervention. Front. Psych. 2021;12(June):1–10. doi: 10.3389/fpsyt.2021.677567.
    1. Clement S., Schauman O., Graham T., Maggioni F., Evans-Lacko S., Bezborodovs N., Morgan C., Rüsch N., Brown J.S.L., Thornicroft G. What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychol. Med. 2015;45(1):11–27. doi: 10.1017/S0033291714000129.
    1. Connolly T.M., Boyle E.A., MacArthur E., Hainey T., Boyle J.M. A systematic literature review of empirical evidence on computer games and serious games. Comput. Educ. 2012;59(2):661–686. doi: 10.1016/j.compedu.2012.03.004.
    1. Corrigan P., Markowitz F.E., Watson A., Rowan D., Corrigan P. An attribution model of public discrimination towards persons with mental illness. J. Health Soc. Behav. 2003;44(2):162–179.
    1. Corrigan P.W., Gause M., Michaels P.J., Buchholz B.A., Larson J.E. The California assessment of stigma change: a short battery to measure improvements in the public stigma of mental illness. Community Ment. Health J. 2015;51(6):635–640. doi: 10.1007/s10597-014-9797-5.
    1. Corrigan P.W., Watson A.C. The paradox of self-stigma and mental illness. Clin. Psychol. Sci. Pract. 2002;9(1):35–53. doi: 10.1093/clipsy/9.1.35.
    1. Crowne D.P., Marlowe D. A new scale of social desirability independent of psychopathology. J. Consult. Psychol. 1960;24(4):349–354. doi: 10.1037/h0047358.
    1. Dell’Osso B., Buoli M., Hollander E., Altamura A.C. Duration of untreated illness as a predictor of treatment response and remission in obsessive – compulsive disorder. World J. Biol. Psychiatry. 2010;11:59–65. doi: 10.3109/15622970903418544.
    1. Eisen J.L., Pinto A., Mancebo M.C., Dyck I.R., Orlando M.E., Rasmussen S.A. A 2-year prospective follow-up study of the course of obsessive-compulsive disorder. The Journal of Clinical Psychiatry. 2010;71(8):1033–1039. doi: 10.4088/JCP.08m04806blu.
    1. Faul F., Erdfelder E., Lang A.-G., Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav. Res. Methods. 2007;39:175–191. doi: 10.3758/BF03193146.
    1. Fitzgerald M., Ratcliffe G. Serious games, gamification, and serious mental illness: a scoping review. Psychiatr. Serv. 2020;71(2):170–183. doi: 10.1176/appi.ps.201800567.
    1. Fleming T.M., Cheek C., Merry S.N., Thabrew H., Bridgman H., Stasiak K., Shepherd M., Perry Y., Hetrick S. Serious games for the treatment or prevention of depression: a systematic review. <span/><span>Rev. Psicopatol. Psicol. Clin</span>. 2015;19(3):227. doi: 10.5944/rppc.vol.19.num.3.2014.13904.
    1. Fleming T.M., de Beurs D., Khazaal Y., Gaggioli A., Riva G., Botella C., Baños R.M., Aschieri F., Bavin L.M., Kleiboer A., Merry S., Lau H.M., Riper H. Maximizing the impact of E-therapy and serious gaming: time for a paradigm shift. Frontiers. Psychiatry. 2016;7(APR) doi: 10.3389/FPSYT.2016.00065/ABSTRACT.
    1. Foa E.B., Huppert J.D., Leiberg S., Langner R., Kichic R., Hajcak G., Salkovskis P.M. The obsessive-compulsive inventory: Development and validation of a short version. Psychol. Assess. 2002;14:485–496. doi: 10.1037/1040-3590.14.4.485.
    1. Fontenelle I.S., Fontenelle L.F., Borges M.C., Prazeres A.M., Rangé B.P., Mendlowicz M.V., Versiani M. Quality of life and symptom dimensions of patients with obsessive-compulsive disorder. Psychiatry Res. 2010;179(2):198–203. doi: 10.1016/j.psychres.2009.04.005.
    1. Fullana M.A., Tortella-Feliu M., Caseras X., Andión O., Torrubia R., Mataix-Cols D. Psychometric properties of the spanish version of the obsessive – compulsive inventory — revised in a non-clinical sample. J. Anxiety Disord. 2005;19:893–903. doi: 10.1016/j.janxdis.2004.10.004.
    1. García-Soriano G., Roncero M. Psychiatry Research, En Revisión. Vol. 250. 2016. What do spanish adolescents think about obsessive-compulsive disorder? Mental health literacy and stigma associated with symmetry/order and aggression-related symptoms.
    1. García-Soriano G., Rufer M., Delsignore A., Weidt S. Factors associated with non-treatment or delayed treatment seeking in OCD sufferers: a review of the literature. Psychiatry Res. 2014;220(1–2) doi: 10.1016/j.psychres.2014.07.009.
    1. García-Soriano G., Belloch A. Symptom dimensions in obsessive-compulsive disorder: differences in distress, interference, appraisals and neutralizing strategies. J. Behav. Ther. Exp. Psychiatry. 2013;44(4):441–448. doi: 10.1016/j.jbtep.2013.05.005.
    1. Glazier K., Wetterneck C., Singh S., Williams M. Stigma and shame as barriers to treatment in obsessive-compulsive and related disorders. Depress. Anxiety. 2015;4(3):191. doi: 10.4191/2167-1044.1000191.
    1. Glazier K., Calixte R.M., Rothschild R., Pinto A. High rates of OCD symptom misidentification by mental health professionals. Ann. Clin. Psychiatry. 2013;25(3):201–209.
    1. Glazier K., McGinn L.K. Non-contamination and non-symmetry OCD obsessions are commonly not recognized by clinical, counseling and school psychology doctoral students. J. Depress. Anxiety. 2015;04(03):1000190. doi: 10.4172/2167-1044.1000190.
    1. Griffiths K.M., Carron-Arthur B., Parsons A., Reid R. Effectiveness of programs for reducing the stigma associated with mental disorders. A meta-analysis of randomized controlled trials. World Psychiatry. 2014;13(2):161–175. doi: 10.1002/wps.20129.
    1. Griffiths M.D. The use of online methodologies in studying paraphilias - a review. J. Behav. Addict. 2012;1(4):143–150. doi: 10.1556/JBA.1.2012.4.1.
    1. Gürbüz A.A., Yorulmaz O., Durna G. Reducing the social stigma associated with obsessive compulsive disorder: a controlled trial of an intervention program in a turkish community sample. J. Evid.-Based Psychother. 2020;20(2):101–120. doi: 10.24193/jebp.2020.2.14.
    1. Gutiérrez S., Sanz J., Espinosa R., Gesteira C., García-Vera M.P. The marlowe-crowne social desirability scale: norms for the spanish general population and development of a short version. An. de Psicol. 2016;32(1):206–217. doi: 10.6018/analesps.32.1.185471.
    1. Hathorn S.K., Lochner C., Stein D.J., Bantjes J. Help-seeking intention in obsessive-compulsive disorder: predictors and barriers in South Africa. Front. Psych. 2021;12(September):1–8. doi: 10.3389/fpsyt.2021.733773.
    1. Koran L.M., Simpson H.B. APA Practice Guidelines, March, 1–22. 2013. Guideline watch (March 2013): Practice guideline for the treatment of patients with obsessive-compulsive disorder.
    1. Lattie E.G., Cohen K.A., Hersch E., Williams K.D.A., Kruzan K.P., MacIver C., Hermes J., Maddi K., Kwasny M., Mohr D.C. Uptake and effectiveness of a self-guided mobile app platform for college student mental health. Internet Interv. 2022;27 doi: 10.1016/j.invent.2021.100493.
    1. Lee E.B., Hoepfl C., Werner C., McIngvale E. A review of tech-based self-help treatment programs for obsessive-compulsive disorder. J. Obs.-Compuls. Relat. Disord. 2019;23(June) doi: 10.1016/j.jocrd.2019.100473.
    1. Link B.G., Cullen F.T., Frank J., Wozniak J.F. The social rejection of former mental patients: understanding why labels matter. Am. J. Sociol. 1987;92(6):1461–1500. doi: 10.1086/228672.
    1. Llorens-Aguilar S., García-Soriano G., Arnáez S., Aardema F., O’Connor K. Is context a crucial factor in distinguishing between intrusions and obsessions in patients with obsessive-compulsive disorder? J. Clin. Psychol. 2021;77(3):804–817. doi: 10.1002/jclp.23060.
    1. McCarty R.J., Guzick A.G., Swan L.K., McNamara J.P.H. Stigma and recognition of different types of symptoms in OCD. Journal of Obsessive-Compulsive and Related Disorders. 2017;12(September 2016):64–70. doi: 10.1016/j.jocrd.2016.12.006.
    1. McKay D., Sookman D., Neziroglu F., Wilhelm S., Stein D.J., Kyrios M., Matthews K., Veale D. Efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder. Psychiatry Res. 2015;227(1):104–113. doi: 10.1016/j.psychres.2015.02.004.
    1. Miralles I., Granell C., Díaz-Sanahuja L., van Woensel W., Bretón-López J., Mira A., Castilla D., Casteleyn S. Smartphone apps for the treatment of mental disorders: systematic review. JMIR MHealth and UHealth. 2020;8(4) doi: 10.2196/14897.
    1. Morgan A.J., Reavley N.J., Ross A., Too L.S., Jorm A.F. Interventions to reduce stigma towards people with severe mental illness: systematic review and meta-analysis. J. Psychiatr. Res. 2018;103(March):120–133. doi: 10.1016/j.jpsychires.2018.05.017.
    1. Muñoz M., Guillén A.I., Pérez-Santos E., Corrigan P.W. A structural equation modeling study of the Spanish mental illness stigma attribution questionnaire (AQ-27-E) Am. J. Orthopsychiatry. 2015;85(3):243–249.
    1. National Institute for Health and Care Excellence (NICE) National Institute for Health and Care Excellence (NICE); 2005. Obsessive-compulsive Disorder and Body Dysmorphic Disorder: Treatment. Issue November 2005.
    1. National Institute for Health and Clinical Excellence . The British Psychological Society and The Royal College of Psychiatrists; 2006. Obsessive-Compulsive Disorder: Core Interventions in the Treatment of Obsessive-Compulsive Disorder (The Britis)
    1. Ociskova M., Prasko J., Cerna M., Jelenova D., Kamaradova D., Latalova K., Sedlackova Z. Obsessive compulsive disorder and stigmatization. Act. Nerv. Super. Rediviva. 2013;55(1):19–26.
    1. Pacheco del Castillo L.A. Dominican college students’ experiences of distress, help-seeking and stigma. Diss. Abstr. Int. A Hum. Soc. Sci. 2018;78(11-A(E)) No-Specified.
    1. Pinto A., Mancebo M.C., Eisen J.L., Pagano M.E., Rasmussen S.A. The Brown longitudinal obsessive compulsive study: clinical features and symptoms of the sample at intake. J. Clin. Psych. 2006;67(5):703–711.
    1. Ponzini G.T., Steinman S.A. A systematic review of public stigma attributes and obsessive–compulsive disorder symptom subtypes. Stigma Health. 2021 doi: 10.1037/sah0000310.
    1. Purdon C.L., Clark D.A. Obsessive intrusive thoughts in nonclinical subjects. Part I. Content and relation with depressive, anxious and obsessional symptoms. Behav. Res. Ther. 1993;31(8):713–720.
    1. Radomsky A.S., Alcolado G.M., Abramowitz J.S., Alonso P., Belloch A., Bouvard M., Clark D.A., Coles M.E., Doron G., Fernández-Álvarez H., Garcia-Soriano G., Ghisi M., Gomez B., Inozu M., Moulding R., Shams G., Sica C., Simos G., Wong W. Part 1—you can run but you can’t hide: intrusive thoughts on six continents. Journal of Obsessive-Compulsive and Related Disorders. 2014;3(3):269–279. doi: 10.1016/j.jocrd.2013.09.002.
    1. Rees C.S., Austen T., Anderson R.A., Egan S.J. Can corrective information reduce negative appraisals of intrusive thoughts in a community sample? Behavioural and Cognitive Psychotherapy. 2014;42(4):502–507. doi: 10.1017/S1352465813000994.
    1. Reinke R.R., Corrigan P.W., Leonhard C., Lundin R.K., Kubiak M.A. Examining two aspects of contact on the stigma of mental illness. J. Soc. Clin. Psychol. 2004;23(3):377–389. doi: 10.1521/jscp.23.3.377.35457.
    1. Robins R.W., Hendin H.M., Trzesniewski K.H. Measuring global self-esteem: construct validation of a single-item measure and the Rosenberg self-esteem scale. Personal. Soc. Psychol. Bull. 2001;27(2):151–161. doi: 10.1177/0146167201272002.
    1. Ruscio A.M., Stein D.J., Chiu W.T., Kessler R.C. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol. Psychiatry. 2010;15(1):53–63. doi: 10.1038/mp.2008.94.The.
    1. Salkovskis P.M. Obsessional-compulsive problems: a cognitive-behavioural analysis. Behav. Res. Ther. 1985;23(5):571–583. doi: 10.1016/0005-7967(85)90105-6.
    1. Sanz J., Navarro R., Fausor R., Altungy P., Gesteira C., Morán N., García-Vera M.P. La escala de deseabilidad social de Marlowe-Crowne como instrumento para la medida de la deseabilidad social, la sinceridad y otros constructos relacionados en psicología legal y forense. Piscopatología Clínica, Legal y Forense. 2018;18:112–133.
    1. Schwartz C., Schlegl S., Kuelz A.K., Voderholzer U. Treatment-seeking in OCD community cases and psychological treatment actually provided to treatment-seeking patients: a systematic review. J. Obs.-Compuls. Relat. Disord. 2013;2(4):448–456. doi: 10.1016/j.jocrd.2013.10.006.
    1. Steinberg D.S., Wetterneck C.T. OCD taboo thoughts and stigmatizing attitudes in clinicians. Community Ment. Health J. 2017;53(3):275–280. doi: 10.1007/s10597-016-0055-x.
    1. Stengler-Wenzke K., Trosbach J., Dietrich S., Angermeyer M.C. Coping strategies used by the relatives of people with obsessive – compulsive disorder. J. Adv. Nurs. 2004;48(1):35–42. doi: 10.1111/j.1365-2648.2004.03166.x.
    1. Stengler K., Olbrich S., Heider D., Dietrich S., Riedel-Heller S., Jahn I. Mental health treatment seeking among patients with OCD: impact of age of onset. Soc. Psychiatry Psychiatr. Epidemiol. 2013;48(5):813–819. doi: 10.1007/s00127-012-0544-3.
    1. Stewart E., Grunthal B., Collins L., Coles M. Public recognition and perceptions of obsessive compulsive disorder. Community Ment. Health J. 2019;55(1):74–82. doi: 10.1007/s10597-018-0323-z.
    1. Thomas N., McLeod B., Jones N., Abbott J.A. Developing internet interventions to target the individual impact of stigma in health conditions. Internet Interv. 2014;2(3):351–358. doi: 10.1016/j.invent.2015.01.003.
    1. Torres A.R., Prince M.J., Bebbington P.E., Bhugra D., Brugha T.S., Farrell M., Jenkins R., Lewis G., Meltzer H., Singleton N. Obsessive-compulsive disorder: prevalence, comorbidity, impact, and help-seeking in the British National Psychiatric Morbidity Survey of 2000. Am. J. Psychiatry. 2006;163(November):1978–1985.
    1. Wantland D.J., Portillo C.J., Holzemer W.L., Slaughter R., Mcghee E.M. The effectiveness of web-based vs. Non-web-based interventions: a meta-analysis of behavioral change outcomes. J. Med. Internet Res. 2004;6(4) doi: 10.2196/jmir.6.4.e40.
    1. Wheaton M.G., Ward H.E., Silber A., McIngvale E., Björgvinsson T. How is the COVID-19 pandemic affecting individuals with obsessive-compulsive disorder (OCD) symptoms? Journal of Anxiety Disorders. 2021;81 doi: 10.1016/J.JANXDIS.2021.102410.
    1. Wilson C.J., Deane F.P. Measuring help seeking intentions: properties of the general help seeking questionnaire. Can. J. Couns. 2005;39(1):15–28.
    1. Wind T.R., Rijkeboer M., Andersson G., Riper H. The COVID-19 pandemic: the ‘black swan’ for mental health care and a turning point for e-health. Internet Interv. 2020;20(March) doi: 10.1016/j.invent.2020.100317.
    1. World Health Organization . WHO; 1999. The “Newly Defined” Burden of Mental Problems. Fact Sheets No. 217.

Source: PubMed

3
订阅