Article

EMOTEO: A Smartphone Application for Monitoring and Reducing Aversive Tension in Borderline Personality Disorder Patients, a Pilot Study

Perspectives in Psychiatric Care

July 2016
53(4)

DOI:10.1111/ppc.12178

Authors:

Ido Zamberg

Hôpitaux Universitaires de Genève

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Purpose: We developed a smartphone application (App; EMOTEO: emotion-meteo [weather forecast]) to help borderline personality disorder (BPD) patients to monitor and regulate their inner tension. The App proposes targeted mindfulness-based exercises. Design and methods: We assessed the usability and efficiency of this App for monitoring and reduction of aversive tension in 16 BPD participants over a 6-month period. Findings: We recorded a mean of 318.1 sessions (SD = 166.7) per participants, with a high level of satisfaction. There was a significant decrease in aversive tension (p < .05) and the App was mainly used around 10 a.m. and 9 p.m. Practice implications: EMOTEO was user-friendly and efficient in reducing aversive tension in BPD patients.

A Systematic Review of Mobile Apps as an Adjunct to Psychological Interventions for Emotion Dysregulation

Article

Full-text available

Jan 2023
Int J Environ Res Publ Health

Background: Mental health care has been enriched with the progressive use of technology during the last ten years, in particular after the COVID-19 pandemic. Mobile applications (apps) and smartphones have become the most widespread access point for many people who look for self-help in the psychological domain. Objective: We focused on a systematic review of mobile apps for mental health, focusing on the blending of apps with psychotherapy contexts, with a specific focus on emotional dysregulation. Methods: A comprehensive literature search (January 2017 to August 2022) in PubMed, PsycInfo, Web of Science, and the Cochrane Library was conducted. Abstracts were included if they described mental health mobile apps targeting emotional dysregulation and their use during ongoing psychological or psychotherapy treatment for adults and adolescents. Results: In total, 397 abstracts were identified; of these, 19 publications describing apps targeting borderline personality disorder, depression, anxiety, suicidal behaviors, and post-traumatic stress disorders met the inclusion criteria. Conclusions: App-enhanced psychotherapy might be a winning combination in many scenarios, but at the same time, many issues must still be faced in this yet emerging scientific field. In conclusion, we tried to put together some major guidelines for mental health mobile app development in the context of psychological treatments.

A systematic review of engagement reporting in remote measurement studies for health symptom tracking

Article

Full-text available

Jun 2022

Remote Measurement Technologies (RMTs) could revolutionise management of chronic health conditions by providing real-time symptom tracking. However, the promise of RMTs relies on user engagement, which at present is variably reported in the field. This review aimed to synthesise the RMT literature to identify how and to what extent engagement is defined, measured, and reported, and to present recommendations for the standardisation of future work. Seven databases (Embase, MEDLINE and PsycINFO (via Ovid), PubMed, IEEE Xplore, Web of Science, and Cochrane Central Register of Controlled Trials) were searched in July 2020 for papers using RMT apps for symptom monitoring in adults with a health condition, prompting users to track at least three times during the study period. Data were synthesised using critical interpretive synthesis. A total of 76 papers met the inclusion criteria. Sixty five percent of papers did not include a definition of engagement. Thirty five percent included both a definition and measurement of engagement. Four synthetic constructs were developed for measuring engagement: (i) engagement with the research protocol, (ii) objective RMT engagement, (iii) subjective RMT engagement, and (iv) interactions between objective and subjective RMT engagement. The field is currently impeded by incoherent measures and a lack of consideration for engagement definitions. A process for implementing the reporting of engagement in study design is presented, alongside a framework for definition and measurement options available. Future work should consider engagement with RMTs as distinct from the wider eHealth literature, and measure objective versus subjective RMT engagement. Registration: This review has been registered on PROSPERO [CRD42020192652].

Exploring the definition, measurement, and reporting of engagement in remote measurement studies for physical and mental health symptom tracking: A systematic review

Preprint

Full-text available

May 2022

Background Remote Measurement Technologies (RMTs) could revolutionise management of chronic health conditions by providing real-time symptom tracking. However, the promise of RMTs relies on user engagement, which at present is variably reported in the field. This review aimed to synthesise the RMT literature to identify how and to what extent engagement is defined, measured, and reported, and to present recommendations for the standardisation of future work.Methods Seven databases (Embase, MEDLINE and PsycINFO (via Ovid), PubMed, IEEE Xplore, Web of Science, and Cochrane Central Register of Controlled Trials) were searched in July 2020 for papers using RMT apps for symptom monitoring in adults with a health condition, prompting users to track at least three times during the study period. Data were synthesised using critical interpretive synthesis.ResultsA total of 76 papers met the inclusion criteria. Sixty five percent of papers did not include a definition of engagement. Thirty five percent included both a definition and measurement of engagement. Four synthetic constructs were developed for measuring engagement: i) engagement with the research protocol, ii) objective RMT engagement, iii) subjective RMT engagement, and iv) interactions between objective and subjective RMT engagement.DiscussionThe field is currently impeded by incoherent measures and a lack of consideration for engagement definitions. A process for implementing the reporting of engagement in study design is presented, alongside a framework for definition and measurement options available. Future work should consider engagement with RMTs as distinct from the wider eHealth literature, and measure objective versus subjective RMT engagement.RegistrationThis review has been registered on PROSPERO [CRD42020192652].

Application of Smartphone Technologies in Disease Monitoring: A Systematic Review

Article

Full-text available

Jul 2021

Technologies play an essential role in monitoring, managing, and self-management of chronic diseases. Since chronic patients rely on life-long healthcare systems and the current COVID-19 pandemic has placed limits on hospital care, there is a need to explore disease monitoring and management technologies and examine their acceptance by chronic patients. We systematically examined the use of smartphone applications (apps) in chronic disease monitoring and management in databases, namely, Medline, Web of Science, Embase, and Proquest, published from 2010 to 2020. Results showed that app-based weight management programs had a significant effect on healthy eating and physical activity (p = 0.002), eating behaviours (p < 0.001) and dietary intake pattern (p < 0.001), decreased mean body weight (p = 0.008), mean Body Mass Index (BMI) (p = 0.002) and mean waist circumference (p < 0.001). App intervention assisted in decreasing the stress levels (paired t-test = 3.18; p < 0.05). Among cancer patients, we observed a high acceptance of technology (76%) and a moderately positive correlation between non-invasive electronic monitoring data and questionnaire (r = 0.6, p < 0.0001). We found a significant relationship between app use and standard clinical evaluation and high acceptance of the use of apps to monitor the disease. Our findings provide insights into critical issues, including technology acceptance along with regulatory guidelines to be considered when designing, developing, and deploying smartphone solutions targeted for chronic patients.

Smartphone applications targeting borderline personality disorder symptoms: A systematic review and meta-analysis

Article

Full-text available

Jun 2020

Background: Smartphone applications could improve symptoms of borderline personality disorder (BPD) in a scalable and resource-efficient manner in the context limited access to specialized care. Objective: This systematic review and meta-analysis aims to evaluate the effectiveness of applications designed as treatment interventions for adults with symptoms such as anger, suicidality, or self-harm that commonly occur in BPD. Data sources: Search terms for BPD symptoms, smartphone applications, and treatment interventions were combined on PubMed, MEDLINE, and PsycINFO from database inception to December 2019. Study selection: Controlled and uncontrolled studies of smartphone interventions for adult participants with symptoms such as anger, suicidality, or self-harm that commonly occur in BPD were included. Study appraisal and synthesis methods: Comprehensive Meta-Analysis v3 was used to compute between-groups effect sizes in controlled designs. The primary outcome was BPD-related symptoms such as anger, suicidality, and impulsivity; and the secondary outcome was general psychopathology. An average dropout rate across interventions was computed. Study quality, target audiences, therapeutic approach and targets, effectiveness, intended use, usability metrics, availability on market, and downloads were assessed qualitatively from the papers and through internet search. Results: Twelve studies of 10 applications were included, reporting data from 408 participants. Between-groups meta-analyses of RCTs revealed no significant effect of smartphone applications above and beyond in-person treatments or a waitlist on BPD symptoms (Hedges’ g = − 0.066, 95% CI [−.257, .125]), nor on general psychopathology (Hedges’ g = 0.305, 95% CI [− 0.14, 0.75]). Across the 12 trials, dropout rates ranged from 0 to 56.7% (M = 22.5, 95% CI [0.15, 0.46]). A majority of interventions studied targeted emotion dysregulation and behavioral dyscontrol symptoms. Half of the applications are commercially available. Conclusions: The effects of smartphone interventions on symptoms of BPD are unclear and there is currently a lack of evidence for their effectiveness. More research is needed to build on these preliminary findings in BPD to investigate both positive and adverse effects of smartphone applications and identify the role these technologies may provide in expanding mental healthcare resources.

Usability Evaluations of Mobile Mental Health Technologies: A Systematic Review Study (Preprint)

Article

Full-text available

Jul 2019
J MED INTERNET RES

Background: There has been a vast amount of mobile health (mHealth) applications for mental health made available in recent years. While there is reason to be optimistic about their effect on improving health and increasing access to care, there is a call for more knowledge concerning how mHealth applications are used in practice. Objective: The goal of this study is to review the literature on how usability is being addressed and measured in mHealth interventions for mental health problems. Methods: We conducted a systematic literature review through a search for peer-reviewed studies published between 2001 and 2018 in the following electronic databases: EMBASE, CINAHL, PsycINFO, PubMED, and Web of Science. Two reviewers independently assessed all abstracts against the inclusion and exclusion criteria, following the PRISMA guidelines. Results: A total of 299 studies were initially identified based on the inclusion keywords. Following a review of the title, abstract and full text, 42 studies were found that fulfilled the criteria, most of which evaluated usability with patients (29) and health care providers (11) as opposed to healthy users (8) and were directed at a wide variety of mental health problems (24). Half of the studies set out to evaluate usability (21), and the remainder focused on feasibility (10) or acceptability (10). Regarding the maturity of the evaluated systems, most were either prototypes or previously tested versions of the technology, and the studies included few accounts of sketching and participatory design processes. The most commonly reason referred to for developing mobile mental health applications was the availability of mobile devices to users, their popularity, and how people in general became accustomed to using them for various purposes. Conclusions: This study provides a detailed account of how evidence of usability of mHealth applications is gathered in the form of usability evaluations from the perspective of computer science and human-computer interaction, including how users feature in the evaluation, how the study objectives and outcomes are stated, which research methods and techniques are used, and what the notion of mobility features is for mHealth applications. Most studies described their methods as trials, gathered data from a small sample size, and carried out a summative evaluation using a single questionnaire, which indicates that usability evaluation was not the main focus. As many studies described using an adapted version of a standard usability questionnaire, there may be a need for developing a standardized mHealth usability questionnaire. Keywords: Systematic review, mobile, apps, mHealth, mental health, usability evaluation

Usability Evaluations of Mobile Mental Health Technologies: A Systematic Review Study (Preprint)

Preprint

Full-text available

Jul 2019

BACKGROUND There has been a vast amount of mHealth applications for mental health made available in the recent years. While there is reason to be optimistic about their effect on improving health and increasing access to care, there is a call for more knowledge about how the usability of the mHealth applications is being addressed and scientifically measured. OBJECTIVE The goal for this study is to review the literature on how usability is being addressed and measured in mHealth interventions for mental health problems. METHODS We conducted a systematic literature review through a search for peer-reviewed studies published between 2001 and 2018 in the following electronic databases: EMBASE, CINAHL, PsycINFO, PubMED and Web of Science. Two reviewers independently assessed all abstracts against the inclusion and exclusion criteria, following the PRISMA guidelines. RESULTS 299 studies were initially identified based on the inclusion keywords. Following a review of the title, abstract and full text, the review resulted in a total of 42 studies. We found that most of the studies evaluated usability with patients (29) and health care providers (11) as opposed to healthy users (8) and were directed at a wide variety of mental health problems (24). Half of the studies set out to evaluate usability (21), secondly feasibility (10) and acceptability (10). Regarding the maturity of the evaluated systems, most were either prototypes or previously tested versions of the technology, and the studies included few accounts of sketching and participatory design processes. The most commonly referred to reason for developing mobile mental health applications was the availability of mobile devices to users, their popularity and how people in general have become accustomed to using them for various purposes. CONCLUSIONS This study provides a detailed account of how evidence of usability of mHealth applications are being gathered in the form of usability evaluations from a perspective of computer science and human-computer interaction, including how users feature in the evaluation, which study objectives and outcomes are being stated, which research methods and techniques are being used, and how the notion of mobility features in the mHealth applications. Most studies described their methods as trials, gathered date from a small sample size, and carried out a summative evaluation using a single questionnaire, indicating that usability evaluation was not the main focus. As many described using an adapted version of a standard usability questionnaire, there may be a need for developing a standardized mHealth usability questionnaire.

A Randomized Controlled Trial of a 14-Day Mindfulness Ecological Momentary Intervention (MEMI) for Generalized Anxiety Disorder (GAD)

Article

Full-text available

Jan 2023
EUR PSYCHIAT

BACKGROUND: Little is known about whether brief mindfulness ecological momentary interventions (MEMI) yield clinically beneficial effects. This gap exists despite the rapid growth of smartphone mindfulness applications. Specifically, no prior brief MEMI has targeted generalized anxiety disorder (GAD). Moreover, although theories propose that MEMI can boost executive functioning (EF), they have largely gone untested. Thus, this randomized controlled trial (RCT) aimed to address these gaps by assessing the efficacy of a 14-day smartphone MEMI (vs. self-monitoring placebo (SMP)). METHOD: Participants with GAD were randomly assigned to either condition (68 MEMI, 42 SMP). MEMI participants exercised multiple core mindfulness strategies and were instructed to practice mindfulness continually. Comparatively, SMP participants were prompted to practice self-monitoring and were not taught any mindfulness strategies. All prompts occurred five times a day for 14 consecutive days. Participants completed self-reports and neuropsychological assessments at baseline, post-treatment, and 1-month follow-up (1MFU). Piecewise hierarchical linear modeling analyses were conducted. RESULTS: MEMI (vs. SMP) produced greater pre-1MFU reductions in GAD severity and perseverative cognitions (between-group |d|=0.393–0.394) and stronger improvements in trait mindfulness and performance-based inhibition (|d|=0.280–0.303). Further, MEMI (vs. SMP) led to more considerable pre-post-treatment reductions in state-level depression and anxiety and more mindfulness gains (|d|=0.50–1.13). Overall, between-treatment effects were stronger at pre-1MFU than pre-post-treatment for trait-level than state-level treatment outcome measures. CONCLUSIONS: Preliminary findings suggest that the beneficial effect of an unguided brief MEMI to target pathological worry, trait mindfulness, and EF is modest yet potentially meaningful. Other theoretical and clinical implications were discussed.

The Use of Computer-Driven Technologies in the Treatment of Borderline Personality Disorder: A Systematic Review

Article

Full-text available

Jun 2022

The objective of this study was to perform a systematic review of the effectiveness of computer-driven technologies for treatment of patients suffering from BPD. A systematic literature review was conducted using the Pubmed, EMBASE, PsycNET (PsycINFO), CINAHL and Google Scholar electronic databases for the period from their inception dates until 2022. Thirty studies were selected for abstract screening. Seven studies were excluded for not meeting inclusion criteria. The remaining 23 studies were fully assessed, and 12 were excluded. Therefore, 11 studies were included in the analysis of the effectiveness of computer-driven technologies, which encompassed mobile applications, telehealth interventions, internet-based interventions, virtual reality MBT and dialogue-based integrated interventions. Computer-driven interventions are showing signs of effectiveness in the treatment of BPD symptoms. The limited number of articles found on the subject demonstrates a need for further exploration of this subject.

A Randomized Controlled Trial of a 14-Day Mindfulness Ecological Momentary Intervention (MEMI) for Generalized Anxiety Disorder

Preprint

Full-text available

Jan 2023

Little is known about whether brief mindfulness ecological momentary interventions (MEMI) yield clinically beneficial effects for generalized anxiety disorder. Thus, this randomized controlled trial evaluated the efficacy of a 14-day smartphone MEMI (vs. self-monitoring placebo (SMP)). Sixty-eight MEMI participants exercised multiple core mindfulness strategies and were instructed to practice mindfulness continually. Comparatively, 42 SMP participants were prompted to practice self-monitoring and were not taught mindfulness strategies. All prompts occurred five times a day for 14 days. MEMI (vs. SMP) led to more pre-post-treatment reductions in state depression and anxiety and more mindfulness gains. Further, MEMI (vs. SMP) produced greater pre-1-month-follow-up (pre-1MFU) reductions in GAD severity and perseverative thoughts and improvements in performance-based inhibition and EF errors. However, there were no notable treatment effects for working memory and verbal fluency. Overall, results were stronger at pre-1MFU than pre-post-treatment. An unguided, technology-assisted, brief MEMI effectively targeted GAD and specific EF facets.

A smartphone application of “Family Connections” to increase the use of skills and improve psychological symptoms in relatives of people with borderline personality disorder: A study protocol for a randomized controlled trial

Article

Full-text available

May 2022

Background The literature reveals that borderline personality disorder (BPD) is an important public mental health problem that affects both the patients and their families. Moreover, studies indicate a high prevalence of psychological symptoms and burden in relatives of people with BPD. Therefore, it is necessary to develop useful and accessible interventions specifically addressed to the caregivers. Smartphone interventions with Ecological Momentary Assessment (EMA) and Ecological Momentary Interventions (EMI) offer several potential advantages in this regard. The aims of our study are to test the effectiveness of a combined intervention supported by a smartphone app versus the same intervention supported by a paper-based manual, studying the feasibility and acceptance of both conditions and evaluating the perceptions and opinions of families about both interventions. This paper contains the study protocol. Method The design of this study protocol is a randomized controlled trial. A minimum of 116 relatives will be randomly assigned to two conditions: Treatment as usual (TAU) (N = 58) or Treatment as usual + EMI (TAU+EMI) (N = 58), with TAU being the Family Connection program. The primary outcome will be the Burden Assessment Scale. Secondary outcomes will include psychological symptoms, mastery and empowerment, and resilience. Outcomes will be assessed from pre-treatment to post-treatment (3 months). Statistical analyses will be performed using Student's t-tests, mixed models (ANCOVA) and intention-to-treat analysis. Discussion The results of this study will provide a basis for future EMA- and EMI-based application interventions for family members of people with BPD and family members of people with other mental disorders who could benefit from the skills taught.

Standalone Smartphone Cognitive Behavioral Therapy-Based Ecological Momentary Interventions to Increase Mental Health: Narrative Review

Article

Full-text available

Nov 2020

Background: A growing number of psychological interventions are delivered via smartphones with the aim of increasing the efficacy and effectiveness of these treatments and providing scalable access to interventions for improving mental health. Most of the scientifically tested apps are based on cognitive behavioral therapy (CBT) principles, which are considered the gold standard for the treatment of most mental health problems. Objective: This review investigates standalone smartphone-based ecological momentary interventions (EMIs) built on principles derived from CBT that aim to improve mental health. Methods: We searched the MEDLINE, PsycINFO, EMBASE, and PubMed databases for peer-reviewed studies published between January 1, 2007, and January 15, 2020. We included studies focusing on standalone app-based approaches to improve mental health and their feasibility, efficacy, or effectiveness. Both within- and between-group designs and studies with both healthy and clinical samples were included. Blended interventions, for example, app-based treatments in combination with psychotherapy, were not included. Selected studies were evaluated in terms of their design, that is, choice of the control condition, sample characteristics, EMI content, EMI delivery characteristics, feasibility, efficacy, and effectiveness. The latter was defined in terms of improvement in the primary outcomes used in the studies. Results: A total of 26 studies were selected. The results show that EMIs based on CBT principles can be successfully delivered, significantly increase well-being among users, and reduce mental health symptoms. Standalone EMIs were rated as helpful (mean 70.8%, SD 15.3; n=4 studies) and satisfying for users (mean 72.6%, SD 17.2; n=7 studies). Conclusions: Study quality was heterogeneous, and feasibility was often not reported in the reviewed studies, thus limiting the conclusions that can be drawn from the existing data. Together, the studies show that EMIs may help increase mental health and thus support individuals in their daily lives. Such EMIs provide readily available, scalable, and evidence-based mental health support. These characteristics appear crucial in the context of a global crisis such as the COVID-19 pandemic but may also help reduce personal and economic costs of mental health impairment beyond this situation or in the context of potential future pandemics.

Standalone smartphone CBT-based Ecological Momentary Interventions to increase mental health - a narrative review (Preprint)

Article

Full-text available

May 2020

Background A growing number of psychological interventions are delivered via smartphones with the aim of increasing the efficacy and effectiveness of these treatments and providing scalable access to interventions for improving mental health. Most of the scientifically tested apps are based on cognitive behavioral therapy (CBT) principles, which are considered the gold standard for the treatment of most mental health problems. Objective This review investigates standalone smartphone-based ecological momentary interventions (EMIs) built on principles derived from CBT that aim to improve mental health. Methods We searched the MEDLINE, PsycINFO, EMBASE, and PubMed databases for peer-reviewed studies published between January 1, 2007, and January 15, 2020. We included studies focusing on standalone app-based approaches to improve mental health and their feasibility, efficacy, or effectiveness. Both within- and between-group designs and studies with both healthy and clinical samples were included. Blended interventions, for example, app-based treatments in combination with psychotherapy, were not included. Selected studies were evaluated in terms of their design, that is, choice of the control condition, sample characteristics, EMI content, EMI delivery characteristics, feasibility, efficacy, and effectiveness. The latter was defined in terms of improvement in the primary outcomes used in the studies. Results A total of 26 studies were selected. The results show that EMIs based on CBT principles can be successfully delivered, significantly increase well-being among users, and reduce mental health symptoms. Standalone EMIs were rated as helpful (mean 70.8%, SD 15.3; n=4 studies) and satisfying for users (mean 72.6%, SD 17.2; n=7 studies). Conclusions Study quality was heterogeneous, and feasibility was often not reported in the reviewed studies, thus limiting the conclusions that can be drawn from the existing data. Together, the studies show that EMIs may help increase mental health and thus support individuals in their daily lives. Such EMIs provide readily available, scalable, and evidence-based mental health support. These characteristics appear crucial in the context of a global crisis such as the COVID-19 pandemic but may also help reduce personal and economic costs of mental health impairment beyond this situation or in the context of potential future pandemics.

Technology-Based Psychosocial Interventions for People with Borderline Personality Disorder: A Scoping Review of the Literature

Article

Full-text available

Sep 2020

Evidence-based psychosocial interventions for borderline personality disorder (BPD) still face multiple challenges regarding treatment accessibility, adherence, duration or economic costs. Over the last decade, technology has addressed these concerns from different disciplines. The current scoping review aimed to delineate novel and ongoing clinical research on technology-based psychosocial interventions for patients with BPD. Online databases (PsycInfo, Web of Science, EMBASE, Google Scholar, PubMed) were searched up to June 2020. Technology-based psychosocial treatments included innovative communication (eHealth) and computational (e.g.,artificial intelligence), computing (e.g.,computer-based) or medical (e.g.,functional magnetic resonance imaging) software. Clinical research encompassed any testing stage (e.g., feasibility, efficacy). Fifteen studies met the inclusion criteria. The main findings were: almost two thirds of the studies (9/15) tested software explicitly conceived as adjunctive interventions to conventional therapy; nearly half of the studies (7/15) were referred to as dialectical behavior therapy-based software; most studies (13/15) were focused on the initial stage of the clinical research cycle (feasibility/acceptance/usability testing), reporting good results at this point; more than one third of the studies (6/15) tested mobile apps; there is emerging evidence for Internet-based interventions and real-time fMRI biofeedback but only little evidence for mHealth interventions, virtual and augmented reality, and computer-based interventions; there was no computational technology-based clinical research; and there was no satisfaction/preference, security/safety or efficiency testing for any software. Taken together, the results suggest that there is a growing, but still incipient amount of technology-based psychosocial interventions for BPD supported by some kind of clinical evidence. Limitations and directions for future research are discussed.

Perspectives of crisis intervention for people diagnosed with "borderline personality disorder": An integrative review

Article

Full-text available

May 2020

*JPMHN Paper of the Year Award 2020* Introduction: “Borderline personality disorder” (“BPD”) is associated with frequent use of crisis intervention services. However, no robust evidence base supports specific interventions, and people's experiences are not well understood. Aim: To explore the experiences of stakeholders involved in the crisis care of people diagnosed with “BPD.” Method: Integrative review with nine databases searched January 2000 to November 2017. The search filtered 3,169 titles and abstracts with 46 full-text articles appraised and included. Results: Four themes were constructed from thematic analysis: crisis as a recurrent multidimensional cycle, variations and dynamics impacting on crisis intervention, im- pact of interpersonal dynamics and communication on crisis, and balancing decision- making and responsibility in managing crisis. Discussion: Crisis is a multidimensional subjective experience, which also contributes to distress for family carers and professionals. Crisis interventions had limited and subjective benefit. They are influenced by accessibility of services, different under- standings of “BPD” and human dynamics in complex decision-making, and can be experienced as helpful or harmful. Implications for practice: Subjectivity of crisis experiences shows limitations of the diagnostic model of “BPD,” emphasizing that interventions should remain person- centred. While thresholds for intervention are often met after self-harm or suicidality, professionals should review approaches to care and support people with underlying distress.

Smartphone apps for the treatment of mental disorders: a systematic review.

Article

Full-text available

Apr 2020
J MED INTERNET RES

Background: Smartphone apps are an increasingly popular means for delivering psychological interventions to patients suffering from a mental disorder. In line with this popularity, there is a need to analyze and summarize the state of the art, both from a psychological and technical perspective. Objective: This study aimed to systematically review the literature on the use of smartphones for psychological interventions. Our systematic review has the following objectives: (1) analyze the coverage of mental disorders in research articles per year; (2) study the types of assessment in research articles per mental disorder per year; (3) map the use of advanced technical features, such as sensors, and novel software features, such as personalization and social media, per mental disorder; (4) provide an overview of smartphone apps per mental disorder; and (5) provide an overview of the key characteristics of empirical assessments with rigorous designs (ie, randomized controlled trials [RCTs]). Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews were followed. We performed searches in Scopus, Web of Science, American Psychological Association PsycNET, and Medical Literature Analysis and Retrieval System Online, covering a period of 6 years (2013-2018). We included papers that described the use of smartphone apps to deliver psychological interventions for known mental disorders. We formed multidisciplinary teams, comprising experts in psychology and computer science, to select and classify articles based on psychological and technical features. Results: We found 158 articles that met the inclusion criteria. We observed an increasing interest in smartphone-based interventions over time. Most research targeted disorders with high prevalence, that is, depressive (31/158,19.6%) and anxiety disorders (18/158, 11.4%). Of the total, 72.7% (115/158) of the papers focused on six mental disorders: depression, anxiety, trauma and stressor-related, substance-related and addiction, schizophrenia spectrum, and other psychotic disorders, or a combination of disorders. More than half of known mental disorders were not or very scarcely (<3%) represented. An increasing number of studies were dedicated to assessing clinical effects, but RCTs were still a minority (25/158, 15.8%). From a technical viewpoint, interventions were leveraging the improved modalities (screen and sound) and interactivity of smartphones but only sparingly leveraged their truly novel capabilities, such as sensors, alternative delivery paradigms, and analytical methods. Conclusions: There is a need for designing interventions for the full breadth of mental disorders, rather than primarily focusing on most prevalent disorders. We further contend that an increasingly systematic focus, that is, involving RCTs, is needed to improve the robustness and trustworthiness of assessments. Regarding technical aspects, we argue that further exploration and innovative use of the novel capabilities of smartphones are needed to fully realize their potential for the treatment of mental health disorders.

François Vatel se serait-il suicidé s'il avait eu un smartphone ? Potentiels de soin et conséquences épistémologiques des technologies mobiles en santé mentale

Article

Jan 2017

Francois Vatel committed suicide on the morning of April 24th, 1671, believing that the fish he had ordered for the sumptuous event, which he had been asked to organize by the Prince of Conde, would not be received in time. Could this famous gesture have been avoided in the e-health era ? The progress in technology stemming from the advent of connected tools and m-health raise a lot of enthusiasm : A myriad of devices now allow to take preventive and proactive actions, in real time and in ecological situations. They offer unprecedented possibilities to refine data collection and intervene on a person’s functioning within their environment. These technological developments provoke and are accompanied by major changes in the categories of understanding of mental health problems. New concepts of mental disorders allow for micro-interventions, which are much more targeted, progressive, and contextualized than previous categorical approaches applying « macro-interventions » to « macropathologies ». Web 3.0 modifies the mental health ecosystem, favoring the emergence, of new actors and commercial issues. This raises many concerns, particularly with regard to which evaluation and regulation modalities are to establish. Such sociological and politico-economic issues include transferring the responsibility burden from the state to the individual, the injunction to be an ideal autonomous citizen, the fragmentation of jurisdictions’, opening the access to the frontier of expertise and the development of inadequate practices halfway between medicine, self-management and well-being. It is an imperative to put the necessary devices in place to supply appropriately the patient 3.0 and the actors 3.0. This means giving them conceptual, cultural and technical tools as well as concrete means to perceive and understand the social configurations « 3.0 » in which they are caught, thus allowing them to be enlightened actors of this new sociotechnical system. * Les évolutions des outils connectés et de la e-santé soulèvent beaucoup d’enthousiasme : une myriade de dispositifs permettent désormais d’agir préventivement et proactivement, en temps réel et en situation écologique. Ils offrent un potentiel inédit de diminution du grain d’analyse et d’intervention. Ces évolutions suscitent et s’accompagnent d’évolutions majeures des catégories d’entendement en santé mentale. Des micro-interventions beaucoup plus ciblées, évolutives et contextualisées que ne le permettaient les précédentes approches appliquant des « macro-interventions » à des « macropathologies » sont désormais possibles. Le Web 3.0 modifie l’écosystème de santé mentale, favorisant l’apparition de nouveaux acteurs et enjeux et provoquant de nombreuses inquiétudes, s’agissant d’évaluation et de régulation. Le transfert des responsabilités de l’État à l’individu, la normativité de l’autonomie du citoyen 3.0 idéal, la fragmentation des juridictions, l’ouverture de zones d’expertises aux frontières et le développement de pratiques entre la médecine, l’autogestion et le bienêtre constituent autant d’enjeux sociologiques et politico-économiques. Il est nécessaire de doter les acteurs de la e-santé de l’outillage conceptuel, culturel, technique et des moyens de comprendre les configurations sociales « 3.0 » dans lesquelles ils se trouvent pris afin qu’ils puissent devenir des acteurs éclairés de ce nouveau système sociotechnique.

FRANÇOIS VATEL SE SERAIT-IL SUICIDÉ S'IL AVAIT EU UN SMARTPHONE ?

Article

Full-text available

Jan 2017

Systematic Review of Mindfulness-Based Ecological Momentary Interventions: Synthesizing Current Methods and Identifying Directions for Future Research

Article

Full-text available

May 2024

Understanding how to disseminate mindfulness-based interventions can help address disparities to support service access and reduce psychopathology. Ecological momentary interventions (EMIs), which are provided in real-world environments using technology, incorporate mindfulness procedures. We conducted a systematic review of mindfulness-based EMIs to identify targets for streamlining design and implementation of these interventions. Databases were searched in November, 2022, and screened without publication date restrictions. References from pertinent systematic and meta-analytic reviews were then screened by two authors, with discrepancies resolved by a third author in Covidence at all review stages (i.e., abstract screen; full-text screen) for inclusion. The final number of articles was 82. There was considerable variability in design of mindfulness-based EMIs, and samples were predominantly White or did not report race/ethnicity. Many studies did not report or discuss statistical power, and theoretical orientations of interventions were variable. Feasibility, effects, and moderators are briefly discussed. While mindfulness-based EMIs are touted to increase access to evidence-based interventions and promote psychological well-being, our findings highlight a lack of diverse samples and reporting of essential study characteristics, information regarding whether studies were sufficiently powered, and a lack of standardization in intervention delivery. The question of whether mindfulness-based EMIs are efficacious is obscured by heterogeneity regarding design and implementation of these interventions. Consolidation of common mindfulness-based EMI methods could inform design decisions and adaptations to certain populations.

A systematic quality rating of available mobile health apps for borderline personality disorder

Article

Full-text available

Jun 2022

Background Mobile health apps (MHAs) may offer a mean to overcome treatment barriers in Borderline Personality Disorder (BPD) mental health care. However, MHAs for BPD on the market lack transparency and quality assessment. Methods European app stores were systematically searched, and two independent trained reviewers extracted relevant MHAs. Employed methods and privacy and security details documentation of included MHAs were extracted. MHAs were then assessed and rated using the German version of the standardized Mobile Application Rating Scale (MARS-G). Mean values and standard deviations of all subscales (engagement, functionality, aesthetics, information, and therapeutic gain) and correlations with user ratings were calculated. Results Of 2977 identified MHAs, 16 were included, showing average quality across the four main subscales (M = 3.25, SD = 0.68). Shortcomings were observed with regard to engagement (M = 2.87, SD = 0.99), potential therapeutic gain (M = 2.67, SD = 0.83), existing evidence base (25.0% of included MHAs were tested empirically), and documented privacy and security details. No significant correlations were found between user ratings and the overall total score of the MARS-G or MARS-G main subscales. Conclusions Available MHAs for BPD vary in quality and evidence on their efficacy, effectiveness, and possible adverse events is scarce. More substantial efforts to ensure the quality of MHAs available for patients and a focus on transparency, particularly regarding privacy and security documentation, are necessary.

Stand-Alone KVT-basierte Interventionen via Smartphone zur Förderung der psychischen Gesundheit

Article

Jun 2021

ZUSAMMENFASSUNG Einleitung Eine wachsende Zahl psychologischer Behandlungsangebote erfolgt über das Smartphone, bzw. über Apps. Viele der wissenschaftlich geprüften Apps basieren auf den Prinzipien der kognitiven Verhaltenstherapie (KVT), Goldstandard zur Behandlung vieler psychischer Problematiken. Ziel dieses Reviews war es, den Status Quo der Forschung zu Stand-Alone Smartphone-basierten Apps zusammenzufassen, welche auf diesen therapeutischen Ansätzen basieren und mittels App-basierten Ecological Momentary Interventions (EMIs) durchgeführt werden. Methode Eine systematische Literaturrecherche in MEDLINE, PsycINFO, Embase und PubMed identifizierte 26 zwischen 2007 und 2020 publizierte, peer-reviewte Studien, in denen Durchführbarkeit und/oder Wirksamkeit und/oder Effektivität von KVT-basierten EMIs sowohl in Studiendesigns mit inter- als auch intraindividuellen Vergleichen, sowohl bei gesunden als auch klinischen Stichproben untersucht wurden. Gemischte Interventionen (blended interventions), z. B. App-basierte Behandlungen in Kombination mit klassischer Psychotherapie wurden nicht mitberücksichtigt. Ergebnisse KVT-basierte EMIs wurden von Teilnehmern angenommen, verbesserten das Wohlbefinden der Nutzer signifikant und reduzierten Symptome psychischer Störungen. Stand-Alone EMIs wurden von den Teilnehmenden als hilfreich (M = 70,8 %) und bezüglich der Outcomes als zufriedenstellend (M = 72,6 %) eingeschätzt. Schlussfolgerung In Summe zeigten die Studien, dass EMIs dazu beitragen können, die psychische Gesundheit zu verbessern und damit Individuen in ihrem täglichen Leben zu unterstützen. Sie bieten somit eine unmittelbar verfügbare, skalierbare und evidenzbasierte Form der Unterstützung psychischer Gesundheit. Diese Charakteristiken sind nicht zuletzt relevant im Kontext der Bemühungen, die individuellen und ökonomischen Kosten psychischer Erkrankungen zu reduzieren, wie auch im Kontext globaler Pandemien.

Therapeutic Relationship in eHealth-A Pilot Study of Similarities and Differences between the Online Program Priovi and Therapists Treating Borderline Personality Disorder

Article

Full-text available

Sep 2020
Int J Environ Res Publ Health

eHealth programs have been found to be effective in treating many psychological conditions. Regarding Borderline Personality Disorder (BPD), few programs have been tested; nevertheless, results are promising. The therapeutic alliance is an important factor predicting treatment outcome in BPD. However, we do not know yet to what extent BPD patients form a therapeutic alliance with an eHealth tool and how this relationship differs from the relationship with their human therapist. This study aims to address this question using priovi, an interactive schema therapy-based eHealth tool for BPD. Semi-structured interviews were conducted to explore how patients perceived the therapeutic alliance with priovi and its differences compared to the alliance with their human therapist (N = 9). Interview data were analyzed following the procedures of qualitative content analysis. Additionally, the Working Alliance Inventory (WAI-SR) was administered in two versions (regarding the human therapist and priovi, N = 16) every three months during the treatment phase of one year. Results indicate that patients were able to form a good therapeutic relationship with priovi, but it differed from the relationship to their human therapist. Important categories were "priovi is helpful, supportive and always there" and "priovi is less flexible". WAI ratings for the task subscale were high in both relationships but significantly higher in WAItherapist compared to WAIpriovi in two measurements (nine-months measurement: t = 2.76, df = 15, p = 0.015; twelve-months measurement: t = 3.44, df = 15, p = 0.004). These results indicate that BPD patients can form a functioning alliance with an eHealth program and that eHealth programs may be especially useful for psychoeducation and cognitive exercises.

A Mobile Medical Knowledge Dissemination Platform (HeadToToe): Mixed Methods Study

Article

Full-text available

Mar 2020

Background: Finding readily accessible high-quality medical references can be a challenging task. HeadToToe is a mobile platform designed to allow easy and quick access to sound, up-to-date, and validated medical knowledge and guidance. It provides easy access to essential clinical medical content in the form of documents, videos, clinical scores and other formats, for the day-to-day access and use by medical students and physicians during their pre- and post-graduate education. Objective: The aim of this paper is to describe the architecture, user interface and potential strengths and limitations of an innovative knowledge dissemination platform developed in the University of Geneva, Switzerland. We also report preliminary results from user experience survey and usage statistics over a selected period. Methods: The dissemination platform consists of a smartphone application. Through an administration interface, content is managed by senior University and Hospital staff. The application includes the following sections: (1) main section of medical guidance, organized by clinical field; (2) checklists for history-taking and clinical examination, organized by body systems; (3) laboratory section with frequently used lab values; (4) favorites section. Each content component is programmed to be available for a given duration as defined by the content's author. Automatic notifications signal the author when the content is about to expire, hence promoting its timely updating and reducing the risk of using obsolete content. In the background, a third-party statistical collecting tool records anonymous utilization statistics. Results: We launched the final version of the platform in March 2019, both at the faculty of medicine and at the University Hospitals of Geneva in Switzerland. A total of 622 students in the University and 613 health professionals in the Hospital downloaded the application. Two thirds of users had an iOS device in both institutions. During practical examination period (May 2019) there was significant increase in number of active users (p = 0.003), user activity (p = 0.0008) and daily usage time (p = 0.0004) within medical students. In addition, there were 1,086 clinical skills videos views during this period compared to a total of 484 in preceding months (108% increase). On a ten-level Likert scale, students and physicians rated the app with mean scores of 8.3 for user experience, usefulness, and relevance of content. In parallel, postgraduate trainees viewed more than 6000 documents during the first 3 months after the implementation in the Division of Neurology in our institution. Conclusions: HeadToToe is an educator driven, mobile dissemination platform, which provides rapid and user-friendly access to up-to-date medical content and guidance. The platform was given a high rate for user experience, usefulness and content quality and was used more often during exams period. This suggests that the platform could be used as tool for exams preparation.

The integration and evaluation of a mobile application into Dialectical Behavior Therapy (DBT) for persons with Borderline personality Disorder: A qualitative and quantitative study (Preprint)

Article

Full-text available

Jun 2019

Background: The advancement of and access to technology such as smartphones has implications for psychotherapeutic health care and how interventions for a range of mental health disorders are provided. Objective: The objective of this study was to describe the experiences of participants while using a mobile phone app that was designed to enhance and support dialectical behavior therapy for personality disorders. Methods: A combination of in-depth interviews and questionnaires were used to capture the experiences of participants who used the app while undergoing dialectical behavior therapy treatment. A mixed methods approach was used; qualitative data from the interviews were analyzed using thematic analysis and were combined with quantitative data from the questionnaires. Results: Participants (N=24) who were receiving dialectical behavior therapy used the trial app. Participants (n=20) completed an evaluation questionnaire and a subset of this group (n=8) participated in semistructured interviews. Major themes that were identified from the interviews were (1) an overall positive experience of using the app-participants perceived that the app facilitated access and implementation of dialectical behavior therapy strategies (to regulate mood and behavior in challenging situations)-and (2) that the app provided a common source of information for patient and therapist interactions-app-based interactions were perceived to facilitate therapeutic alliance. Qualitative themes from the interviews were largely congruent with the quantitative responses from the questionnaires. Conclusions: Participants welcomed the integration of technology as a supplement to clinical treatment. The app was perceived to facilitate and support many of the therapeutic techniques associated with dialectical behavior therapy treatment. The incorporation of technology into psychotherapeutic interventions may facilitate the transfer of knowledge and strategies that are learned in therapy to use in real-world settings thereby promoting recovery from mental health problems.

A Schema Therapy-Based eHealth Program for Patients with Borderline Personality Disorder (priovi): Naturalistic Single-Arm Observational Study

Article

Full-text available

Dec 2018

Smartphone apps for the treatment of mental disorders: a systematic review. (Preprint)

Preprint

Jun 2019

BACKGROUND Smartphone apps are an increasingly popular means for providing psychological interventions to patients suffering from a mental disorder. In line with this popularity, there is a need to analyse and summarize the state of the art, both from a psychological and technical perspective. OBJECTIVE This systematic review focuses on the use of smartphones for psychological interventions. We aim to: (i) analyze the evolution of research over time as well as the covered mental disorders; (ii) study the characteristics of assessments that were performed; (iii) map the use of advanced technical features, such as sensors, and novel software features, such as personalization and social media; and (iv) provide an overview of developed smartphone apps per mental disorder. METHODS The PRISMA guidelines for systematic reviews were followed. We performed searches in Scopus, Web of Science, APA PsycNET and MEDLINE, covering a period of over five years (2013+). We included papers that describe the use of smartphone apps to deliver psychological interventions for known mental disorders. We formed multidisciplinary teams, comprising experts in psychology and ICT, to select and classify articles based on psychological and technical features. RESULTS 111 articles met the inclusion criteria. We observed an increasing interest in this field. More and more studies are focusing on clinical effects in addition to (only) usability/UX, but Randomly Controlled Trials (RCT) are still a small minority (16,2%). Around 70% of the papers focus on 6 mental disorders: depression, anxiety, trauma and stressor-related, substance-related and addiction, schizophrenia spectrum and other psychotic disorders, or a combination of disorders. More than half of known mental disorders are not or very scarcely (<3%) represented. Whereas interventions are leveraging the improved modalities (screen, sound) and interactivity of smartphones, their truly novel capabilities, such as sensors, alternative delivery paradigms and analytical methods, are only sparingly exploited. CONCLUSIONS We found an overall increase in smartphone-based interventions over time. Most research targets disorders with high prevalence, i.e., depressive (19,8%) and anxiety disorders (12,6%). Hence, there is a need for designing interventions that focus on disorders with high severity as well, such as personality disorders, which are currently only scarcely found. The majority of assessments evaluated usability/UX, and we found only a limited number of RCT. We contend that, to improve the robustness and trustworthiness of assessments, an increasingly systematic focus is needed as to effect on clinical symptomatology. Regarding technical aspects, most studies rather conservatively transfer traditional ICT interventions to smartphones. We argue that more innovative use of their novel capabilities is needed to fully realize promising treatments, such as Ecological Momentary Interventions, as they require context-awareness, though the use of sensors and analytics, to determine the need for interventions at times that patients need them most.

Treatment of Borderline Personality Disorder: Is Supply Adequate to Meet Public Health Needs?

Article

Full-text available

May 2019

Objectives: This study aimed to assess the supply of and demand for treatment of borderline personality disorder (BPD) to inform current standards of care and training in the context of available resources worldwide. Methods: The total supply of mental health professionals and mental health professionals certified in specialist evidence-based treatments for BPD was estimated for 22 countries by using data from publicly available sources and training programs. BPD prevalence and treatment-seeking rates were drawn from large-scale national epidemiological studies. Ratios of treatment-seeking patients to available providers were computed to assess whether current systems are able to meet demand. Training and certification requirements were summarized. Results: The ratio of treatment-seeking patients with BPD to mental health professionals (irrespective of professionals’ interest or training in treating BPD) ranged from approximately 4:1 in Australia, the Netherlands, and Norway to 192:1 in Singapore. The ratio of treatment-seeking patients to clinicians certified in providing evidence-based care ranged from 49:1 in Norway to 148,215:1 in Mexico. Certification requirements differed by treatment and by country. Conclusions: Shortages of both providers available to treat BPD and providers certified in specialist treatments of BPD exist in most of the 22 countries studied. In well-resourced countries, training clinicians to provide generalist or abbreviated treatments for BPD, in addition to specialist treatments, could help address the current implementation gap. More resource-efficient alternatives must be considered in countries with insufficient staff to implement even generalist treatments. Consideration of realistic allocation of care may shape future guidelines and standards of BPD treatments, beyond intensive evidence-based psychotherapies.

Strategies to Deal With Suicide and Non-suicidal Self-Injury in Borderline Personality Disorder, the Case of DBT

Article

Full-text available

Dec 2018

One of the most problematic aspects of borderline personality disorder resides in repeated non-suicidal self-injury (NSSI) and suicide attempts. These behaviors constitute the prime therapeutic target and a factor that complicates patient care, namely in terms of therapeutic continuity. It has been demonstrated that Dialectical Behavior Therapy (DBT) is efficient in reducing the symptomatology of this disorder, as well as NSSI and suicide. DBT is a multi-component psychotherapeutic treatment, and the effectiveness of its individual constituents is therefore a relevant question. Studies comparing its various components (individual therapy, group therapy, and standard DBT) have not revealed any marked difference between them, other than a tendency toward improved patient retention rates in the standard version of the treatment. The aim of this study is to review the various components of DBT and their constituent parts, in order to highlight the importance of focusing on self-harm behaviors within the therapy as a whole. Although therapeutic strategies may differ and target directly suicide or NSSI, managing the quality of life, and the persistence of the therapeutic alliance (and of the interpersonal alliance) is equally important in terms of treatment efficacy.

(Preprint)

Article

May 2018

Background Electronic health (eHealth) programs have been found to be effective in treating many psychological conditions. However, regarding borderline personality disorder (BPD), only a few eHealth programs have been tested, involving small interventions based on the dialectical behavior therapy treatment approach. We investigated priovi, a program based on the schema therapy (ST) approach. priovi is considerably more comprehensive than prior programs, offering broad psychoeducation content and many therapeutic exercises. Objective We tested the acceptability and feasibility of priovi in 14 patients with BPD as an add-on to individual face-to-face ST. Methods Patients received weekly individual ST and used priovi over a period of 12 months. We assessed BPD symptom severity using self-reported and interview-based measures. Qualitative interviews were conducted with both patients and therapists to assess their experiences with priovi. Results BPD symptoms improved significantly (Cohen d=1.0). Overall, qualitative data showed that priovi was positively received by both patients and therapists. Some exercises provoked mild anxiety; however, no serious threat to safety was detected. Conclusions priovi is a potentially helpful and safe tool that could support individual ST. It needs to be further tested in a randomized controlled study. Trial Registration German Clinical Trials Register DRKS00011538; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00011538 (Archived by WebCite at http://www.webcitation.org/74jb0AgV8)

Priovi, an EHealth Programm for Patients with Borderline Personality Disorder to support individual face-to-face schema therapy� Pilot Study (Preprint)

Preprint

May 2018

BACKGROUND Electronic health (eHealth) programs have been found to be effective in treating many psychological conditions. However, regarding borderline personality disorder (BPD), only a few eHealth programs have been tested, involving small interventions based on the dialectical behavior therapy treatment approach. We investigated priovi, a program based on the schema therapy (ST) approach. priovi is considerably more comprehensive than prior programs, offering broad psychoeducation content and many therapeutic exercises. OBJECTIVE We tested the acceptability and feasibility of priovi in 14 patients with BPD as an add-on to individual face-to-face ST. METHODS Patients received weekly individual ST and used priovi over a period of 12 months. We assessed BPD symptom severity using self-reported and interview-based measures. Qualitative interviews were conducted with both patients and therapists to assess their experiences with priovi. RESULTS BPD symptoms improved significantly (Cohen d=1.0). Overall, qualitative data showed that priovi was positively received by both patients and therapists. Some exercises provoked mild anxiety; however, no serious threat to safety was detected. CONCLUSIONS riovi is a potentially helpful and safe tool that could support individual ST. It needs to be further tested in a randomized controlled study. CLINICALTRIAL German Clinical Trials Register DRKS00011538; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00011538

The formidable cluster: The challenge of personality disorders among hospitalized patients

Article

Sep 2016
J HOSP MED

Android Application for Human Respiratory System Diagnosis: A Systematic Review

Conference Paper

Nov 2022

A Randomized Controlled Trial of a 14-Day Mindfulness Ecological Momentary Intervention (MEMI) for Generalized Anxiety Disorder (GAD)

Article

Full-text available

Jan 2023
EUR PSYCHIAT

Background Little is known about whether brief mindfulness ecological momentary interventions (MEMIs) yield clinically beneficial effects. This gap exists despite the rapid growth of smartphone mindfulness applications. Specifically, no prior brief MEMI has targeted generalized anxiety disorder (GAD). Moreover, although theories propose that MEMIs can boost executive functioning (EF), they have largely gone untested. Thus, this randomized controlled trial (RCT) aimed to address these gaps by assessing the efficacy of a 14-day smartphone MEMI (versus self-monitoring placebo [SMP]). Method Participants with GAD were randomly assigned to either condition (68 MEMI and 42 SMP). MEMI participants exercised multiple core mindfulness strategies and were instructed to practice mindfulness continually. Comparatively, SMP participants were prompted to practice self-monitoring and were not taught any mindfulness strategies. All prompts occurred five times a day for 14 consecutive days. Participants completed self-reports and neuropsychological assessments at baseline, posttreatment, and 1-month follow-up (1MFU). Piecewise hierarchical linear modeling analyses were conducted. Results MEMI (versus SMP) produced greater pre-1MFU reductions in GAD severity and perseverative cognitions (between-group d = 0.393–0.394) and stronger improvements in trait mindfulness and performance-based inhibition ( d = 0.280–0.303). Further, MEMI (versus SMP) led to more considerable pre- to posttreatment reduction in state-level depression and anxiety and more mindfulness gains ( d = 0.50–1.13). Overall, between-treatment effects were stronger at pre-1MFU than pre- to posttreatment for trait-level than state-level treatment outcome measures. Conclusions Preliminary findings suggest that the beneficial effect of an unguided brief MEMI to target pathological worry, trait mindfulness, and EF is modest yet potentially meaningful. Other theoretical and clinical implications were discussed.

Crisis Resolution Home Treatment Team Clinicians' perceptions of using a Recovery Approach with people with a diagnosis of Borderline Personality Disorder

Article

Dec 2022
J PSYCHIATR MENT HLT

Introduction: People with a diagnosis of borderline personality disorder (BPD) are often in contact with mental health services at a point of crisis and in the UK this includes Crisis Resolution Home Treatment teams (CRHTT). There is a drive for services to be recovery orientated, however, there is little evidence about the degree to which community services achieve this for people with a diagnosis of BPD when in crisis. Research aim: To understand the perceptions held by CRHTT clinicians about their provision of recovery-orientated acute care, for people with a diagnosis of BPD METHOD: From a purposive sample of a single CRHTT, seven registered mental health nurses were interviewed and Braun and Clarke's thematic analysis framework was used to interpret the data. Results: Five themes emerged: person-centred care; the timing is wrong; inconsistent staffing; the risks are too great; and BPD as a label. Discussion: The results demonstrate tensions between a drive to deliver person-centred care and a range of challenges that inhibit this, with the possibility of re-framing a recovery approach as 'recovery-ready'. Implications for practice: A whole-systems approach is required to enable a consistent recovery-oriented approach, but research is also needed for brief interventions specific to this context.

Technologies mobiles connectées et reconfigurations du champ de la santé mentale

Chapter

Sep 2018

Xavier Briffault

Les technologies informatiques mobiles connectées intègrent peu à peu le champ de la santé mentale. Par le potentiel d’extension ubiquitaire d’observation et d’action qu’elles offrent, elles sont susceptibles d’avoir un impact majeur sur les modalités théoriques, pratiques et éthiques du soin en santé mentale. Les extensions spatio-temporelles, thématiques, relationnelles de la consultation traditionnelle, et l’augmentation du pouvoir d’agir des patients sont susceptibles d’entraîner une déconstruction massive des catégories d’entendement qui organisent le champ de la médecine mentale et des reconfigurations fondamentales du champ, qu’il est nécessaire d’anti-ciper dès à présent.

How Do eMental Health Apps Implement Cognitive Behavioral Therapy: A Literature Review (Preprint)

Article

Full-text available

Feb 2021
J MED INTERNET RES

Background: To address the matter of limited resources for treating persons with mental disorders, eMental Health gained in interest in the last years. More specifically, mobile health (mHealth) apps have been suggested as electronic mental health interventions, accompanying cognitive behavioral therapy (CBT). Objective: The current study aims to identify which therapeutic aspects of CBT have been implemented in existing mHealth apps and by which technologies. From this, we derive research gaps that should be addressed in future. Methods: Three databases were screened for studies on mHealth apps in the context of mental disorders that implement techniques of CBT: PubMed, IEEE Xplore, and ACM Digital Library. The studies were independently selected by two reviewers who then extracted data from the included studies. Data on CBT techniques and their technical implementation in mHealth apps were synthesized narratively. Results: Out of 530 citations retrieved, 34 studies were included in this review. mHealth applications for CBT exploit two groups of technologies: 1) technologies that implement CBT techniques for cognitive restructuring, behavioral activation and problem solving; exposure, is not yet realized in mHealth apps, 2) technologies that aim to increase user experience, adherence, and engagement. The synergy of these technologies enable patients to self-manage and self-monitor their mental state and access relevant information on their mental illness which helps coping with mental health problems and allows self-treatment. Conclusions: There are CBT techniques that can be implemented in mHealth apps. Additional research is needed on efficacy of the mHealth interventions, its side effects including inequalities due to the digital divide, addictive internet behavior, lack of trust in mHealth, anonymity issues, risks and biases for user groups and social contexts, and ethical implications. Further research is required to integrate and test psychological theories to improve mHealth’s impact and adherence to the eMental health intervention.

Psychoéducation et régulation émotionnelle en temps de confinement : faisabilité et intérêt de vidéos YouTube de thérapie comportementale dialectique [Psychoeducation and emotional regulation in times of confinement: Feasibility and interest of YouTube videos of dialectical behavioral therapy]

Article

Full-text available

Nov 2021
ANN MED-PSYCHOL

Introduction La Thérapie Comportementale Dialectique (TCD) vise à diminuer la dysrégulation émotionnelle, notamment par l’apprentissage en groupe de compétences. En mars 2020, le confinement dû à la COVID-19 a interrompu brutalement ces groupes. Nous avons poursuivi cet apprentissage par vidéos YouTube. Notre objectif est d’évaluer la faisabilité de ce format pendant le confinement. Méthode Tous les participants à des groupes d’entraînement aux compétences TCD réalisés à Strasbourg ont été inclus (n = 37). Les vidéos psychoéducatives ont été publiées, de façon bihebdomadaire, durant le confinement sur la chaîne YouTube « GREMO HUS ». Les participants ont été encouragés à visionner ces vidéos par appels/messages. Un mois après la fin du confinement, un questionnaire en ligne a évalué la satisfaction. Résultats Au total, 92 % des patients ont répondu. Sur les 34 répondeurs, 28 (82 %) avaient regardé au moins une vidéo, et 32 % plus de 6 vidéos. Une très large majorité des utilisateurs étaient satisfaits des vidéos. Au total, 79 % se disaient fortement aidés dans la compréhension des compétences, et 77 % pensaient avoir utilisé plus fréquemment les compétences TCD. Tous sauf un se sont dit aidés par les compétences pour mieux surmonter les difficultés en période de confinement. Discussion Notre étude est la première à interroger directement des patients concernant des vidéos YouTube. Ces vidéos sont jugées pertinentes par les participants en période de confinement. Leur utilisation pourrait être un complément des groupes hors confinement, ainsi que pour la formation des thérapeutes. Introduction Dialectical Behavior Therapy (DBT) aims to decrease emotional dysregulation, particularly through psychoeducation groups targeting skills learning. In March 2020, the confinement due to COVID-19 abruptly interrupted these groups. We continued skills training through YouTube videos. Our objective is to evaluate the feasibility of this format during the confinement. Method All the participants in the DBT skills group carried out in Strasbourg were included (n = 37). The psychoeducational videos were published biweekly during the confinement on the YouTube channel “GREMO HUS”. Participants were encouraged to view these videos by calls/messages. One month after the end of the confinement, an online questionnaire assessed satisfaction. Results In total, 92% of patients responded. Of the 34 respondents, 28 (82%) had watched at least one video, and 32% had watched more than 6 videos. A very large majority of users were satisfied with the videos. Seventy-nine percent said they were very helpful in understanding the skills, and 77% thought they had used the DBT skills more frequently. All but one said that the skills helped them to overcome difficulties in times of confinement. Discussion Our study is the first to interview patients directly regarding DBT YouTube videos. These videos were considered relevant by participants during the confinement period. Their use could compliment DBT skills training groups, and serve as a training support for therapists.

Tablet-based patient educational interventions in care and management of complex movement disorders

Article

Mar 2021

Background Patient education is an essential part of management of complex, disabling neurological disorders. Mobile web-based educational materials provide a novel and potentially valuable means to communicate clinical information that can aid in both medical management and rehabilitation. Aims We, therefore, evaluated an educational tablet-based intervention in three patient cohorts regarding the following topics: Parkinson’s disease (PD) medications, dystonia and botulinum toxin treatment. Methods A total of 50 subjects with PD, 32 with dystonia and 61 receiving botulinum toxin treatment for movement disorders or sialorrhoea were enrolled. Participants in each cohort completed a specific educational module at the time of their regularly scheduled clinic visit, comprising slides, in addition to pre- and post-module quizzes and a satisfaction survey. Additionally, participants in the dystonia and botulinum toxin modules were given a follow-up test at their 3- or 6-month clinical treatment visit. Results There were 143 participants with 50 completing the PD module, 32 completing the dystonia module and 61 completing the botulinum toxin module. All three groups demonstrated significant improvement in knowledge of module content between their pre- and post-module test scores (PD: p=.0001, dystonia: p<.0001 and botulinum toxin: p=.008), and those who took the dystonia module maintained significant improvement at either a 3- or 6-month follow up compared to pre-module (p <.0001). Conclusions Tablet-based teaching modules are an effective means of communicating key concepts to patients. This study supports their use for improving patient understanding that can support lifelong approaches to managing disabling, neurological conditions. • Implication for Rehabilitation • Tablet-based modules are relatively easy to use for enhancing education during clinic visits and can possibly help reduce and maintain disability with chronic conditions like Parkinson’s disease and dystonia. • Improvements in post-test scores suggested that patient participants were able to retain information from the tablets about their complex and challenging conditions and treatments. • Adding patients who are fluent in another language would have made this study more generalizable and future studies exploring educational interventions are warranted to help better tailor interventions to patients with chronic neurologic illnesses to help understand the complex aspects of their medical and rehabilitation therapy. • The effect of cognitive changes in neurological conditions and understanding of educational information needs to be further tested. • This positive result is especially meaningful during the COVID-19 pandemic when in-person access to both medical and rehabilitative care has been curtailed.

mHealth Interventions for Self-Harm: A Scoping Review (Preprint)

Article

Full-text available

Oct 2020
J MED INTERNET RES

Background Self-harm is a growing issue with increasing prevalence rates; however, individuals who self-harm do not often receive treatment. Mobile health (mHealth) interventions are a possible solution to some of the barriers that individuals face when seeking support, and they have also been found to be effective in improving mental health. Thus far, reviews of mHealth interventions for self-harm have been limited by study type. Therefore, we determined that a broader scoping review will provide a more exhaustive understanding of mHealth interventions for self-harm. Objective This scoping review aims to identify mHealth interventions for self-harm within the literature, understand the types and features of interventions that have been developed and evaluated, highlight research findings around mHealth interventions for self-harm, and determine what outcomes are typically used to assess the efficacy of interventions. MethodsA search was conducted using Embase, PubMed, PsycINFO, PsycEXTRA, Web of Science, and the Cochrane Library. Studies were included if they described an mHealth intervention designed to have a direct (ie, if the intervention was designed for self-harm or for people who self-harm) or indirect (ie, if self-harm was measured as an outcome) treatment effect and if the paper was available in English. There were no exclusion criteria based on the study design. ResultsA total of 36 papers were included in the review, and most of them were randomized controlled trials published within the last 4 years. The interventions were mostly smartphone apps and calling or texting services, with 62% (21/34) having underlying therapeutic models to inform the intervention content. They were generally shown to be promising and appealing, but only 5 were widely available for use. Outcomes focused on a reduction of self-harm and suicidality, mood, and the users’ experiences of the intervention. Samples were typically nondiverse, and there was limited variety in the study designs and in the measurements of self-harm recovery. Conclusions Promising and appealing mHealth interventions have been developed but are not widely available. Research could benefit from greater diversity as well as a broader and more nuanced understanding of recovery from self-harm.

B·RIGHT: Usability and satisfaction with a mobile app for self-managing emotional crises in patients with borderline personality disorder

Article

Full-text available

Mar 2020
AUSTRALAS PSYCHIATRY

Objective: Borderline personality disorder (BPD) is a severe mental disorder characterized by emotional crises. To date, crisis interventions for BPD have been conducted via telephone calls and emergency units, which are associated with an extra amount of resources. The aim of this research was to test the usability and satisfaction with a psychotherapeutic mobile app for self-managing crises in BPD. Method: The B·RIGHT app was designed based on Artificial Intelligence psychotherapeutic algorithms. Usability and satisfaction with the app were assessed in 25 outpatients diagnosed with BPD (84% female, mean age=35.80 years) using the System Usability Scale (SUS) and other questionnaires. Clinical features were assessed using the Borderline Symptom List, the Difficulties in Emotion Regulation Scale and Beck’s Depression Inventory. Results: Patients with BPD considered the app user-friendly (mean total score=4.03) and highly satisfactory (mean total score=4.02), resulting in a positive user experience (mean total score=4.09). Total usability was negatively associated with age (r=-.44), positively associated with educational level (rho=.47) and with overall emotion dysregulation (r=.51), and negatively associated with depression severity (r=-.47). Conclusions: The usability and satisfaction testing of the B·RIGHT app showed promising findings, which warrant further research in order to validate its effectiveness.

Smartphone-Based Interventions for the Treatment of Mental Health Problems - Studies on Feasibility, Treatment Effects, and the Assessment of Common Factors for a Transdiagnostic Approach

Thesis

Jan 2019

Christian Aljoscha Lukas

Mental health problems are common in the general population and are associated with high individual and economic burden. To reduce this burden, psychotherapy research and practice have been increasingly professionalized since the latter half of the 20th century and evidence-based psychotherapeutic treatments have been made widely available. Despite the costly efforts to provide evidence-based psychotherapy on a large scale, a significant number of patients remain untreated or do not respond to available interventions. With the integration of computers into everyday life in the 1990s, research has increasingly focused on computer-based interventions (CBIs) to improve both the provision and the quality of evidence-based treatments for all patients. In the last two decades, numerous studies have demonstrated the effectiveness of CBIs for the treatment of mental health problems. In the 21st century, technology is rapidly progressing, and smartphones have gradually taken the place of personal computers in the general population. As a result, smartphone-based interventions (SBIs) are widely discussed as possible aids for the treatment of mental health problems, and there already exists a plethora of SBIs for various patient groups. However, the majority of available SBIs lack empirical evidence as they have not been evaluated in experimental studies. Hence, there exists considerable uncertainty regarding the benefits and possible treatment effects of SBIs. Moreover, most SBIs lack quality in terms of their interventional content, their use of the smartphone’s technological facilities, and their utilization of strategies that engage the patient to use the SBI regularly. Therefore, this dissertation addresses the development and evaluation of an SBI approach that uses evidence-based strategies, seizes upon the smartphones’ technological features, and applies gamification elements to increase patient engagement. Based on the promising findings for blended interventions that combine traditional face-to-face cognitive-behavioral therapy (CBT) with computerized approach-avoidance modification training (AAMT) in the treatment of alcohol use disorders and depression, the SBI approach introduced in this dissertation makes use of intervention techniques from both CBT and smartphone-based AAMT. In six studies, problem-specific SBIs that apply this combined approach are evaluated for their usability and possible effects in the treatment of various mental health problems. Study 7 presents emotion regulation (ER) as a possible common factor in psychopathology that can be targeted by a single SBI addressing patients suffering from various mental health problems. Study 1 examines the feasibility and explores possible effects of an intervention that combines a brief individual counseling session with two weeks of smartphone-based AAMT. This approach is evaluated in a sample of college students meeting criteria for problematic alcohol use. Findings on both usability and treatment effects provide preliminary evidence that the intervention can significantly reduce dysfunctional beliefs about alcohol, craving of alcohol, and alcohol consumption. Study 2 is a multi-center study that assesses the effect of smartphone-based AAMT combined with a brief individual counseling session for participants with elevated levels of body dissatisfaction. Results show that the intervention significantly reduces body dissatisfaction and symptoms of eating disorders. Study 3 evaluates a blended intervention for the reduction of procrastination. Results from this study provide preliminary evidence that a blended intervention that combines two group counseling sessions with 14 days of smartphone-based AAMT can significantly reduce both general and academic procrastination. In Study 4, the blended intervention is comprised of a brief individual psychoeducation session and smartphone-based AAMT for the training of inter- and intraindividual emotion recognition skills in alexithymic individuals. Results show that the intervention improved computer-assessed emotion recognition skills and demonstrated additional effects over a psychoeducation-only control condition. Studies 5 and 6 evaluate SBIs in samples of individuals reporting heightened levels of depression. While results from Study 5 provide preliminary efficacy for an intervention that combines 14-days of smartphone-based AAMT in combination with a psychoeducation group session, Study 6 examines the effectiveness of a stand-alone SBI targeting depressive symptoms using an automated approach that includes an increased degree of gamification. Results of Study 6 demonstrate that 14 days of training with this stand-alone SBI could significantly reduce depressive symptoms. Study 7 comprises two studies that focus on the cross-sectional assessment of deficits in ER skills with the aim to identify common factors that may be targeted by a single, transdiagnostic SBI. Comparisons between two clinical samples and a sample from the general population indicated that participants that met diagnostic criteria for a mental disorder reported lower ER skills than participants from the general population and that ER skills differed across the clinical subgroups. In conclusion, the present dissertation provides evidence that: (1) the AAMT paradigm can be successfully transferred from computers to smartphone devices as indicated by high acceptance scores, high usability ratings, and the frequent use of the SBIs by participants included in the pilot studies; (2) problem-specific SBIs that incorporate face-to-face CBT techniques with AAMT principles may be efficacious for the reduction of symptoms in the targeted mental health problems; (3) a standalone SBI that applies automated CBT techniques and technologically enriched AAMT variants may effectively reduce symptoms of depression; and that (4) ER skills are promising transdiagnostic processes that may be successfully trained in a single SBI that targets a broad range of mental health problems. Further research using larger, more heterogeneous samples including participants that meet diagnostic criteria for mental disorders is necessary to confirm the findings from this dissertation.

Mobile Intervention for Individuals With Psychosis, Dual Disorders, and Their Common Comorbidities: A Literature Review

Article

Full-text available

May 2019

Over 50% of people diagnosed with a severe mental illness, such as schizophrenia or bipolar disorder, will meet criteria for a substance use disorder in their lifetime. This dual disorder often starts during youth and leads to significant societal costs, including lower employability rates, more hospitalizations, and higher risk of homelessness and of suicide attempts when compared to those with a serious mental illness without substance misuse. Moreover, many individuals presenting with comorbid disorders also present with other psychological difficulties as well, such as personality disorders or anxiety and depression, also known as complex comorbid disorders. Transdiagnostic treatments that focus on core difficulties found in people with complex dual disorders, such as emotional regulation, are direly needed. Emotional regulation skills can help reduce distress related to psychotic symptoms and maintain abstinence in substance use disorders. New technologies in the field of communications have developed considerably over the past decade and have the potential to improve access to such treatments, a major problem in many health care settings. As such, this paper aims at: presenting core difficulties present in many individuals with dual disorders, reviewing the scientific literature pertaining to the use of mobile applications in mental health and addictions, and presenting the development and potential of a new application for emotional regulation for people with dual disorders.

Applications of Good Psychiatric Management for Borderline Personality Disorder: Consultation-Liaison Service

Chapter

Apr 2019

Patients with borderline personality disorder (BPD) have a disproportionately higher burden of medical illness when compared with matched cohorts. For this reason, they are high utilizers not just of psychiatric resources, but also of medical and surgical care. In a United Kingdom-based registry review (Fok et al., 2012), female and male patients with a personality disorder diagnosis had life expectancies of 63.3 years and 59.1 years respectively. The decrease in life expectancy compared to matched peers was 18.7 years for females and 17.7 years for males. Notably, similar decreases have been observed, but more widely publicized, for patients with chronic psychotic disorders (Hjorthøj et al, 2017). It is not surprising that patients with BPD suffer adverse health outcomes related to their difficulties with impulsivity, substance abuse, vulnerability to psychiatric polypharmacy, and emotional reactivity. Under duress, difficulties with emotional reactivity can lead patients with BPD to avoid necessary treatment or, when they present, to be met with condescension and prejudice from medical providers that further hinder the patient’s motivation to follow up. In this chapter, we will review the specific ways in which the psychiatric consultation-liaison (C/L) service can help improve the experience of medical and surgical hospitalization and the quality of psychiatric care, while reducing the potential iatrogenic harm inflicted by physicians who have not been trained to manage BPD. Good Psychiatric Management (GPM) is an easily adaptable, low-resource intervention that the psychiatric consultant can readily learn and put into use to accomplish these goals.

Reducing procrastination using a smartphone-based treatment program: A randomized controlled pilot study

Article

Full-text available

Jul 2017

Background Procrastination affects a large number of individuals and is associated with significant mental health problems. Despite the deleterious consequences individuals afflicted with procrastination have to bear, there is a surprising paucity of well-researched treatments for procrastination. To fill this gap, this study evaluated the efficacy of an easy-to-use smartphone-based treatment for procrastination. Method N = 31 individuals with heightened procrastination scores were randomly assigned to a blended smartphone-based intervention including two brief group counseling sessions and 14 days of training with the mindtastic procrastination app (MT-PRO), or to a waitlist condition. MT-PRO fosters the approach of functional and the avoidance of dysfunctional behavior by systematically utilizing techniques derived from cognitive bias modification approaches, gamification principles, and operant conditioning. Primary outcome was the course of procrastination symptom severity as assessed with the General Procrastination Questionnaire. Results Participating in the smartphone-based treatment was associated with a significantly greater reduction of procrastination than was participating in the control condition (η² = .15). Conclusion A smartphone-based intervention may be an effective treatment for procrastination. Future research should use larger samples and directly compare the efficacy of smartphone-based interventions and traditional interventions for procrastination.

Aversive tension in female adolescents with Anorexia Nervosa: A controlled ecological momentary assessment using smartphones

Article

Full-text available

Apr 2016
BMC PSYCHIATRY

Background Current models of Anorexia Nervosa (AN) emphasize the role of emotion regulation. Aversive tension, described as a state of intense arousal and negative valence, is considered to be a link between emotional events and disordered eating. Recent research focused only on adult patients, and mainly general emotion regulation traits were studied. However, the momentary occurrence of aversive tension, particularly in adolescents with AN, has not been previously studied. Method20 female adolescents with AN in outpatient treatment and 20 healthy adolescents aged 12 to 19 years participated in an ecological momentary assessment using their smartphones. Current states of aversive tension and events were assessed hourly for two consecutive weekdays. Mean and maximum values of aversive tension were compared. Multilevel analyses were computed to test the influence of time and reported events on aversive tension. The effect of reported events on subsequent changes of aversive tension in patients with AN were additionally tested in a multilevel model. ResultsAN patients showed higher mean and maximum levels of aversive tension. In a multilevel model, reported food intake was associated with higher levels of aversive tension in the AN group, whereas reported school or sport-related events were not linked to specific states of aversive tension. After food intake, subsequent increases of aversive tension were diminished and decreases of aversive tension were induced in adolescents with AN. Conclusions Aversive tension may play a substantial role in the psychopathology of AN, particular in relation with food intake. Therefore, treatment should consider aversive tension as a possible intervening variable during refeeding. Our findings encourage further research on aversive tension and its link to disordered eating. Trial registrationGerman register of clinical trials (DRKS): DRKS00005228 (Date of registration: September 2, 2013).

Developing a smartphone app to support the nursing community

Article

Full-text available

Feb 2016
Nursing

Healthcare professionals are turning increasingly to the digital sector to access information they need for their work. Mobile technology, such as smartphones and tablets, provides a unique opportunity to place high-quality information directly into users' hands. This article describes the ongoing development of a smartphone app, Preparing for Caring, designed to prepare the future workforce by enabling mentors and nursing students to access supportive material during practice-based learning episodes. The article explores the rationale for designing the app and discusses the challenges and benefits of developing this resource from the perspectives of student, mentor and healthcare manager.

Effects of mindfulness training on different components of impulsivity in borderline personality disorder: Results from a pilot randomized study

Article

Full-text available

Jan 2016

Impulsivity is considered a core characteristic of borderline personality disorder (BPD). Previous research on the effects of mindfulness training (MT) has shown that it might modify impulsivity-related aspects of BPD. Therefore, the aim of this study was to investigate the impact of MT on various facets of impulsivity in BPD patients. Subjects with BPD diagnosis (n = 64) were randomly assigned to 10 weeks of MT (n = 32) or interpersonal effectiveness skills training (IE; n = 32). All participants were assessed pre- and post-intervention with a self-reported measure of impulsivity and five behavioral neuropsychological tasks to evaluate response inhibition, tolerance for delay rewards, and time perception. An interaction effect of time × group was only observed for some of the behavioral paradigms used. Participants in the MT group improved their ability to delay gratification and showed changes in time perception, consistent with a decrease in impulsivity. No differences were observed between treatments in terms of trait impulsivity and response inhibition. Mindfulness training might improve some aspects of impulsivity but not others. Further study is warranted to better determine the effects of mindfulness training on the components of impulsivity. Trial registration ClinicalTrials.gov Identifier: NCT02397031.

Dialectical Behavior Therapy for High Suicide Risk in Individuals With Borderline Personality Disorder: A Randomized Clinical Trial and Component Analysis

Article

Full-text available

Mar 2015

Dialectical behavior therapy (DBT) is an empirically supported treatment for suicidal individuals. However, DBT consists of multiple components, including individual therapy, skills training, telephone coaching, and a therapist consultation team, and little is known about which components are needed to achieve positive outcomes. To evaluate the importance of the skills training component of DBT by comparing skills training plus case management (DBT-S), DBT individual therapy plus activities group (DBT-I), and standard DBT which includes skills training and individual therapy. We performed a single-blind randomized clinical trial from April 24, 2004, through January 26, 2010, involving 1 year of treatment and 1 year of follow-up. Participants included 99 women (mean age, 30.3 years; 69 [71%] white) with borderline personality disorder who had at least 2 suicide attempts and/or nonsuicidal self-injury (NSSI) acts in the last 5 years, an NSSI act or suicide attempt in the 8 weeks before screening, and a suicide attempt in the past year. We used an adaptive randomization procedure to assign participants to each condition. Treatment was delivered from June 3, 2004, through September 29, 2008, in a university-affiliated clinic and community settings by therapists or case managers. Outcomes were evaluated quarterly by blinded assessors. We hypothesized that standard DBT would outperform DBT-S and DBT-I. The study compared standard DBT, DBT-S, and DBT-I. Treatment dose was controlled across conditions, and all treatment providers used the DBT suicide risk assessment and management protocol. Frequency and severity of suicide attempts and NSSI episodes. All treatment conditions resulted in similar improvements in the frequency and severity of suicide attempts, suicide ideation, use of crisis services due to suicidality, and reasons for living. Compared with the DBT-I group, interventions that included skills training resulted in greater improvements in the frequency of NSSI acts (F1,85 = 59.1 [P < .001] for standard DBT and F1,85 = 56.3 [P < .001] for DBT-S) and depression (t399 = 1.8 [P = .03] for standard DBT and t399 = 2.9 [P = .004] for DBT-S) during the treatment year. In addition, anxiety significantly improved during the treatment year in standard DBT (t94 = -3.5 [P < .001]) and DBT-S (t94 = -2.6 [P = .01]), but not in DBT-I. Compared with the DBT-I group, the standard DBT group had lower dropout rates from treatment (8 patients [24%] vs 16 patients [48%] [P = .04]), and patients were less likely to use crisis services in follow-up (ED visits, 1 [3%] vs 3 [13%] [P = .02]; psychiatric hospitalizations, 1 [3%] vs 3 [13%] [P = .03]). A variety of DBT interventions with therapists trained in the DBT suicide risk assessment and management protocol are effective for reducing suicide attempts and NSSI episodes. Interventions that include DBT skills training are more effective than DBT without skills training, and standard DBT may be superior in some areas. clinicaltrials.gov Identifier: NCT00183651.

Metadata Correction: Smartphone Ownership and Interest in Mobile Applications to Monitor Symptoms of Mental Health Conditions

Article

Full-text available

Jul 2014

Background: Patient retrospective recollection is a mainstay of assessing symptoms in mental health and psychiatry. However, evidence suggests that these retrospective recollections may not be as accurate as data collection though the experience sampling method (ESM), which captures patient data in "real time" and "real life." However, the difficulties in practical implementation of ESM data collection have limited its impact in psychiatry and mental health. Smartphones with the capability to run mobile applications may offer a novel method of collecting ESM data that may represent a practical and feasible tool for mental health and psychiatry. Objective: This paper aims to provide data on psychiatric patients' prevalence of smartphone ownership, patterns of use, and interest in utilizing mobile applications to monitor their mental health conditions. Methods: One hundred psychiatric outpatients at a large urban teaching hospital completed a paper-and-pencil survey regarding smartphone ownership, use, and interest in utilizing mobile applications to monitor their mental health condition. Results: Ninety-seven percent of patients reported owning a phone and 72% reported that their phone was a smartphone. Patients in all age groups indicated greater than 50% interest in using a mobile application on a daily basis to monitor their mental health condition. Conclusions: Smartphone and mobile applications represent a practical opportunity to explore new modalities of monitoring, treatment, and research of psychiatric and mental health conditions.

Randomized, Controlled Pilot Trial of a Smartphone App for Smoking Cessation Using Acceptance and Commitment Therapy

Article

Full-text available

Oct 2014
DRUG ALCOHOL DEPEN

Smartphone data as objective measures of bipolar disorder symptoms

Article

Full-text available

Mar 2014

A Smartphone Application to Support Recovery From Alcoholism A Randomized Clinical Trial

Article

Full-text available

Mar 2014

Importance Patients leaving residential treatment for alcohol use disorders are not typically offered evidence-based continuing care, although research suggests that continuing care is associated with better outcomes. A smartphone-based application could provide effective continuing care.Objective To determine whether patients leaving residential treatment for alcohol use disorders with a smartphone application to support recovery have fewer risky drinking days than control patients.Design, Setting, and Participants An unmasked randomized clinical trial involving 3 residential programs operated by 1 nonprofit treatment organization in the Midwestern United States and 2 residential programs operated by 1 nonprofit organization in the Northeastern United States. In total, 349 patients who met the criteria for DSM-IV alcohol dependence when they entered residential treatment were randomized to treatment as usual (n = 179) or treatment as usual plus a smartphone (n = 170) with the Addiction–Comprehensive Health Enhancement Support System (A-CHESS), an application designed to improve continuing care for alcohol use disorders.Interventions Treatment as usual varied across programs; none offered patients coordinated continuing care after discharge. A-CHESS provides monitoring, information, communication, and support services to patients, including ways for patients and counselors to stay in contact. The intervention and follow-up period lasted 8 and 4 months, respectively.Main Outcomes and Measures Risky drinking days—the number of days during which a patient’s drinking in a 2-hour period exceeded 4 standard drinks for men and 3 standard drinks for women, with standard drink defined as one that contains roughly 14 g of pure alcohol (12 oz of regular beer, 5 oz of wine, or 1.5 oz of distilled spirits). Patients were asked to report their risky drinking days in the previous 30 days on surveys taken 4, 8, and 12 months after discharge from residential treatment.Results For the 8 months of the intervention and 4 months of follow-up, patients in the A-CHESS group reported significantly fewer risky drinking days than did patients in the control group, with a mean of 1.39 vs 2.75 days (mean difference, 1.37; 95% CI, 0.46-2.27; P = .003).Conclusions and Relevance The findings suggest that a multifeatured smartphone application may have significant benefit to patients in continuing care for alcohol use disorders.Trial Registration clinicaltrials.gov Identifier: NCT01003119

MHealth and global mental health: Still waiting for the mH2 wedding?

Article

Full-text available

Mar 2014

Background Two phenomena have become increasingly visible over the past decade: the significant global burden of disease arising from mental illness and the rapid acceleration of mobile phone usage in poorer countries. Mental ill-health accounts for a significant proportion of global disability-adjusted life years (DALYs) and years lived with disability (YLDs), especially in poorer countries where a number of factors combine to exacerbate issues of undertreatment. Yet poorer countries have also witnessed significant investments in, and dramatic expansions of, mobile coverage and usage over the past decade. Debate The conjunction of high levels of mental illness and high levels of mobile phone usage in poorer countries highlights the potential for “mH2” interventions – i.e. mHealth (mobile technology-based) mental health interventions - to tackle global mental health challenges. However, global mental health movements and initiatives have yet to engage fully with this potential, partly because of scepticism towards technological solutions in general and partly because existing mH2 projects in mental health have often taken place in a fragmented, narrowly-focused, and small-scale manner. We argue for a deeper and more sustained engagement with mobile phone technology in the global mental health context, and outline the possible shape of an integrated mH2 platform for the diagnosis, treatment, and monitoring of mental health. Summary Existing and developing mH2 technologies represent an underutilised resource in global mental health. If development, evaluation, and implementation challenges are overcome, an integrated mH2 platform would make significant contributions to mental healthcare in multiple settings and contexts.

Use of Mobile Phones, Computers and Internet Among Clients of an Inner-City Community Psychiatric Clinic

Article

Full-text available

Mar 2014

Objective: Recent years have witnessed an expansion of Internet- and mobile-phone-based interventions for health promotion, yet few studies have focused on the use of technology by individuals with mental illness. This study examined the extent to which patients at an inner-city community psychiatry clinic had access to information and communications technology (ICT) and how they used those resources. Methods: Patients of an outpatient, inner-city community psychiatry program (N=189) completed a survey that included questions about demographics and ICT use which were adapted from an existing local population-based health survey (community sample, N=968). Frequencies of ICT use were assessed for the clinic sample and questions common to both the surveys completed by the clinic and community samples were compared using logistic regression. Results: Among clinic cases, 105 (55.6%) reported owning or using a computer, 162 (85.7%) reported owning or using a mobile phone, and 112 (59.3%) reportedf using the Internet. Among those who used mobile phones, the majority reported using them daily; 42% of those who used the Internet reported using it several times per day. Differences in frequency of Internet use between samples were not significant, but clinic participants used the Internet more intensively to email, instant message, access health information, and use social media sites. Conclusions: A majority of patients in this community psychiatry clinic sample use ICT. Greater access to and use of the Internet by those with mental illness has important implications for the feasibility and impact of technology-based interventions.

Feasibility, Acceptability, and Preliminary Efficacy of a Smartphone Intervention for Schizophrenia

Article

Full-text available

Mar 2014

The FOCUS smartphone intervention was developed to provide automated real-time/real-place illness management support to individuals with schizophrenia. The system was specifically designed to be usable by people with psychotic disorders who may have cognitive impairment, psychotic symptoms, negative symptoms, and/or low reading levels. FOCUS offers users both prescheduled and on-demand resources to facilitate symptom management, mood regulation, medication adherence, social functioning, and improved sleep. In this study, 33 individuals with schizophrenia or schizoaffective disorder used FOCUS over a 1-month period in their own environments. Participants were able to learn how to use the intervention independently, and all but one participant completed the trial successfully and returned the smartphones intact. Completers used the system on 86.5% of days they had the device, an average of 5.2 times a day. Approximately 62% of use of the FOCUS intervention was initiated by the participants, and 38% of use was in response to automated prompts. Baseline levels of cognitive functioning, negative symptoms, persecutory ideation, and reading level were not related to participants' use of the intervention. Approximately 90% of participants rated the intervention as highly acceptable and usable. Paired samples t tests found significant reductions in psychotic symptoms, depression, and general psychopathology, after 1 month of FOCUS use. This study demonstrated the feasibility, acceptability, and preliminary efficacy of the FOCUS intervention for schizophrenia and introduces a new treatment model which has promise for extending the reach of evidence-based care beyond the confines of a physical clinic using widely available technologies.

Impact of a mobile phone and Web program on symptom and functional outcomes for people with mild-to-moderate depression, anxiety and stress: A randomised controlled trial

Article

Full-text available

Nov 2013
BMC PSYCHIATRY

Mobile phone-based psychological interventions enable real time self-monitoring and self-management, and large-scale dissemination. However, few studies have focussed on mild-to-moderate symptoms where public health need is greatest, and none have targeted work and social functioning. This study reports outcomes of a CONSORT-compliant randomised controlled trial (RCT) to evaluate the efficacy of myCompass, a self-guided psychological treatment delivered via mobile phone and computer, designed to reduce mild-to-moderate depression, anxiety and stress, and improve work and social functioning. Community-based volunteers with mild-to-moderate depression, anxiety and/or stress (N = 720) were randomly assigned to the myCompass program, an attention control intervention, or to a waitlist condition for seven weeks. The interventions were fully automated, without any human input or guidance. Participants' symptoms and functioning were assessed at baseline, post-intervention and 3-month follow-up, using the Depression, Anxiety and Stress Scale and the Work and Social Adjustment Scale. Retention rates at post-intervention and follow-up for the study sample were 72.1% (n = 449) and 48.6% (n = 350) respectively. The myCompass group showed significantly greater improvement in symptoms of depression, anxiety and stress and in work and social functioning relative to both control conditions at the end of the 7-week intervention phase (between-group effect sizes ranged from d = .22 to d = .55 based on the observed means). Symptom scores remained at near normal levels at 3-month follow-up. Participants in the attention control condition showed gradual symptom improvement during the post-intervention phase and their scores did not differ from the myCompass group at 3-month follow-up. The myCompass program is an effective public health program, facilitating rapid improvements in symptoms and in work and social functioning for individuals with mild-to-moderate mental health problems.Trial registration: Australian New Zealand Clinical Trials Registry ACTRN 12610000625077.

Development and initial evaluation of a smartphone application based on Acceptance and Commitment Therapy

Article

Full-text available

Jul 2012

An intervention, consisting of an ACT-based smartphone-application and a web-based psychoeducation, has been developed. The smartphone-application, together with the psychoeducation, aims to function as a self-help intervention for living consistently with one's values. The study is an exploratory investigation of this new smartphone-based tool. Primarily, the study aims at investigating a new field, providing a basis for generating hypotheses for further research. The first aim of this initial, exploratory study was to examine if this intervention had an effect on the variables of: valued actions, psychological flexibility, and life satisfaction as well as the states of depression, anxiety and stress, for a non-clinical sample of 11 Swedish Iphone users. This was made with a quasi-experimental pretest-posttest design without control group. The second aim was to investigate how the participants experienced the intervention, as measured by a qualitative questionnaire. The group analyses showed that the participants increased their valued action and psychological flexibility significantly during the intervention. Furthermore, value-based actions and psychological flexibility showed small effect sizes when comparing pretest and posttest score. However, the design of the study makes it impossible to draw any certain conclusions. The qualitative questionnaire showed a general positive experience of the intervention. The results from the present study indicated that the intervention should be studied further. The findings also generated a number of hypotheses that could be investigated in further research.

Chronic Sleep Disturbances and Borderline Personality Disorder Symptoms

Article

Full-text available

Jun 2013

Edward Selby

Objective: Few studies have examined the experience of chronic sleep disturbances in those with borderline personality disorder (BPD), and further establishing this association may be pertinent to enhancing current treatments, given the relevance of sleep to emotion regulation and stress management. Method: Data were analyzed (N = 5,692) from Part II of the National Comorbidity Survey-Replication (NCS-R) sample (Kessler & Merikangas, 2004), which assessed personality disorders and sleep problems. Rates of chronic sleep disturbances (difficulty initiating sleep, difficulty maintaining sleep, and waking earlier than desired), as well as the consequences of poor sleep, were examined. Indices for BPD diagnosis and symptoms were used in logistic and linear regression analyses to predict sleep and associated problems after accounting for chronic health problems, Axis I comorbidity, suicidal ideation over the last year, and key sociodemographic variables. Results: BPD was significantly associated with all 3 chronic sleep problems assessed, as well as with the consequences of poor sleep. The magnitude of the association between BPD and sleep problems was comparable to that for Axis I disorders traditionally associated with sleep problems. BPD symptoms interacted with chronic sleep problems to predict elevated social/emotional, cognitive, and self-care impairment. Conclusions: Sleep disturbances are consistently associated with BPD symptoms, as are the daytime consequences of poor sleep. There may also be a synergistic effect where BPD symptoms are aggravated by poor sleep and lead to higher levels of functional impairment. Sleep in patients with BPD should be routinely assessed, and ameliorating chronic sleep problems may enhance treatment by improving emotion regulation and implementation of therapeutic skills. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

CBT for depression: A pilot RCT comparing mobile phone vs. computer

Article

Full-text available

Feb 2013
BMC PSYCHIATRY

This paper reports the results of a pilot randomized controlled trial comparing the delivery modality (mobile phone/tablet or fixed computer) of a cognitive behavioural therapy intervention for the treatment of depression. The aim was to establish whether a previously validated computerized program (The Sadness Program) remained efficacious when delivered via a mobile application. 35 participants were recruited with Major Depression (80% female) and randomly allocated to access the program using a mobile app (on either a mobile phone or iPad) or a computer. Participants completed 6 lessons, weekly homework assignments, and received weekly email contact from a clinical psychologist or psychiatrist until completion of lesson 2. After lesson 2 email contact was only provided in response to participant request, or in response to a deterioration in psychological distress scores. The primary outcome measure was the Patient Health Questionnaire 9 (PHQ-9). Of the 35 participants recruited, 68.6% completed 6 lessons and 65.7% completed the 3-months follow up. Attrition was handled using mixed-model repeated-measures ANOVA. Both the Mobile and Computer Groups were associated with statistically significantly benefits in the PHQ-9 at post-test. At 3 months follow up, the reduction seen for both groups remained significant. These results provide evidence to indicate that delivering a CBT program using a mobile application, can result in clinically significant improvements in outcomes for patients with depression. Trial registration Australian New Zealand Clinical Trials Registry ACTRN 12611001257954

The feasibility and validity of ambulatory self-report of psychotic symptoms using a smartphone software application

Article

Full-text available

Oct 2012
BMC PSYCHIATRY

Background Semi-structured interview scales for psychosis are the gold standard approach to assessing psychotic and other symptoms. However, such assessments have limitations such as recall bias, averaging, insensitivity to change and variable interrater reliability. Ambulant, real-time self-report assessment devices may hold advantages over interview measures, but it needs to be shown that the data thus collected are valid, and the collection method is acceptable, feasible and safe. We report on a monitoring system for the assessment of psychosis using smartphone technology. The primary aims were to: i) assess validity through correlations of item responses with those on widely accepted interview assessments of psychosis, and ii) examine compliance to the procedure in individuals with psychosis of varying severity. Methods A total of 44 participants (acute or remitted DSM-4 schizophrenia and related disorders, and prodromal) completed 14 branching self-report items concerning key psychotic symptoms on a touch-screen mobile phone when prompted by an alarm at six pseudo-random times, each day, for one week. Face to face PANSS and CDS interviews were conducted before and after the assessment period blind to the ambulant data. Results Compliance as defined by completion of at least 33% of all possible data-points over seven days was 82%. In the 36 compliant participants, 5 items (delusions, hallucinations, suspiciousness, anxiety, hopelessness) showed moderate to strong (rho 0.6-0.8) associations with corresponding items from interview rating scales. Four items showed no significant correlation with rating scales: each was an item based on observable behaviour. Ambulant ratings showed excellent test-retest reliability and sensitivity to change. Conclusions Ambulatory monitoring of symptoms several times daily using smartphone software applications represents a feasible and valid way of assessing psychotic phenomena for research and clinical management purposes. Further evaluation required over longer assessment periods, in clinical trials and service settings.

Treatment Utilization by Patients With Personality Disorders

Article

Full-text available

Mar 2001

Utilization of mental health treatment was compared in patients with personality disorders and patients with major depressive disorder without personality disorder. Semistructured interviews were used to assess diagnosis and treatment history of 664 patients in four representative personality disorder groups-schizotypal, borderline, avoidant, and obsessive-compulsive-and in a comparison group of patients with major depressive disorder. Patients with personality disorders had more extensive histories of psychiatric outpatient, inpatient, and psychopharmacologic treatment than patients with major depressive disorder. Compared to the depression group, patients with borderline personality disorder were significantly more likely to have received every type of psychosocial treatment except self-help groups, and patients with obsessive-compulsive personality disorder reported greater utilization of individual psychotherapy. Patients with borderline personality disorder were also more likely to have used antianxiety, antidepressant, and mood stabilizer medications, and those with borderline or schizotypal personality disorder had a greater likelihood of having received antipsychotic medications. Patients with borderline personality disorder had received greater amounts of treatment, except for family/couples therapy and self-help, than the depressed patients and patients with other personality disorders. These results underscore the importance of considering personality disorders in diagnosis and treatment of psychiatric patients. Borderline and schizotypal personality disorder are associated with extensive use of mental health resources, and other, less severe personality disorders may not be addressed sufficiently in treatment planning. More work is needed to determine whether patients with personality disorders are receiving adequate and appropriate mental health treatments.

Reasons for Suicide Attempts and Nonsuicidal Self-Injury in Women With Borderline Personality Disorder

Article

Full-text available

Feb 2002

Self-reported reasons for suicide attempts and nonsuicidal self-injury were examined using the Parasuicide History Interview within a sample of chronically suicidal women meeting criteria for borderline personality disorder (N = 75). Overall, reasons given for suicide attempts differed from reasons for nonsuicidal self-injury. Nonsuicidal acts were more often reported as intended to express anger, punish oneself, generate normal feelings, and distract oneself, whereas suicide attempts were more often reported as intended to make others better off. Almost all participants reported that both types of parasuicide were intended to relieve negative emotions. It is likely that suicidal and nonsuicidal parasuicide have multiple intents and functions.

Distress and affective dysregulation in patients with borderline personality disorder: a psychophysiological ambulatory monitoring study

Article

Apr 2008

Borderline personality disorder (BPD) is characterized by enduring psychological distress and affective dysregulation. Several models have linked both phenomena, but are lacking empirical support. To investigate the relation between psychological distress and components of affective dysregulation (especially inability to label emotions, conflictive emotions, and physiological hyperarousal), we repeatedly assessed these components using a 24-hour ambulatory monitoring approach in a group of 50 BPD patients and 50 healthy controls. Hierarchical linear model analyses identified a clear relation between inability to label emotions and distress in the BPD group (p = 0.0009) but not across all subjects (p = 0.6492). Conflictive emotions were related to psychological distress in both groups (p < 0.0001). This relation is, however, most pertinent to the BPD group who experienced conflicting emotions more frequently. Physiological arousal (heart rate) was related to distress in both groups. Our empirical findings emphasize training in labeling emotions and distress tolerance interventions in treatment for BPD.

E-health and Nursing: Using smartphones to enhance nursing practice

Article

Jan 2012

Phones have evolved from a two-way analog form of communication to palm sized computers called smartphones. Smartphones support audio, video, text, email communication, calendars, lists, contacts, journals, calculators, pictures, weather updates, medical applications and more. One of the greatest advantages of using healthcare applications on smartphones is convenience. The portability supports quick access to references and tools that have not been easily accessible until now. Smartphones even assist healthcare workers with completing their daily tasks. For example, nurses may teach patients about monitoring their health, such as tracking their blood pressure by using tools on smartphones. A variety of applications are available for managing chronic disease, diet, exercise and lifestyle choices. While smartphones have many useful features, like any other technology, smartphones are ever changing with more advanced features. This creates a challenge for nurses to keep up with the latest but there are helpful guides and websites dedicated to this topic. This paper will briefly review smartphone adoption, various operating systems for smartphones, and highlight more commonly used applications and websites.

Mindfulness for personality disorders

Article

Dec 2015
CURR OPIN PSYCHIATR

Purpose of review: Third-wave cognitive-behaviour therapies such as dialectical behaviour therapy have demonstrated effectiveness in the treatment of personality disorders, which are considered difficult to treat. These therapies typically incorporate some component of mindfulness practice. The current study examines current applications and effectiveness of mindfulness to the treatment of personality disorders. Recent findings: The majority of evidence available focuses on borderline personality disorder, and highlights positive associations between mindfulness practice and reduced psychiatric and clinical symptoms, less emotional reactivity, and less impulsivity. Fewer studies examine the other personality disorders, though emerging case studies have applied mindfulness techniques to treatment with antisocial, avoidant, paranoid, and obsessive-compulsive personality disorders. Summary: Mindfulness is a promising clinical tool for the treatment of personality disorders, and appears to be adaptable to the unique features of different types of personality disorders. However, further empirical research with greater methodological rigour is required to clarify the effectiveness of mindfulness as a specific skill component, and to identify the underlying mechanisms that contribute to therapeutic change.

Structured clinical interview for the DSM-IV personality disorders (SCID-II)

Book

Jan 1987

Borderline Personality Disorder, Suicide, and Pharmacotherapy

Article

Oct 2002

Joel Paris

Using Smartphone Apps to Promote Psychiatric and Physical Well-Being

Article

Jan 2015

This pilot study tested the acceptability and usability of a prototype app designed to promote the physical well-being of adults with psychiatric disorders. The application under evaluation, WellWave, promoted walking as a physical exercise, and offered a variety of supportive non-physical activities, including confidential text-messaging with peer staff, and a digital library of readings and videos on recovery from psychiatric illness. Study participants engaged strongly in the app throughout the 4-week study, showing a 94 % mean daily usage rate, and a 73 % mean response rate across all electronic messages and prompts, which approximates the gold standard of 75 % for momentary ecological assessment studies. Seven of the ten study participants averaged two or more walks per week, beginning with 5-min walks and ending with walks lasting 20 min or longer. This responsiveness to the walking prompts, and the overall high rate of engagement in other app features, suggest that adults with psychiatric conditions would welcome and benefit from similar smartphone interventions that promote healthy behaviours in life domains other than exercise. Pilot study results also suggest that smartphone applications can be useful as research tools in the development and testing of theories and practical strategies for encouraging healthy lifestyles. Participants were prompted periodically to rate their own health quality, perceived control over their health, and stage-of-change in adopting a walking routine, and these electronic self-ratings showed acceptable concurrent and discriminant validity, with all participants reporting moderate to high motivation to exercise by the end of the study.

Cognitive-Behavioral Treatment of Borderline Personality Disorder

Article

Mar 1996

Mobile phone ownership, usage and readiness to use by patients in drug treatment

Article

Nov 2014
DRUG ALCOHOL DEPEN

Beyond Borderline Personality Disorder: The Mindful Brain

Article

Oct 2014

Numerous studies have showed an improvement in symptoms characteristic of borderline personality disorder (BPD) when mindfulness-based interventions were integrated into the daily lives of individuals with BPD. Although these studies have examined the etiology and diagnostic prognosis of BPD, and have discussed the use of mindfulness-based treatments, few researchers have attempted to interpret the neuroscientific findings, which have showed an increase in gray matter in key areas of the brain in clients with BPD who engaged in mindfulness practice. Some clients who had originally met a minimum of five of the DSM-IV-TR diagnostic criteria for BPD no longer did so upon engaging in mindfulness-based treatment. This article highlights the efficacy of mindfulness-based interventions with an emphasis on meditation, which leads to overall better psychological functioning in clients with BPD in three key areas: impulsivity, emotional irregularity, and relationship instability.

A Surveillance Tool Using Mobile Phone Short Message Service to Reduce Alcohol Consumption Among Alcohol-Dependent Patients

Article

Apr 2014
ALCOHOL CLIN EXP RES

Background In public health settings, short message service (SMS) appears to be a promising low-cost modality for reducing alcohol consumption. Here, we test a simple interactive SMS-based helpline with detoxified alcohol-dependent patients to extend findings to curative settings.Methods This controlled, prospective, 2-group before-after block-assignment, open pilot study tested the feasibility and efficacy of an 8-week outpatient interactive mobile phone SMS intervention (n = 42) against treatment as usual (TAU; n = 38) after inpatient detoxification. Patients were asked whether they needed any help via an automatically generated text message twice a week. A therapist called the individual back when notified. Alcohol consumption was assessed using the telephone version of Form-90 4 and 8 weeks after discharge from inpatient detoxification. The primary end point was defined as attaining low-risk consumption (males ≤30 g or 3.75 units per drinking day (DDD); females ≤20 g or 2.5 units per DDD) 8 weeks after discharge. Missing data were replaced by multiple imputation.ResultsAmong all messages sent, 20.5% were followed by a phone call. Feasibility and acceptability were good, as indicated by successful implementation of the SMS procedure and the rapid inclusion of patients. Adherence was satisfactory with 57.14% of the participants replying to at least 50% of the prompts. Patients reported a typical preadmission DDD of 281.25 ± 244.61 g. In the SMS group, 55.7% of 42 patients, and 40% of 38 patients in the TAU group, achieved low-risk consumption (risk diff: 0.16; 95% CI −0.06 to 0.37; p = 0.122).Conclusions In detoxified alcohol-dependent patients, relapse prevention based on SMS was well received and implemented efficiently and rapidly. An adequately powered multicenter study is currently being conducted to test the nonsignificant but encouraging findings of this exploratory study with more rigorous trial methods (ISRCTN78350716).

Cognitive Behavior Therapy versus Interpersonal Psychotherapy for social anxiety disorder delivered via smartphone and computer: a randomized controlled trial

Article

May 2014

In this study, a previously evaluated guided Internet-based cognitive behavior therapy for social anxiety disorder (SAD) was adapted for mobile phone administration (mCBT). The treatment was compared with a guided self-help treatment based on interpersonal psychotherapy (mIPT). The treatment platform could be accessed through smartphones, tablet computers, and standard computers. A total of 52 participants were diagnosed with SAD and randomized to either mCBT (n = 27) or mIPT (n = 25). Measures were collected at pre-treatment, during the treatment, post-treatment and 3 month follow-up. On the primary outcome measure, the Liebowitz Social Anxiety Scale–self rated, both groups showed statistically significant improvements. However, mCBT performed significantly better than mIPT (between group Cohen's d =0.64 in favor of mCBT). A larger proportion of the mCBT group was classified as responders at post-treatment (55.6% versus 8.0% in the mIPT group). We conclude that CBT for SAD can be delivered using modern information technology. IPT delivered as a guided self-help treatment may be less effective in this format.

Use of Mental Health Telemetry to Enhance Identification and Predictive Value of Early Changes During Augmentation Treatment of Major Depression

Article

Oct 2013
J CLIN PSYCHOPHARM

Standard clinical trial methodology in depression does not allow for careful examination of early changes in symptom intensity. The purpose of this study was to use daily "Mental Health Telemetry" (MHT) to prospectively record change in depressive and anxiety symptoms for depressed pa

EMOTEO: A Smartphone Application for Monitoring and Reducing Aversive Tension in Borderline Personality Disorder Patients, a Pilot Study

Abstract

No full-text available