Patterns of Skills Review in Smartphone Cognitive Behavioral Therapy for Depression: Observational Study of Intervention Content Use

BackgroundSmartphones could enhance access to effective cognitive behavioral therapy (CBT). Users may frequently and flexibly access bite-size CBT content on personal devices, review and practice skills, and thereby achieve better outcomes. ObjectiveWe explored th...

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Bibliographic Details
Main Authors: Emily E Bernstein, Katharine E Daniel, Peyton E Miyares, Susanne S Hoeppner, Kate H Bentley, Ivar Snorrason, Lauren B Fisher, Jennifer L Greenberg, Hilary Weingarden, Oliver Harrison, Sabine Wilhelm
Format: Article
Language:English
Published: JMIR Publications 2025-02-01
Series:JMIR Mental Health
Online Access:https://mental.jmir.org/2025/1/e63497
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Summary:BackgroundSmartphones could enhance access to effective cognitive behavioral therapy (CBT). Users may frequently and flexibly access bite-size CBT content on personal devices, review and practice skills, and thereby achieve better outcomes. ObjectiveWe explored the distribution of actual interactions participants had with therapeutic content in a trial of smartphone CBT for depression and whether interactions were within assigned treatment modules or revisits to prior module content (ie, between-module interactions). MethodsWe examined the association between the number of within- and between-module interactions and baseline and end-of-treatment symptom severity during an 8-week, single-arm open trial of a therapist-guided CBT for depression mobile health app. ResultsInteractions were more frequent early in treatment and modestly declined in later stages. Within modules, most participants consistently made more interactions than required to progress to the next module and tended to return to all types of content rather than focus on 1 skill. By contrast, only 15 of 26 participants ever revisited prior module content (median number of revisits=1, mode=0, IQR 0-4). More revisits were associated with more severe end-of-treatment symptom severity after controlling for pretreatment symptom severity (P<.05). ConclusionsThe results suggest that the frequency of use is an insufficient metric of engagement, lacking the nuance of what users are engaging with and when during treatment. This lens is essential for developing personalized recommendations and yielding better treatment outcomes. Trial RegistrationClinicalTrials.gov NCT05386329; https://clinicaltrials.gov/study/NCT05386329?term=NCT05386329
ISSN:2368-7959