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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| Format: | Article |
| Language: | English |
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JMIR Publications
2025-02-01
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| Series: | JMIR Mental Health |
| Online Access: | https://mental.jmir.org/2025/1/e63497 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Emily E Bernstein |
| collection | DOAJ |
| description |
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 |
| format | Article |
| id | doaj-art-90fa6311b74a4d298f8774cd61063f8d |
| institution | DOAJ |
| issn | 2368-7959 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Mental Health |
| spelling | doaj-art-90fa6311b74a4d298f8774cd61063f8d2025-08-20T02:45:09ZengJMIR PublicationsJMIR Mental Health2368-79592025-02-0112e6349710.2196/63497Patterns of Skills Review in Smartphone Cognitive Behavioral Therapy for Depression: Observational Study of Intervention Content UseEmily E Bernsteinhttps://orcid.org/0000-0001-8609-3153Katharine E Danielhttps://orcid.org/0000-0002-4371-2740Peyton E Miyareshttps://orcid.org/0009-0007-6803-9648Susanne S Hoeppnerhttps://orcid.org/0000-0003-2060-1666Kate H Bentleyhttps://orcid.org/0000-0002-6875-6440Ivar Snorrasonhttps://orcid.org/0000-0002-5979-3151Lauren B Fisherhttps://orcid.org/0000-0003-4670-2457Jennifer L Greenberghttps://orcid.org/0000-0002-2919-3673Hilary Weingardenhttps://orcid.org/0000-0002-3448-3755Oliver Harrisonhttps://orcid.org/0000-0001-6947-2581Sabine Wilhelmhttps://orcid.org/0000-0002-5316-2711 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=NCT05386329https://mental.jmir.org/2025/1/e63497 |
| spellingShingle | 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 Patterns of Skills Review in Smartphone Cognitive Behavioral Therapy for Depression: Observational Study of Intervention Content Use JMIR Mental Health |
| title | Patterns of Skills Review in Smartphone Cognitive Behavioral Therapy for Depression: Observational Study of Intervention Content Use |
| title_full | Patterns of Skills Review in Smartphone Cognitive Behavioral Therapy for Depression: Observational Study of Intervention Content Use |
| title_fullStr | Patterns of Skills Review in Smartphone Cognitive Behavioral Therapy for Depression: Observational Study of Intervention Content Use |
| title_full_unstemmed | Patterns of Skills Review in Smartphone Cognitive Behavioral Therapy for Depression: Observational Study of Intervention Content Use |
| title_short | Patterns of Skills Review in Smartphone Cognitive Behavioral Therapy for Depression: Observational Study of Intervention Content Use |
| title_sort | patterns of skills review in smartphone cognitive behavioral therapy for depression observational study of intervention content use |
| url | https://mental.jmir.org/2025/1/e63497 |
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