Preventing relapse with personalized smart‐messaging after cognitive behavioural therapy: A proof‐of‐concept evaluation

OBJECTIVES: Cognitive behavioural therapy (CBT) can improve symptoms of anxiety and depression, but also reduces the risk of future relapse after therapy completion. However, current CBT relapse prevention methods are resource‐intensive and can be limited in clinical practice. This paper investigates a personalized means of reducing relapse using smart‐messaging in two settings: research and routine care. DESIGN: Study 1 presents a cohort study comparing a cohort of smart‐messaging users versus non‐users. Study 2 presents time series follow‐up data from a case series of smart‐messaging users from clinical practice. METHODS: Fifteen of 56 CBT completers who participated in a trial for the treatment of health anxiety wrote advice they would want if in future they were doing well, experiencing early warning signs of relapse, or experiencing full relapse. Following CBT, participants received weekly text‐message requests to rate their well‐being. Dependent upon their response, participants received tailored advice they had written, appropriate to the well‐being level reported after recovery from health anxiety. Smart‐messaging was also trialled in a routine practice sample of 14 CBT completers with anxiety and depression. RESULTS: Across a 12‐month follow‐up, participants receiving smart‐messaging showed greater health improvements than those who did not. Well‐being scores showed stability between CBT completion and 6‐month follow‐up among routine care patients. CONCLUSIONS: These findings suggest that a low‐intensity, personalized relapse prevention method can have a clinical benefit following CBT for common mental health problems. PRACTITIONER POINTS: Post‐treatment outcomes may be improved using personalized smart‐messaging to prevent relapse following cognitive behavioural therapy (CBT) for health anxiety. In clinical practice, post‐treatment smart‐messaging can be well‐used by patients and may help maintain stable well‐being in the 6 months after CBT ends. This evidence supports the clinical utility of a brief tailored digital intervention, which can be integrated within routine clinical practice with minimal therapist input. Overall, longer‐term post‐CBT outcomes may be improved by integrating a smart‐messaging intervention at the end of therapy.