Cargando…

A Clinician-Controlled Just-in-time Adaptive Intervention System (CBT+) Designed to Promote Acquisition and Utilization of Cognitive Behavioral Therapy Skills in Bulimia Nervosa: Development and Preliminary Evaluation Study

BACKGROUND: Cognitive behavioral therapy (CBT) for bulimia nervosa (BN) is most effective when patients demonstrate adequate skill utilization (ie, the frequency with which a patient practices or uses therapeutic skills) and skill acquisition (ie, the ability to successfully perform a skill learned...

Descripción completa

Detalles Bibliográficos
Autores principales: Juarascio, Adrienne, Srivastava, Paakhi, Presseller, Emily, Clark, Kelsey, Manasse, Stephanie, Forman, Evan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8204236/
https://www.ncbi.nlm.nih.gov/pubmed/34057416
http://dx.doi.org/10.2196/18261
_version_ 1783708312666112000
author Juarascio, Adrienne
Srivastava, Paakhi
Presseller, Emily
Clark, Kelsey
Manasse, Stephanie
Forman, Evan
author_facet Juarascio, Adrienne
Srivastava, Paakhi
Presseller, Emily
Clark, Kelsey
Manasse, Stephanie
Forman, Evan
author_sort Juarascio, Adrienne
collection PubMed
description BACKGROUND: Cognitive behavioral therapy (CBT) for bulimia nervosa (BN) is most effective when patients demonstrate adequate skill utilization (ie, the frequency with which a patient practices or uses therapeutic skills) and skill acquisition (ie, the ability to successfully perform a skill learned in treatment). However, rates of utilization and acquisition of key treatment skills (eg, regular eating, urge management skills, and mood management skills) by the end of the treatment are frequently low; as a result, outcomes from CBT for BN are affected. Just-in-time adaptive interventions (JITAIs) may improve skill acquisition and utilization by delivering real-time interventions during algorithm-identified opportunities for skill practice. OBJECTIVE: In this manuscript, we describe a newly developed JITAI system called CBT+ that is designed to facilitate the acquisition and utilization of CBT for BN treatment skills when used as a treatment augmentation. We also present feasibility, acceptability, and preliminary outcomes data from a small proof-of-concept pilot trial (n=5 patients and n=3 clinicians) designed to identify opportunities for iterative development of CBT+ ahead of a larger ongoing randomized controlled trial. METHODS: A total of 5 individuals with BN received 16 sessions of outpatient CBT for BN while using the CBT+ app. Data were collected from patients and clinicians to evaluate the feasibility (eg, app use and user adherence), acceptability (eg, qualitative patient and clinician feedback, including usefulness ratings of CBT+ on a 6-point Likert scale ranging from 1=extremely useless to 6=extremely useful), and preliminary outcomes (eg, improvements in skill utilization and acquisition and BN symptoms) of the CBT+ system. RESULTS: Patients reported that CBT+ was a relatively low burden (eg, quick and easy-to-use self-monitoring interface), and adherence to in-app self-monitoring was high (mean entries per day 3.13, SD 1.03). JITAIs were perceived as useful by both patients (median rating 5/6) and clinicians (median rating 5/6) for encouraging the use of CBT skills. Large improvements in CBT skills and clinically significant reductions in BN symptoms were observed post treatment. Although preliminary findings indicated that the CBT+ system was acceptable to most patients and clinicians, the overall study dropout was relatively high (ie, 2/5, 40% patients), which could indicate some moderate concerns regarding feasibility. CONCLUSIONS: CBT+, the first-ever JITAI system designed to facilitate the acquisition and utilization of CBT for BN treatment skills when used as a treatment augmentation, was shown to be feasible and acceptable. The results indicate that the CBT+ system should be subjected to more rigorous evaluations with larger samples and should be considered for wider implementation if found effective. Areas for iterative improvement of the CBT+ system ahead of a randomized controlled trial are also discussed.
format Online
Article
Text
id pubmed-8204236
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher JMIR Publications
record_format MEDLINE/PubMed
spelling pubmed-82042362021-06-29 A Clinician-Controlled Just-in-time Adaptive Intervention System (CBT+) Designed to Promote Acquisition and Utilization of Cognitive Behavioral Therapy Skills in Bulimia Nervosa: Development and Preliminary Evaluation Study Juarascio, Adrienne Srivastava, Paakhi Presseller, Emily Clark, Kelsey Manasse, Stephanie Forman, Evan JMIR Form Res Original Paper BACKGROUND: Cognitive behavioral therapy (CBT) for bulimia nervosa (BN) is most effective when patients demonstrate adequate skill utilization (ie, the frequency with which a patient practices or uses therapeutic skills) and skill acquisition (ie, the ability to successfully perform a skill learned in treatment). However, rates of utilization and acquisition of key treatment skills (eg, regular eating, urge management skills, and mood management skills) by the end of the treatment are frequently low; as a result, outcomes from CBT for BN are affected. Just-in-time adaptive interventions (JITAIs) may improve skill acquisition and utilization by delivering real-time interventions during algorithm-identified opportunities for skill practice. OBJECTIVE: In this manuscript, we describe a newly developed JITAI system called CBT+ that is designed to facilitate the acquisition and utilization of CBT for BN treatment skills when used as a treatment augmentation. We also present feasibility, acceptability, and preliminary outcomes data from a small proof-of-concept pilot trial (n=5 patients and n=3 clinicians) designed to identify opportunities for iterative development of CBT+ ahead of a larger ongoing randomized controlled trial. METHODS: A total of 5 individuals with BN received 16 sessions of outpatient CBT for BN while using the CBT+ app. Data were collected from patients and clinicians to evaluate the feasibility (eg, app use and user adherence), acceptability (eg, qualitative patient and clinician feedback, including usefulness ratings of CBT+ on a 6-point Likert scale ranging from 1=extremely useless to 6=extremely useful), and preliminary outcomes (eg, improvements in skill utilization and acquisition and BN symptoms) of the CBT+ system. RESULTS: Patients reported that CBT+ was a relatively low burden (eg, quick and easy-to-use self-monitoring interface), and adherence to in-app self-monitoring was high (mean entries per day 3.13, SD 1.03). JITAIs were perceived as useful by both patients (median rating 5/6) and clinicians (median rating 5/6) for encouraging the use of CBT skills. Large improvements in CBT skills and clinically significant reductions in BN symptoms were observed post treatment. Although preliminary findings indicated that the CBT+ system was acceptable to most patients and clinicians, the overall study dropout was relatively high (ie, 2/5, 40% patients), which could indicate some moderate concerns regarding feasibility. CONCLUSIONS: CBT+, the first-ever JITAI system designed to facilitate the acquisition and utilization of CBT for BN treatment skills when used as a treatment augmentation, was shown to be feasible and acceptable. The results indicate that the CBT+ system should be subjected to more rigorous evaluations with larger samples and should be considered for wider implementation if found effective. Areas for iterative improvement of the CBT+ system ahead of a randomized controlled trial are also discussed. JMIR Publications 2021-05-31 /pmc/articles/PMC8204236/ /pubmed/34057416 http://dx.doi.org/10.2196/18261 Text en ©Adrienne Juarascio, Paakhi Srivastava, Emily Presseller, Kelsey Clark, Stephanie Manasse, Evan Forman. Originally published in JMIR Formative Research (https://formative.jmir.org), 31.05.2021. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on https://formative.jmir.org, as well as this copyright and license information must be included.
spellingShingle Original Paper
Juarascio, Adrienne
Srivastava, Paakhi
Presseller, Emily
Clark, Kelsey
Manasse, Stephanie
Forman, Evan
A Clinician-Controlled Just-in-time Adaptive Intervention System (CBT+) Designed to Promote Acquisition and Utilization of Cognitive Behavioral Therapy Skills in Bulimia Nervosa: Development and Preliminary Evaluation Study
title A Clinician-Controlled Just-in-time Adaptive Intervention System (CBT+) Designed to Promote Acquisition and Utilization of Cognitive Behavioral Therapy Skills in Bulimia Nervosa: Development and Preliminary Evaluation Study
title_full A Clinician-Controlled Just-in-time Adaptive Intervention System (CBT+) Designed to Promote Acquisition and Utilization of Cognitive Behavioral Therapy Skills in Bulimia Nervosa: Development and Preliminary Evaluation Study
title_fullStr A Clinician-Controlled Just-in-time Adaptive Intervention System (CBT+) Designed to Promote Acquisition and Utilization of Cognitive Behavioral Therapy Skills in Bulimia Nervosa: Development and Preliminary Evaluation Study
title_full_unstemmed A Clinician-Controlled Just-in-time Adaptive Intervention System (CBT+) Designed to Promote Acquisition and Utilization of Cognitive Behavioral Therapy Skills in Bulimia Nervosa: Development and Preliminary Evaluation Study
title_short A Clinician-Controlled Just-in-time Adaptive Intervention System (CBT+) Designed to Promote Acquisition and Utilization of Cognitive Behavioral Therapy Skills in Bulimia Nervosa: Development and Preliminary Evaluation Study
title_sort clinician-controlled just-in-time adaptive intervention system (cbt+) designed to promote acquisition and utilization of cognitive behavioral therapy skills in bulimia nervosa: development and preliminary evaluation study
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8204236/
https://www.ncbi.nlm.nih.gov/pubmed/34057416
http://dx.doi.org/10.2196/18261
work_keys_str_mv AT juarascioadrienne acliniciancontrolledjustintimeadaptiveinterventionsystemcbtdesignedtopromoteacquisitionandutilizationofcognitivebehavioraltherapyskillsinbulimianervosadevelopmentandpreliminaryevaluationstudy
AT srivastavapaakhi acliniciancontrolledjustintimeadaptiveinterventionsystemcbtdesignedtopromoteacquisitionandutilizationofcognitivebehavioraltherapyskillsinbulimianervosadevelopmentandpreliminaryevaluationstudy
AT presselleremily acliniciancontrolledjustintimeadaptiveinterventionsystemcbtdesignedtopromoteacquisitionandutilizationofcognitivebehavioraltherapyskillsinbulimianervosadevelopmentandpreliminaryevaluationstudy
AT clarkkelsey acliniciancontrolledjustintimeadaptiveinterventionsystemcbtdesignedtopromoteacquisitionandutilizationofcognitivebehavioraltherapyskillsinbulimianervosadevelopmentandpreliminaryevaluationstudy
AT manassestephanie acliniciancontrolledjustintimeadaptiveinterventionsystemcbtdesignedtopromoteacquisitionandutilizationofcognitivebehavioraltherapyskillsinbulimianervosadevelopmentandpreliminaryevaluationstudy
AT formanevan acliniciancontrolledjustintimeadaptiveinterventionsystemcbtdesignedtopromoteacquisitionandutilizationofcognitivebehavioraltherapyskillsinbulimianervosadevelopmentandpreliminaryevaluationstudy
AT juarascioadrienne cliniciancontrolledjustintimeadaptiveinterventionsystemcbtdesignedtopromoteacquisitionandutilizationofcognitivebehavioraltherapyskillsinbulimianervosadevelopmentandpreliminaryevaluationstudy
AT srivastavapaakhi cliniciancontrolledjustintimeadaptiveinterventionsystemcbtdesignedtopromoteacquisitionandutilizationofcognitivebehavioraltherapyskillsinbulimianervosadevelopmentandpreliminaryevaluationstudy
AT presselleremily cliniciancontrolledjustintimeadaptiveinterventionsystemcbtdesignedtopromoteacquisitionandutilizationofcognitivebehavioraltherapyskillsinbulimianervosadevelopmentandpreliminaryevaluationstudy
AT clarkkelsey cliniciancontrolledjustintimeadaptiveinterventionsystemcbtdesignedtopromoteacquisitionandutilizationofcognitivebehavioraltherapyskillsinbulimianervosadevelopmentandpreliminaryevaluationstudy
AT manassestephanie cliniciancontrolledjustintimeadaptiveinterventionsystemcbtdesignedtopromoteacquisitionandutilizationofcognitivebehavioraltherapyskillsinbulimianervosadevelopmentandpreliminaryevaluationstudy
AT formanevan cliniciancontrolledjustintimeadaptiveinterventionsystemcbtdesignedtopromoteacquisitionandutilizationofcognitivebehavioraltherapyskillsinbulimianervosadevelopmentandpreliminaryevaluationstudy