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Human Support in App-Based Cognitive Behavioral Therapies for Emotional Disorders: Scoping Review

BACKGROUND: Smartphone app–based therapies offer clear promise for reducing the gap in available mental health care for people at risk for or people with mental illness. To this end, as smartphone ownership has become widespread, app-based therapies have become increasingly common. However, the rese...

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Autores principales: Bernstein, Emily E, Weingarden, Hilary, Wolfe, Emma C, Hall, Margaret D, Snorrason, Ivar, Wilhelm, Sabine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9034419/
https://www.ncbi.nlm.nih.gov/pubmed/35394434
http://dx.doi.org/10.2196/33307
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author Bernstein, Emily E
Weingarden, Hilary
Wolfe, Emma C
Hall, Margaret D
Snorrason, Ivar
Wilhelm, Sabine
author_facet Bernstein, Emily E
Weingarden, Hilary
Wolfe, Emma C
Hall, Margaret D
Snorrason, Ivar
Wilhelm, Sabine
author_sort Bernstein, Emily E
collection PubMed
description BACKGROUND: Smartphone app–based therapies offer clear promise for reducing the gap in available mental health care for people at risk for or people with mental illness. To this end, as smartphone ownership has become widespread, app-based therapies have become increasingly common. However, the research on app-based therapies is lagging behind. In particular, although experts suggest that human support may be critical for increasing engagement and effectiveness, we have little systematic knowledge about the role that human support plays in app-based therapy. It is critical to address these open questions to optimally design and scale these interventions. OBJECTIVE: The purpose of this study is to provide a scoping review of the use of human support or coaching in app-based cognitive behavioral therapy for emotional disorders, identify critical knowledge gaps, and offer recommendations for future research. Cognitive behavioral therapy is the most well-researched treatment for a wide range of concerns and is understood to be particularly well suited to digital implementations, given its structured, skill-based approach. METHODS: We conducted systematic searches of 3 databases (PubMed, PsycINFO, and Embase). Broadly, eligible articles described a cognitive behavioral intervention delivered via smartphone app whose primary target was an emotional disorder or problem and included some level of human involvement or support (coaching). All records were reviewed by 2 authors. Information regarding the qualifications and training of coaches, stated purpose and content of the coaching, method and frequency of communication with users, and relationship between coaching and outcomes was recorded. RESULTS: Of the 2940 titles returned by the searches, 64 (2.18%) were eligible for inclusion. This review found significant heterogeneity across all of the dimensions of coaching considered as well as considerable missing information in the published articles. Moreover, few studies had qualitatively or quantitatively evaluated how the level of coaching impacts treatment engagement or outcomes. Although users tend to self-report that coaching improves their engagement and outcomes, there is limited and mixed supporting quantitative evidence at present. CONCLUSIONS: Digital mental health is a young but rapidly expanding field with great potential to improve the reach of evidence-based care. Researchers across the reviewed articles offered numerous approaches to encouraging and guiding users. However, with the relative infancy of these treatment approaches, this review found that the field has yet to develop standards or consensus for implementing coaching protocols, let alone those for measuring and reporting on the impact. We conclude that coaching remains a significant hole in the growing digital mental health literature and lay out recommendations for future data collection, reporting, experimentation, and analysis.
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spelling pubmed-90344192022-04-24 Human Support in App-Based Cognitive Behavioral Therapies for Emotional Disorders: Scoping Review Bernstein, Emily E Weingarden, Hilary Wolfe, Emma C Hall, Margaret D Snorrason, Ivar Wilhelm, Sabine J Med Internet Res Review BACKGROUND: Smartphone app–based therapies offer clear promise for reducing the gap in available mental health care for people at risk for or people with mental illness. To this end, as smartphone ownership has become widespread, app-based therapies have become increasingly common. However, the research on app-based therapies is lagging behind. In particular, although experts suggest that human support may be critical for increasing engagement and effectiveness, we have little systematic knowledge about the role that human support plays in app-based therapy. It is critical to address these open questions to optimally design and scale these interventions. OBJECTIVE: The purpose of this study is to provide a scoping review of the use of human support or coaching in app-based cognitive behavioral therapy for emotional disorders, identify critical knowledge gaps, and offer recommendations for future research. Cognitive behavioral therapy is the most well-researched treatment for a wide range of concerns and is understood to be particularly well suited to digital implementations, given its structured, skill-based approach. METHODS: We conducted systematic searches of 3 databases (PubMed, PsycINFO, and Embase). Broadly, eligible articles described a cognitive behavioral intervention delivered via smartphone app whose primary target was an emotional disorder or problem and included some level of human involvement or support (coaching). All records were reviewed by 2 authors. Information regarding the qualifications and training of coaches, stated purpose and content of the coaching, method and frequency of communication with users, and relationship between coaching and outcomes was recorded. RESULTS: Of the 2940 titles returned by the searches, 64 (2.18%) were eligible for inclusion. This review found significant heterogeneity across all of the dimensions of coaching considered as well as considerable missing information in the published articles. Moreover, few studies had qualitatively or quantitatively evaluated how the level of coaching impacts treatment engagement or outcomes. Although users tend to self-report that coaching improves their engagement and outcomes, there is limited and mixed supporting quantitative evidence at present. CONCLUSIONS: Digital mental health is a young but rapidly expanding field with great potential to improve the reach of evidence-based care. Researchers across the reviewed articles offered numerous approaches to encouraging and guiding users. However, with the relative infancy of these treatment approaches, this review found that the field has yet to develop standards or consensus for implementing coaching protocols, let alone those for measuring and reporting on the impact. We conclude that coaching remains a significant hole in the growing digital mental health literature and lay out recommendations for future data collection, reporting, experimentation, and analysis. JMIR Publications 2022-04-08 /pmc/articles/PMC9034419/ /pubmed/35394434 http://dx.doi.org/10.2196/33307 Text en ©Emily E Bernstein, Hilary Weingarden, Emma C Wolfe, Margaret D Hall, Ivar Snorrason, Sabine Wilhelm. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 08.04.2022. 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 the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.
spellingShingle Review
Bernstein, Emily E
Weingarden, Hilary
Wolfe, Emma C
Hall, Margaret D
Snorrason, Ivar
Wilhelm, Sabine
Human Support in App-Based Cognitive Behavioral Therapies for Emotional Disorders: Scoping Review
title Human Support in App-Based Cognitive Behavioral Therapies for Emotional Disorders: Scoping Review
title_full Human Support in App-Based Cognitive Behavioral Therapies for Emotional Disorders: Scoping Review
title_fullStr Human Support in App-Based Cognitive Behavioral Therapies for Emotional Disorders: Scoping Review
title_full_unstemmed Human Support in App-Based Cognitive Behavioral Therapies for Emotional Disorders: Scoping Review
title_short Human Support in App-Based Cognitive Behavioral Therapies for Emotional Disorders: Scoping Review
title_sort human support in app-based cognitive behavioral therapies for emotional disorders: scoping review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9034419/
https://www.ncbi.nlm.nih.gov/pubmed/35394434
http://dx.doi.org/10.2196/33307
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