11
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Digital mental health apps and the therapeutic alliance: initial review

      review-article
      , AB, BE, , BS, , MD, PhD, , MD, , MD, MBI
      BJPsych Open
      Cambridge University Press
      Smartphone, alliance, Individual Psychotherapy

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          As mental healthcare expands to smartphone apps and other technologies that may offer therapeutic interventions without a therapist involved, it is important to assess the impact of non-traditional therapeutic relationships.

          Aims

          To determine if there were any meaningful data regarding the digital therapeutic alliance in smartphone interventions for serious mental illnesses.

          Method

          A literature search was conducted in four databases (PubMed, PsycINFO, Embase and Web of Science).

          Results

          There were five studies that discuss the therapeutic alliance when a mobile application intervention is involved in therapy. However, in none of the studies was the digital therapeutic alliance the primary outcome. The studies looked at different mental health conditions, had different duration of technology use and used different methods for assessing the therapeutic alliance.

          Conclusions

          Assessing and optimising the digital therapeutic alliance holds the potential to make tools such as smartphone apps more effective and improve adherence to their use. However, the heterogeneous nature of the five studies we identified make it challenging to draw conclusions at this time. A measure is required to evaluate the digital therapeutic alliance.

          Related collections

          Most cited references27

          • Record: found
          • Abstract: not found
          • Article: not found

          Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Systematic review: impact of health information technology on quality, efficiency, and costs of medical care.

            Experts consider health information technology key to improving efficiency and quality of health care. To systematically review evidence on the effect of health information technology on quality, efficiency, and costs of health care. The authors systematically searched the English-language literature indexed in MEDLINE (1995 to January 2004), the Cochrane Central Register of Controlled Trials, the Cochrane Database of Abstracts of Reviews of Effects, and the Periodical Abstracts Database. We also added studies identified by experts up to April 2005. Descriptive and comparative studies and systematic reviews of health information technology. Two reviewers independently extracted information on system capabilities, design, effects on quality, system acquisition, implementation context, and costs. 257 studies met the inclusion criteria. Most studies addressed decision support systems or electronic health records. Approximately 25% of the studies were from 4 academic institutions that implemented internally developed systems; only 9 studies evaluated multifunctional, commercially developed systems. Three major benefits on quality were demonstrated: increased adherence to guideline-based care, enhanced surveillance and monitoring, and decreased medication errors. The primary domain of improvement was preventive health. The major efficiency benefit shown was decreased utilization of care. Data on another efficiency measure, time utilization, were mixed. Empirical cost data were limited. Available quantitative research was limited and was done by a small number of institutions. Systems were heterogeneous and sometimes incompletely described. Available financial and contextual data were limited. Four benchmark institutions have demonstrated the efficacy of health information technologies in improving quality and efficiency. Whether and how other institutions can achieve similar benefits, and at what costs, are unclear.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              The efficacy of smartphone-based mental health interventions for depressive symptoms: a meta-analysis of randomized controlled trials.

              The rapid advances and adoption of smartphone technology presents a novel opportunity for delivering mental health interventions on a population scale. Despite multi-sector investment along with wide-scale advertising and availability to the general population, the evidence supporting the use of smartphone apps in the treatment of depression has not been empirically evaluated. Thus, we conducted the first meta-analysis of smartphone apps for depressive symptoms. An electronic database search in May 2017 identified 18 eligible randomized controlled trials of 22 smartphone apps, with outcome data from 3,414 participants. Depressive symptoms were reduced significantly more from smartphone apps than control conditions (g=0.38, 95% CI: 0.24-0.52, p<0.001), with no evidence of publication bias. Smartphone interventions had a moderate positive effect in comparison to inactive controls (g=0.56, 95% CI: 0.38-0.74), but only a small effect in comparison to active control conditions (g=0.22, 95% CI: 0.10-0.33). Effects from smartphone-only interventions were greater than from interventions which incorporated other human/computerized aspects along the smartphone component, although the difference was not statistically significant. The studies of cognitive training apps had a significantly smaller effect size on depression outcomes (p=0.004) than those of apps focusing on mental health. The use of mood monitoring softwares, or interventions based on cognitive behavioral therapy, or apps incorporating aspects of mindfulness training, did not affect significantly study effect sizes. Overall, these results indicate that smartphone devices are a promising self-management tool for depression. Future research should aim to distil which aspects of these technologies produce beneficial effects, and for which populations.
                Bookmark

                Author and article information

                Journal
                BJPsych Open
                BJPsych Open
                BJO
                BJPsych Open
                Cambridge University Press (Cambridge, UK )
                2056-4724
                January 2019
                29 January 2019
                : 5
                : 1
                : e15
                Affiliations
                [1]Research Assistant, Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School , USA
                [2]Research Assistant, Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School , USA
                [3]Chair of Child and Adolescent Psychiatry and Director, NIHR MindTech MedTech Co-operative, NIHR Nottingham BRC Mental Health; and Technology Theme Lead, University of Nottingham and Institute of Mental Health , UK
                [4]Stanley Cobb Professor and Vice-Chair for Public Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School , USA
                [5]Director of Digital Psychiatry, Departments of Psychiatry and Clinical Informatics, Beth Israel Deaconess Medical Center, Harvard Medical School , USA
                Author notes
                Correspondence: John Torous, MD, Departments of Psychiatry and Clinical Informatics,, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston 02446, MA, USA. Email: jtorous@ 123456bidmc.harvard.edu
                Article
                S2056472418000868 00086
                10.1192/bjo.2018.86
                6381418
                30762511
                9be26b2e-1f12-4d93-9496-b0247235734e
                © The Royal College of Psychiatrists 2019

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 07 September 2018
                : 30 November 2018
                : 04 December 2018
                Page count
                Figures: 1, Tables: 1, References: 36, Pages: 5
                Categories
                Review

                smartphone,alliance,individual psychotherapy
                smartphone, alliance, individual psychotherapy

                Comments

                Comment on this article