smartphone-based CBT Archives

A smartphone app that supports online therapy

by Thomas Lethenborg | Aug 4, 2020 | Blog

Monsenso offers a smartphone app that supports online therapy by enabling users to share valuable health data with their therapists in real-time.

What is online therapy used for?

Online therapy, also called e-therapy or teletherapy has many advantages and it gives users access to therapy services offered by mental healthcare providers from the comfort of their home. Therapists can use one of the many secure platforms available to connect with their patients through video conference, phone calls or chat functionality. It also helps reach people who have very busy schedules and can’t spare the commute, or those are not too comfortable with face to face appointments.

Online therapy can be effective to treat many mood and behavioural disorders such as depression, anxiety, bipolar disorder and borderline personality disorder. In fact, according to research led by McMaster University online therapy can be more effective than in person.

Just as in traditional therapy, it is important that the goals of online therapy are created by both, the therapist and the client.

Online Cognitive Behavioural Therapy

Cognitive behavioral therapy (CBT) is a tool used to treat a number of mental and physical health issues, and due to its flexibility, CBT online offers many of the benefits found in the face-to-face model. CBT is widely available online, so people experiencing unwanted symptoms linked to anxiety, depression, and other conditions should view it as a viable option to treat their overall well-being.

Online Dialectical Behavioural Therapy

Dialectical Behavioural Therapy (DBT) is a type of therapy that primarily involves skills training such as mindfulness, emotional regulation, and distress tolerance to assist individuals to better manage emotional distress. It also provides problem-solving strategies to identify and alter harmful behaviors and replace them with constructive ones.

An app that supports online treatment

Before using the Monsenso smartphone app to support his therapy, Peter Hagelund, followed the typical therapeutic setting. His psychiatrist would schedule an appointment every two-three weeks, and they would discuss Peter’s previous weeks. On most occasions, Peter would say that he had been doing fine, but sometimes he forgot important details that he wanted to discuss.

Now, instead of relying on Peter’s memory during the consultation, his psychiatrist can access his data and see how he has been doing, as it happened. He can view how much he has sleept, how much he exercises, how much he drinks, the levels of anxiety he has, and other relevant aspects to his treatment and his disorder.

Mads Trier-Blom, another Monsenso user, said that the app helps him to be more connected with his clinician, Bente, who intervenes when she can see that he is not feeling well, to help him avoid having an episode.

Psychiatrist Kristoffer Södersten from PsykiatriResurs in Sweden says that the accuracy from a diagnosis obtained can very much depend on many factors such as cultural background and how comfortable the patient is in the conversation. Therefore, it can be very arbitrary the diagnosis a patient receives.

The information gathered from the Monsenso smartphone app helps him get a consistent and clearer view of an individual’s mental health. He finds the Monsenso mHealth solution to be particularly helpful in capturing relevant objective data. The solution provides a comprehensive and easily accessible overview of relevant patient data, such as the individual’s overall day score, his mood, the number of hours he slept, and if he took his medication. The smartphone app also collects sensor data, such as physical activity, social activity, phone usage and voice features which helps to supplement the subjective data provided.

The Monsenso mHealth solution has helped mental healthcare providers to get an overview of an individual’s historical data and correlation analysis. It also helps them identify the triggers and early warning signs everyone has, enabling them to intervene at an early stage before they have an episode, such as in the case of Mads.

Besides, the smartphone app helps users to be more aware of their mood, their symptoms and the reason why these symptoms appear. It also provides them with useful skill-training content to help them deal with stressful situations.

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Online therapy can be more effective than in person, according to research

by Thomas Lethenborg | Jul 22, 2020 | Blog

Online therapy can be more effective than in person, according to research led by McMaster University.

Based on randomized control trials, the systematic review and analysis revealed that cognitive behavioural therapy that connected therapists and patients through such modes as web-based applications, video-conferencing, email and texting, improved patients’ symptoms better than face to face when measured using standardized mood symptoms scales. As well, there was no difference in the level of satisfaction or function between the two methods of delivery.

The details were published in EClinicalMedicine, published by The Lancet.

“Although this study started before the current COVID-19 pandemic, it is timely and assuring that treatment delivered electronically works as well if not better than face to face and there is no compromise on the quality of care that patients are receiving during this stressful time,” said corresponding author Zena Samaan, associate professor of psychiatry and behavioural neurosciences at McMaster and a psychiatrist at St. Joseph’s Healthcare Hamilton.

Using online therapy to treat patients with geographical limitations

Cognitive behavioural therapy is a type of psychotherapy widely used to treat depression. However, limited resource availability poses several barriers to patients seeking access to care, including lengthy wait times and geographical limitations.

In this evidence review, researchers identified 17 randomized control trials comparing therapist-supported cognitive behavioural therapy delivered electronically to face to face cognitive behavioural therapy. The studies were conducted between 2003 and 2018 in the United States, Australia, Netherlands, Switzerland, Sweden and the United Kingdom.

Samaan said the findings of the meta-analysis debunk widely-held perceptions about psychotherapy.

“The common understanding was that face to face psychotherapy has the advantage of the connection with the therapist and this connection is in part what makes the difference in treatment,” she said.

“However, it is not surprising that electronic interventions are helpful in that they offer flexibility, privacy and no travel time, time off work, transport or parking costs. It makes sense that people access care, especially mental health care, when they need it from their own comfort space.”

Samaan noted that the findings support advocacy and widespread implementation of electronic cognitive behavioural therapy.

“Electronic options should be considered to be implemented for delivering therapy to patients,” she said. “This can potentially vastly improve access for patients, especially those in rural or under-served areas, and during pandemics.”

This article was published originally by Science Daily, click here to view it.

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RADMIS Research Project: A smartphone-based platform that delivers CBT for patients with depression

by Thomas Lethenborg | Mar 26, 2017 | News, Research Projects

The RADMIS Research Project is supported by the Innovation Foundation in Denmark and is done in collaboration with the “MONARCA team” with the department of psychiatry represented (RHP) by professor Lars V. Kessing and DTU represented by professors Jakob E. Bardram and Ole Winther.

Depression and bipolar disorder

According to WHO, depression and bipolar disorder are leading causes of disability worldwide, and they cause a high burden in terms of cost, lost productivity, morbidity, suffering, and mortality. According to the European Commission, depression is one of the most pressing public health concerns today, accounting for more than 12% of all estimated ill health and premature mortality in Europe, only exceeded by heart disease and cancer.

Although during the last few decades, psychiatric treatment has shifted more from inpatient treatment to outpatient treatment, the costs of psychiatric hospitalisations are still significant.
In fact, patients with affective disorders are more frequently hospitalised than any other patient group, counting for approximately 20% of all psychiatric hospitalisations.

Monsenso’s involvement in the RADMIS RESEARCH PROJECT

Monsenso is responsible for improving and developing four modules in the Monsenso mHealth solution.

1. Data-collection framework. This task will research and develop a framework for data collection, clustering, preprocessing, and management based on both patient self-reporting and automatic sensor data collection. This will be done as part of the Monsenso platform with input from DTU research on data preprocessing and pathological insight from RHP.

2. Context-aware CBT module. This task will research and develop a module for context-aware (just-in-time) delivery of a rumination-focused CBT and (b) concreteness training, a facilitated self-help intervention intended to increase specificity of processing in patients with depression. This will be done as part of the Monsenso platform with design and technical input from DTU and psychological insight and input from RHP.

3. CBT content. This task will develop multimedia content for CBT training, such as action and coping plans for patients, cartoon and video instruction material, and medication guidance. This content will be developed by psychologist from RHP and incorporated into the CBT module.

4. Illness-forecasting module. This task will research and develop a module for disease forecasting based on research from DTU on correlations analysis and prediction. This module will be included into the Monsenso platform.

To learn more read:

Smartphone-based CBT aims to reduce hospital readmissions 50%

by Thomas Lethenborg | Mar 30, 2016 | Children and Adolescents

Smartphone-based CBT aims to help individuals with depression and bipolar disorder, since these are two of the leading causes of disability worldwide. Together, they account for nearly 50% of all morbidity and mortality due to mental and substance use disorders. Besides, patients with affective disorders are more frequently hospitalised than any other patient group.

In 2013, Danish authorities estimated that in Denmark, a country with 5.6 million people, patients with bipolar disorder and depression accounted for 20% of all psychiatric hospitalisations, which is the equivalent of more than 10,800 patients. The cost of these hospitalisations was estimated to be around 87 million Euros per year, which corresponds to 10,800 admissions with an average stay of 20 days at a cost of 400 Euros per day. The most effective treatment for both of these mental disorders includes medication and Cognitive Behavioural Therapy (CBT).

Smartphone-based CBT

The RADMIS research project, which was granted a budget of 1.3 million Euros by the Danish Innovation Fund, will be done in collaboration with the Mental Health Services of the Capital Region of Denmark (RHP) and the Danish Technical University (DTU).

The project aims to establish clinical evidence that the Monsenso mHealth solution can reduce the number of hospital readmissions of patients with depression and bipolar disorder by 50%. It also seeks to decrease the symptoms and improve the quality of life of outpatients with depression or bipolar disorder receiving smartphone-based CBT.

The multi-disciplinary team involved in the project is comprised of scientific researchers, psychiatrists, psychologists, and computer scientists. This group has already shown promising scientific results with the MONARCA research project.

The use of an intelligent, smartphone-based CBT for the monitoring and treatment for depression and bipolar disorders has never been tried before.

The system combines automatic sensing and data collection with customisable self-assessment forms
It provides advanced data analysis and forecasting of disease progression, allowing patient and treatment personnel day-to-day assessment, prediction and insight into causes of changes in health state
It provides a platform for CBT treatment using innovative multi-media messages delivered ‘in-context’, tracking of medicine administration and compliance, as well as two-way communication between the patient and the clinic

Furthermore, smartphones have never been used in the research and collection of clinical evidence to reduce re-hospitalisation and improve treatment response among patients with depression and bipolar disorder.

After being discharged from the hospital, psychiatric patients undergo a high-risk period in which they are considered to have an increased risk of suicide of 300 times more during the first week and a high-risk of readmission. In fact, psychiatric patients are often afraid to leave the hospital, feeling alone and overwhelmed with the prospect of an appointment with a clinician in one or more months ahead.

A pilot study in Copenhagen involving 29 recently-discharged patients revealed the importance of continued contact with a care provider. In this study, patients used a daily computer system to self-monitor.

The study revealed that daily contact with a nurse using the bidirectional feedback system combined with a smartphone-based identifier of early-warning signs lowers the risk of relapse of depressive and (hypo-) manic symptoms. The pilot study also revealed that the incidence of suicide attempts and the rate of re-hospitalisation decreased.

The hypotheses to be investigated by the project

This project investigates two clinical questions related to the treatment of patients and one technical question related to online learning forecast systems:

Can the risk and duration of psychiatric re-hospitalisation be reduced by using smartphone-based treatment?
Can depressive and manic symptoms, psycho-social function, recovery, empowerment and quality of life be improved by using smartphone-based treatment?
Can machine learning methodology, that runs on a smartphone app and adapts to data as it is collected, give users accurate forecasts and feedback on early warning signs of upcoming depression and hypomania/mania?

A bi-weekly workshop with 6-8 users will be conducted with a focus on the design of the features of the smartphone-based treatment system.

The questions will be investigated in two separate RCTs, focusing on the two patient groups (depressive and bipolar patients) with similar designs comparing the use of smartphone-based treatment with standard care. Each patient will be subject to the trial for six months. Recruitment, inclusion criteria and randomisation: 200 patients with recurrent depression and 200 patients with bipolar disorder at one of the five psychiatric centres in RHP. Patients aged 18 to 70 years will be screened with Schedules for Clinical Assessment in Neuropsychiatry (SCAN) to confirm the ICD-10 diagnosis.

Health outcomes:

Primary: Rate of re-hospitalisation and duration of hospitalisations.
Secondary: Severity of depression according to scores on the Hamilton Depression Rating Scale (36) and Young Mania Rating Scale (YMRS) (37) (for bipolar disorder patients only), at a given time point during the 6 month trial period. Functional assessment short test (FAST) (psychosocial function) (38).
Tertiary: Recovery Assessment Scale (39), empowerment according to Rogers empowerment scale (40), the WHO (Five) well-being index (41) and the Verona Satisfaction Scale-Affective Disorder (VSS-A) (42). Assessment of outcomes will be done by researchers blinded to allocation (single blinded).

A smartphone app that supports online therapy

What is online therapy used for?

Online Cognitive Behavioural Therapy

Online Dialectical Behavioural Therapy

An app that supports online treatment

Online therapy can be more effective than in person, according to research

Using online therapy to treat patients with geographical limitations

RADMIS Research Project: A smartphone-based platform that delivers CBT for patients with depression

Depression and bipolar disorder

Monsenso’s involvement in the RADMIS RESEARCH PROJECT

Smartphone-based CBT aims to reduce hospital readmissions 50%

Smartphone-based CBT

The hypotheses to be investigated by the project

Health outcomes:

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