Enhancing Delivery of Problem Solving Therapy Using SmartPhone Technology
| Status: | Completed |
|---|---|
| Conditions: | Anxiety, Depression, Depression |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - 64 |
| Updated: | 7/11/2015 |
| Start Date: | April 2014 |
| End Date: | March 2015 |
| Contact: | Kathleen M Grubbs, PhD |
| Email: | kathleen.grubbs@va.gov |
| Phone: | (501) 257-1261 |
This project will be the first to evaluate the Moving Forward app in VA. Identifying an
effective treatment for anxiety and depression in primary care is imperative within VHA as
they are both common, chronic, and debilitating conditions associated with a number of
personal and health-related costs. In close partnership with app developers at MHS, a major
contribution of this research is the actionable feedback on the acceptability, feasibility
and effectiveness of augmenting traditional PST with the Moving Forward app for future app
development. If effectiveness can be established, Moving Forward has the potential for
integration into the larger continuum of care for depression and anxiety in PC-MHI (e.g.,
care management, co-located collaborative care). Lastly, this pilot project will provide
preliminary data for future research on SmartPhone technology. Veteran feedback on treatment
components, ease of executing the study successfully and preliminary effect size
calculations, will inform the design of the larger project.
effective treatment for anxiety and depression in primary care is imperative within VHA as
they are both common, chronic, and debilitating conditions associated with a number of
personal and health-related costs. In close partnership with app developers at MHS, a major
contribution of this research is the actionable feedback on the acceptability, feasibility
and effectiveness of augmenting traditional PST with the Moving Forward app for future app
development. If effectiveness can be established, Moving Forward has the potential for
integration into the larger continuum of care for depression and anxiety in PC-MHI (e.g.,
care management, co-located collaborative care). Lastly, this pilot project will provide
preliminary data for future research on SmartPhone technology. Veteran feedback on treatment
components, ease of executing the study successfully and preliminary effect size
calculations, will inform the design of the larger project.
Access and engagement in evidence-based psychotherapies for Veterans are high priorities for
the Veterans Health Administration (VHA), especially the Office of Rural Health (ORH) and
the office of Mental Health Services (MHS). SmartPhone applications are an emerging
technology with a vast potential to extend the reach of traditional in-person psychotherapy
by allowing increased digital access to providers and self-management tools. Due to the
relatively recent development of this technology, there are no data on the effectiveness of
SmartPhone-delivered psychotherapy. Preliminary data on acceptability and satisfaction are
promising, suggesting a need for further research. The National Center for PTSD in
collaboration with the National Center for Telehealth & Technology (T2) recently completed
the development of an app called Moving Forward, a Veteran-friendly adaptation of Problem
Solving Therapy (PST), an evidence based therapy available through Primary Care Integration
Clinics (PC-MHI). In partnership with MHS, this proposed pilot project will gather
preliminary data on the effectiveness and acceptability of Moving Forward and provide timely
feedback to the app creators. Participants will include approximately 40 Veterans diagnosed
with an anxiety or mood disorder interested in obtaining mental health treatment in PC-MHI.
Participants will be randomly assigned to receive either PST augmented by the Moving Forward
app or PST alone. Participants will complete assessments at baseline, 6 weeks and 12 weeks.
Investigators propose 3 specific hypotheses. In hypothesis 1, investigators predict a
moderate effect size will be observed when comparing homework completion and satisfaction
for patients randomized to PST plus the Moving Forward app compared to patients randomized
to PST alone. In hypothesis 2, investigators predict a moderate effect size will be observed
when comparing change scores on the problem solving style for patients randomized to PST
plus the Moving Forward app compared to patients randomized to PST alone. In hypothesis 3,
investigators predict a moderate effect size will be observed when comparing depression,
anxiety, stress and quality of life change for patients randomized to PST plus the Moving
Forward app compared to patients randomized to PST alone. Key informant interviews will
provide qualitative feedback on the Moving Forward app which investigators will share with
our partners at MHS. The proposed project is important to the VA mission to improve access
for all Veterans particularly those who face barriers to engagement in traditional
face-to-face treatment. The proposed research addresses one of three primary focus areas of
the Office of Research and Development (Access), two of HSR&D's research priorities
(Access/Rural Health and Mental Health), and three of Secretary Shinseki's Transformational
Initiatives for the 21st Century including improving: 1) access to care, 2) mental health,
and 3) patient-centeredness. This proposed work is innovative as it focuses on a rapidly
emerging mobile technology that has great potential to improve access and engagement in
mental health service delivery. To date, there have been no randomized effectiveness trials
that have examined SmartPhone apps for mental health service delivery. The project is also
timely as there is a temporary moratorium (imposed by the Office of Information Technology)
on app dissemination within VHA, presenting an opportunity to study Moving Forward prior to
its release. At the completion of this project, investigators expect that the work proposed
in this study will highlight the clinical value of the Moving Forward app, which will inform
both VA policy makers and the scientific community at large about the utility of SmartPhone
technology in mental health care delivery. Investigators also expect that this study will
provide our partners at MHS with helpful feedback on the Moving Forward app design and
future app development.
the Veterans Health Administration (VHA), especially the Office of Rural Health (ORH) and
the office of Mental Health Services (MHS). SmartPhone applications are an emerging
technology with a vast potential to extend the reach of traditional in-person psychotherapy
by allowing increased digital access to providers and self-management tools. Due to the
relatively recent development of this technology, there are no data on the effectiveness of
SmartPhone-delivered psychotherapy. Preliminary data on acceptability and satisfaction are
promising, suggesting a need for further research. The National Center for PTSD in
collaboration with the National Center for Telehealth & Technology (T2) recently completed
the development of an app called Moving Forward, a Veteran-friendly adaptation of Problem
Solving Therapy (PST), an evidence based therapy available through Primary Care Integration
Clinics (PC-MHI). In partnership with MHS, this proposed pilot project will gather
preliminary data on the effectiveness and acceptability of Moving Forward and provide timely
feedback to the app creators. Participants will include approximately 40 Veterans diagnosed
with an anxiety or mood disorder interested in obtaining mental health treatment in PC-MHI.
Participants will be randomly assigned to receive either PST augmented by the Moving Forward
app or PST alone. Participants will complete assessments at baseline, 6 weeks and 12 weeks.
Investigators propose 3 specific hypotheses. In hypothesis 1, investigators predict a
moderate effect size will be observed when comparing homework completion and satisfaction
for patients randomized to PST plus the Moving Forward app compared to patients randomized
to PST alone. In hypothesis 2, investigators predict a moderate effect size will be observed
when comparing change scores on the problem solving style for patients randomized to PST
plus the Moving Forward app compared to patients randomized to PST alone. In hypothesis 3,
investigators predict a moderate effect size will be observed when comparing depression,
anxiety, stress and quality of life change for patients randomized to PST plus the Moving
Forward app compared to patients randomized to PST alone. Key informant interviews will
provide qualitative feedback on the Moving Forward app which investigators will share with
our partners at MHS. The proposed project is important to the VA mission to improve access
for all Veterans particularly those who face barriers to engagement in traditional
face-to-face treatment. The proposed research addresses one of three primary focus areas of
the Office of Research and Development (Access), two of HSR&D's research priorities
(Access/Rural Health and Mental Health), and three of Secretary Shinseki's Transformational
Initiatives for the 21st Century including improving: 1) access to care, 2) mental health,
and 3) patient-centeredness. This proposed work is innovative as it focuses on a rapidly
emerging mobile technology that has great potential to improve access and engagement in
mental health service delivery. To date, there have been no randomized effectiveness trials
that have examined SmartPhone apps for mental health service delivery. The project is also
timely as there is a temporary moratorium (imposed by the Office of Information Technology)
on app dissemination within VHA, presenting an opportunity to study Moving Forward prior to
its release. At the completion of this project, investigators expect that the work proposed
in this study will highlight the clinical value of the Moving Forward app, which will inform
both VA policy makers and the scientific community at large about the utility of SmartPhone
technology in mental health care delivery. Investigators also expect that this study will
provide our partners at MHS with helpful feedback on the Moving Forward app design and
future app development.
Inclusion Criteria:
- Veterans will be eligible if they are 18 years old or older,
- speak and understand English,
- are patients in the CAVHS PC-MHI,
- and have a current diagnosis of depression (major depressive disorder, 296.2x and
296.3x; dysthymic disorder, 300.4; depressive disorder NOS, 311) and/or anxiety
(panic disorder without agoraphobia, 300.01; panic disorder with agoraphobia, 300.21;
specific phobia, 300.29; social phobia, 300.23; obsessive-compulsive disorder; 300.3;
posttraumatic stress disorder, 309.81; acute stress disorder, 308.3; generalized
anxiety disorder, 300.02; or anxiety disorder NOS, 300.00).
- We considered enrolling only those Veterans diagnosed with mild-to-moderate
depression, but chose to include a range of anxiety and depression-related disorders
in order to reflect the population of Veterans seen in PC-MHI.
- Additionally, PST is designed to treat a range of stress-related problems, including
both anxiety and depressive disorders.
- Veterans taking prescribed anxiolytics or anti-depressants will be eligible if they
are on a stable medication regimen.
Exclusion Criteria:
- Exclusionary criteria include any current suicidal ideation,
- substance dependence diagnosis and current use,
- any psychotic spectrum diagnoses or
- inability to provide informed consent.
- Diagnosis will be confirmed by chart review and MINI clinical interview.
- Acute suicidal ideation will be determined by the assessing or treating clinician.
- During the baseline and follow-up interviews, any Veteran who endorses a "1" or
higher on item # 21 on the DASS "I feel that life isn't worthwhile" or item # 9 on
the PHQ-9 "thoughts that you would be better off dead or of hurting yourself" will be
asked follow-up questions on the suicide risk protocol (see appendix 3).
- Current substance or alcohol use will be determined by the alcohol and substance use
modules of the MINI.
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