Applied Psychology OPUS

r u ok? Mobile Therapy and Modern Mental Health

by Javanna N. Obregon

As of recent, researchers are investigating the applicability of mobile technology, such as cell phones, for various therapeutic treatments. Known as mobile therapy, this treatment method imple-ments text message correspondence between patients and their therapist either in tandem with face-to-face therapy, or as a mean to maintain advances made in therapy post-treatment. The goals of mobile therapy are to keep patients actively engaged with their treatment, alleviate their symptoms, and to increase the effectiveness of traditional face-to-face therapy (Boschen & Casey, 2008). More specifically, mobile therapy is currently being applied to Cognitive Behavioral therapy (CBT) (Boschen & Casey, 2008), a treatment method that focuses on changing one’s thoughts concerning a specific event or object to alter his or her behavioral response (Corey, 2009).

While researchers agree that CBT is an effective treatment for a range of disorders (Bulter, Champman, Forman, & Beck, 2006; Westbrook & Kirk, 2005), they also identify quite a few areas for improvement. These include difficulties with adherence to self-monitoring methods such as using a journal to record feelings toward treatment and issues with homework assignment completion, both of which are common techniques used in CBT (Boschen & Casey, 2008). Furthermore, many patients experience difficulties in applying strategies learned in the clinical setting in the real world, which can increase frustration with treatment and lead to relapse. Researchers believe that in combination with CBT, mobile therapy will address these issues, thereby increasing the effectiveness of therapeutic treatments for many patients (Boschen & Casey, 2008).

Thus far, technological devices, such as mobile phones and computers, have been successfully implemented in the medical setting, as evident from cancer research (Forbat, Maguire, McCann, Illingworth, & Kearney, 2009) and studies of diabetes (Bellazzi et al., 2004), laying the groundwork for its potential use in the field of mental health. More specifically, researchers believe that mobile therapy will provide patients with immediate feedback and better self-monitoring outside the clinical setting (Boschen & Casey, 2008). This is important for those receiving CBT because it could improve the quality of treatment in the real world. Also, the brief exchanges will provide clinicians with accurate and regularly updated data to inform treatment plans. With the great proliferation of cell phone usage within modern society, many researchers suggest that the accessibility and prevalence of mobile phone use will increase patient engagement and help with maintenance of treatment over time. Furthermore, mobile therapy could possibly decrease the cost of traditional face-to-face therapy while still maintaining effectiveness (Crow, Mitchell, Crosby, Swanson, Wonderlich, & Lancaster, 2009). The combination of low cost, ease of use, and accessibility in a society that values the use of instant communication could make mobile-based therapy plausible for a wide range of disorders as well as a broad range of patients.

Based on these possible benefits of mobile-based therapy, the treatment has recently been examined for a variety of mental illnesses, including bipolar disorder (Bauer, Grof, Gyulai, Rasgon, Glenn, & Whybrow, 2004), substance abuse disorders (Riley, Obermayer, & Jean-Mary, 2008; Koski-Jannes, Cunningham, & Tolonen, 2009; Obermayer, Riley, Asif, & Jean-Mary, 2004), and eating disorders (Shapiro et al., 2010; Robinson et al., 2006). Findings from this body of research suggest that people suffering from eating disorders may especially benefit from mobile therapy because these disorders involve specific behaviors (e.g., binging and purging) that must be regularly monitored in terms of both frequency and intensity (Shapiro et al., 2010; Robinson et al., 2006). Also, eating disorders are typically treated with CBT, leaving those suffering from eating disorders vulnerable to the limitations associated with the use of CBT, the same issues that mobile therapy hopes to rectify. Stated simply, the addition of mobile therapy to CBT could better treat patients with eating disorders by encouraging greater involvement in the therapeutic process through the use of practical and engaging mediums.

According to the developing body of research, text messaging as a treatment for eating disorders appears to be a viable treatment method, however more research needs to be conducted (Shapiro et al., 2010; Robinson et al., 2006). Varying results in replications of mobile therapy studies (Robinson et al., 2006) indicate that researchers must learn and adjust the mechanisms involved in treatment to more effectively treat eating disorders. In a study conducted by Robinson et al. (2006), the researchers used texting messaging to treat patients after they completed conventional inpatient treatment for an eating disorder. Over the course of six months, the participants sent weekly text messages to the researchers that answered questions about their symptomology and general mood. Despite the fact that the researchers were replicating a successful German study conducted by Bauer, Percevic, Okon, Merrmann, & Kordy (2003), Robinson et al. (2006) found that the patients were not fully engaged with the use of mobile therapy. Those patients who were not as engaged as expected cited lack of face-to-face interaction as a reason.

Shapiro et al. (2010) conducted a study that included CBT group therapy and tailored text messages with feedback for the patients. Compared to the Robinson et al. (2006), the patients responded significantly better to the mobile therapy treatment method as evident from the high treatment acceptability. Moreover, the patients showed improvement in the realm of depression, eating disorder, and night eating compared to the baseline (Shapiro et al., 2010). The success of this study suggests that when combined with face-to-face therapy and tailored to the individual patient, mobile therapy can be beneficial for the treatment of eating disorders.

Despite promising results, many limit-ations exist with these early empirical efforts, such as attrition and the absence of a comparison group (Shapiro et al., 2010). Leach & Christensen (2006) reviewed the literature of studies on mobile therapy and found that though results support the effectiveness of cell phone-based inter-ventions, these studies were poorly designed: the studies reviewed had small sample sizes, lacked randomized control methods, and rarely conducted intention-to-treat analyses, making the previous conclusions questionable. Therefore, the authors recommend continued investi-gations that include larger samples with better control in order to truly understand the applicability of technology in the therapeutic setting.

Though previous research may lack rigor, the results of the preceding studies still suggest that mobile therapy is a viable treatment, which should be studied in further detail. Based on the previous research, the benefits of mobile therapy lie in its ability to help patients receive more individual attention from his or her therapists (Shapiro et al., 2010) and the prevalence of cell phone usage among society (Parr, 2010). Moreover, these two benefits combine effortlessly considering society’s increasing tendency to communicate via text messaging as opposed to voice conversations (Parr, 2010). The combination of instant communication, availability, and user friendliness indicate that mobile-based interventions could be the future of psychotherapy, k?

References

Bauer, M., Grof, P., Gyulai, L., Rasgon, N., Glenn, T., & Whybrow, P.C. (2004) Using technology to prove longitudinal studies: Self-reporting with Bipolar Disorder. Bipolar Disorders, 6, 67-74.

Bauer, S., Percevic, R., Okon, E., Meermann, R., & Kordy, H. (2003) Use of text messaging in the aftercare of patients with bulimia nervosa. European Eating Disorders Review, 11(3), 279-290.

Bellazzi, R., Arcelloni, M., Ferrari, P., Decata, P., Hernando, M. E., Garcia, A., Gazzaruso, C., Gomez, E. J., Larizza, C., Fratino, P., & Stefanelli, M. (2004). Management of patients with diabetes through information technology: Tools for monitoring and control of patients' metabolic behavior. Diabetes Technology & Therapeutics, 6(5), 567-578.

Boschen, M. J., & Casey, L. M. (2008). The use of mobile telephones as adjuncts to cognitive behavioral  psychotherapy. Professional Psychology: Research and Practice, 39(5), 546-552.

Corey, G. (2009). Theory and practice of counseling and psychotherapy. Belmont, CA: Brooks.

Crow, S. J., Mitchell, J. E., Crosby, R. D., Swanson, S. A., Wonderlich, S., & Lancanster, K.(2009). The cost effectiveness of cognitive behavioral therapy for Bulimia Nervosa delivered via telemedicine versus face- to-face. Behavior Research and Therapy, 47, 451-453.

Forbat, L., Maguire, R., McCann, L., Illingworth, N., & Kearney, N. (2009). The use of technology in cancer  care: Applying Foucault's ideas to the changing dynamics of power in health care. Journal of Advanced Nursing, 65(2), 306-315.

Koski-Jannes, A., Cunninham, J., & Tolonen, K. (2009). Self-assessment of drinking on the internet: 3-, 6-, and 12- month follow-ups. Alcohol & Alcoholism, 44(3), 301-305.

Leach, L.S., & Christensen, H. (2006). A systematic review of telephone-based interventions for mental disorders. Journal of Telemedicine and Telecare, 12(3), 122-129.

Obermayer, J.L., Riley, W.T., Asif, O., & Jean-Mary, J. (2004). College smoking-cessation using cell phone text messaging. Journal of American College Health, 53(3), 71-78. Parr, B. (2010, October 16). The average teenager sends 3,339 texts per month. [Web log message]. Retrieved from http://mashable.com

Riley, W., Obermayer, J., & Jean-Mary, J. (2008). Internet and mobile phone text messaging interventions for college smokers. Journal of American College Health, 57(2), 245-248.

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Shapiro, J. R., Bauer, S., Andrews, E., Pisetsky, E., Bulik- Sullivan, B., Hamer, R. M., & Bulik, C. M.. (2009). Mobile therapy: Use of text- messaging in the treatment of Bulimia Nervosa. International Journal of Eating Disorders, 43(6), 513-519.