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British Journal of Psychology; Preventing relapse with personalized smart‐messaging after cognitive behavioural therapy: A proof‐of‐concept evaluation

posted 11 Jun 2020, 04:42 by Hollie O'Connell







11 June 2020 



We are delighted to share a recent British Journal of Psychology publication “Preventing relapse with personalized smart‐messaging after cognitive behavioural therapy: A proof‐of‐concept evaluation”.  The study independently evaluates the application of Florence’s smart-messaging techniques to reduce relapse from Cognitive behavioural therapy (CBT) and compliments the recent publication from the Clinical Psychology Cancer Service Team at Sherwood Forest Hospital Foundation Trust, around their proof of concept evaluation of using Flo to support cancer patients undertaking mindfulness-based CBT in the open-access Psycho-Oncology journal.

The publication reports outcomes from two focussed studies
  • STUDY 1: Clinical Outcomes of Smart-Messaging Users Versus Non-Users Following Remotely Delivered CBT for Health Anxiety
  • STUDY 2: Feasibility of Smart-Messaging Users in Routine Care (see here)


CBT can improve symptoms of anxiety and depression, but importantly also reduces the risk of future relapse after therapy completion.  However, current CBT relapse prevention methods are resource‐intensive and can be limited in clinical practice.  Studies suggest that acquiring CBT‐related coping skills is an important component of any relapse prevention.  However, 30–50% of patients attending CBT for anxiety and depressive disorders still relapse within the first year after treatment, with greater relapse rates found in clinical practice than controlled research conditions (Delgadillo et al., 2018; Hollon et al., 2005).  Existing CBT interventions to specifically prevent relapse are time and resource intensive with mitigation typically involving additional therapy sessions focused on developing relapse prevention plans, identifying potential triggers for relapse, and learning coping strategies to manage such eventualities (Bockting et al., 2005).
  
Digital health interventions have previously been harnessed to increase the reach and accessibility of relapse prevention interventions in several recent trials, however meta‐analyses of digital relapse prevention interventions suggest that the benefits are moderated by the degree of personalisation included (Hennemann et al., 2018).  In addition, minimal, but personalised, relapse prevention methods that include an individual plan are preferred if regular contact with a mental health professional is not an option (Muntingh et al., 2019). 
 
From this evidence, the team identified that Florence's unique persona-based, pragmatic and innovative mix of messaging technology and psychology was an opportunity to extend the impact of therapy sessions across both cohorts.  The team also recognised that it was critical for Florence’s interactions to be personalised, and subsequently worked with participants within their final two therapy sessions to co-design Florence’s interactions around the advice that they would want to receive once face-to-face therapy had ended if in future they were either doing well, experiencing early warning signs of relapse, or experiencing full relapse including patterns of thought, behaviour, and characteristic emotional responses. 
For 25 weeks post-therapy, participants were supported by weekly interactions with Florence, being able to rate their well‐being and dependent upon their response, receiving the tailored advice they had written, appropriate to the well‐being level reported after recovery from health anxiety. 

Outcomes collected by independent researchers demonstrated that:
  • Across a 12‐month follow‐up, participants receiving smart‐messaging showed greater health improvements than those who did not.  Well‐being scores showed stability between CBT completion and 6‐month follow‐up among routine care patients.
  • The findings suggest that a low‐intensity, personalised relapse prevention method can have a clinical benefit following CBT for common mental health problems.
  • In clinical practice, post‐treatment smart‐messaging can be well used by patients and may help maintain stable well‐being in the 6 months after CBT ends.
  • The evidence supports the clinical utility of a brief tailored digital intervention, which can be integrated within routine clinical practice with minimal therapist input.
  • Overall, longer‐term post‐CBT outcomes may be improved by integrating a smart‐messaging intervention at the end of therapy.
  • The study offers initial evidence that post‐treatment smart‐messaging may support greater outcome improvement over a 12‐month follow‐up period and is worthy of formal evaluation in a randomised controlled trial, due to its potential as a cost-effective and accessible means of enhancing CBT outcomes.
The full journal article is open-access and available here, or if you would like to learn more about the pathway and the team’s journey, please don't hesitate to get in touch via our contact us form.