Subject:
TECHNOLOGY

Short Description:
Can Instant Messaging Enhance Treatment Outcomes?

Background:
Whether you see your patients quarterly, monthly, or even weekly, you certainly are not with them as much as their cell phones are. Theoretically (at least, for some types of therapy), we could enhance treatment outcomes by texting patients therapeutic messages on a regular basis.

In a systematic review of research involving the use of cell phones and handheld computers for psychiatric interventions, researchers were able to find eight studies conducted over the past 15 or so years that met their methodological criteria. Three of these studies targeted anxiety, while the remaining five targeted smoking cessation.

In the typical cell-phone based interventions, participants were either texted or called in support of their quitting efforts. The phone-based smoking cessation programs were generally successful; however, the most successful of these were also the most interactive. The participants that received eight sessions of CBT over the phone with a real person were five times more likely to achieve smoking abstinence than a “usual care” group (researchers didn’t explain what “usual care” was). While still showing a positive result, a study that examined text message based smoking cessation counseling saw a more modest two to three times greater abstinence rate than the control condition.

The anxiety studies all involved handheld computers that offered learning modules to augment CBT that was performed in the traditional face-to-face manner. Two studies looked at augmentation of CBT for panic disorder with a computer that allowed for self-monitoring of symptoms and additional treatment modules. This intervention was superior to placebo, but CBT alone won out as the best treatment. In the final anxiety trial, people with social anxiety were given 12 weeks of CBT, 12 weeks of CBT plus handheld computer intervention, or waitlist control. The study found no significant differences between the augmentation group and the waitlist control (Ehrenreich B et al, J Nerv Ment Dis 2011;199(11):886–891).

TCPR's Take:
Judging by this study, it looks like computers aren’t going to replace you in treating anxiety. However, suggesting a phone-based intervention to your patients who are trying to quit smoking might be worthwhile. You can learn more about one of the texting interventions studied, STOMP, at http://bit.ly/bbdB3g. Www.smokefree.gov also offers a smoking cessation text messaging program.