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Ly, Kien Hoa
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Ly, K. H., Ly, A.-M. & Andersson, G. (2017). A fully automated conversational agent for promoting mental well-being: A pilot RCT using mixed methods. Internet Interventions, 10, 39-46
Open this publication in new window or tab >>A fully automated conversational agent for promoting mental well-being: A pilot RCT using mixed methods
2017 (English)In: Internet Interventions, ISSN 2214-7829, Vol. 10, p. 39-46Article in journal (Refereed) Published
Abstract [en]

Fully automated self-help interventions can serve as highly cost-effective mental health promotion tools for massive amounts of people. However, these interventions are often characterised by poor adherence. One way to address this problem is to mimic therapy support by a conversational agent. The objectives of this study were to assess the effectiveness and adherence of a smartphone app, delivering strategies used in positive psychology and CBT interventions via an automated chatbot (Shim) for a non-clinical population — as well as to explore participants views and experiences of interacting with this chatbot. A total of 28 participants were randomized to either receive the chatbot intervention (n = 14) or to a wait-list control group (n = 14). Findings revealed that participants who adhered to the intervention (n = 13) showed significant interaction effects of group and time on psychological well-being (FS) and perceived stress (PSS-10) compared to the wait-list control group, with small to large between effect sizes (Cohens d range 0.14–1.06). Also, the participants showed high engagement during the 2-week long intervention, with an average open app ratio of 17.71 times for the whole period. This is higher compared to other studies on fully automated interventions claiming to be highly engaging, such as Woebot and the Panoply app. The qualitative data revealed sub-themes which, to our knowledge, have not been found previously, such as the moderating format of the chatbot. The results of this study, in particular the good adherence rate, validated the usefulness of replicating this study in the future with a larger sample size and an active control group. This is important, as the search for fully automated, yet highly engaging and effective digital self-help interventions for promoting mental health is crucial for the public health. © 2017 The Authors

Place, publisher, year, edition, pages
Elsevier, 2017
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-146974 (URN)10.1016/j.invent.2017.10.002 (DOI)2-s2.0-85032031216 (Scopus ID)
Available from: 2018-04-09 Created: 2018-04-09 Last updated: 2018-04-09
Areàn, P. A., Ly, K. H. & Andersson, G. (2016). Mobile technology for mental health assessment.. Dialogues in Clinical Neuroscience, 18(2), 163-169
Open this publication in new window or tab >>Mobile technology for mental health assessment.
2016 (English)In: Dialogues in Clinical Neuroscience, ISSN 1294-8322, E-ISSN 1958-5969, Vol. 18, no 2, p. 163-169Article in journal (Refereed) Published
Abstract [en]

Assessment and outcome monitoring are critical for the effective detection and treatment of mental illness. Traditional methods of capturing social, functional, and behavioral data are limited to the information that patients report back to their health care provider at selected points in time. As a result, these data are not accurate accounts of day-to-day functioning, as they are often influenced by biases in self-report. Mobile technology (mobile applications on smartphones, activity bracelets) has the potential to overcome such problems with traditional assessment and provide information about patient symptoms, behavior, and functioning in real time. Although the use of sensors and apps are widespread, several questions remain in the field regarding the reliability of off-the-shelf apps and sensors, use of these tools by consumers, and provider use of these data in clinical decision-making.

Place, publisher, year, edition, pages
Neuilly sur Seine, France: Les Laboratoires Servier, 2016
Keywords
mobile assessment; ecological monetary measurement; sensor; mental health technology
National Category
Psychology
Identifiers
urn:nbn:se:liu:diva-130820 (URN)000390192700006 ()27489456 (PubMedID)
Available from: 2016-08-26 Created: 2016-08-26 Last updated: 2017-11-28Bibliographically approved
Ly, K. H., Janni, E., Wrede, R., Sedem, M., Donker, T., Carlbring, P. & Andersson, G. (2015). Experiences of a guided smartphone-based behavioral activation therapy for depression: A qualitative study. Internet Interventions, 2(1), 60-68
Open this publication in new window or tab >>Experiences of a guided smartphone-based behavioral activation therapy for depression: A qualitative study
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2015 (English)In: Internet Interventions, ISSN 2214-7829, Vol. 2, no 1, p. 60-68Article in journal (Refereed) Published
Abstract [en]

Recently, a number of studies have investigated treatments administered via smartphones showing that this treatment format has a potential to be effective. However, we still have limited knowledge of how patients experience this treatment format. The objective of this study was to explore participants' views of a smartphone-based behavioral activation treatment. In-depth interviews were conducted with 12 strategically (participants with different overall experiences) selected participants, suffering from major depression according to the DSM-IV. The interview data were processed with the aid of thematic analysis. The analysis generated the three main themes: Commitment, Treatment and Lack of important components, with attached subthemes. In conclusion, the findings from the current study correspond with existing knowledge in the field of internet-based treatment. Considering that this kind of treatment is still quite new, the need for further research and development is considerable. Nevertheless, its availability, assimilation into users' everyday lives and possible motivational qualities speak of its potential.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
Smartphone treatment, Depression, Behavioral activation, Mobile application
National Category
Psychology Interaction Technologies
Identifiers
urn:nbn:se:liu:diva-113993 (URN)10.1016/j.invent.2014.12.002 (DOI)
Available from: 2015-02-05 Created: 2015-02-05 Last updated: 2017-12-05Bibliographically approved
Ly, K. H., Topooco, N., Cederlund, H., Wallin, A., Bergström, J., Molander, O., . . . Andersson, G. (2015). Smartphone-supported versus full behavioural activation for depression: a randomised controlled trial. PLoS ONE, 10(5), Article ID e0126559.
Open this publication in new window or tab >>Smartphone-supported versus full behavioural activation for depression: a randomised controlled trial
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2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 5, article id e0126559Article in journal (Refereed) Published
Abstract [en]

Background

There is need for more cost and time effective treatments for depression. This is the first randomised controlled trial in which a blended treatment - including four face-to-face sessions and a smartphone application - was compared against a full behavioural treatment. Hence, the aim of the current paper was to examine whether a blended smartphone treatment was non-inferior to a full behavioural activation treatment for depression.

Methods

This was a randomised controlled non-inferiority trial (NCT01819025) comparing a blended treatment (n=46) against a full ten-session treatment (n=47) for people suffering from major depression. Primary outcome measure was the BDI-II, that was administered at pre- and post-treatment, as well as six months after the treatment.

Results

Results showed significant improvements in both groups across time on the primary outcome measures (within-group Cohen’s d=1.35; CI [−0.82, 3.52] to d=1.58; CI [0.51, 2.65]; between group d=−0.13 CI [−2.37, 2.09] to d=0.05 CI [−1.18, 1.27]). At the same time, the blended treatment reduced the therapist time with an average of 47%.

Conclusions

We could not establish whether the blended treatment was non-inferior to a full BA treatment. Nevertheless, this study points to that the blended treatment approach could possibly treat nearly twice as many patients suffering from depression by using a smartphone applica¬tion as add-on. More studies are needed before we can suggest that the blended treatment method is a promising cost-effective alternative to regular face-to-face treatment for depression.

Place, publisher, year, edition, pages
Public Library of Science, 2015
Keywords
Behavioural activation, major depression, smartphone application, mobile app, blended treatment
National Category
Psychology Interaction Technologies
Identifiers
urn:nbn:se:liu:diva-113994 (URN)10.1371/journal.pone.0126559 (DOI)000355183900033 ()26010890 (PubMedID)
Funder
Swedish Research Council, 2011-2476EU, FP7, Seventh Framework Programme, ICT4Depression Consortium
Available from: 2015-02-05 Created: 2015-02-05 Last updated: 2018-12-12Bibliographically approved
Ly, K. H. (2015). Use of a Smartphone Application in the Treatment of Depression: The New Wave of Digital Tools in Psychological Treatment. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Use of a Smartphone Application in the Treatment of Depression: The New Wave of Digital Tools in Psychological Treatment
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Internet-delivered programs based on cognitive behavior therapy (CBT) have during the past decade shown to work in an effective way for the treatment of depression. Due to its accessibility and independence of time and location, smartphone-based CBT might represent the next generation of digital interventions. Depression is an affective disorder that affects as many as 350 million people worldwide. However, with CBT, depression can be treated, but access to this treatment is scarce due to limited health care resources and trained therapists. As a result of this, health care could highly benefit from the use of smartphones for delivering cost-effective treatment that can be made available to a large part of the population who suffer from depression. One treatment that should be especially suitable for the smartphone format is behavioral activation (BA), since it has strong empirical support as well as the benefits of being flexible and rather simple.

The overall aim of the thesis was to test and further develop a BA smartphone application, as well as to build a method for how this smartphone application could be used in a comprehensive and effective way in depression treatment. To fulfill this aim, four studies were conducted. The results showed that smartphones have the ability to be used in an effective way in the treatment of depression, including as an add-on to traditional face-to-face sessions. The results also showed that the smartphone format was experienced as a portable and flexible way of accessing the treatment – and thus could be more present in everyday life.

In conclusion, there is reason to believe that smartphones will be integrated even further in society and therefore may serve an important role in future mental health care. Since the first indications reveal that depression can be treated by means of a supported smartphone application, it is highly possible that applications for other mental health problems will follow. Furthermore, in this thesis, the same smartphone application has been tested in three different ways and there is potential to apply smartphones in a range of other formats, such as in relapse prevention and as a way to intensify treatment during periods when needed. From a psychiatric research point of view, as my research group has been doing trials on guided internet treatment for more than 15 years, it is now time to move to the next generation of information technology – smartphones.

Abstract [sv]

Internetbaserad kognitiv beteendeterapi (KBT) har under det senaste decenniet visat sig fungera effektivt i behandling av depression. På grund av dess tillgänglighet och flexibilitet i tid och plats har smartphonebaserad KBT potential att bli nästa generation av digitala behandlingar. Depression är en affektiv sjukdom som drabbar så många som 350 miljoner människor världen över. Med hjälp av KBT kan depression behandlas. Dock är tillgången till denna behandling knapp på grund av begränsade resurser i form av utbildade terapeuter. Därmed skulle sjukvården kunna dra stor nytta av användningen av smartphones för att leverera kostnadseffektiv behandling, som kan göras tillgänglig för människor som lider av depression. En behandling som kan vara särskilt lämplig för smartphone-formatet är beteendeaktivering (BA), eftersom den har starkt empiriskt stöd samtidigt som den är flexibel och relativt enkel. Det övergripande syftet med avhandlingen var att testa och vidareutveckla en smartphone-applikation baserad på BA, samt att bygga en behandlingsmetod för denna smartphone-applikation som skulle kunna användas för att effektivt behandla depression. För att uppnå detta syfte genomfördes fyra studier. Resultaten visade att smartphones kan användas på ett effektivt sätt i behandling av depression, bland annat som komplement till traditionella live-sessioner. Resultaten visade också initiala indikationer på att smartphoneformatet upplevdes som ett portabelt och flexibelt sätt att komma åt behandlingen - och därmed blev mer närvarande i vardagen.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. p. 103
Series
Linköping Studies in Arts and Sciences, ISSN 0282-9800 ; 640Linköping Studies in Behavioural Science, ISSN 1654-2029 ; 188
Keywords
Behavioral activation, depression, smartphone, application, mobile app, internetadministered, digitally administered, blended treatment, Beteendeaktivering, depression, smartphone, applikation, mobilapp, internetadministrerad, digital behandling, blandform
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-113996 (URN)10.3384/diss.diva-113996 (DOI)978-91-7519-136-2 (ISBN)
Public defence
2015-03-06, VAL, Hus Vallfarten, Campus Valla, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2015-02-05 Created: 2015-02-05 Last updated: 2019-10-29Bibliographically approved
Ly, K. H., Trüschel, A., Jarl, L., Magnusson, S., Windahl, T., Johansson, R., . . . Andersson, G. (2014). Behavioural activation versus mindfulness-based guided self-help treatment administered through a smartphone application: a randomised controlled trial. BMJ Open, 4(1), e003440
Open this publication in new window or tab >>Behavioural activation versus mindfulness-based guided self-help treatment administered through a smartphone application: a randomised controlled trial
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2014 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 4, no 1, p. e003440-Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Evaluating and comparing the effectiveness of two smartphone-delivered treatments: one based on behavioural activation (BA) and other on mindfulness.

DESIGN: Parallel randomised controlled, open, trial. Participants were allocated using an online randomisation tool, handled by an independent person who was separate from the staff conducting the study.

SETTING: General community, with recruitment nationally through mass media and advertisements.

PARTICIPANTS: 40 participants diagnosed with major depressive disorder received a BA treatment, and 41 participants received a mindfulness treatment. 9 participants were lost at the post-treatment.

INTERVENTION BA: An 8-week long behaviour programme administered via a smartphone application. Mindfulness: An 8-week long mindfulness programme, administered via a smartphone application.

MAIN OUTCOME MEASURES: The Beck Depression Inventory-II (BDI-II) and the nine-item Patient Health Questionnaire Depression Scale (PHQ-9).

RESULTS: 81 participants were randomised (mean age 36.0 years (SD=10.8)) and analysed. Results showed no significant interaction effects of group and time on any of the outcome measures either from pretreatment to post-treatment or from pretreatment to the 6-month follow-up. Subgroup analyses showed that the BA treatment was more effective than the mindfulness treatment among participants with higher initial severity of depression from pretreatment to the 6-month follow-up (PHQ-9: F (1, 362.1)=5.2, p<0.05). In contrast, the mindfulness treatment worked better than the BA treatment among participants with lower initial severity from pretreatment to the 6-month follow-up (PHQ-9: F (1, 69.3)=7.7, p<0.01); BDI-II: (F(1, 53.60)=6.25, p<0.05).

CONCLUSIONS: The two interventions did not differ significantly from one another. For participants with higher severity of depression, the treatment based on BA was superior to the treatment based on mindfulness. For participants with lower initial severity, the treatment based on mindfulness worked significantly better than the treatment based on BA.

TRIAL REGISTRATION: Clinical Trials NCT01463020.

Place, publisher, year, edition, pages
BMJ Publishing Group, 2014
Keywords
Behavioral Activation, Depression, Mindfulness, Smartphone Application
National Category
Psychology
Identifiers
urn:nbn:se:liu:diva-104626 (URN)10.1136/bmjopen-2013-003440 (DOI)000334311200010 ()24413342 (PubMedID)
Available from: 2014-02-19 Created: 2014-02-19 Last updated: 2017-12-06Bibliographically approved
Ly, K. H., Asplund, K. & Andersson, G. (2014). Stress management for middle managers via an acceptance and commitment-based smartphone application: A randomized controlled trial. Internet Interventions, 1(3), 95-101
Open this publication in new window or tab >>Stress management for middle managers via an acceptance and commitment-based smartphone application: A randomized controlled trial
2014 (English)In: Internet Interventions, ISSN 2214-7829, Vol. 1, no 3, p. 95-101Article in journal (Refereed) Published
Abstract [en]

Stress is a major health problem in today's workplace. Recent studies suggest that acceptance and commitment therapy (ACT) is effective for reducing stress at work, specifically among managers. Moreover, smartphone-delivered treatments have been developed and increasingly used in research. The objective of our study was to evaluate the efficacy of an ACT-based smartphone treatment among middle managers at medium- and large-sized companies (> 50 employees) in Sweden. A total of 73 participants were randomized to either receive the six-week stress intervention (n = 36) or to a waitlist control group (n = 37). Results showed small to moderate within-group effect sizes (Cohen's d range 0.37–0.62) for the treatment group, and small to moderate between group effects (Cohen's d range 0.41–0.50). In conclusion, the study indicates that a smartphone administered stress intervention based on ACT can reduce perceived stress and increase general health among Swedish middle managers in the private sector.

Place, publisher, year, edition, pages
Elsevier, 2014
Keywords
Stress management, Acceptance and commitment therapy, Leadership, Middle managers, Smartphone, Application
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-142214 (URN)10.1016/j.invent.2014.06.003 (DOI)2-s2.0-84950306644 (Scopus ID)
Available from: 2017-10-23 Created: 2017-10-23 Last updated: 2017-11-02Bibliographically approved
Lindner, P., Ivanova, E., Hoa Ly, K., Andersson, G. & Carlbring, P. (2013). Guided and unguided CBT for social anxiety disorder and/or panic disorder via the Internet and a smartphone application: study protocol for a randomised controlled trial. Trials, 14(437)
Open this publication in new window or tab >>Guided and unguided CBT for social anxiety disorder and/or panic disorder via the Internet and a smartphone application: study protocol for a randomised controlled trial
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2013 (English)In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 14, no 437Article in journal (Refereed) Published
Abstract [en]

Background: Smartphone technology presents a novel and promising opportunity to extend the reach of psychotherapeutic interventions by moving selected parts of the therapy into the real-life situations causing distress. This randomised controlled trial will investigate the effects of a transdiagnostic, Internet-administered cognitive behavioural (iCBT) self-help program for anxiety, supplemented with a smartphone application. The effect of added therapist support will also be studied. Methods/Design: One hundred and fifty participants meeting diagnostic criteria for social anxiety disorder and/or panic disorder will be evenly randomised to either one of three study groups: 1, smartphone-supplemented iCBT with therapist support; 2, smartphone-supplemented iCBT without therapist support; or 3, an active waiting list control group with delayed treatment. Primary outcome measure will be the Generalised Anxiety Disorder 7-item self-rating scale. Secondary measures include other anxiety, depression and quality of life measures. In addition to pre- and post-treatment measurements, the study includes two mid-treatment (days 24 and 48) and two follow-up assessments (12 and 36 months) to assess rapid and long-term effects. Discussion: To our knowledge, this is the first study to investigate the effectiveness of smartphone-supplemented iCBT for anxiety disorders. Hence, the findings from this trial will constitute great advancements in the burgeoning and promising field of smartphone-administered psychological interventions. Limitations are discussed.

Place, publisher, year, edition, pages
BioMed Central, 2013
Keywords
Smartphone; Application; App; Cognitive behavioural; Internet-administered; Anxiety; Randomised controlled trial
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-103874 (URN)10.1186/1745-6215-14-437 (DOI)000329515300002 ()
Available from: 2014-01-31 Created: 2014-01-30 Last updated: 2017-12-06
Ly, K. H., Carlbring, P. & Andersson, G. (2012). Behavioral activation-based guided self-help treatment administered through a smartphone application: study protocol for a randomized controlled trial. Trials, 13(62)
Open this publication in new window or tab >>Behavioral activation-based guided self-help treatment administered through a smartphone application: study protocol for a randomized controlled trial
2012 (English)In: Trials, ISSN 1745-6215, Vol. 13, no 62Article in journal (Refereed) Published
Abstract [en]

Background: The need for cost-effective interventions for people suffering from major depressive disorders is essential. Behavioral activation is an intervention that can largely benefit from the use of new mobile technologies (for example smartphones). Therefore, developing smartphone-based behavioral activation interventions might be a way to develop cost-effective treatments for people suffering from major depressive disorders. The aim of this study will be to test the effects of a smartphone-delivered behavioral activation treatment. less thanbrgreater than less thanbrgreater thanMethods: The study will be a randomized controlled trial with a sample size of 120 participants, with 60 patients in each group. The treatment group includes an 8-week smartphone-based behavioral activation intervention, with minimal therapist contact. The smartphone-based intervention consists of a web-based psychoeducation, and a smartphone application. There is also a back-end system where the therapist can see reports from the patients or activities being reported. In the attention control group, we will include brief online education and then recommend use of a smartphone application that is not directly aimed at depression (for example, Effective meditation). The duration of the control condition will also be 8 weeks. For ethical reasons we will give the participants in the control group access to the behavioral activation treatment following the 8-week treatment period. less thanbrgreater than less thanbrgreater thanDiscussions: We believe that this trial has at least three important implications. First, we believe that smartphones can be integrated even further into society and therefore may serve an important role in health care. Second, while behavioral activation is a psychological treatment approach for which there is empirical support, the use of a smartphone application could serve as the therapists prolonged arm into the daily life of the patient. Third, as we have been doing trials on guided Internet treatment for more than 10 years it is now time to move to the next generation of information technology - smartphones - which are not only relevant for Swedish conditions but also for developing countries in the world which are increasingly empowered by mobile phones with Internet connection.

Place, publisher, year, edition, pages
BioMed Central, 2012
Keywords
Depression, Behavioral activation, Smartphone application, Cost-effectiveness, Randomized, Controlled trial
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-81224 (URN)10.1186/1745-6215-13-62 (DOI)000307297200001 ()
Note

Funding Agencies|Swedish Research Council||

Available from: 2012-09-10 Created: 2012-09-10 Last updated: 2014-11-28
Ly, K. H., Dahl, J., Carlbring, P. & Andersson, G. (2012). Development and initial evaluation of a smartphone application based on acceptance and commitment therapy. SpringerPlus, 1(11)
Open this publication in new window or tab >>Development and initial evaluation of a smartphone application based on acceptance and commitment therapy
2012 (English)In: SpringerPlus, ISSN 2193-1801, Vol. 1, no 11Article in journal (Refereed) Published
Abstract [en]

Background

An intervention, consisting of an ACT-based smartphone-application and a web-based         psychoeducation, has been developed. The smartphone-application, together with the         psychoeducation, aims to function as a self-help intervention for living consistently         with one's values. The study is an exploratory investigation of this new smartphone-based         tool.     

Case description

Primarily, the study aims at investigating a new field, providing a basis for generating         hypotheses for further research. The first aim of this initial, exploratory study         was to examine if this intervention had an effect on the variables of: valued actions,         psychological flexibility, and life satisfaction as well as the states of depression,         anxiety and stress, for a non-clinical sample of 11 Swedish Iphone users. This was         made with a quasi-experimental pretest-posttest design without control group. The         second aim was to investigate how the participants experienced the intervention, as         measured by a qualitative questionnaire.     

Discussion and evaluation

The group analyses showed that the participants increased their valued action and         psychological flexibility significantly during the intervention. Furthermore, value-based         actions and psychological flexibility showed small effect sizes when comparing pretest         and posttest score. However, the design of the study makes it impossible to draw any         certain conclusions. The qualitative questionnaire showed a general positive experience         of the intervention.     

Conclusions

The results from the present study indicated that the intervention should be studied         further. The findings also generated a number of hypotheses that could be investigated         in further research.

Place, publisher, year, edition, pages
Springer, 2012
National Category
Psychology
Identifiers
urn:nbn:se:liu:diva-84450 (URN)10.1186/2193-1801-1-11 (DOI)000209459000011 ()
Funder
Swedish Research Council
Available from: 2012-10-08 Created: 2012-10-08 Last updated: 2018-03-09
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