Strengthening the Impact of Digital Cognitive Behavioral Interventions through a Dual Intervention: Motivational Interviewing Coaching Protocol Plus In-Application Techniques (Preprint)

BACKGROUND The COVID-19 pandemic has accelerated the adoption of digital tools to support individuals struggling with their mental health. The use of a digital intervention plus human coaching (“dual” intervention) is gaining momentum to increase overall engagement in digital cognitive behavioral interventions (dCBIs). However, there is limited insight about the methodologies and coaching models used by those deploying dual interventions. To achieve a deeper understanding, we need to identify and promote effective engagement that leads to clinical outcomes, versus simply monitoring engagement metrics. Motivational Interviewing (MI) is a collaborative, goal-oriented communication approach with particular attention to the language of change and an effective engagement approach for helping people manage mental health issues. However, this approach has been traditionally used in in-person or telephonic interventions and less is known about the application of MI to digital interventions. OBJECTIVE We sought to provide a dual intervention approach and address multiple factors across two levels to operationalize a dCBI that combined: (1) Cognitive behavioral therapy (CBT)-based techniques; and (2) MI-based interactions between the digital health coach (DHC) and user. METHODS We reviewed hundreds of digital exchanges between DHCs and users to identify and improve training and quality assurance activities for digital interventions. RESULTS We tested five hypotheses and found that: (1) users of a dual digital behavioral health intervention had greater engagement levels than users of a non-coached intervention (p<0.0001); (2) DHCs with a demonstrated competency in applying MI to digital messages had more engaged users, as measured by DHC-to-user message exchange ratio (p<0.001); (3) DHC-to-user message exchange ratio was correlated with more engagement in app activities (r = 0.28 (95% CI [0.23,0.33])); (4) DHCs with demonstrated MI proficiency elicited greater amount of “change talk” from users than did DHCs without MI proficiency (H = 25.12, p<0.0001); and (5) users who were engaged by DHCs with MI proficiency had better clinical outcomes compared to users engaged by DHCs without MI proficiency (p= 0.0151). CONCLUSIONS This data indicates potential and need for further research in establishing coaching models in dCBIs that incorporate MI to promote effective engagement and optimize positive behavioral outcomes.

Medication adherence in cardiovascular medicine

Cardiovascular disease is the leading cause of death globally. While pharmacological advancements have improved the morbidity and mortality associated with cardiovascular disease, non-adherence to prescribed treatment remains a significant barrier to improved patient outcomes. A variety of strategies to improve medication adherence have been tested in clinical trials, and include the following categories: improving patient education, implementing medication reminders, testing cognitive behavioral interventions, reducing medication costs, utilizing healthcare team members, and streamlining medication dosing regimens. In this review, we describe specific trials within each of these categories and highlight the impact of each on medication adherence. We also examine ongoing trials and future lines of inquiry for improving medication adherence in patients with cardiovascular diseases.

Evaluation of the Effect of Cognitive Behavioral Interventions on the Emotional Reactions of Parents of Children with Retinoblastoma

Background: Retinoblastoma is the most common primary intraocular malignancy in childhood. Diagnosis of the disease and treatment decisions put a lot of stress on the family. Excessive anxiety and stress can lead to serious psychological problems. The cognitive behavioral approach focuses on the individuals’ thoughts, behaviors, and emotions and their interaction. This study aimed to investigate the effect of cognitive behavioral interactions on the emotional reactions of parents of children with retinoblastoma. Methods: This study was carried out using a quasi-experimental design on 106 parents of children with retinoblastoma referred to the Farabi Eye Hospital, Tehran, Iran, between 2017 and 2018. Cognitive behavioral therapy was performed through eight sessions of 90-minute training for parents. The data collection method was self-responding using the depression, anxiety, and stress scale-21 Items (DASS-21) questionnaire. Pre-and post-intervention test scores were collected for statistical analysis. Results: The mean anxiety score decreased from 13.65 (moderate anxiety) before the cognitive-behavioral intervention to 10.13 (mild anxiety) after the intervention (p<0.05). The mean depression score decreased from 11.26 (mild depression) before the intervention to 8.32 (no depression) after the intervention (p<0.05). The mean stress score decreased from 10.79 (normal) before the intervention to8.25 (normal) after the intervention (p<0.05). Conclusion: Our study showed that the occurrence of retinoblastoma in children poses a significant risk to the mental health of their parents. Cognitive-behavioral interventions can be effective in improving the level of parent's anxiety, depression, and stress.

A scoping review of insomnia treatments for people living with HIV

To date, little is known in terms of viable treatments for insomnia in people living with HIV. The primary aim of this scoping review is to identify non-pharmacological treatments for insomnia in people living with HIV (PLWH). A framework by Arksey and O’Malley was used to guide the conduct of this scoping review. Seven studies were identified. Three of the studies used cognitive-behavioral type of treatments versus physical or alternative types of treatment. The most effective treatments with the largest effect sizes were found to be cognitive-behavioral treatments for the sleep outcomes of sleep quantity (1.11-1.91) and sleep quality (1.11-1.91). This review found that cognitive behavioral interventions were found to be the most effective treatments for insomnia for PLWH. Further research would benefit from larger sample size studies in addition to focusing on the determinants of insomnia in PLWH in order to further provide a treatment that is focused on the needs of PLWH.