mHealth helps patients stick with the program

Online programs providing cognitive behaviour therapy (CBT) to people with mild depression and anxiety are proven to work, but the new myCompass site launched by the federal Minister for Mental Health this week has a big point of difference – it's mobile.

Developed by researchers at the Black Dog Institute and the University of NSW and funded by the federal government, myCompass is a web-based program offering a range of modules to help people with moderate stress, anxiety and depression to identify triggers for their conditions and clinically validated methods to overcome them.

However, two of the main problems with online programs – or face-to-face therapy for that matter – is motivating people to stick with the program and recording moods and triggers in real time.

The myCompass program aims to overcome those barriers by using that most ubiquitous of devices, the mobile phone. According to one of the program's developers, the Black Dog Institute’s Judy Proudfoot, myCompass is one of the few in the world that is using mobile phones to provide real-time monitoring for people undertaking web-based CBT.

“Mobile interventions are just starting to take off internationally, so we were at the forefront,” Associate Professor Proudfoot said. “I think our program is one of the few in the world, if not the first in the world, that is for adults with depression, anxiety or stress. myCompass is a self-help program and can also be used by GPs with their patients. It has the dual functionality.”

myCompass has two “active ingredients” that together improve outcomes for people using the program. The first is a series of web-based modules, which use a variety of evidence-based therapies in addition to CBT, and the second is the real-time monitoring element utilising mobile phones or other hand-held devices.

“The cognitive behaviour therapy modules are accessed via computers and that's only because mobile screens are a bit small to be doing interactive, tailored programs with lots of graphics,” A/Prof Proudfoot said.

“But the monitoring is on the mobile, so that means it's ideal for people on the go. They can use the program when they are at the bus stop, in their lunch hour and so on. The system reminds them to do their monitoring, and whenever they monitor they are asked situational questions to help them find triggers to their moods and behaviours and also look for patterns in their responses.”

The ratings and situational information can then be displayed as a graph to show users when, where and how their moods and behaviours change. A/Prof Proudfoot said that by understanding these triggers, the cognitive behaviour techniques can then be used to manage those moods and behaviours.

In addition to the key targets of stress, anxiety and depression, the monitoring function can also be used to track lifestyle factors such as healthy eating and exercise behaviours, as well as sleep patterns, concentration and worrying.

“They can choose what they want to monitor, or if they like, the myCompass system offers a profiling tool that helps people choose the areas that would be most helpful for them to work on,” she said.

While it is a self-help program, A/Prof Proudfoot said she would encourage users to involve their GPs, and for GPs to encourage their patients to try the system.

“The patient can take their monitoring graph back to their GP and discuss it with them. It gives a very clear picture of what's happening, and with the additional situational information, it provides helpful information for the GP to use with their patient.

“And then of course the GP can say you are having trouble with your sleep or you're having trouble with depression, why don't you do the depression modules in myCompass. Each of the modules is very short. They are only three sessions in length and each session takes about 10 minutes, with tasks to do between sessions.”

She said the real-time element also overcomes a long-standing issue of people not filling in their diaries or monitoring forms properly. “For maximum benefit, people need to monitor in real-time because retrospective monitoring, where the patient may sit in the waiting room filling in their week's worth of monitoring forms before they see you, is notoriously inaccurate."

A/Prof Proudfoot pointed to a 2002 research study into patient non-compliance with paper diaries, published in the British Medical Journal, in which the researchers gave patients three weeks' worth of monitoring forms with instructions to monitor at set times of the day.

“But what they didn't tell them was that embedded in the cover of the monitoring folder was a little microchip which recorded every time they opened the folder,” she said.

“They asked the participants how often they monitored at the designated times and they reported it was about 90 per cent. The microchip showed it was 11 per cent and that retrospective recording was common, which of course called into question the validity of the monitoring. None of us can remember how we were a week ago, so monitoring in real time is much more accurate.”

The BMJ article also showed that compliance when using a hand-held was over 90 per cent.

To help overcome the problem of users not keeping up with their monitoring or sticking with the program, the system uses a series of motivational messages that can be emailed or SMSed to the users. “They can choose when they want to receive them and of course we have reminders as well. They are set up as a default, so if people don't want to receive the reminders, they can turn them off, but we know they help to get the most from myCompass.

“The myCompass program is not a quick fix and people need to stick with it for about seven weeks to receive benefit. We've just finished a clinical trial showing very strong outcomes over seven weeks. We recommend that people monitor their mood or behaviours two or three times a day, every day, and complete at least three of the CBT modules in a seven-week period.”

Posted in Australian eHealth

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