Symposia
Technology
Emily E. Bernstein, Ph.D.
Clinical Psychologist
Massachusetts General Hospital, Harvard Medical School
Somerville, Massachusetts
Hilary Weingarden, Ph.D.
Psychologist/Assistant Professor
Massachusetts General Hospital
Boston, Massachusetts
Emma C. Wolfe, PhD
Clinical Research Coordinator
Massachusetts General Hospital
Somerville, Massachusetts
Margaret D. Hall, PhD
Clinical Research Coordinator
Massachusetts General Hospital
Boston, Massachusetts
Ivar Snorrason, PhD
Psychologist/Instructor
Massachusetts General Hospital / Harvard Medical School
Boston, MA
Sabine Wilhelm, Ph.D.
Professor, Chief of Psychology
Harvard Medical School
Boston, MA
Background: Experts in digital mental health regularly espouse that human support may be critical for increasing engagement and effectiveness of app-based therapies. Yet, we have little systematic knowledge about the topic. It is critical to address these open questions in order to design and optimize these interventions. Indeed, the cost and limited resources of clinicians and even lay-person coaches can dramatically impact scalability. The purpose of the present study was to provide a scoping review of the use of human support or coaching in cognitive behavioral therapy-based apps for emotional concerns or disorders, identify critical knowledge gaps, and offer recommendations for future research.
Methods: We conducted systematic searches of three databases (PubMed, PsycINFO, and Embase). Broadly, eligible manuscripts described an app based at least in part in cognitive behavioral therapy whose primary target was an emotional disorder or problem and which included some level of human involvement or support (“coaching”). All records were reviewed by two authors. Information regarding (a) the qualifications and training of coaches, (b) stated purpose and content of the coaching, (c) method and frequency of communication with users, and (d) relationship between coaching and outcomes was recorded.
Results: Of the 2,940 titles returned by the searches, 64 manuscripts were eligible for inclusion. This review found significant heterogeneity across all of the dimensions of coaching considered as well as considerable missing information in the published manuscripts. Moreover, few studies had qualitatively or quantitatively evaluated how level of coaching impacts treatment engagement or outcomes. Although users tend to self-report that coaching improves their engagement and outcomes, there is limited and mixed supporting quantitative evidence at present.
Conclusions: Digital mental health is a young but rapidly expanding field with great potential to improve the reach of evidence-based care. With the relative infancy of these treatment approaches, however, this review found that the field has yet to develop standards or consensus for implementing coaching protocols, let alone measuring and reporting on the impact. We conclude that coaching remains a significant hole in the growing digital mental health literature and lay out specific recommendations for future data collection, standards of reporting, methods of experimentation, and targets for analysis.