Enhancing Delivery of Problem Solving Therapy Using SmartPhone Technology
Condition: Depression; Anxiety
MeSH terms: Depression
Study type: Interventional
Phase: Phase 1/Phase 2

Summary: 
      This project will be the first to evaluate the Moving Forward app in VA. Identifying an
      effective treatment for anxiety and depression in primary care is imperative within Veterans
      Health Administration as they are both common, chronic, and debilitating conditions
      associated with a number of personal and health-related costs. In close partnership with app
      developers at Mental Health Services, a major contribution of this research is the actionable
      feedback on the acceptability, feasibility and effectiveness of augmenting traditional
      Problem Solving Therapy with the Moving Forward app for future app development. If
      effectiveness can be established, Moving Forward has the potential for integration into the
      larger continuum of care for depression and anxiety in Primary Care-Mental Health Integration
      (e.g., care management, co-located collaborative care). Lastly, this pilot project will
      provide preliminary data for future research on SmartPhone technology. Veteran feedback on
      treatment components, ease of executing the study successfully and preliminary effect size
      calculations, will inform the design of the larger project.
    

Detailed description: 
      Access and engagement in evidence-based psychotherapies for Veterans are high priorities for
      the Veterans Health Administration, especially the Office of Rural Health and the office of
      Mental Health Services. SmartPhone applications are an emerging technology with a vast
      potential to extend the reach of traditional in-person psychotherapy by allowing increased
      digital access to providers and self-management tools. Due to the relatively recent
      development of this technology, there are no data on the effectiveness of
      SmartPhone-delivered psychotherapy. Preliminary data on acceptability and satisfaction are
      promising, suggesting a need for further research. The National Center for Posttraumatic
      Stress Disorder in collaboration with the National Center for Telehealth & Technology (T2)
      recently completed the development of an app called Moving Forward, a Veteran-friendly
      adaptation of Problem Solving Therapy, an evidence based therapy available through Primary
      Care Integration Clinics. In partnership with Mental Health Services, this proposed pilot
      project will gather preliminary data on the effectiveness and acceptability of Moving Forward
      and provide timely feedback to the app creators. Participants will include approximately 40
      Veterans diagnosed with an anxiety or mood disorder interested in obtaining mental health
      treatment in Primary Care -Mental Health Integration. Participants will be randomly assigned
      to receive either Problem Solving Therapy augmented by the Moving Forward app or Problem
      Solving Therapy alone. Participants will complete assessments at baseline, 6 weeks and 12
      weeks. Investigators propose 3 specific hypotheses. In hypothesis 1, investigators predict a
      moderate effect size will be observed when comparing homework completion and satisfaction for
      patients randomized to Problem Solving Therapy plus the Moving Forward app compared to
      patients randomized to Problem Solving Therapy alone. In hypothesis 2, investigators predict
      a moderate effect size will be observed when comparing change scores on the problem solving
      style for patients randomized to Problem Solving Therapy plus the Moving Forward app compared
      to patients randomized to Problem Solving Therapy alone. In hypothesis 3, investigators
      predict a moderate effect size will be observed when comparing depression, anxiety, stress
      and quality of life change for patients randomized to Problem Solving Therapy plus the Moving
      Forward app compared to patients randomized to Problem Solving Therapy alone. Key informant
      interviews will provide qualitative feedback on the Moving Forward app which investigators
      will share with our partners at Mental Health Services. The proposed project is important to
      the VA mission to improve access for all Veterans particularly those who face barriers to
      engagement in traditional face-to-face treatment. The proposed research addresses one of
      three primary focus areas of the Office of Research and Development (Access), two of Health
      Services Research &Development's research priorities (Access/Rural Health and Mental Health),
      and three of Secretary Shinseki's Transformational Initiatives for the 21st Century including
      improving: 1) access to care, 2) mental health, and 3) patient-centeredness. This proposed
      work is innovative as it focuses on a rapidly emerging mobile technology that has great
      potential to improve access and engagement in mental health service delivery. To date, there
      have been no randomized effectiveness trials that have examined SmartPhone apps for mental
      health service delivery. The project is also timely as there is a temporary moratorium
      (imposed by the Office of Information Technology) on app dissemination within Veterans Health
      Administration, presenting an opportunity to study Moving Forward prior to its release. At
      the completion of this project, investigators expect that the work proposed in this study
      will highlight the clinical value of the Moving Forward app, which will inform both VA policy
      makers and the scientific community at large about the utility of SmartPhone technology in
      mental health care delivery. Investigators also expect that this study will provide our
      partners at Mental Health Services with helpful feedback on the Moving Forward app design and
      future app development.
    

Intervention name(s): Problem Solving Therapy plus Moving Forward; Problem Solving Therapy
Intervention type(s): Other; Other
Intervention description(s): All Veterans will receive a standard 6-session administration of Problem Solving Therapy (Nezu & D'Zurilla, 1999). Session 1 will take place in-person during a scheduled appointment and will last for 1 hour. Subsequent sessions will take place over the telephone and will last for approximately 30 minutes. Participants in this arm will also receive the Moving Forward app for SmartPhones, which was adapted from Problem Solving Therapy to be used either as a standalone treatment or as an adjunct to other related therapies such as in-person Problem Solving Therapy or the Moving Forward website. The phone content matches Problem Solving Therapy. Benefits of the app include 24-hours accessibility of psychoeducational materials and worksheets.; All Veterans will receive a standard 6-session administration of Problem Solving Therapy (Nezu & D'Zurilla, 1999). Session 1 will take place in-person during a scheduled appointment and will last for 1 hour. Subsequent sessions will take place over the telephone and will last for approximately 30 minutes.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Veterans; Health Services; Mental Health; Technology; Primary Health Care; Psychotherapy