An Ecological Momentary Intervention Study of Emotional Responses to Smartphone-Prompted CBT Skills Practice and the Relationship to Clinical Outcomes. Issue 2 (March 2022)

• Record Type: Journal Article
• Authors: Bernstein, Emily E.; Bentley, Kate H.; Nock, Matthew K.; Stein, Michelle B; Beck, Stuart; Kleiman, Evan M.
• Is Part Of: Behavior therapy. Volume 53:Issue 2(2022)
• Page Start: 267
• Page End: 280
• Publication Date: 2022-03
• Subjects: cognitive behavioral therapy -- skills -- ecological momentary assessment -- ecological momentary intervention -- mHealth; Behavior therapy -- Periodicals; 616.8914205
• DOI: 10.1016/j.beth.2021.09.001
• Languages: English
• ISSNs: 0005-7894

Abstract

Highlights: Independent practice of cognitive behavioral therapy skills improves outcomes. Patients reported modest reductions in negative affect after skills practice. Immediate reductions were largely unrelated to clinical outcomes. Outcomes were predicted by skills-related improvements in affect after a delay. Abstract: The practice of therapeutic skills outside of sessions in which they are learned is one presumed key component of cognitive behavioral therapy (CBT). Yet, our understanding of how skills practice relates to clinical outcomes remains limited. Here, we explored patients' emotional responses to CBT skills practice in a pilot study pairing smartphone-app-delivered skills reminders and guided practice (ecological momentary intervention [EMI]) using ecological momentary assessment (EMA). Participants ( n = 25) were adults recently hospitalized for a suicide attempt or severe suicidal thinking. They received brief inpatient CBT (1 to 3 sessions covering core CBT skills from the Unified Protocol), followed by 1 month of EMI and EMA after discharge. On average, participants reported modest reductions in negative affect after skills use (i.e., immediate responses; median time elapsed = 4.30 minutes). Additionally, participants tended to report less negative affect when the timepoint preceding the current assessment included EMI skills practice, rather than EMA alone (i.e., delayed responses; median time elapsed between prompts = 2.17 hours). Immediate effects were unrelated to longer-term clinical outcomes, whereas greater delayed effects were associated with lower symptom severity at follow-up. Future studies should further examine how CBT skills use in daily life may alleviate symptoms.