Hostname: page-component-89b8bd64d-nlwjb Total loading time: 0 Render date: 2026-05-07T06:41:48.080Z Has data issue: false hasContentIssue false
  • English
  • Français

Tailored Text Message Prompts to Increase Therapy Homework Adherence: A Single-Case Randomised Controlled Study

Published online by Cambridge University Press:  11 April 2019

Sven Alfonsson ,
Joakim Englund  and
Thomas Parling
Sven Alfonsson*
Affiliation:
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
Joakim Englund
Affiliation:
Department of Psychology, Uppsala University, Uppsala, Sweden
Thomas Parling
Affiliation:
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
*
*Corresponding author: Sven Alfonsson, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Norra Stationsgatan 69, SE-113 64 Stockholm, Sweden. E-mail: sven.alfonsson@ki.se
Get access

Abstract

Background: Psychotherapy homework completion is associated with positive treatment outcomes, but many patients show low adherence to prescribed assignments. Whether text-message prompts are effective in increasing adherence to assignments is unknown. Aims: To evaluate whether tailored daily text-message prompts can increase homework adherence in a stress/anxiety treatment. Method: This study used a randomised controlled single-case alternating treatment design with parallel replication in seven participants. Participants received a five-week relaxation program for stress and anxiety with daily exercises. The intervention consisted of daily text messages tailored for each participant. Phases with or without text messages were randomly alternated over the study course. Randomisation tests were used to statistically analyse differences in mean number of completed relaxation exercises between phases. Results: There was a significant (combined p = .018) effect of daily text messages on homework adherence across participants with weak to medium effect size improvements. No negative effects of daily text messages were identified. Conclusions: Tailored text messages can marginally improve adherence to assignments for patients in CBT. Further studies may investigate how text messages can be made relevant for more patients and whether text messages can be used to increase homework quality rather than quantity.

Keywords

homework assignmentstreatment adherencepromptsmobile phonecognitive behaviour therapy

Information

Type
Standard Paper
Information
Behaviour Change , Volume 36 , Issue 3 , September 2019 , pp. 180 - 191
Copyright
Copyright © The Author(s) 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Addis, ME and Jacobson, NS (2000). A closer look at the treatment rationale and homework compliance in cognitive-behavioral therapy for depression. Cognitive Ttherapy and Research, 24, 313–326.Google Scholar
Aguilera, A and Muñoz, RF (2011). Text messaging as an adjunct to CBT in low-income populations: A usability and feasibility pilot study. Professional Psychology: Research and Practice, 42, 472–478.Google Scholar
Agyapong, V, Farren, C and McLoughlin, D (2011). Mobile phone text message interventions in psychiatry-what are the possibilities? Current Psychiatry Reviews, 7, 50–56.Google Scholar
Antony, MM, Bieling, PJ, Cox, BJ, Enns, MW and Swinson, RP (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological Assessment, 10, 176–181.Google Scholar
Attkisson, CC and Greenfield, TK (1999). The UCSF Client Satisfaction Scales: I The Client Satisfaction Questionnaire-8. In Maruish, M (Ed.), The use of psychological testing for treatment planning and outcomes assessment (2nd ed.). Mahwah NJ: Lawrence Erlbaum Associates Publishers.Google Scholar
Attkisson, CC and Zwick, R (1982). The Client Satisfaction Questionnaire: Psychometric properties and correlations with service utilization and psychotherapy outcome. Evaluation and Program Planning, 5, 233–237.Google Scholar
Baker, A and Hambridge, J (2002). Motivational interviewing: Enhancing engagement in treatment for mental health problems. Behaviour Change, 19, 138–145.Google Scholar
Blampied, NM (1999). A legacy neglected: Restating the case for single-case research in cognitive-behaviour therapy. Behaviour Change, 16, 89–104.Google Scholar
Bulté, I and Onghena, P (2008). An R package for single-case randomization tests. Behavior Research Methods, 40, 467–478.Google Scholar
Bulté, I and Onghena, P (2013). The single-case data analysis package: Analysing single-case experiments with R software. Journal of Modern Applied Statistical Methods, 12, 28.Google Scholar
Clough, BA and Casey, LM (2011). Technological adjuncts to increase adherence to therapy: A review. Clinical Psychology Review, 31, 697–710.Google Scholar
Clough, BA and Casey, LM (2015). The smart therapist: A look to the future of smartphones and mHealth technologies in psychotherapy. Professional Psychology: Research and Practice, 46, 147–153.Google Scholar
Cohen, S, Kamarck, T and Mermelstein, R (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385–396.Google Scholar
Cox, DJ, Tisdelle, DA and Culbert, JP (1988). Increasing adherence to behavioral homework assignments. Journal of Behavioral Medicine, 11, 519–522.Google Scholar
Cucciare, DMA and Weingardt, KR (2007). Integrating information technology into the evidence-based practice of psychology. Clinical Psychologist, 11, 61–70.Google Scholar
Edelman, RE and Chambless, DL (1995). Adherence during sessions and homework in cognitive-behavioral group treatment of social phobia. Behaviour Research and Therapy, 33, 573–577.Google Scholar
Edgington, E and Onghena, P (2007). Randomization tests. Boca Ranton FL: CRC Press.Google Scholar
Ferron, J and Ware, W (1995). Analyzing single-case data: The power of randomization tests. The Journal of Experimental Education, 63, 167–178.Google Scholar
Ferron, J and Onghena, P (1996). The power of randomization tests for single-case phase designs. The Journal of Experimental Education, 64, 231–239.Google Scholar
Fjeldsoe, BS, Marshall, AL and Miller, YD (2009). Behavior change interventions delivered by mobile telephone short-message service. American Journal of Preventive Medicine, 36, 165–173.Google Scholar
Fogg, BJ (2009). A behavior model for persuasive design. In Proceedings of the 4th international Conference on Persuasive Technology. doi:10.1145/1541948.1541999.Google Scholar
Furber, G, Jones, GM, Healey, D and Bidargaddi, N (2013). A comparison between phone-based psychotherapy with and without text messaging support in between sessions for crisis patients. Journal of Medical Internet Research, 16, e219–e219.Google Scholar
Guay, F, Vallerand, RJ and Blanchard, C (2000). On the assessment of situational intrinsic and extrinsic motivation: The Situational Motivation Scale (SIMS). Motivation and Emotion, 24, 175–213.Google Scholar
Haardörfer, R and Gagné, P (2010). The use of randomization tests in single-subject research. Focus on Autism and Other Developmental Disabilities, 25, 47–54.Google Scholar
Hayes-Skelton, SA, Roemer, L, Orsillo, SM and Borkovec, TD (2013). A contemporary view of applied relaxation for generalized anxiety disorder. Cognitive Behaviour Therapy, 42, 292–302.Google Scholar
Helbig, S and Fehm, L (2004). Problems with homework in CBT: Rare exception or rather frequent? Behavioural and Cognitive Psychotherapy, 32, 291–301.Google Scholar
Henry, JD and Crawford, JR (2005). The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44, 227–239.Google Scholar
Heyvaert, M and Onghena, P (2014). Randomization tests for single-case experiments: State of the art state of the science and state of the application. Journal of Contextual Behavioral Science, 3, 51–64.Google Scholar
Jacobson, NS and Truax, P (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12–19.Google Scholar
Jones, DJ, Anton, M, Gonzalez, M, Honeycutt, A, Khavjou, O, Forehand, R and Parent, J (2015). Incorporating mobile phone technologies to expand evidence-based care. Cognitive and Behavioral Practice, 22, 281–290.Google Scholar
Kazantzis, N and Lampropoulos, GK (2002). Reflecting on homework in psychotherapy: What can we conclude from research and experience? Journal of Clinical Psychology, 58, 577–585.Google Scholar
Kazantzis, N, Arntz, AR, Borkovec, T, Holmes, EA and Wade, T (2010). Unresolved issues regarding homework assignments in cognitive and behavioural therapies: an expert panel discussion at AACBT Behaviour Change, 27, 119–129.Google Scholar
Kazantzis, N, Whittington, C and Dattilio, F (2010). Meta-analysis of homework effects in cognitive and behavioral therapy: A replication and extension. Clinical Psychology: Science and Practice, 17, 144–156.Google Scholar
Kazantzis, N, Whittington, C, Zelencich, L, Kyrios, M, Norton, PJ and Hofmann, SG (2016). Quantity and quality of homework compliance: A meta-analysis of relations with outcome in cognitive behavior therapy. Behavior Therapy, 47, 755–772.Google Scholar
Kazdin, AE (2011). Single-case research designs: Methods for clinical and applied settings. New York, NY: Oxford University Press.Google Scholar
Kratochwill, TR, Hitchcock, JH, Horner, RH, Levin, JR, Odom, SL, Rindskopf, DM and Shadish, WR (2012). Single-case intervention research design standards. Remedial and Special Education, 34, 26–38.Google Scholar
Kratochwill, TR and Levin, JR (2010). Enhancing the scientific credibility of single-case intervention research: Randomization to the rescue. Psychological Methods, 15, 124–144.Google Scholar
Kroenke, K, Spitzer, RL, Williams, JB and Löwe, B (2010). The patient health questionnaire somatic anxiety and depressive symptom scales: a systematic review. General Hospital Psychiatry, 32, 345–359.Google Scholar
Lee, E-H (2012). Review of the psychometric evidence of the perceived stress scale. Asian Nursing Research, 6, 121–127.Google Scholar
Lindhiem, O, Bennett, CB, Rosen, D and Silk, J (2015). Mobile technology boosts the effectiveness of psychotherapy and behavioral interventions: a meta-analysis. Behavior Modification, 39, 785–804.Google Scholar
Lovibond, PF (1995). Manual for the Depression Anxiety Stress Scales. Sydney, Australia: Sydney Psychology Foundation of Australia.Google Scholar
Lovibond, PF and Lovibond, SH (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33, 335–343.Google Scholar
Löwe, B, Decker, O, Müller, S, Brähler, E, Schellberg, D, Herzog, W and Herzberg, PY (2008). Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Medical Care, 46, 266–274.Google Scholar
Manolov, R and Moeyaert, M (2016). Recommendations for choosing single-case data analytical techniques. Behavior Therapy, 48, 97–114.Google Scholar
Manzoni, GM, Pagnini, F, Castelnuovo, G and Molinari, E (2008). Relaxation training for anxiety: A ten-years systematic review with meta-analysis. BMC Psychiatry, 8, 41.Google Scholar
Markland, D, Ryan, RM, Tobin, VJ and Rollnick, S (2005). Motivational interviewing and self-determination theory. Journal of Social and Clinical Psychology, 24, 811.Google Scholar
Mausbach, BT, Moore, R, Roesch, S, Cardenas, V and Patterson, TL (2010). The relationship between homework compliance and therapy outcomes: An updated meta-analysis. Cognitive therapy and research 34, 429–438.Google Scholar
Michalak, J and Holtforth, MG (2006). Where do we go from here? The goal perspective in psychotherapy. Clinical Psychology: Science and Practice, 13, 346–365.Google Scholar
Nordin, M and Nordin, S (2013). Psychometric evaluation and normative data of the Swedish version of the 10-item perceived stress scale. Scandinavian Journal of Psychology, 54, 502–507.Google Scholar
Onghena, P and Edgington, ES (1994). Randomization tests for restricted alternating treatments designs. Behaviour Research and Therapy, 32, 783–786.Google Scholar
Orr, JA and King, RJ (2015). Mobile phone SMS messages can enhance healthy behaviour: A meta-analysis of randomised controlled trials. Health Psychology Review, 9, 397–416.Google Scholar
Öst, L-G (1987). Applied relaxation: Description of a coping technique and review of controlled studies. Behaviour Research and Therapy, 25, 397–409.Google Scholar
Parker, RI and Vannest, K (2009). An improved effect size for single-case research: Nonoverlap of all pairs. Behavior Therapy, 40, 357–367.Google Scholar
Scheel, MJ, Hanson, WE and Razzhavaikina, TI (2004). The process of recommending homework in psychotherapy: A review of therapist delivery methods client acceptability and factors that affect compliance. Psychotherapy: Theory Research Practice Training, 41, 38–55.Google Scholar
Shapiro, JR, Bauer, S, Andrews, E, Pisetsky, E, Bulik-Sullivan, B, Hamer, RM and Bulik, CM (2010). Mobile therapy: Use of text-messaging in the treatment of bulimia nervosa. International Journal of Eating Disorders, 43, 513–519.Google Scholar
Shingleton, RM, Pratt, EM, Gorman, B, Barlow, DH, Palfai, TP and Thompson-Brenner, H (2016). Motivational text message intervention for eating disorders: A single case alternating treatment design using Ecological Momentary Assessment. Behavior Therapy, 47, 325–338.Google Scholar
Simpson, HB, Marcus, SM, Zuckoff, A, Franklin, M and Foa, EB (2012). Patient adherence to cognitive-behavioral therapy predicts long-term outcome in obsessive-compulsive disorder. The Journal of Clinical Psychiatry, 73, 1265–1266.Google Scholar
Solmi, F and Onghena, P (2014). Combining p-values in replicated single-case experiments with multivariate outcome. Neuropsychological Rehabilitation, 24, 607–633.Google Scholar
Solmi, F, Onghena, P, Salmaso, L and Bulté, I (2014). A permutation solution to test for treatment effects in alternation design single-case experiments. Communications in Statistics-Simulation and Computation, 43, 1094–1111.Google Scholar
Spitzer, RL, Kroenke, K, Williams, JB and Löwe, B (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 1092–1097.Google Scholar
Standage, M, Duda, JL, Treasure, DC and Prusak, KA (2003). Validity reliability and invariance of the Situational Motivation Scale (SIMS) across diverse physical activity contexts. Journal of Sport and Exercise Psychology, 25, 19–43.Google Scholar
ter Kuile, MM, Bulté, I, Weijenborg, P, Beekman, A, Melles, R and Onghena, P (2009). Therapist-aided exposure for women with lifelong vaginismus: A replicated single-case design. Journal of Consulting and Clinical Psychology, 77, 149–159.Google Scholar
Tompkins, MA (2002). Guidelines for enhancing homework compliance. Journal of Clinical Psychology, 58, 565–576.Google Scholar
Supplementary material: File

Alfonsson et al. supplementary material

Alfonsson et al. supplementary material 1

Download Alfonsson et al. supplementary material(File)
File 28.8 KB