The challenger app for social anxiety disorder: New advances in mobile psychological treatment

Internet Interventions

Volumn 2, Issue 4, 2015, Pages 382-391

  Miloff, Alexander ^a   Marklund, Arvid ^a   Carlbring, Per ^a  

^a STOCKHOLM UNIVERSITY   (Sweden)

Author keywords

Cognitive behavioral therapy; Internet; Mental health; Mobile applications; Smartphones; Social anxiety disorder

Indexed keywords

ACCURACY; ACTIVITY TRACKING; COMMUNITY; DEPRESSION; GAME; HEALTH PRACTITIONER; HUMAN; INFORMATION PROCESSING; INSTALLATION; META ANALYSIS (TOPIC); MOBILE APPLICATION; PSYCHIATRIC TREATMENT; PSYCHOEDUCATION; QUALITY OF LIFE; REVIEW; SCORING SYSTEM; SELF CONCEPT; SENSITIVITY AND SPECIFICITY; SLEEP DISORDER; SOCIAL PHOBIA; SYSTEMATIC REVIEW (TOPIC); TECHNOLOGY; THEORY;

EID: 84944719934     PISSN: 22147829     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.invent.2015.08.001     Document Type: Review

References (91)

1. Abramowitz J.S., et al. Self-help cognitive-behavioral therapy with minimal therapist contact for social phobia: a controlled trial. J. Behav. Ther. Exp. Psychiatry 2009, 40(1):98-105. 10.1016/j.jbtep.2008.04.004.
2. Aguilera A., Muench F. There's an app for that: information technology applications for cognitive behavioral practitioners. Behav. Ther. 2012, 29(4):997-1003.
3. Aguilera A., Muñoz R.F. Text messaging as an adjunct to CBT in low-income populations: a usability and feasibility pilot study. Prof. Psychol. Res. Pract. 2011, 42(6):472.
4. Andersson G., et al. Development of a new approach to guided self-help via the Internet: the Swedish experience. J. Technol. Hum. Serv. 2008, 26(2-4):161-181.
5. Andersson G., et al. Guided internet-based CBT for common mental disorders. J. Contemp. Psychother. 2013, 43:223-233.
6. Andersson G., et al. Internet-based vs. face-to-face cognitive behaviour therapy for psychiatric and somatic disorders: a systematic review and meta-analysis. World Psychiatry 2014, 1-23. (October).
7. Apple Inc. ResearchKit [Online] Available at:, (Accessed: 11th March 2015). http://www.apple.com/researchkit/.
8. Bellack A.S., et al. The development of a computer-based cognitive remediation program for schizophrenia. Isr. J. Psychiatry Relat. Sci. 2005, 42(1):5-14.
9. Bennett K., Bennett A.J., Griffiths K.M. Security Considerations for E-Mental Health Interventions. J. Med. Internet Res. 2010, 12(5):e61. 10.2196/jmir.1468.
10. Oxford Guide to Behavioural Experiments in Cognitive Therapy 2004, Oxford University Press. J. Bennett-Levy, G. Butler, M. Fennell, A. Hackmann, M. Mueller, D. Westbrook (Eds.).
11. Berger T., Hohl E., Caspar F. Internet-based treatment for social phobia: a randomized controlled trial. J. Clin. Psychol. 2009, 65(10):1021-1035.
12. Boettcher J., et al. Internet-based interventions for social anxiety disorder - an overview. Verhaltenstherapie 2013, 23:160-168. (August).
13. Boettcher J., et al. Internet-based mindfulness treatment for anxiety disorders: a randomised controlled trial. Behav. Ther. 2014, 45:241-253.
14. Boettcher J., Rozental A., Andersson G., Carlbring P. Side effects in Internet-based interventions for Social Anxiety Disorder. Internet Interv. 2014, 1(1):3-11. 10.1016/j.invent.2014.02.002.
15. Bruch M.A., Fallon M., Heimberg R.G. Social phobia and difficulties in occupational adjustment. J. Couns. Psychol. 2003, 50(1):109-117.
16. Carlbring P., et al. Individually-tailored, Internet-based treatment for anxiety disorders: A randomized controlled trial. Behav. Res. Ther. 2011, 49(1):18-24.
17. Carsten P. 'China has more people going online with a mobile device than a PC', Reuters 21 July Available from:, (5 June 2015). http://in.reuters.com.
18. Chen F., et al. My smartphone knows i am hungry. Proceedings of the 2014 Workshop on Physical Analytics - WPA'14 2014, 9-14. (Available at: http://dl.acm.org/citation.cfm?doid=2611264.2611270).
19. Choi I., et al. Culturally attuned internet treatment for depression amongst Chinese Australians: a randomised controlled trial. J. Affect. Disord. 2012, 136(3):459-468. 10.1016/j.jad.2011.11.003.
20. Christensen H., et al. A Comparison of Changes in Anxiety and Depression Symptoms of Spontaneous Users and Trial Participants of a Cognitive Behavior Therapy Website. J. Med. Internet Res. 2004, 6(4):e46. 10.2196/jmir.6.4.e46.
21. Danaher B.G., Brendryen H., Seeley J.R., Tyler M.S., Woolley T. From black box to toolbox: outlining device functionality, engagement activities, and the pervasive information architecture of mHealth interventions. Internet Interv. 2015, 2(1):91-101.
22. Dattilio F.M., Kazantzis N., Shinkfield G., Carr A.G. A survey of homework use, experience of barriers to homework, and attitudes about the barriers to homework among couples and family therapists. J. Marital. Fam. Ther. 2011, 37(2):121-136.
23. Deterding S., et al. From game design elements to gamefulness. Proceedings of the 15th International Academic MindTrek Conference on Envisioning Future Media Environments - MindTrek'11 2011, 9-11. (Available at: http://dl.acm.org/citation.cfm?doid=2181037.2181040). 10.1145/2181037.2181040.
24. Difede J., et al. Virtual reality exposure therapy for the treatment of posttraumatic stress disorder following September 11, 2001. J. Clin. Psychiatry 2007, 68:1639-1647. (November, Available at: http://www.ncbi.nlm.nih.gov/pubmed/18052556).
25. Donker T., et al. Smartphones for smarter delivery of mental health programs: a systematic review. J. Med. Internet Res. 2013, 15(11):e247. 10.2196/jmir.2791.
26. Erwin B.A., et al. The internet: home to a severe population of individuals with social anxiety disorder?. J. Anxiety Disord. 2004, 18:629-646.
27. Eysenbach G. The law of attrition. J. Med. Internet Res 2005, 7(1):e11. 10.2196/jmir.7.1.e11.
28. Eysenbach G., et al. Health related virtual communities and electronic support groups: systematic review of the effects of online peer to peer interactions. BMJ 2004, 328:1-6. (May).
29. Fehm L., et al. Size and burden of social phobia in Europe. Eur. Neuropsychopharmacol. 2005, 15:453-462.
30. Fernández-Aranda F., et al. Video games as a complementary therapy tool in mental disorders: PlayMancer, a European multicentre study. J. Ment. Health 2012, 21:364-374. (August).
31. Free C., et al. The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review. PLoS Med. 2013, 10(1).
32. Furmark T., et al. Guided and unguided self-help for social anxiety disorder: randomised controlled trial. Br. J. Psychiatry 2009, 195(5):440-447.
33. Geraghty A.W.A., Wood A.M., Hyland M.E. Attrition from self-directed interventions: investigating the relationship between psychological predictors, intervention content and dropout from a body dissatisfaction intervention. Soc. Sci. Med. 2010, 71(1):30-37. 10.1016/j.socscimed.2010.03.007.
34. Giota K.G., Kleftaras G. Mental health apps: innovations, risks and ethical considerations. E-Health Telecommun. Syst. Netw. 2014, 3:19-23.
35. Goh D.H., Ang R.P., Tan H.C. Strategies for designing effective psychotherapeutic gaming interventions for children and adolescents. Comput. Hum. Behav. 2008, 24:2217-2235.
36. Goldin P.R., Gross J.J. Effects of mindfulness-based stress reduction (MBSR) on emotion regulation in social anxiety disorder. Emotion 2010, 10(1):83.
37. Gollwitzer P.M., Muskowitz G.B. Goal Effects. Social Psychology: Handbook of Basic Principles 1996, 361-399. E.T. Higgins, Kruglanski (Eds.).
38. Harris S.R., Kemmerling R.L., North M.M. Brief virtual reality therapy for public speaking anxiety. Cyberpsychol. Behav. 2002, 5(6):543-550.
39. Haug T., et al. Self-help treatment of anxiety disorders: a meta-analysis and meta-regression of effects and potential moderators. Clin. Psychol. Rev. 2012, 32(5):425-445. 10.1016/j.cpr.2012.04.002.
40. Heimberg R.G. Cognitive-behavioral therapy for social anxiety disorder: Current status and future directions. Biol. Psychiatry 2002, 51:101-108. (Gabbard 1992).
41. Helgadottir F.D., et al. Online CBT I: bridging the gap between Eliza and modern online CBT treatment packages. Behav. Chang. 2009, 26(2009):245-253.
42. Hofmann S.G. Cognitive factors that maintain social anxiety disorder: a comprehensive model and its treatment implications. Cogn. Behav. Ther. 2007, 36(4):193-209.
43. Horne-Moyer H.L., et al. The use of electronic games in therapy: a review with clinical implications. Curr. Psychiatry Rep. 2014, 16. (Available at: http://link.springer.com/10.1007/s11920-014-0520-6).
44. Karyotaki E., et al. Predictors of treatment dropout in self-guided web-based interventions for depression: an 'individual patient data' meta-analysis. Psychol. Med. 2015, 1-10.
45. Kazantzis N., Lampropoulos G.K. Reflecting on homework in psychotherapy: what can we conclude from research and experience?. J. Clin. Psychol. 2002, 58(5):577-585.
46. Kessler R.C., et al. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int. J. Methods Psychiatr. Res. 2012, 21(3):169-184.
47. Kocovski N.L., Fleming J.E., Hawley L.L., Huta V., Antony M.M. Mindfulness and acceptance-based group therapy versus traditional cognitive behavioral group therapy for social anxiety disorder: a randomized controlled trial. Behav. Res. Ther. 2013, 51(12):889-898.
48. Koestner R., et al. Attaining personal goals: self-concordance plus implementation intentions equals success. J. Pers. Soc. Psychol. 2002, 83(1):231-244.
49. Kolb D.A., Boyatzis R.E. Goal-setting and self-directed behavior change. Hum. Relat. 1970, 23(5):439-457.
50. Kolb D.A., Winter S., Berlew D. Self-directed change: two studies. J. Appl. Behav. Sci. 1968, 4:453-473.
51. Koszycki D., Benger M., Shlik J., Bradwejn J. Randomized trial of a meditation based stress reduction program and cognitive behavior therapy in generalized social anxiety disorder. Behav. Res. Ther. 2007, 45(10):2518-2526.
52. Levy H.C., Radomsky A.S. Safety behaviour enhances the acceptability of exposure. Cogn. Behav. Ther. 2014, 43(1):83-92.
53. Lewis C., Pearce J., Bisson J.I. Efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders: systematic review. Br. J. Psychiatry 2012, 200:15-21.
54. Ljótsson B., et al. Internet-delivered acceptance and values-based exposure treatment for fibromyalgia: a pilot study. Cogn. Behav. Ther. 2013, 43(2):93-104.
55. Lyons E.J., et al. Behavior change techniques implemented in electronic lifestyle activity monitors: a systematic content analysis. J. Med. Internet Res. 2014, 16(8):e192. 10.2196/jmir.3469.
56. Marks I. Self-administered behavioural treatment. Behav. Psychother. 1991, 19:42.
57. Mausbach B.T., Moore R., Roesch S., Cardenas V., Patterson T.L. The relationship between homework compliance and therapy outcomes: an updated meta analysis. Cogn. Ther. Res. 2010, 34(5):429-438.
58. Mayo-Wilson E., et al. Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. Lancet Psychiatry 2014, 1(5):368-376. 10.1016/S2215-0366(14)70329-3.
59. McMillan D., Lee R. A systematic review of behavioral experiments vs. exposure alone in the treatment of anxiety disorders: a case of exposure while wearing the emperor's new clothes?. Clin. Psychol. Rev. 2010, 30(5):467-478.
60. Merry S.N., et al. The effectiveness of SPARX, a computerised self help intervention for adolescents seeking help for depression: randomised controlled non-inferiority trial. BMJ 2012, 344:e2598. (April).
61. Michalak J., Klappheck M.A., Kosfelder J. Personal goals of psychotherapy patients: the intensity and the "why" of goal-motivated behavior and their implications for the therapeutic process. Psychother. Res. 2004, 14:193-209. (February 2015).
62. Moëll B., Kollberg L., Nasri B., Lindefors N., Kaldo V. Living SMART-a randomized controlled trial of a guided online course teaching adults with ADHD or sub clinical ADHD to use smartphones to structure their everyday life. Internet Interv. 2015, 2(1):24-31.
63. Mohr D.C., et al. Behavioral intervention technologies: evidence review and recommendations for future research in mental health. Gen. Hosp. Psychiatry 2013, 35(4):332-338. 10.1016/j.genhosppsych.2013.03.008.
64. Musiat P., Tarrier N. Collateral outcomes in e-mental health: A systematic review of the evidence for added benefits of computerized cognitive behavior therapy interventions for mental health. Psychol. Med. 2014, 3137-3150. (Available at: http://www.ncbi.nlm.nih.gov/pubmed/25065947).
65. Newman M.G., et al. A review of technology-assisted self-help and minimal contact therapies for drug and alcohol abuse and smoking addiction: is human contact necessary for therapeutic efficacy?. Clin. Psychol. Rev. 2011, 31(1):178-186. 10.1016/j.cpr.2010.09.008.
66. Nicholas J., et al. The ins and outs of an online bipolar education program: a study of program attrition. J. Med. Internet Res. 2010, 12(5):e57. 10.2196/jmir.1450.
67. Nicholson S. A user-centered theoretical framework for meaningful gamification a brief introduction to gamification organismic integration theory situational relevance and situated motivational affordance. Games Learn. Soc. 2012, 80.
68. Nordin S., Carlbring P., Cuijpers P., Andersson G. Expanding the limits of bibliotherapy for panic disorder: randomized trial of self-help without support but with a clear deadline. Behav. Ther. 2010, 41(3):267-276.
69. Olthuis J., et al. Therapist-delivered distance cognitive behavioural therapy for anxiety disorders in adults. Cochrane Libr. Cochrane D 2015, (3). (Available at: http://onlinelibrary.wiley.com). 10.1002/14651858.CD009028/full.
70. Patel A., Knapp M., Henderson J., Baldwin D. The economic consequences of social phobia. J. Affect. Disord. 2002, 68(2):221-233.
71. Palmqvist B., Carlbring P., Andersson G. Internet-delivered treatments with or without therapist input: does the therapist factor have implications for efficacy and cost?. Expert Rev. Pharmacoecon. Outcomes Res. 2007, 7(3):291-297.
72. Piano Stairs (video file), Available at:, (Accessed: 9th March 2015). http://www.thefuntheory.com.
73. Pijnenborg G.H.M., et al. The efficacy of SMS text messages to compensate for the effects of cognitive impairments in schizophrenia. Br. J. Clin. Psychol./Br. Psychol. Soc. 2010, 49:259-274.
74. Powell A.C., Landman A.B., Bates D.W. In search of a few good apps. J. Am. Med. Assoc. 2014, 311(18).
75. Prensky M. Computer games and learning: digital-based games. Handbook of Computer Game Studies 2005, 97-124. (Available at: http://admin.futurelab.org.uk/resources/documents/discussion_papers/Computer_Games_and_Learning_discpaper.pdf).
76. Price M., et al. mHealth: a mechanism to deliver more accessible more effective mental health care. Clin. Psychol. Psychother. 2014, 21:427-436. 10.1002/cpp.1855.
77. Proudfoot J.G., et al. Community attitudes to the appropriation of mobile phones for monitoring and managing depression, anxiety, and stress. J. Med. Internet Res. 2010, 12(5):e64. 10.2196/jmir.1475.
78. Rozental A., et al. Consensus statement on defining and measuring negative effects of Internet interventions. Internet Interv. 2014, 1(1):12-19. 10.1016/j.invent.2014.02.001.
79. Saeb S., et al. Mobile phone sensor correlates of depressive symptom severity in daily life behavior: an exploratory study. J. Med. Internet Res. 2015, 17(7):e175. 10.2196/jmir.4273.
80. Somers J.M., et al. Prevalence and incidence studies of anxiety disorders: a systematic review of the literature. Can. J. Psychiatr. 2006, 51(2):100-113.
81. Stein M.B.K. Disability and quality of life in social phobia. Am. J. Psychiatr. 2000, 1606. (October).
82. Thorén E., Svensson M., Törnqvist A., Carlbring P., Lunner T. Rehabilitative online education versus internet discussion group for hearing aid users: a randomized controlled trial. J. Am. Acad. Audiol. 2011, 22(5):274-285.
83. Tillfors M., Furmark T., Carlbring P., Andersson G. Risk profiles for poor treatment response to internet-delivered CBT in people with social anxiety disorder. J. Anxiety Disord. 2015, (in press).
84. Torous J., Powell A.C. Current research and trends in the use of smartphone applications for mood disorders. Internet Interv. 2015, 2(2015):169-173.
85. Torous J., et al. Patient smartphone ownership and interest in mobile apps to monitor symptoms of mental health conditions: a survey in four geographically distinct psychiatric clinics. J. Med. Internet Res. Ment. Health 2014, 1(1):e5. 10.2196/mental.4004.
86. Tran K., et al. Medical students and personal smartphones in the clinical environment: the impact on confidentiality of personal health information and professionalism. J. Med. Internet Res. 2014, 16(5):e132. 10.2196/jmir.3138.
87. Vlaescu G., Carlbring P., Lunner T., Andersson G. An e-platform for rehabilitation of persons with hearing problems. Am. J. Audiol. 2015, 10.1044/2015_AJA-14-0083.
88. Wang P.S., et al. Failure and delay in initial treatment contact after first onset of mental disorders in the national comorbidity survey replication. Arch. Gen. Psychiatry 2005, 62:603-613. (June 2005).
89. Wang R., et al. StudentLife: assessing behavioral trends, mental well-being and academic performance of college students using smartphones. UbiComp'14, September 13-17, 2014, Seattle, WA, USA 2014, 10.1145/2632048.2632054.
90. West J.H., et al. There's an app for that: content analysis of paid health and fitness apps. J. Med. Internet Res. 2012, 14(3):e72. 10.2196/jmir.1977.
91. Wollburg E., Braukhaus C. Goal setting in psychotherapy: the relevance of approach and avoidance goals for treatment outcome. Psychother. Res. 2010, 20:488-494. (February 2015).