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Top1. Introduction
Technology is being increasingly integrated within the treatment of many mental health conditions (Barnett & Scheetz, 2003; Carlbring & Andersson, 2006; Donker et al., 2013). To date, the focus of these technological approaches has primarily been to reduce or even eliminate therapist contact by replicating face-to-face therapy procedures. However, many potential users of these interventions continue to report a preference for face-to-face modalities (Casey, Joy, & Clough, 2013). Additionally, there is considerable scope to improve outcomes within face-to-face treatment (Robinson et al., 2006; Taylor, Walters, Vittengl, Krebaum, & Jarrett, 2010). A range of technological devices may be used as adjuncts to enhance face-to-face psychotherapy practices (Clough & Casey, 2011a, 2011b). In particular, the programmable mobile phone, or “Smartphone”, is one such adjunct that may be able to considerably enhance current face-to-face therapy practices.
Programmable mobile phones, such as Smartphones, offer many advantages to researchers and clinicians. Smartphones often include features such as multimedia input and output capabilities, internet access, camera, global positioning system, voice and video calling, messaging, and ability to handle large quantities of data (Boschen & Casey, 2008; Clough & Casey, in press; Raento, Oulasvirta, & Eagle, 2009). These features make Smartphones a unique technological adjunct, in that the user often has a personal relationship with the device, with such devices playing an important role in the user’s social and interpersonal networks (Matthews, Doherty, Sharry, & Fitzpatrick, 2008; Preziosa, Grassi, Gaggioli, & Riva, 2009). These advantages make the Smartphone a particularly attractive option in facilitating the adoption, maintenance and generalization of various therapeutic behaviours into the client’s everyday life.
Research examining the effectiveness of the Smartphone as an adjunct to traditional therapy services is limited. Despite the large number of therapeutic Smartphone Applications (Apps) available, a recent review identified only five that had been empirically tested (Donker et al., 2013). These Apps targeted depression, anxiety, and substance abuse. The large number of Smartphone Apps commercially available indicates that clearly people do want to use Apps for mental health concerns. However, consumers need to be provided with options for evidence based Apps, which are limited, particularly with regards to those designed for adjunctive use.
Reger and colleagues (2013) describe the development of a therapeutic Smartphone App to be used in conjunction with prolonged exposure therapy. The App was designed to enhance client engagement both during and between therapy sessions. It includes areas to assist in the design of exposure hierarchies, audio record sessions or exposures, record homework adherence and track symptomology. However, this App has yet to be empirically tested for efficacy, usability, or consumer acceptability. Furthermore, exposure is only part of standard treatments for anxiety disorders. An App that includes other components such as psychoeducation, emotion awareness and regulation strategies, symptom monitoring, and motivational exercises would facilitate integration of the App into the client’s entire treatment program.
Smartphone Apps have also been developed to assist in the monitoring of symptoms for clients with psychosis (Palmier-Claus et al., 2013) and as an adjunct to treatment for clients with comorbid Borderline Personality Disorder and Substance Abuse Disorder (Rizvi, Dimeff, Skutch, Carroll, & Linehan, 2011). Rizvi and colleagues (2011) found that their App “DBT Coach” was well received by participants, and was used regularly. Similarly, Palmier-Claus et al (2013) found that over a six day period, client use and acceptability was high for their App designed to increase personal monitoring of symptoms.