(PS8-D79) Delivering Measurement-based Care and Personalized Psychotherapy for Adults with Emotional Disorders Using Technology: A Feasibility Trial Protocol

Introduction: Anxiety and depressive disorders, commonly known as emotional disorders (EDs), are the most frequent mental health problems globally. Fortunately, extensions and innovations of cognitive behavioral therapy (CBT), such as the emergence of transdiagnostic interventions and novel forms of delivery (internet-based CBT, iCBT), have been developed in an attempt to facilitate the dissemination of psychotherapy for EDs. However, research has shown that around 40% of patients do not respond to the interventions as expected (i.e., not-on-track patients). A possible explanation may lie in the morphology of internet-based treatments, which are characterized by having pre-established modules that patients must complete in a linear manner, clearly ignoring patient needs and evolution during treatment. Ecological momentary assessments (EMAs) and ecological momentary interventions (EMIs) could facilitate tailoring treatments to patient progress during psychotherapy (i.e., Measurement-Based Care, MBC). 

Objectives: This study aims to explore the feasibility of an app-based system called Mi EMI, Bienestar Emocional [My EMI, Emotional Well-being] that will provide personalized EMIs according to patients’ evolution observed with EMAs. This EMA+EMI system will complement a self-applied online transdiagnostic treatment that has been already tested in people with EDs (Unified Protocol, UP). The current study describes the study protocol for this trial. Method and analysis: A single-group, open trial design will be implemented. Participants will be 30 adults suffering from EDs. EMAs will be sent to the patients on a daily basis during ten days before the beginning of the treatment (baseline or A phase) and during the whole duration of the intervention (2 months). The content included in the app will allow the daily monitoring of both outcome variables (i.e., anxiety, sadness, happiness, activity level, positive and negative affect) and mechanisms of therapeutic change (i.e., mediators, namely mindfulness, cognitive flexibility, countering emotional behaviors, tolerance to unpleasant physical sensations, and situational exposures). According to the results of the EMAs, EMIs will offer supportive digital content (images, infographics, videos) in a first stage, and short phone calls or episodic videocalls if the detected problem persists. Data on the feasibility, usability, satisfaction, adherence, compliance, retention rates, and acceptability of this new EMA+EMI procedure will be recorded at the end of the study. Ethics and dissemination:  The Ethics Committee of the Jaume I University approved the study and all its procedures (CD/111/2021) in December 2021.

Discussion: Identifying accessible and scalable interventions that can be carried out in adverse conditions (for example, during the current COVID-19 crisis) is paramount to reduce the psychological distress of the population. Feasibility data of this self-applied online transdiagnostic intervention supported by EMA and EMI will be important to explore whether this modern approach is a real option to move forward personalized psychological interventions for persons with EDs.