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

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