scholarly journals A Personalized, Interactive, Cognitive Behavioral Therapy–Based Digital Therapeutic (MODIA) for Adjunctive Treatment of Opioid Use Disorder: Development Study

10.2196/31173 ◽  
2021 ◽  
Vol 8 (10) ◽  
pp. e31173
Author(s):  
Björn Meyer ◽  
Geri-Lynn Utter ◽  
Catherine Hillman
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
The United States ◽  
Opioid Use Disorder ◽  
Text Messages ◽  
Cognitive Behavioral ◽  
Evidence Based ◽  
Negative Consequences ◽  
Opioid Use ◽  
Economic Implications

Background Opioid use disorder (OUD) is characterized by the inability to control opioid use despite attempts to stop use and negative consequences to oneself and others. The burden of opioid misuse and OUD is a national crisis in the United States with substantial public health, social, and economic implications. Although medication-assisted treatment (MAT) has demonstrated efficacy in the management of OUD, access to effective counseling and psychosocial support is a limiting factor and a significant problem for many patients and physicians. Digital therapeutics are an innovative class of interventions that help prevent, manage, or treat diseases by delivering therapy using software programs. These applications can circumvent barriers to uptake, improve treatment adherence, and enable broad delivery of evidence-based management strategies to meet service gaps. However, few digital therapeutics specifically targeting OUD are available, and additional options are needed. Objective To this end, we describe the development of the novel digital therapeutic MODIA. Methods MODIA was developed by an international, multidisciplinary team that aims to provide effective, accessible, and sustainable management for patients with OUD. Although MODIA is aligned with principles of cognitive behavioral therapy, it was not designed to present any 1 specific treatment and uses a broad range of evidence-based behavior change techniques drawn from cognitive behavioral therapy, mindfulness, acceptance and commitment therapy, and motivational interviewing. Results MODIA uses proprietary software that dynamically tailors content to the users’ responses. The MODIA program comprises 24 modules or “chats” that patients are instructed to work through independently. Patient responses dictate subsequent content, creating a “simulated dialogue” experience between the patient and program. MODIA also includes brief motivational text messages that are sent regularly to prompt patients to use the program and help them transfer therapeutic techniques into their daily routines. Thus, MODIA offers individuals with OUD a custom-tailored, interactive digital psychotherapy intervention that maximizes the personal relevance and emotional impact of the interaction. Conclusions As part of a clinician-supervised MAT program, MODIA will allow more patients to begin psychotherapy concurrently with opioid maintenance treatment. We expect access to MODIA will improve the OUD management experience and provide sustainable positive outcomes for patients.

scholarly journals A Personalized, Interactive, Cognitive Behavioral Therapy–Based Digital Therapeutic (MODIA) for Adjunctive Treatment of Opioid Use Disorder: Development Study (Preprint)

2021 ◽  
Author(s):  
Björn Meyer ◽  
Geri-Lynn Utter ◽  
Catherine Hillman
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
The United States ◽  
Opioid Use Disorder ◽  
Text Messages ◽  
Cognitive Behavioral ◽  
Evidence Based ◽  
Negative Consequences ◽  
Opioid Use ◽  
Economic Implications

BACKGROUND Opioid use disorder (OUD) is characterized by the inability to control opioid use despite attempts to stop use and negative consequences to oneself and others. The burden of opioid misuse and OUD is a national crisis in the United States with substantial public health, social, and economic implications. Although medication-assisted treatment (MAT) has demonstrated efficacy in the management of OUD, access to effective counseling and psychosocial support is a limiting factor and a significant problem for many patients and physicians. Digital therapeutics are an innovative class of interventions that help prevent, manage, or treat diseases by delivering therapy using software programs. These applications can circumvent barriers to uptake, improve treatment adherence, and enable broad delivery of evidence-based management strategies to meet service gaps. However, few digital therapeutics specifically targeting OUD are available, and additional options are needed. OBJECTIVE To this end, we describe the development of the novel digital therapeutic MODIA. METHODS MODIA was developed by an international, multidisciplinary team that aims to provide effective, accessible, and sustainable management for patients with OUD. Although MODIA is aligned with principles of cognitive behavioral therapy, it was not designed to present any 1 specific treatment and uses a broad range of evidence-based behavior change techniques drawn from cognitive behavioral therapy, mindfulness, acceptance and commitment therapy, and motivational interviewing. RESULTS MODIA uses proprietary software that dynamically tailors content to the users’ responses. The MODIA program comprises 24 modules or “chats” that patients are instructed to work through independently. Patient responses dictate subsequent content, creating a “simulated dialogue” experience between the patient and program. MODIA also includes brief motivational text messages that are sent regularly to prompt patients to use the program and help them transfer therapeutic techniques into their daily routines. Thus, MODIA offers individuals with OUD a custom-tailored, interactive digital psychotherapy intervention that maximizes the personal relevance and emotional impact of the interaction. CONCLUSIONS As part of a clinician-supervised MAT program, MODIA will allow more patients to begin psychotherapy concurrently with opioid maintenance treatment. We expect access to MODIA will improve the OUD management experience and provide sustainable positive outcomes for patients.

scholarly journals An evaluation of the feasibility, acceptability, and preliminary efficacy of cognitive-behavioral therapy for opioid use disorder and chronic pain

2019 ◽  
Vol 194 ◽  
pp. 460-467 ◽  
Author(s):  
Declan T. Barry ◽  
Mark Beitel ◽  
Christopher J. Cutter ◽  
David A. Fiellin ◽  
Robert D. Kerns ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Opioid Use Disorder ◽  
Cognitive Behavioral ◽  
Opioid Use

Feasibility and Acceptability of reSET-O®: Patient and Provider Reported Experiences in a Pilot Study of a Novel Digital Therapeutic in People with Opioid Use Disorder (Preprint)

2021 ◽  
Author(s):  
Sarah Kawasaki ◽  
Sara Mills-Huffnagle ◽  
Nicole Aydinoglo ◽  
Halley Maxin ◽  
Edward Nunes
Keyword(s):  
Pilot Study ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Treatment ◽  
Behavioral Therapy ◽  
Contingency Management ◽  
Opioid Use Disorder ◽  
Cognitive Behavioral ◽  
Opioid Use ◽  
Hub And Spoke ◽  
Buprenorphine Treatment

BACKGROUND Medications for treatment of opioid use disorder (OUD), such as buprenorphine, are effective and essential for addressing the opioid epidemic. However, high dropout rates from medication remain a challenge. Behavioral treatment with contingency management plus cognitive behavioral counseling has shown promise for improving outcomes of buprenorphine treatment, but is complicated to deliver. Delivery of behavioral treatment through technology-based platforms has the potential to make it more feasible for widespread dissemination. OBJECTIVE reSET-O® is a Prescription Digital Therapeutic and a commercial adaptation of the Therapeutic Education System, an internet-based, interactive program with a Community Reinforcement Approach to cognitive behavioral therapy. It delivers cognitive behavioral therapy modules and contingency management rewards upon completion of modules and negative urine drug screens. A pilot study was performed to assess feasibility and acceptability of reSET-O® in a Hub and Spoke model of care as part of a larger strategy to maintain individuals in treatment. Objective and qualitative results, as well as acceptability and likeability of reSET-O®, were obtained from fifteen individuals. METHODS English-speaking individuals over the age of 18 with a diagnosis of current OUD were recruited after being on buprenorphine for at least one week of treatment. Two 12-week prescriptions for reSET-O® were written for a 24-week study. Patient report of drug use and likeability scales of reSET-O® were conducted at weeks 4,8, 12 and 24 of the study. Qualitative interviews were also conducted. Four providers were recruited and gave feedback on the acceptability and feasibility of reSET-O®. RESULTS Of 15 participants who entered this pilot study, 7 completed 24 weeks and 8 were unable to complete due to drop out after enrollment, attrition in treatment, or incarceration. An average of $96 in contingency management rewards were earned by the participants for completion of modules for the duration of the pilot study. Participants’ subjective feedback found that reSET-O® was easy to use, enjoyable, and helped provide a safe space to admit recurring substance use. CONCLUSIONS ReSET-O® was well accepted based on patient and provider feedback in this pilot study, but adherence and retention in treatment remain areas for improvement, as with traditional MOUD and CBT approaches. A randomized control trial in a Hub and Spoke model will be needed to assess if retention on buprenorphine treatment is enhanced through the use of technology based behavioral interventions such as reSET-O®. CLINICALTRIAL NCT03826966

scholarly journals Development of an integrated cognitive behavioral therapy for anxiety and opioid use disorder: Study protocol and methods

2017 ◽  
Vol 60 ◽  
pp. 105-112 ◽  
Author(s):  
R. Kathryn McHugh ◽  
Victoria R. Votaw ◽  
David H. Barlow ◽  
Garrett M. Fitzmaurice ◽  
Shelly F. Greenfield ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Study Protocol ◽  
Behavioral Therapy ◽  
Opioid Use Disorder ◽  
Cognitive Behavioral ◽  
Opioid Use

Cognitive behavioral therapy for chronic pain and opioid use disorder

2022 ◽  
pp. 235-246
Author(s):  
Marina G. Gazzola ◽  
Mark Beitel ◽  
Christopher J. Cutter ◽  
Declan T. Barry
Keyword(s):  
Chronic Pain ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Opioid Use Disorder ◽  
Cognitive Behavioral ◽  
Opioid Use

scholarly journals Brief Psychotherapy for Depression: A Systematic Review and Meta-Analysis

2012 ◽  
Vol 43 (2) ◽  
pp. 129-151 ◽  
Author(s):  
Jason A. Nieuwsma ◽  
Ranak B. Trivedi ◽  
Jennifer McDuffie ◽  
Ian Kronish ◽  
Dinesh Benjamin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Problem Solving ◽  
Cognitive Behavioral Therapy ◽  
Systematic Reviews ◽  
Behavioral Therapy ◽  
Meta Analysis ◽  
Cognitive Behavioral ◽  
Evidence Based ◽  
Brief Psychotherapy ◽  
Problem Solving Therapy

Objective: Because evidence-based psychotherapies of 12 to 20 sessions can be perceived as too lengthy and time intensive for the treatment of depression in primary care, a number of studies have examined abbreviated psychotherapy protocols. The purpose of this study was to conduct a systematic review and meta-analysis to determine the efficacy of brief psychotherapy (i.e., < 8 sessions) for depression. Methods: We used combined literature searches in PubMed, EMBASE, PsycINFO, and an Internet-accessible database of clinical trials of psychotherapy to conduct two systematic searches: one for existing systematic reviews and another for randomized controlled trials (RCTs). Included studies examined evidence-based psychotherapy(s) of eight or fewer sessions, focused on adults with depression, contained an acceptable control condition, were published in English, and used validated measures of depressive symptoms. Results: We retained 2 systematic reviews and 15 RCTs evaluating cognitive behavioral therapy, problem-solving therapy, and mindfulness-based cognitive therapy. The systematic reviews found brief psychotherapies to be more efficacious than control, with effect sizes ranging from −0.33 to −0.25. Our meta-analysis found six to eight sessions of cognitive behavioral therapy to be more efficacious than control (ES −0.42, 95% CI −0.74 to −0.10, I2 = 56%). A sensitivity analysis controlled for statistical heterogeneity but showed smaller treatment effects (ES −0.24, 95% CI −0.42 to −0.06, I2 = 0%). Conclusions: Depression can be efficaciously treated with six to eight sessions of psychotherapy, particularly cognitive behavioral therapy and problem-solving therapy. Access to non-pharmacologic treatments for depression could be improved by training healthcare providers to deliver brief psychotherapies.

scholarly journals Trauma informed interventions: A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252747
Author(s):  
Hae-Ra Han ◽  
Hailey N. Miller ◽  
Manka Nkimbeng ◽  
Chakra Budhathoki ◽  
Tanya Mikhael ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Health Inequities ◽  
The United States ◽  
Psychological Outcomes ◽  
Cognitive Behavioral ◽  
Health Concern ◽  
Ptsd Symptoms ◽  
Wide Range ◽  
Trauma Informed

Background Health inequities remain a public health concern. Chronic adversity such as discrimination or racism as trauma may perpetuate health inequities in marginalized populations. There is a growing body of the literature on trauma informed and culturally competent care as essential elements of promoting health equity, yet no prior review has systematically addressed trauma informed interventions. The purpose of this study was to appraise the types, setting, scope, and delivery of trauma informed interventions and associated outcomes. Methods We performed database searches— PubMed, Embase, CINAHL, SCOPUS and PsycINFO—to identify quantitative studies published in English before June 2019. Thirty-two unique studies with one companion article met the eligibility criteria. Results More than half of the 32 studies were randomized controlled trials (n = 19). Thirteen studies were conducted in the United States. Child abuse, domestic violence, or sexual assault were the most common types of trauma addressed (n = 16). While the interventions were largely focused on reducing symptoms of post-traumatic stress disorder (PTSD) (n = 23), depression (n = 16), or anxiety (n = 10), trauma informed interventions were mostly delivered in an outpatient setting (n = 20) by medical professionals (n = 21). Two most frequently used interventions were eye movement desensitization and reprocessing (n = 6) and cognitive behavioral therapy (n = 5). Intervention fidelity was addressed in 16 studies. Trauma informed interventions significantly reduced PTSD symptoms in 11 of 23 studies. Fifteen studies found improvements in three main psychological outcomes including PTSD symptoms (11 of 23), depression (9 of 16), and anxiety (5 of 10). Cognitive behavioral therapy consistently improved a wide range of outcomes including depression, anxiety, emotional dysregulation, interpersonal problems, and risky behaviors (n = 5). Conclusions There is inconsistent evidence to support trauma informed interventions as an effective approach for psychological outcomes. Future trauma informed intervention should be expanded in scope to address a wide range of trauma types such as racism and discrimination. Additionally, a wider range of trauma outcomes should be studied.

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