Adding an app-based intervention to the Cognitive Behavioral Analysis System of Psychotherapy (CBASP): Concept and Feasibility in a Pilot Routine Clinical Trial (Preprint)

BACKGROUND The Cognitive Behavioral Analysis System of Psychotherapy (CBASP), developed specifically for the treatment of persistent depressive disorder (PDD), is an empirically supported treatment. However, given the high rates of non-response and relapse, there is need for optimization. Studies suggest that outcomes can be improved by increasing the treatment dose, e.g., by constant online-based application of therapy strategies between sessions. The highly structured nature of CBASP encourages augmenting it with online interventions, which are of increasing importance for mental health care. OBJECTIVE We developed the app-based intervention "CBASPath", which is designed to be used in addition to face-to-face CBASP therapy in terms of blended therapy. CBASPath offers eight sequential modules with interactive exercises to facilitate additional engagement with the therapy content and a separate exercise to conduct situational analyses within the app at any time. METHODS CBASPath was tested in an open pilot study as part of routine outpatient CBASP treatment. Participating patients (n=13) were asked to report their usage patterns and blended use (integrated use of app as part of therapy sessions) at three assessment points over the 6-month test period and to rate the usability, quality, and their satisfaction with CBASPath. RESULTS Results of the pilot trial show that 12 participants used CBASPath as a blended tool during their therapy and maintained this throughout the study period. Overall, they reported good usability and quality ratings along with high user satisfaction. All participants showed favourable engagement with CBASPath, but with frequency of use differing widely among participants and assessment points. The situational analysis was used by all participants, while the number of completed modules ranged between 1 and 7. All participants reported blended use, although the frequency of integration in face-to-face sessions varied widely. CONCLUSIONS Our findings suggest that a digital augmentation of the complex and highly interactive CBASP therapy in the form of blended therapy with CBASPath is feasible in routine outpatient care. Therapeutic guidance might contribute to the high adherence and increase patients’ self-management. Few adjustments within the app could facilitate higher user engagement. A randomized controlled trial to investigate the efficacy and the added value of this blended approach is now needed. In the long term, CBASPath could help optimize PDD treatment and reduce relapse by intensifying therapy and providing long-term patient support through the app. CLINICALTRIAL No Registration due to pilot character of the study.