Smartphone psychotherapy trial with MGH reveals multiple patterns of effective engagement in mental health treatment

Koa Health
Publish Date
  • Use of Koa Perspectives’  smartphone-delivered CBT was associated with a reduction in the severity of Body Dysmorphic Disorder (BDD) compared to a waitlist
  • Multiple ways of engaging with the app were associated with reductions in symptoms
  • An app-based approach to care is promising, as it allows users to take control of their therapy and work at their own speed
  • The Koa Perspectives app has been identified by the British National Institute for Health and Care Excellence (NICE) as a promising new medical technology and conditionally recommended for rapid deployment into the National Health Service (NHS)

Boston, May 11, 2023: New research from Massachusetts General Hospital, founding member of Mass General Brigham, and Koa Health has found that people have varying preferences around how to use smartphone therapy apps and there are multiple ways of engaging associated with improvement in the digital treatment of mental health conditions.

The study, published in Internet Interventions, developed a new methodology to measure and study smartphone psychotherapy engagement, building upon a previously published study that found Koa Perspectives’ smartphone-delivered Cognitive Behavioral Therapy (CBT) to be effective in reducing the severity of Body Dysmorphic Disorder (BDD).

While numerous studies support the use of CBT for BDD, many patients are unable to find providers with expertise in this therapy modality or cannot afford treatment. App-based treatment—if engaged with effectively—may offer a practical alternative.

Extended analysis of the 12-week randomized waitlist-controlled trial results showed improvement in BDD severity across three types of users who exhibited different patterns of engagement with the app, namely samplers, deep users and light users. Samplers used the app frequently and widely, but engaged briefly, and perhaps more superficially. Deep users engaged with the app less overall, but when they did log in, engaged more deeply for a longer time. Light users were active on the app for shorter sessions and less frequently than the other two user types. Deep users experienced marginally higher levels of improvement than light users, but the results suggest varying levels of engagement can be efficacious. Furthermore, due to the currently limited data around how people prefer to engage with psychotherapy apps and what constitutes effective engagement, these results provide a useful framework for how to evaluate and improve behavioral engagement in digital interventions.

Developed by Sabine Wilhelm, PhD, Hilary Weingarden, PhD, and Jennifer Greenberg, PsyD from the Center for OCD and Related Disorders (CORD), and the Center for Digital Mental Health in collaboration with Koa Health, Koa Perspectives is coach-supported and was recently identified as a promising new medical technology and conditionally recommended for rapid deployment into the National Health Service (NHS) by the British National Institute for Health and Care Excellence (NICE).

Dr. Aleks Matic, Research and Development Director at Koa Health said, “Digital solutions have given us the potential to redefine how people engage with therapy—they allow patients to progress on their terms and achieve positive outcomes. Positive treatment response isn’t about volume, but rather about engagement, and our research points to there being more than one type of engaged user that benefits from digitally-enabled care.”

Dr. Sabine Wilhem, Chief of Psychology and founder and director of Body Dysmorphic Disorder Clinic and Research Unit at Massachusetts General Hospital said, “Body Dysmorphic Disorder is notoriously difficult to treat, and the method that we’ve seen to be among the most effective, Cognitive Behavioral Therapy, is time-intensive and costly for many patients. Our study results indicate that an app-based approach can be of help across a range of engagement levels.”

Dr. Hilary Weingarden, Assistant Director at the Center for Digital Mental Health and assistant professor at Harvard Medical School, and lead author on this piece said, “It’s exciting to see that not everyone has to use therapy apps in exactly the same way. People can use Perspectives BDD when and how they prefer to use it, to fit within their lives.”

Dr. Anna Mandeville, UK Clinical Director, Koa Health said, “When I trained as a therapist there was no option but to do everything in the one hour session, in-person. We had to help people feel comfortable and build trust, explain theory, set goals and assign homework. Unfortunately, some patients lost their homework sheets, or forgot what goals we planned, because at that point they were really struggling to cope— and anyway it's hard to remember! Digital mental health takes some of the heavy lifting out of therapy sessions, because it helps patients to check back on theories, remember goals, plan activities and track their progress, for example, on a dashboard, in between therapy sessions. Some people worry digital therapies take the ‘humanness’ out of therapy. From what I’ve seen they don't. Digitally-enabled therapies provide more continuous support for patients and create space for mental health professionals to be really effective by concentrating on collaborative problem solving, progress blockers and celebrating successes in scheduled sessions. What an improvement!”

Dr. Oliver Harrison, CEO at Koa Health said, “Digitally-enabled treatment allows people to take control of their own therapy in a way they weren’t previously able to. This makes a lot of sense, as people have different learning and engagement styles, with some taking more or less time to absorb new information than others. The exciting news is that the data from our study of Perspectives BDD shows that there’s no one ‘right’ way to engage with a digital solution, as users with a variety of engagement styles achieved very similar, and very positive clinical outcomes.”



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About Massachusetts General Hospital

Founded in 1811, and ranked #8 in U.S. News and World Report list of America’s best hospitals for 2022, Massachusetts General Hospital is the original and largest teaching school of Harvard University. The Mass General Research Institute operates the largest hospital-based research program in the United States, with research operations of more than $1 billion and a team of more than 9,500 researchers working across more than 30 centers, departments and institutes collaborating on behalf of patients to bridge innovation science with state-of-the-art clinical medicine.

About Koa Health

Koa Health is a leading digital platform for workplace mental health, helping business leaders care for high-performing teams across the full continuum of mental health. Koa offers personalized solutions with proven user outcomes from improving mental wellbeing to supporting treatment for a range of common mental disorders. Backed by investors including Telefónica, Ancora Finance Group and Wellington Partners, Koa Health leverages technology and research to enable people to change their behaviors with effective and accessible support that adapts to their unique circumstances.

Headquartered in the Netherlands, Koa Health has operations in Barcelona, the US, and the UK. Koa Health partners with leading clinicians and academics, including Massachusetts General Hospital, University College of London, the London School of Economics, and Birmingham and Solihull Mental Health NHS Foundation Trust.

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  1. A work in progress, Koa Perspectives is not in commercial distribution in the US.

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