An Ecological Momentary Intervention for people with social anxiety: A descriptive case study

ABSTRACT

This study describes the development and pilot evaluation of a smartphone- delivered Ecological Momentary Intervention (EMI) for people with social anxiety symptoms. Using a software engineering framework (agile modeling, model-driven development, bottom-up development), mental health experts and software developers collaborated to develop a 4-module EMI app designed to reduce social anxiety in real-time. Fifty-five participants with social anxiety were randomly allocated to the EMI or a wait-list control arm. App downloads, usage and user satisfaction data were collected and mental health outcomes assessed at baseline and post-intervention. Software development practices allowed mental health experts to distil core elements of a psychological intervention into discrete software components but there were challenges in engaging mental health experts in the process. Relative to control there was no significant reduction in social anxiety among the EMI participants in the pilot trial. However, post-test data were available for only 4 intervention and 10 control participants and only 2 (4.0%) of the EMI participants downloaded the app. The two participants who both accessed the app and completed the post-test reported being satisfied with the intervention. Future research should address managing resources and providing additional training to support ongoing engagement with key stakeholders.

KEYWORDS:

• App development
• software engineering
• social anxiety
• telehealth

Author’s Contribution

All authors contributed to the design of the study. BLG developed software artifacts, including the ExposureTherapy app. Some of the e-couch social anxiety toolkit content (scripted by Georgia Tayler & KMG) was modified and incorporated into the app’s content with additional input from JR, KMG, LP, and AG. The paper was drafted by BLG critically edited and reviewed by AG, JR, PJB and KMG. All authors approved the final version of the paper.

Acknowledgments

The authors would like to thank Les Posen (LP), Dr Andrew White, Dr Lou Farrer, and Dr Dominque Kazan for providing additional advice on the development of the app. Additionally, the authors would like to thank Arjun Rajshekhar for his assistance on some of the technical aspects of the app, and Dr Juanita Fernando for her assistance on the final proofs of the manuscript.

Disclosure of interest

KMG is entitled to a percentage of royalties from any profits derived by the ANU from the commercialisation of e-couch, the online application from which some of the content of ExposureTherapy was derived. KMG has no financial interest in the spin-off company e-hub Health Pty Ltd which now owns e-couch but serves in an honorary position on an advisory committee to that company. The other authors declare that there is no conflict of interest. PB is supported by the National Health and Medical Research Fund (NHMRC) Fellowship under Grant 1,158,707. At the time of the development of the EMI, KMG was supported by NHMRC Senior Research Fellowship (GNT1059620).

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Notes

¹ 1. Interpersonal psychotherapy is a psychological therapy targeting problems in interpersonal relations.

² 2. A wait-list control group is a control condition that delays access to the smartphone app following the date of the posttest (follow-up assessments).

Additional information

Funding

This work was supported by the National Health and Medical Research Council [GNT1059620]; National Health and Medical Research Council [1158707].