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To augment cognitive-behavioral therapy, clinicians advise some patients experiencing significant distress to use a “hope box”—a physical container that stores items that serve as reminders of positive life experiences, people who care, and coping and distracting strategies.
On the basis of this concept, Nigel Bush, Ph.D., of the National Center for Telehealth and Technology and colleagues created the Virtual Hope Box (VHB), which uses smartphone capabilities to enhance and personalize the physical hope box on a highly accessible medium.
To assess the impact of the VHB on coping self-efficacy and clinical outcomes, the researchers randomly assigned 118 U.S. service veterans who were in treatment and had a recent history of suicidal ideation to receive treatment as usual supplemented with the VHB app or to a control group who received treatment as usual supplemented with printed materials about coping with suicidality over a 12-week period.
The Coping Self-Efficacy Scale, Beck Scale for Suicidal Ideation, and Brief Reasons for Living Inventory were collected at baseline (before randomization), and again at three, six, and 12 weeks. Secondary measures—the Interpersonal Needs Questionnaire, Perceived Stress Scale, and Columbia-Suicide Severity Rating Scale—were collected at baseline and 12 weeks.
Patients who used the VHB showed the greatest improvements in their ability to cope with unpleasant emotions and thoughts over time compared with those in the control group, with the largest difference between the treatment groups seen at 12 weeks. In contrast, the VHB was not associated with increases in coping efficacy to enlist support from friends and family. There were no statistically significant differences between the treatment groups on the secondary outcome measures.
“Usage data from this study confirmed that the VHB was used regularly and frequently, was reported as easy to use, was found helpful and beneficial in dealing with stress and emotional difficulties, was likely to be used in the future, and would be recommended to others,” the authors wrote. “Moreover, user self-reports indicated that the VHB was used as intended—for relaxation and distraction or inspiration when feeling distressed, when emotions were overwhelming, or when they felt like hurting themselves. Clinician feedback was similarly positive.”
The authors concluded, “Military behavioral health patients experiencing distress, emotional dysregulation, or suicidal ideation are often separated from direct clinical support when they need it. Although impacts on some outcomes in this study were limited, users of the VHB nonetheless noted multiple benefits. The VHB smartphone app offers a highly portable, accessible, and discreet suite of tools for effectively increasing coping self-efficacy.”
For related information, see the Psychiatric News article “Expert Calls on Psychiatry, APA to Lead in Testing Tech Advances.”
(Image: Kostenko Maxim/shutterstock.com)
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