Effects on voice hearing distress and social functioning of unguided application of a smartphone app — A randomized controlled trial
Alyssa Jongeneel (Vrije Universiteit Amsterdam, Parnassia Psychiatric Institute)
Philippe Delespaul (Mondriaan Mental Health Centre, Heerlen, Maastricht University)
Nynke Tromp (TU Delft - Form and Experience)
Dorien Scheffers (Parnassia Psychiatric Institute)
Berber van der Vleugel (Viersprong Institute for Personality Disorders, Amsterdam, GGZ Noord-Holland Noord, Alkmaar)
Paul de Bont (Land van Cuijck en Noord Limburg)
Martijn Kikkert (Arkin BasisGGZ)
Carlos F. Croes (GGz Centraal)
David van den Berg (Vrije Universiteit Amsterdam, Parnassia Psychiatric Institute)
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Abstract
Background: Temstem is a smartphone app developed with and for clinical voice hearing individuals with the aim to reduce their voice hearing distress and improve social functioning. Methods: A randomized controlled trial with adult outpatients suffering from distressing and frequent auditory verbal hallucinations (AVH) was conducted. Participants were randomized to unguided ‘Temstem+AVH monitoring’ or unguided ‘AVH monitoring only’ (control condition). Assessments were performed at baseline, post-intervention (week 5–6), and follow-up (week 9–10). Primary outcomes were voice hearing distress and social functioning, as measured with Experience Sampling Method (ESM), consisting of multiple daily questionnaires during six days. In addition, voices and mood were self-monitored with help of a daily reflective questionnaire. Analyses were linear regression models (intention-to-treat). Results: 44 Participants were allocated to Temstem and 45 to the control condition. No significant differences between the groups were found on both primary outcomes. Conclusion: Our results do not support the effectiveness of stand-alone use of Temstem versus symptom monitoring on voice hearing distress or social functioning in voice hearing individuals. In order to potentially improve effectiveness of an mHealth tool in a population of people with frequent and distressing voices, we recommend to involve persons with lived experience in all stages of development and research; to thoroughly test the (technological) usability before performing an RCT; to test whether guidance of a therapist is needed to optimize effectiveness; and to provide prompts to remind the user to actually use the tool.
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