Characterizing Behavioral Engagement in Smartphone Cognitive Behavioral Therapy for Obsessive Compulsive Disorder: Secondary Analysis of a Randomized Controlled Trial.
Hilary Weingarden, Geneva K Jonathan, Susanne S Hoeppner et al.
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In 30 seconds
This exploratory secondary analysis of a 12-week randomized controlled trial examined behavioral engagement with smartphone cognitive behavioral therapy for obsessive compulsive disorder (OCD) in 60 participants. Using 21 app-analytics measures, hierarchical cluster analysis identified high-, moderate-, and low-use profiles. All three groups had significant reductions in OCD severity, with no significant between-group differences in pre-to-post Yale-Brown Obsessive Compulsive Scale change. The low-use group reported lower treatment credibility, expectations, and satisfaction than the moderate-use group. The findings suggest that engagement is multidimensional and that symptom improvement was not clearly related to app-use profile.
Key findings
- Engagement profiles were high use (21/60, 35%), moderate use (31/60, 52%), and low use (8/60, 13%).
- All three profiles showed significant OCD severity reductions, with no significant differences in pre-to-post Yale-Brown Obsessive Compulsive Scale change.
- Compared with the moderate-use group, the low-use group reported significantly lower treatment credibility, expectations, and posttreatment satisfaction.
- All profiles rated app quality similarly highly; descriptively, the high-use group had a higher treatment-responder rate than the low-use group.
Why it matters
The analysis illustrates why digital treatment engagement may be better understood through multiple behavioral measures than through a single usage metric. Similar symptom change across use profiles cautions against assuming that greater app use necessarily produces greater benefit. Differences in credibility and expectations may help explain engagement patterns and point to factors worth examining in future digital intervention research.
What to keep in mind
This was an exploratory secondary analysis with a small sample, particularly in the low-use group. The authors note that limited power may have obscured differences in symptom improvement across profiles.