Lessons Learned: Providing Supportive Accountability in an Online Anxiety Intervention

Abstract

Technology-delivered interventions have the potential to help address the treatment gap in mental health care but are plagued by high attrition. Adding coaching, or minimal contact with a nonspecialist provider, may encourage engagement and decrease dropout, while remaining scalable. Coaching has been studied in interventions for various mental health conditions but has not yet been tested with anxious samples. This study describes the development of and reactions to a low-intensity coaching protocol administered to N = 282 anxious adults identified as high risk to drop out of a web-based cognitive bias modification for interpretation intervention. Undergraduate research assistants were trained as coaches and communicated with participants via phone calls and synchronous text messaging. About half of the sample never responded to coaches' attempts to schedule an initial phone call or did not answer the call, though about 30% completed the full intervention with their coach. Some anxious adults may choose technology-delivered interventions specifically for their lack of human contact and may fear talking to strangers on the phone; future recommendations include taking a more intensive user-centered design approach to creating and implementing a coaching protocol, allowing coaching support to be optional, and providing users with more information about how and why the intervention works.

Keywords: coaching; cognitive bias modification; eHealth; technology-delivered intervention.

FIGURE 1

SMART design of larger clinical trial. Note. SMART = sequential, multiple assignment, randomized trial. In this paper, we focus on the CBM-I + telecoaching condition.

FIGURE 2

Screenshots of sample CBM-I training scenario and comprehension question.

FIGURE 3

Basic coaching protocol.