Behavioral activation-based guided self-help treatment administered through a smartphone application: study protocol for a randomized controlled trial
Open accessAbstract
BACKGROUND: The need for cost-effective interventions for people suffering from major depressive disorders is essential. Behavioral activation is an intervention that can largely benefit from the use of new mobile technologies (for example smartphones). Therefore, developing smartphone-based behavioral activation interventions might be a way to develop cost-effective treatments for people suffering from major depressive disorders. The aim of this study will be to test the effects of a smartphone-delivered behavioral activation treatment. METHODS: The study will be a randomized controlled trial with a sample size of 120 participants, with 60 patients in each group. The treatment group includes an 8-week smartphone-based behavioral activation intervention, with minimal therapist contact. The smartphone-based intervention consists of a web-based psychoeducation, and a smartphone application. There is also a back-end system where the therapist can see reports from the patients or activities being reported. In the attention control group, we will include brief online education and then recommend use of a smartphone application that is not directly aimed at depression (for example, 'Effective meditation'). The duration of the control condition will also be 8 weeks. For ethical reasons we will give the participants in the control group access to the behavioral activation treatment following the 8-week treatment period. DISCUSSIONS: We believe that this trial has at least three important implications. First, we believe that smartphones can be integrated even further into society and therefore may serve an important role in health care. Second, while behavioral activation is a psychological treatment approach for which there is empirical support, the use of a smartphone application could serve as the therapist's prolonged arm into the daily life of the patient. Third, as we have been doing trials on guided Internet treatment for more than 10 years it is now time to move to the next generation of information technology - smartphones - which are not only relevant for Swedish conditions but also for developing countries in the world which are increasingly empowered by mobile phones with Internet connection. TRIAL REGISTRATION: ClinicalTrials.gov NCT01463020.
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Conclusive evidence of effectiveness of existing mobile mental wellness apps is not yet available.
“Conclusive evidence of effectiveness of existing mobile mental wellness apps is not yet available”
From Mobile Mental Wellness Training for Stress Management: Feasibility and Design Implications Based on a One-Month Field Study (2013) · cites this paper as [25]
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BackgroundMobile health solutions in developing countries: a stakeholder perspective
Eze, E., Gleasure, R., & Heavin, C. (2018) · Health Systems · doi:10.1080/20476965.2018.1457134 · Cited by 28 · see citing works
Vij, A., Kassab, K., Chawla, H., Kaur, A., Kodumuri, V., Jolly, N., & Doukky, R. (2021) · Clinical Cardiology · doi:10.1002/clc.23592 · Cited by 27 · see citing works
Morgan, A. J., Mackinnon, A. J., & Jorm, A. F. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.11.002 · Cited by 28 · see citing works
A Narrative Review of Empirical Literature of Behavioral Activation Treatment for Depression
Wang, X., & Feng, Z. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.845138 · Cited by 26 · see citing works
Internetbasierte psychologische Behandlung bei Depressionen
Klein, J. P., & Berger, T. (2013) · Verhaltenstherapie · doi:10.1159/000354046 · Cited by 22 · see citing works
“Eine neuere Entwicklung ist auch die Darbietung von Selbsthilfeinhalten in Smartphone-Apps [Ly et al., 2012] oder in Form sogenannter Serious Games, d.h. interaktiver Spielformate [Merry et al., 2012].”
BackgroundImproving pain treatment with a smartphone app: Study protocol for a randomized controlled trial
Suso-Ribera, C., Mesas, Á., Medel, J., Server, A., Márquez, E., Castilla, D., Zaragozá, I., & García-Palacios, A. (2018) · Trials · doi:10.1186/s13063-018-2539-1 · Cited by 20 · see citing works
The Application of Mobile Technology in E-Learning and Online Education Environments
Tsai, C., Shen, P., & Chiang, Y. (2013) · International Journal of Enterprise Information Systems · doi:10.4018/ijeis.2013100106 · Cited by 19 · see citing works
Lin, W.-C., Burke, L. E., Schlenk, E. A., & Yeh, C. H. (2018) · CIN Computers Informatics Nursing · doi:10.1097/cin.0000000000000478 · Cited by 12 · see citing works
“An EMA allows improved pain treatment and possibly enhanced compliance with pain-reduction interventions.(14,15) Data collection for an EMA is best done with the use of a mobile device such as a smartphone.”
MethodMena-Moreno, T., Munguía, L., Granero, R., Lucas, I., Fernández-Aranda, F., Gómez-Peña, M., Moragas, L., Verdejo-García, A., Menchón, J., & Jiménez-Múrcia, S. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11226798 · Cited by 13 · see citing works
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“The use of mobile phone and tablet technology for service provision has a range of potential benefits, including the ability to record information, portability, acceptability, relatively low costs, and near constant connectivity to young people and carers [17].”
BackgroundHarnessing technology for hope: a systematic review of digital suicide prevention tools
Sherekar, P., & Mehta, M. (2025) · Discover Mental Health · doi:10.1007/s44192-025-00245-y · Cited by 12 · see citing works
Lambert, J. D., Loades, M. E., Marshall, N., Higson‐Sweeney, N., Chan, S. W. Y., Mahmud, A., Pile, V., Maity, A., Adam, H., Sung, B., et al. (2025) · Journal of Medical Internet Research · doi:10.2196/58164 · Cited by 9 · see citing works
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“Apps have been used for registering weight for obesity control [19] and, in a guided version, to help users with behavioral activation in their own chosen valued direction [20].”
Fulford, H., McSwiggan, L. C., Kroll, T., & MacGillivray, S. A. (2016) · JMIR Mental Health · doi:10.2196/mental.5966 · Cited by 9 · see citing works
“Psychological interventions have been effectively delivered through ICTs [5] while having the ability to reach rural areas within diverse populations and settings [6].”
East, M. L., Havard, B., & Hastings, N. B. (2016) · Journal of Technology in Human Services · doi:10.1080/15228835.2016.1233842 · Cited by 7 · see citing works
“…large scale behavioral health interventions (Cohn, Hunter-Reel, Hagman, & Mitchell, 2011; Derbyshire & Dancey, 2013; Gasser et al., 2006; Kazdin & Rabbitt, 2013; Luxton et al., 2011; Ly, Carlbring, & Andersson, 2012; “mHealth Market,” 2013; “Mobile Applications,” 2012; Ricciardi et al., 2013).”
Vertola, G., Marcello, A., Bottone, M., Sperandeo, R., Muzii, B., Scandurra, C., & Maldonato, N. M. (2022) · IEEE International Conference on Cognitive Infocommunications · doi:10.1109/coginfocom55841.2022.10081617 · Cited by 7 · see citing works
Activación Conductual: Revisión Histórica, Conceptual y Empírica
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Les nouvelles thérapies par Internet
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Social Networking Services-Based Communicative Care for Patients with Diabetes Mellitus in Korea
Kim, H., Jeong, Y., Baik, S. J., Yang, S. J., Kim, T. M., Kim, H., Lee, H., Lee, S., Cho, J., Choi, I.-Y., et al. (2016) · Applied Clinical Informatics · doi:10.4338/aci-2016-06-ra-0088 · Cited by 6 · see citing works
User Experiences of a Mobile Mental Well-Being Intervention Among Pregnant Women
Muuraiskangas, S., Mattila, E., Kyttälä, P., Koreasalo, M., & Lappalainen, R. (2016) · Communications in Computer and Information Science · doi:10.1007/978-3-319-32270-4_14 · Cited by 5 · see citing works
Askari, J., Kakhki, A. S., Taheri, H., & Yassini, S. M. (2017) · Open Journal of Medical Psychology · doi:10.4236/ojmp.2017.62007 · Cited by 4 · see citing works
“The reliability and validity of the original version of this questionnaire [39]”
BackgroundRoss, V., Brijs, K., Dirix, H., Wets, G., Neven, A., Vanrompay, Y., Claes, N., & Jacobs, N. (2023) · Journal of Evidence-Based Psychotherapies · doi:10.24193/jebp.2023.1.5 · Cited by 3 · see citing works
Askari, J., Kakhki, A. S., Taheri, H., & Yassini, S. M. (2017) · Open Journal of Medical Psychology · doi:10.4236/ojmp.2017.63016 · Cited by 3 · see citing works
“The reliability and validity of the original version of this scale [40] and those of the Persian version [41] are optimal and acceptable.”
BackgroundAndrews, L., Gajanayake, R., & Sahama, T. R. (2013) · IEEE International Conference on e-Health Networking, Applications and Services (Healthcom) · doi:10.1109/healthcom.2013.6720732 · Cited by 2 · see citing works
“0 capabilities and the multi-media components of the mobile spectrum [4-7].”
BackgroundÉducation thérapeutique du trouble dépressif récurrent
Carde, S., & Hatif, S. (2016) · Soins Psychiatrie · doi:10.1016/j.spsy.2015.11.010 · Cited by 2 · see citing works
Methods for Preventing Depression on Digital Platforms and in Social Media
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A Framework for Analyzing Patient-centered Mobile Applications for Mental Health
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Critical Making for Cybertherapy Innovation Design in HCI
Reid, T. (2014) · DiVA at Umeå University (Umeå University)
Ivanova, E., Lindner, P., Dahlin, M., Ly, H. G., Vernmark, K., Andersson, G., & Carlbring, P. (2015) · DiVA (Stockholm University)
Self-citationSmartphone technology in mental health
Loubir, D. B., Housbane, S., & Serhier, Z. (2014)
Eze, E. (2018) · Cork Open Research Archive (University College Cork, Ireland)
STAYING RELEVANT IN THE TECHNICAL ERA? There’s an App for That!
Jojic, M. (2014) · JAACAP Connect · doi:10.62414/001c.92679
Akodu, A. K., Ipinnimo, O., & Osuntoki, A. A. (2024) · Turkish Journal of Physical Medicine and Rehabilitation · doi:10.5606/tftrd.2024.12392
“[11,12] For proper neck posture to be assumed by people using smartphones, a system to observe and estimate angle of the neck of smartphone users when using their phones was proposed by Lawanont et al. [13] Higher mobile technology is now an essential part of the healthcare industry.”
MethodJiang, G., & Wang, J. (2026) · Acta Psychologica · doi:10.1016/j.actpsy.2026.107017
- Authors
- Ly, K. H., Carlbring, P., & Andersson, G.
- Affiliations
- Linköping University (SE)
- Umeå University (SE)
- Corresponding author
- Ly, Kien Hoa
- Venue
- Trials
- Published
- 2012-05-18
- Volume
- 13
- Issue
- 1
- Pages
- 62-62
- ISSN
- 1745-6215 (ISSN-L)
- PMC
- PMC3404948
- OpenAlex
- W2098932432
- Cited by
- 61
- References
- 58
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 1 · 2022: 5 · 2021: 1 · 2020: 2 · 2019: 2 · 2018: 4 · 2017: 5 · 2016: 9 · 2015: 9 · 2014: 9 · 2013: 9 · 2012: 1
- FWCI
- 12.64
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Trials (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Vetenskapsrådet
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- behavioral activation, major depressive disorder, mobile application, mobile health, guided self-help, cost-effective treatment, digital mental health interventions
- MeSH terms
- Behavior Therapy, Depressive Disorder, Major, Major Depressive Disorder, Humans, Health Knowledge, Attitudes, Practice, Patient Education as Topic, Psychiatric Status Rating Scales, Research Design, Self Care, Sweden, Time Factors, Treatment Outcome, Internet, Cell Phone
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