We conducted a meta-analysis on the effects of mobile technology on treatment outcome for psychotherapy and other behavioral interventions. Our search of the literature resulted in 26 empirical articles describing 25 clinical trials testing the benefits of smartphone applications, personal digital assistants (PDAs), or text messaging systems either to supplement treatment or substitute for direct contact with a clinician. Overall, mobile technology use was associated with superior treatment outcome across all study designs and control conditions, effect size (ES) = .34, p < .0001. For the subset of 10 studies that looked specifically at the added benefit of mobile technology using a rigorous “Treatment” versus “Treatment + Mobile” design, effect sizes were only slightly more modest (ES = .27) and still significant (p < .05). Overall, the results support the role of mobile technology for the delivery of psychotherapy and other behavioral interventions.
*AskinsM. A.SahlerO. J. Z.ShermanS. A.FaircloughD. L.ButlerR. W.KatzE. R.. . . PhippsS. (2009). Report from a multi-institutional randomized clinical trial examining computer-assisted problem-solving skills training for English- and Spanish-speaking mothers of children with newly diagnosed cancer. Journal of Pediatric Psychology, 34, 551-563. doi:10.1093/jpepsy/jsn124
2.
*BauerS.OkonE.MeermannR.KordyH. (2012). Technology-enhanced maintenance of treatment gains in eating disorders: Efficacy of an intervention delivered via text messaging. Journal of Consulting and Clinical Psychology, 80, 700-706. doi:10.1037/a0028030
3.
BoschenM. J. (2009). Mobile telephones and psychotherapy: II. A review of empirical research. The Behavior Therapist, 32, 175-181.
4.
*BurkeL. E.ConroyM. B.SereikaS. M.ElciO. U.StynM. A.AcharyaS. D.. . . GlanzK. (2011). The effect of electronic self-monitoring on weight loss and dietary intake: A randomized behavioral weight loss trial. Obesity, 19, 338-344. doi:10.1038/oby.2010.208
5.
CushingC. C.SteeleR. G. (2010). A meta-analytic review of eHealth interventions for pediatric health promoting and maintaining behaviors. Journal of Pediatric Psychology, 35, 937-949. doi:10.1093/jpepsy/jsq023
6.
*de NietJ.TimmanR.BauerS.van den AkkerE.de KlerkC.KordyH.PasschierJ. (2012). Short message service reduces dropout in childhood obesity treatment: A randomized controlled trial. Health Psychology, 31, 797-805. doi:10.1037/a0027498
7.
*DuncanM.VandelanotteC.KoltG. S.RosenkranzR. R.CaperchioneC. M.GeorgeE. S.. . . MummeryW. K. (2014). Effectiveness of a web- and mobile phone-based intervention to promote physical activity and healthy eating in middle-aged males: Randomized controlled trial of the ManUp study. Journal of Medical Internet Research, 16, 40-60. doi:10.2196/jmir.3107
8.
EhrenreichB.RighterB.RockeD. A.DixonL.HimelhochS. (2011). Are mobile phones and handheld computers being used to enhance delivery of psychiatric treatment? A systematic review. Journal of Nervous and Mental Disease, 199, 886-891. doi:10.1097/NMD.0b013e3182349e90
9.
*EnockP. M.HofmannS. G.McNallyR. J. (2014). Attention bias modification training via smartphone to reduce social anxiety: A randomized, controlled multi-session experiment. Cognitive Therapy and Research, 38, 200-216. doi:10.1007/s10608-014-9606-z
10.
FiordelliM.DivianiN.SchulzP. J. (2013). Mapping mHealth research: A decade of evolution. Journal of Medical Internet Research, 15, 73-86. doi:10.2196/jmir.2430
11.
*FreeC.KnightR.RobertsonS.WhittakerR.EdwardsP.ZhouW.RobertsI. (2011). Smoking cessation support delivered via mobile phone text messaging (txt2stop): A single-blind, randomised trial. The Lancet, 378, 49-55. doi:10.1016/S0140-6736(11)60701-0
12.
*GentryT.KrinerR.SimaA.McDonoughJ.WehmanP. (2014). Reducing the need for personal supports among workers with autism using an iPod touch as an assistive technology: Delayed randomized control trial. Journal of Autism and Developmental Disorders, 45, 669-684. doi:10.1007/s10803-014-2221-8
13.
*GonzalesR.AngA.MurphyD. A.GlikD. C.AnglinM. D. (2014). Substance use recovery outcomes among a cohort of youth participating in a mobile-based texting aftercare pilot program. Journal of Substance Abuse Treatment, 47, 20-26. doi:10.1016/j.jsat.2014.01.010
14.
*GustafsonD. H.McTavishF. M.ChihM.AtwoodA. K.JohnsonR. A.BoyleM. G.. . . ShahD. (2014). A smartphone application to support recovery from alcoholism: A randomized clinical trial. JAMA Psychiatry, 71, 566-572. doi:10.1001/jamapsychiatry.2013.4642
15.
*HaugS.SchaubM. P.VenzinV.MeyerC.JohnU. (2013). Efficacy of a text message-based smoking cessation intervention for young people: A cluster randomized controlled trial. Journal of Medical Internet Research, 15, 142-155. doi:10.2196/jmir.2636
16.
HeadK. J.NoarS. M.IannarinoN. T.HarringtonN. G. (2013). Efficacy of text messaging-based interventions for health promotion: A meta-analysis. Social Science & Medicine, 97, 41-48. doi:10.1016/j.socscimed.2013.08.003
17.
HundtN. E.MignognaJ.UnderhillC.CullyJ. A. (2013). The relationship between use of CBT skills and depression treatment outcome: A theoretical and methodological review of the literature. Behavior Therapy, 44, 12-26. doi:10.1016/j.beth.2012.10.001
18.
JonesD. J. (2014). Future directions in the design, development, and investigation of technology as a service delivery vehicle. Journal of Clinical Child and Adolescent Psychology, 43, 128-144. doi:10.1080/15374416.2013.859082
19.
*JonesD. J.ForehandR.CuellarJ.ParentJ.HoneycuttA.KhavjouO.. . . NeweyG. A. (2014). Technology-enhanced program for child disruptive behavior disorders: Development and pilot randomized control trial. Journal of Clinical Child and Adolescent Psychology, 43, 88-101. doi:10.1080/15374416.2013.822308
20.
JonesD. J.ForehandR.McKeeL. G.CuellarJ.KincaidC. (2010). Behavioral parent training: Is there an “app” for that?Behavior Therapist, 33, 72-77.
21.
KahnM.BakerB. (1968). Desensitization with minimal therapist contact. Journal of Abnormal Psychology, 73, 198-200. doi:10.1037/h0025866
22.
KenardyJ. A.DowM. G. T.JohnstonD. W.NewmanM. G.ThomsonA.TaylorC. B. (2003). A comparison of delivery methods of cognitive-behavioral therapy for panic disorder: An international multicenter trial. Journal of Consulting and Clinical Psychology, 71, 1068-1075. doi:10.1037/0022-006X.71.6.1068
23.
*KirwanM.VandelanotteC.FenningA.DuncanM. J. (2013). Diabetes self-management smartphone application for adults with type 1 diabetes: Randomized controlled trial. Journal of Medical Internet Research, 15, 53-66. doi:10.2196/jmir.2588
24.
KoumansA. J. R.MullerJ. J.MillerC. F. (1967). Use of telephone calls to increase motivation for treatment in alcoholics. Psychological Reports, 21, 327-328. doi:10.2466/pr0.1967.21.1.327
25.
*KristjánsdóttirÓ. B.ForsE. A.EideE.FinsetA.StensrudT. L.van DulmenS.EideH. (2013). A smartphone-based intervention with diaries and therapist-feedback to reduce catastrophizing and increase functioning in women with chronic widespread pain: Randomized controlled trial. Journal of Medical Internet Research, 15, 125-146. doi:10.2196/jmir.2249
26.
LindhiemO.HigaJ.TrentacostaC. J.HerschellA. D.KolkoD. J. (2014). Skill acquisition and utilization during evidence-based psychosocial treatments for childhood disruptive behavior problems: A review and meta-analysis. Clinical Child and Family Psychology Review, 17, 41-66. doi:10.1007/s10567-013-0136-0
27.
LipseyM. W.WilsonD. B. (2001). Practical meta-analysis. Thousand Oaks, CA: SAGE.
28.
*LouchG.DalkinS.BodanskyJ.ConnerM. (2013). An exploratory randomised controlled trial using short messaging service to facilitate insulin administration in young adults with type 1 diabetes. Psychology, Health & Medicine, 18, 166-174. doi:10.1080/13548506.2012.689841
29.
LuxtonD. D.McCannR. A.BushN. E.MishkindM. C.RegerG. M. (2011). mHealth for mental health: Integrating smartphone technology in behavioral healthcare. Professional Psychology: Research and Practice, 42, 505-512. doi:10.1037/a0024485
30.
MojtabaiR.OlfsonM.SampsonN. A.JinR.DrussB.WangP. S.. . . KesslerR. C. (2011). Barriers to mental health treatment: Results from the National Comorbidity Survey Replication. Psychological Medicine, 41, 1751-1761. doi:10.1017/S0033291710002291
31.
*NaughtonF.JamisonJ.BoaseS.SloanM.GilbertH.PrevostA. T.SuttonS. (2014). Randomized controlled trial to assess the short-term effectiveness of tailored web- and text-based facilitation of smoking cessation in primary care (iQuit in practice). Addiction, 109, 1184-1193. doi:10.1111/add.12556
32.
*OerlemansS.van CranenburghO.HerremansP.SpreeuwenbergP.van DulmenS. (2011). Intervening on cognitions and behavior in irritable bowel syndrome: A feasibility trial using PDAs. Journal of Psychosomatic Research, 70, 267-277. doi:10.1016/j.jpsychores.2010.09.018
33.
OrwinR. G. (1983). A fail-safe N for effect size in meta-analysis. Journal of Educational Statistics, 8, 157-159.
34.
*ParkL. G.Howie-EsquivelJ.ChungM. L.DracupK. (2014). A text messaging intervention to promote medication adherence for patients with coronary heart disease: A randomized controlled trial. Patient Education and Counseling, 94, 261-268. doi:10.1016/j.pec.2013.10.027
35.
*PedersenE. R.KaysenD. L.LindgrenK. P.BlayneyJ.SimpsonT. L. (2014). Impact of daily assessments on distress and PTSD symptoms in trauma-exposed women. Journal of Interpersonal Violence, 29, 824-845. doi:10.1177/0886260513505705
PiaseckiT. M.HuffordM. R.SolhanM.TrullT. J. (2007). Assessing clients in their natural environments with electronic diaries: Rationale, benefits, limitations, and barriers. Psychological Assessment, 19, 25-43. doi:10.1037/1040-3590.19.1.25
38.
PramanaG.ParmantoB.KendallP. C.SilkJ. S. (2014). The SmartCAT: An m-Health platform for ecological momentary intervention in child anxiety treatment. Telemedicine and e-Health, 20, 419-427. doi:10.1089/tmj.2013.0214
39.
RideoutV. J.FoehrU. G.RobertsD. F. (2010). Generation M2: Media in the lives of 8- to 18-year-olds. Menlo Park, CA: Henry J. Kaiser Family Foundation.
40.
*ShapiroJ. R.KoroT.DoranN.ThompsonS.SallisJ. F.CalfasK.PatrickK. (2012). Text4Diet: A randomized controlled study using text messaging for weight loss behaviors. Preventive Medicine: An International Journal Devoted to Practice and Theory, 55, 412-417. doi:10.1016/j.ypmed.2012.08.011
*SteinbergD. M.LevineE. L.AskewS.FoleyP.BennettG. G. (2013). Daily text messaging for weight control among racial and ethnic minority women: Randomized controlled pilot study. Journal of Medical Internet Research, 15, 67-77. doi:10.2196/jmir.2844
43.
TeachmanB. A. (2014). No appointment necessary: Treating mental illness outside the therapist’s office. Perspectives on Psychological Science, 9, 85-87. doi:10.1177/1745691613512659
44.
*WattsS.MackenzieA.ThomasC.GriskaitisA.MewtonL.WilliamsA.AndrewsG. (2013). CBT for depression: A pilot RCT comparing mobile phone vs. computer. BMC Psychiatry, 13, 49. doi:10.1186/1471–244X-13-49
45.
WhalenC. K.HenkerB.IshikawaS. S.JamnerL. D.FloroJ. N.JohnstonJ. A.. . . SwindleR. (2006). An electronic diary study of contextual triggers and ADHD: Get ready, get set, get mad. Journal of the American Academy of Child & Adolescent Psychiatry, 45, 166-174. doi:10.1097/01.chi.0000189057.67902.10
46.
WhalenC. K.HenkerB.JamnerL. D.IshikawaS. S.FloroJ. N.SwindleR.. . . JohnstonJ. A. (2006). Toward mapping daily challenges of living with ADHD: Maternal and child perspectives using electronic diaries. Journal of Abnormal Child Psychology, 34, 115-130. doi:10.1007/s10802-005-9008-5
47.
*WhittakerR.DoreyE.BramleyD.BullenC.DennyS.ElleyC. R.SalmonP. (2011). A theory-based video messaging mobile phone intervention for smoking cessation: Randomized control trial. Journal of Medical Internet Research, 13, 61-72. doi:10.2196/jmir.1553
48.
*YbarraM. L.HoltropJ. S.PrescottT. L.RahbarM. H.StrongD. (2013). Pilot RCT results of Stop My Smoking USA: A text messaging-based smoking cessation program for young adults. Nicotine & Tobacco Research, 15, 1388-1399. doi:10.1093/ntr/nts339
49.
*YonB. A.JohnsonR. K.Harvey-BerinoJ.GoldB. C.HowardA. B. (2007). Personal digital assistants are comparable to traditional diaries for dietary self-monitoring during a weight loss program. Journal of Behavioral Medicine, 30, 165-175. doi:10.1007/s10865-006-9092-1
