Integration of Virtual Hope Box Mobile Application in Clinical Care

Nigel E Bush Ph.D. & Amanda Stewart, Ph.D.16 OCT 2014

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Integration of Virtual Hope Box

Mobile Application in Clinical CareOctober 16, 2014, 1-2:30pm (EST)

Presenters: Nigel Bush, Ph.D.Deputy Chief of Research

National Center for Telehealth & Technology (T2)Joint Base Lewis McChord, WA

Amanda Edwards-Stewart, Ph.D.Clinical Psychologist, Deputy Director of Emerging Technologies Program

National Center for Telehealth & Technology (T2)Joint Base Lewis McChord, WA

Moderator: Robert Ciulla, Ph.D.

Psychologist, Division Chief for Mobile Health ProgramNational Center for Telehealth & Technology (T2)

Joint Base Lewis McChord, WA

Learning Objectives

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At the conclusion of this webinar, participants will be able to…”  

• Describe the social paradigm shift to mobile health among younger

service members.

• Articulate the potential benefits of mobile personal technologies as

accessories to behavioral health treatment.

• Examine the value of clinical involvement in patient use of health related

smartphone apps.

• Incorporate key principles behind hope box use in clinical therapy.

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Presenters

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Nigel Bush, Ph.D.

U.S. Department of DefenseNational Center for Telehealth & Technology (T2)

Deputy Chief of Research

University of WashingtonAffiliate Associate Professor, Dept of Psychiatry &

Behavioral Sciences

nigel.e.bush.civ@mail.mil

Presenters

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Amanda Edwards-Stewart, Ph.D.

U.S. Department of DefenseNational Center for Telehealth & Technology (T2)Clinical Psychologist, Subject Matter ExpertDeputy Director of Emerging Technologies Program

Northwest UniversityAdjunct Professor

amanda.e.stewart7.civ@mail.mil

Disclosures

• The views expressed in this presentation are those of the presenters and do not reflect the official policy of the U.S. Department of Defense.

• We have no relevant financial relationships to disclose.• We will be discussing web and mobile applications that have

been developed by the Defense Department, including those developed by the National Center for Telehealth and Technology (T2). Some of these applications may fall under FDA device regulations, and in those cases we will consult with the USAMRMC Division of Regulated Activities and Compliance for guidance.

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Making Self-Help Apps

Source: National Center for Telehealth & Technology (T2)

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Augment Standard Care

Source: VA/DoD

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VHB Overview

Source: National Center for Telehealth & Technology (T2)

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Physical vs. Virtual

Source: National Center for Telehealth & Technology (T2)

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Advantages of Virtual Hope Box

Conventional Hope Box: physically unwieldy and inconvenient- often not available when patient needs it most during crises.

A “Virtual Hope Box” (VHB) takes common hope box practice and uses smartphone vehicle and features to enhance access and experience.

• Personal cellphone use extremely high among active and recently retired military personnel

• Service members highly mobile. Need for psychological support most likely to emerge in absence of healthcare providers.

• Smartphone apps can expand the reach of traditional therapeutic interventions beyond the clinic and benefit from rich multimedia.

• Smartphone-based app allows for easily personalized VHB that is highly portable and always available to a user in distress wherever they are.

US Service Members are Heavy Users of Smartphones and Personal Technologies

Military Veterans (N=57)

Guard/Reserve (N=29)

Active SMs (n=151)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

96.6%

96.6%

97.4%

2013: % Using Mobile Phones at Home.

Bush NE, Wheeler WM. Personal Technology Use by US Military Service Members and Veterans: An Update. Telemedicine and eHealth. 2014; In Press.

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US Service Members are Heavy Users of Smartphones and Personal Technologies

Games

Music

Photos/Videos

Texting

Email

Browsing Net

Mobile Phone

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

68.9%

78.8%

65.6%

92.7%

87.4%

91.4%

97.4%

24.9%

28.5%

31.1%

64.1%

26.3%

42.1%

87.6%

2010/11 vs. 2013% of Active Duty SMs Using Mobile Phones at Home.

Years 2010-2011 (N=273) Year 2013 (N=151)

Bush NE, Wheeler WM. Personal Technology Use by US Military Service Members and Veterans: An Update. Telemedicine and eHealth. 2014; In Press.

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Providers and Smartphones

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T2 Virtual Hope Box

VHB designed as tool for use by MH providers with patients as accessory to tx

Patient and MH Provider work together in the clinic to populate VHB on patient’s own smartphone with appropriate personalized content

Patient uses VHB away from clinic and continues to add/change content as needed, with guidance from provider

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Reminders: Focuses the user on cherished memories, reminders in digital media: Photos, videos, recorded messages, music.

Distraction tools: Puzzles/word search games taken from user content.

Preloaded inspirational quotes can be supplemented or replaced by personal quotes, family aphorisms, biblical phrases, etc.

Relaxation tools: controlled breathing tool, progressive muscle relaxation, guided meditations.

User customized support contacts, hotline info.

Coping Tools: (a) Coping Cards highlight adaptive thoughts and behaviors when in crisis or managing problematic core beliefs.

(b) Activity Planner used to improve mood by engaging in activities that are meaningful.

T2 Virtual Hope Box

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Example: Remind Me

Take photos with phone, select existing photos from phone, or download

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Example: Remind Me

Record personal audio or video with phone, select existing from phone, or download

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Example: Remind Me

Select existing music from phone, or download

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Example: Remind Me

Select from collection of media in multiple formats. Set Remind Me to shuffle display.

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Example: Relax Me

Selectable timing and duration for inhale, hold, and exhale

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Example: Distract Me

Puzzle photos and words extracted from existing user content

Selectable levels of difficulty

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Example: Coping Tools

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Example: Coping Tools

John Doe

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Example: Inspire Me

Dr. Bush’s Mother:

“Better to be kind than clever”

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Example: Contacts

John Doe

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Pilot study: Cross-Over Design

Screening & Enrollment

DBT Patients1st Field Testing:

PHB or VHB6-8 Weeks:

Phone Interviews

every 2 weeks

2nd Field Testing:

VHB or PHB6-8 Weeks:

Phone Interviews

every 2 weeks Evaluation of 2nd Field Test

& Final Assessments

In Clinic Away from Clinic

Baseline Assessments

Construction of 2nd Hope Box (PHB or VHB)

Evaluation of 1st Field Test.

Clinician Focus Group

Construction of 1st Hope Box (PHB or VHB)

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Results: Baseline Demographics

     

Sex MaleFemale

108

Age MeanSD

Range

41.48.6

28-56Race Hispanic

Asian/Pacific IslanderAfrican American

WhiteOther/More than one

111

141

Education

 

GED/HSSome College

AA/Tech DegreeBachelor’s Degree

2844

Former Military Branch

 

Air ForceArmy

Marine CorpNavy

Coast Guard

38151

Former Rank

 

E1–E4E5-E9O1-O5

1161

Deployment Hx

NoneDesert Storm

OIFOEF

VietnamOther

925413

PTSD/ Depression 3

PTSD/Bipolar II 1

Borderline Personality Disorder/ Anxiety Disorder 1

Borderline Personality Disorder/ PTSD 2

PTSD 2

PTSD/Opioid Dependence 1

Depression/ Alcohol Dependence 2

PTSD/ Bipolar 1

Mood Disorder NOS 1

Bipolar II/ Alcohol abuse 1

Borderline Personality Disorder/ Bipolar I 1

Borderline Personality Disorder/ Bipolar II 1

Borderline Personality Disorder/ Depression 1

Total 18

• 18 US Service Veterans at high-risk-of-self-harm• Entering the VAMC Portland Mental Health Clinic

DBT program for BPD or PTSD• Identified as clinically suitable by their clinicians for

hope box utilization as part of treatment• Own and regularly use/carry their own iPhones or

Android phones

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Results: Experience with Technology

Self-Rating of Computer Skills

Novice 1

Advanced beginner 3

Competent 6

Proficient 8

Total 18

Smartphone Use <1 Year 1-2 Years >2 YearsiPhone 4 4 2

Android 3 3 5Blackberry 1 4 1

Windows 1 0 0

Personal cellphone usage hours per week

  Less than 1 1

2-5 3

6-10 5

More than 10 9

Total 18

Smartphone Used  

iPhone 9

Android 9

• Participants were relatively experienced smartphone users, with nearly 80% using a smartphone for 6 or more hours a week

• Type of personal phone used for the VHB were evenly divided between iPhone and Android

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Selected Pilot Study Results: Downloaded VHB Usage Logs

Typical new App use in market place: 1-2 times, < 5 minutes, then uninstall

22% of apps used only once (Marketing Pilgrim. 2013. )Only one in four apps engages user (Gahran A. CNNTech. 2011.)

VHB Usage

Detailed usage logs recorded for each patient (17/18) by VHB

VHB # of Days: VHB used on average one or more times on more than 13 separate days (mean=13.58, range 4 - 43 days) away from the clinic

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Downloaded VHB Usage Logs

Overall period of VHB use

14 Typical Users

3 High Users

Almost all patients used the VHB either intermittently or regularly across several weeks away from the clinic. • 15 of the 17 patients used the VHB for more than 2 weeks • 13 used the VHB for more than 4 weeks • 10 of 17 for more than 6 -8 weeks.

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Downloaded VHB Usage Logs

The remaining three show exceptional commitment to daily use of VHB, averaging 26 total hours of VHB use.

Total Duration of VHB Use over All Days

Participants with total duration of use < 2.7 hours

Duration of VHB use amounted to an average of more than one hour of total individual use for the more typical 14 of 17 patients

Three outliers with total duration of use > 15 hours

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Selected Pilot Study Results: Downloaded VHB Usage Logs

Added by Patients Away from Clinic

After initial VHB setup, patients added a variety of personalized media to their VHBs to fit their needs over time, as was intended.

• 483 new Photos• 328 new Inspirational Quotes• 184 new Music files• 74 new Contacts• 40 new Coping Cards

Selected Results: Self-Report Comparing VHB with PHB

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Compared to the Physical Hope Box

More patients

a) used the VHB regularly;

b) found the VHB beneficial and helpful;

c) found the VHB easy to set up;

d) said they were likely to use the VHB in the future and;

e) would recommend the VHB to peers.

Found

Set

up E

asy

Used

at le

ast

1-4

/wk

Found

Help

ful &

Ben

efici

al

Wou

ld co

nside

r usin

g in

futu

re

Wou

ld re

com

men

d to

fello

w vet o

r SM

0

2

4

6

8

10

12

14

16

18

VHB/PHB Patient Feedback N=18

VHB

PHB

# P

ati

en

tsSelf-Report Comparing VHB with Physical

Hope Box (PHB)

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Compared to the Self-Soothing Box or Physical Hope Box,

a) Twice as many patients preferred the VHB for future use than the PHB.

b) Some recommended using both VHB and PHB as a complementary combination

c) None (0) of the patients would recommend the PHB alone to fellow veterans or SMs

d) 38.8% (7) would recommend the VHB alone

e) 61.1% (11) would recommend the VHB and PHB in combination.

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4

4Prefer VHB alone for future use

Prefer PHB alone for future use

Prefer Combination of VHB & PHB for future use

7

11

Would recommend VHB alone to fellow SM or Vet

Would recommend PHB alone to fellow SM or Vet (none)

Prefer Combination of VHB & PHB for future use

Reported Preferences between VHB and PHB

Self-Report Comparing VHB with Physical Hope Box (PHB)

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PHB Items Collected

• blanket/soothing feeling

• rock

• I play with broken lighters to take mind away from negative

• Pocket bible from uncle

• Stuffed animal

• Rock from Israel

• Bath salts

• relaxation cd

• coffee

• Sit by fireplace feeling warmth or failing to determine how to keep fire lit :)

• Vanilla candle

• Jars of tears earrings (gift from sister from Israel)

• Oils/scents - amber & sandalwood

• candy cane

• tea

• Quote cards

• A smooth stone from my therapist with a positive message printed on it

• Deck of cards (to shuffle)

• vanilla/coconut oil

• Stone

• blanket

• coffee/tea

• articles (car related)

• Veterans crisis line reminder card.

• calming techniques cd

• rock, most useful

• Rocks

• Bath salts

• candy • Children's hair • Dried flowers from my father he gave

me flowers when I graduated DBT and I dried them to keep them.

• Candy mints

• Scented bath crystals • My un-plated dime

• Candles, incense, scented oil

• Shells

• movies

• Rock gold (iron pyrite)

• Stones • My shells

• Lighting that can be adjusted/moved

• Pictures

• Marbles

• Small pillow of hair from my children • My knife

• Notebook/journal for thoughts/ideas

• Loop (for jewelry)• Loop (for jewelry)

• Magnetic balls

• Plastic baby doll • My Monkey card

• Assorted colored rocks • My collage • cats

• baby doll • stones • canes

• sunflower seeds

• vanilla/coconut oil • Candle with scented oils

• kids arts and crafts• Sparkly rock

Items collected and used by patients in Self-Soothing (PHB).

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Comments Comparing Two Versions

Self-Soothing Box (PHB) “Tangible”, “Personalized”, “Want to be able to physically touch”; “Having the smell, taste, and touch is important sometimes”

VHB “Can take it everywhere with you”, “More convenient”, “More private”, “More portable”, “With me all the time and it's more effective”, “The other one I have to keep at home”, “More accessible and easier to put together”, “More options”, “Easier to remember to use”;

VHB and PHB Together “There is a benefit to both. PHB has tactile advantage, VHB is more accessible”, “PHB can be more comforting at times, but less convenient.” “The convenience of the VHB and the tools it has, has been beneficial”.

VHB Patient Feedback

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Patient Feedback for VHB

Participants confirmed that they used the VHB application when they felt distressed or emotionally overwhelmed, and spoke to the importance of the application being something private they could access, whether at home, or in a crowded area

• “Helped numb away from distress. Quotes helped turn a negative self-image into a positive self-talk “

• “Keeps me grounded, there are options at what to look at, made it very personal”

• “Helped manage distress at work when having memory issues”

• “Controlled breathing helps me to relax. Pictures remind me that I have a reason to stay on the earth”

• “Quotes keep me thinking about who I am and gave me positive messages. Coping cards reminded me that it is ok to not be perfect”

• “Helped to soothe when thought about cutting. Was distracting until felt better”

• “Helped manage PTSD symptoms like hyper-vigilance”

• “wouldn’t want to get rid of it”

• “It is soothing and prevent me from doing things like yelling at people in line, used box instead to distract self”

VHB Patient Feedback

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Patient Feedback for VHB

Participants confirmed that they used the VHB application when they felt distressed or emotionally overwhelmed, and spoke to the importance of the application being something private they could access, whether at home, or in a crowded area

• “Helped numb away from distress. Quotes helped turn a negative self-image into a positive self-talk “

• “Keeps me grounded, there are options at what to look at, made it very personal”

• “Helped manage distress at work when having memory issues”

• “Controlled breathing helps me to relax. Pictures remind me that I have a reason to stay on the earth”

• “Quotes keep me thinking about who I am and gave me positive messages. Coping cards reminded me that it is ok to not be perfect”

• “Helped to soothe when thought about cutting. Was distracting until felt better”

• “Helped manage PTSD symptoms like hyper-vigilance”

• “wouldn’t want to get rid of it”

• “It is soothing and prevent me from doing things like yelling at people in line, used box instead to distract self”

“Helped numb away from distress. Quotes helped turn a negative self-image into a positive self-talk”

“Controlled breathing helps me to relax. Pictures remind me that I have a reason to stay on the earth” “Quotes keep me thinking about who I am and gave

me positive messages. Coping cards reminded me that it is ok to not be perfect”

“Helped to soothe when thought about cutting. Was distracting until felt better”

“Helped manage PTSD symptoms like hyper-vigilance”

“It is soothing and prevent me from doing things like yelling at people in line, used box instead to distract self”

VHB Clinician Feedback

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Clinician Feedback

• “I find the VHB to be a great tool for completing, working, collaborating with a client, actively, in session.  When I find that the focus of a session turns to themes of “I can’t do anything”; “Nothing will work”; “I won’t do that”, this tool enables collaboration to happen...”.

• “I think it’s great, super easy to use. I show it to all the clients I work with, even the non DBT clients, to show them the range of other apps they can use. … there’s nothing I didn’t like. I found it to be really, really easy to use, remarkably so…”

• “I think VHB could be used both therapeutically or more generalized to other vets. I found it seemed beneficial to those who used it and were engaged with it, not just those with suicidal ideation – good for distress tolerance in general.”

• “Lots of disorders could benefit, like PTSD, depression, anxiety – it could be generalizable therapeutically. It’s not so specific that it only works for certain disorders.”

• “The biggest thing I did was coping cards. It was very powerful to observe and describe their negative statements which were hard to identify as beliefs because they seemed so true. That was a powerful intervention to have those discussions about beliefs vs. truths.

VHB Clinician Feedback

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Clinician Feedback

• “I find the VHB to be a great tool for completing, working, collaborating with a client, actively, in session.  When I find that the focus of a session turns to themes of “I can’t do anything”; “Nothing will work”; “I won’t do that”, this tool enables collaboration to happen...”.

• “I think it’s great, super easy to use. I show it to all the clients I work with, even the non DBT clients, to show them the range of other apps they can use. … there’s nothing I didn’t like. I found it to be really, really easy to use, remarkably so…”

• “I think VHB could be used both therapeutically or more generalized to other vets. I found it seemed beneficial to those who used it and were engaged with it, not just those with suicidal ideation – good for distress tolerance in general.”

• “Lots of disorders could benefit, like PTSD, depression, anxiety – it could be generalizable therapeutically. It’s not so specific that it only works for certain disorders.”

• “The biggest thing I did was coping cards. It was very powerful to observe and describe their negative statements which were hard to identify as beliefs because they seemed so true. That was a powerful intervention to have those discussions about beliefs vs. truths.

“I find the VHB to be a great tool for completing, working, collaborating with a client, actively, in session.  When I find that the focus of a session turns to themes of “I can’t do anything”; “Nothing will work”; “I won’t do that”, this tool enables collaboration to happen...”.

“I think VHB could be used both therapeutically or more generalized to other vets. I found it seemed beneficial to those who used it and were engaged with it, not just those with suicidal ideation – good for distress tolerance in general.”

“Lots of disorders could benefit, like PTSD, depression, anxiety – it could be generalizable therapeutically. It’s not so specific that it only works for certain disorders.”

“The biggest thing I did was coping cards. It was very powerful to observe and describe their negative statements which were hard to identify as beliefs because they seemed so true. That was a powerful intervention to have those discussions about beliefs vs. truths.

Market Place Feedback

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Love it! Great app!

Love this app. Thanks you put it for free use It can save lives. I can carry VHB anywhere whether im deplyed or at home. Could be improved with more sharp sceneries and sounds. It will be good idea if one has the option of playing a favourite game by storing it in the box apart from the few fixed ones in box.

Won't install on HTC Incredible 4G Looks great, but on installation it keeps giving an "unknown installation error: 919"

Finally! This is a great app for when you need a lift and some hope no matter where you are. Bravo!!!

WONDERFUL APP Incredible incredible app. Very helpful. MA MFT Great app. I recommend it to my clients.Inspiring As someone who suffers from depression and anxiety it can be hard for me to relax or focus on positive things. I have never found an app more perfect. I never write reviews or rate but this app deserves it!!Fantastic app My therapist recommended this app to me and I downloaded it immediately. I have suffered from anxiety and depression most of my life and I find this app helps me tremendously. Can't recommend it highly enough.Good app Very nice, helpful... I like it

Thank you I use the app everyday. And I have used plenty of apps but this one seems to be the best.

Highly recommend This is just what I was looking for as assistance following some intense therapy sessions. Highly recommend to anyone needing a variety of distractions or grounding to use in different situations.

Joyful, relaxing and positive This app is so well balanced and is a positive and meaningful part of my recovery

Wonderful app! I use this app for myself and for my clients struggling with anxiety and depression. I love it and my clients love this app. I hope you all continue to update the app often. Keep up the good work!

Like I just installed it and will recommend it to my patients, but I haven't added any content as yet. When I or my patients find it helpful, I can give a better rating.

Virtual hope box This app really helps meLike the app for variety dont like that you can't play bg music when doing puzzles or playing games

More apps like this needed! Excellent app! This is the type of thing needed for today's youth and creating healthy ways to interact and use technology! Bravo! We will be recommending this for our inpatient psychiatric adolescent patients!A beautiful app I just love this APP. Kudo's to whoever designed this one!

Helpful It's a great start. The tools could be very useful and potentially save lives. I will be recommending this to my Soldiers.

Great Awesome app, has a few glitches on the music portion and the hold on the relax part, helps me when trying to sleep after a long day

amazing Amazing app!! I use this myself and recommend it to my clients! Love it!!!

Wow This is really really great. never found anything like this - for someone with ptsd & bipolar disorder, this is like a dream-App come true! thank you!

Excellent, take home tools for your clients in a teen friendly format

As a person who suffers from SAD and Bipolar this app is great for my down days and helps me get through those days where I feel like I'm stuck with no escape

Hallelujah! An app that I can use myself and recommend to my Soldiers. Well done, easy to use and simple. I will be using this app with all of my Soldiers in conjunction with our HeartMath biofeedback sessions.

Amazing As a therapist this is the best app I've ever seen. Takes complete advantage of every capability of a smart phone. Just what the Dr. Ordered.

Market Place Feedback

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Love it! Great app!

Love this app. Thanks you put it for free use It can save lives. I can carry VHB anywhere whether im deplyed or at home. Could be improved with more sharp sceneries and sounds. It will be good idea if one has the option of playing a favourite game by storing it in the box apart from the few fixed ones in box.

Won't install on HTC Incredible 4G Looks great, but on installation it keeps giving an "unknown installation error: 919"

Finally! This is a great app for when you need a lift and some hope no matter where you are. Bravo!!!

WONDERFUL APP Incredible incredible app. Very helpful. MA MFT Great app. I recommend it to my clients.Inspiring As someone who suffers from depression and anxiety it can be hard for me to relax or focus on positive things. I have never found an app more perfect. I never write reviews or rate but this app deserves it!!Fantastic app My therapist recommended this app to me and I downloaded it immediately. I have suffered from anxiety and depression most of my life and I find this app helps me tremendously. Can't recommend it highly enough.Good app Very nice, helpful... I like it

Thank you I use the app everyday. And I have used plenty of apps but this one seems to be the best.

Highly recommend This is just what I was looking for as assistance following some intense therapy sessions. Highly recommend to anyone needing a variety of distractions or grounding to use in different situations.

Joyful, relaxing and positive This app is so well balanced and is a positive and meaningful part of my recovery

Wonderful app! I use this app for myself and for my clients struggling with anxiety and depression. I love it and my clients love this app. I hope you all continue to update the app often. Keep up the good work!

Like I just installed it and will recommend it to my patients, but I haven't added any content as yet. When I or my patients find it helpful, I can give a better rating.

Virtual hope box This app really helps meLike the app for variety dont like that you can't play bg music when doing puzzles or playing games

More apps like this needed! Excellent app! This is the type of thing needed for today's youth and creating healthy ways to interact and use technology! Bravo! We will be recommending this for our inpatient psychiatric adolescent patients!A beautiful app I just love this APP. Kudo's to whoever designed this one!

Helpful It's a great start. The tools could be very useful and potentially save lives. I will be recommending this to my Soldiers.

Great Awesome app, has a few glitches on the music portion and the hold on the relax part, helps me when trying to sleep after a long day

amazing Amazing app!! I use this myself and recommend it to my clients! Love it!!!

Wow This is really really great. never found anything like this - for someone with ptsd & bipolar disorder, this is like a dream-App come true! thank you!

Excellent, take home tools for your clients in a teen friendly format

As a person who suffers from SAD and Bipolar this app is great for my down days and helps me get through those days where I feel like I'm stuck with no escape

Hallelujah! An app that I can use myself and recommend to my Soldiers. Well done, easy to use and simple. I will be using this app with all of my Soldiers in conjunction with our HeartMath biofeedback sessions.

Amazing As a therapist this is the best app I've ever seen. Takes complete advantage of every capability of a smart phone. Just what the Dr. Ordered.

“Inspiring As someone who suffers from depression and anxiety it can be hard for me to relax or focus on positive things. I have never found an app more perfect. I never write reviews or rate but this app deserves it!!”

“Fantastic app My therapist recommended this app to me and I downloaded it immediately. I have suffered from anxiety and depression most of my life and I find this app helps me tremendously. Can't recommend it highly enough.”“Joyful, relaxing and positive This app is so well balanced and is a positive and meaningful part of my recovery”“Wonderful app! I use this app for myself and for my clients struggling with anxiety and depression. I love it and my clients love this app. I hope you all continue to update the app often. Keep up the good work!”

“More apps like this needed! Excellent app! This is the type of thing needed for today's youth and creating healthy ways to interact and use technology! Bravo! We will be recommending this for our inpatient psychiatric adolescent patients!”

“Wow This is really really great. never found anything like this - for someone with ptsd & bipolar disorder, this is like a dream-App come true! thank you”“As a person who suffers from SAD and Bipolar this app is great for my down days and helps me get through those days where I feel like I'm stuck with no escape ”“Hallelujah! An app that I can use myself and recommend to my Soldiers. Well done, easy to use and simple. I will be using this app with all of my Soldiers”

“Amazing As a therapist this is the best app I've ever seen. Takes complete advantage of every capability of a smart phone. Just what the Dr. Ordered.”

Need for More Awareness

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Current Status

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1. Release: Revised production VHB released as free app to Android and IOS marketplaces March/April 2014.

• 500-600 downloads/week, 10,000 total by September 8.

2. RCT: New 2 year MSRC RCT: 100 VA patients at elevated risk for suicidal self-harm behaviors:

• VHB vs. TAU for 12 weeks with measures at baseline, 3 weeks, 6 weeks and 12 weeks.

• Effectiveness of VHB smartphone app to a) reduce severity of suicidal ideation; b) increase ability to cope with stressors and; c) increase perceived reasons for living, both pre-post and compared to TAU

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Individual vs. Group Therapy

• Research above is largely based on Individual therapy but skills building is often done in a group setting

• Using VHB in IOP

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In Session

(1). Emergency Contact

(2). Remind me

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In Session Work

(1). Coping Cards

(2). Activities

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Clinician Buy-in

• Train-the-trainer model used in IOP• Do they have a smartphone?• Do they know how to use it?• Do they have the time to learn the app?• Privacy/Security concerns

– Understanding a EULA

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Call to Action

• Military provider’s technology use, in the support of treatment, is limited and less than medical providers use.

• Several mobile applications exist to support gold standard treatments such as PE, ACT, CPT, DBT, CBTi. – As well as applications that support therapy efforts

(PES, mindfulness training)

• Education and training efforts should be made to increase use of such technologies among DoD and VA providers.

Translation into Practice: Downloads & User Guides

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o Androidhttps://play.google.com/store/apps/details?id=com.t2.vhb

o IOShttps://itunes.apple.com/us/app/virtual-hope-box/id825099621?mt=8

o Downloadable Clinician and Patients Use Guides

http://www.t2health.org/apps/virtual-hope-boxhttp://www.t2health.dcoe.mil/apps/virtual-hope-box

Paper of results : Bush NE, Dobscha SK, Crumpton R, et al. A Virtual Hope Box Smartphone App as an Accessory to Therapy: Proof-of-Concept in a Clinical Sample of Veterans. Suicide & Life-Threatening Behavior. 2014. DOI: 10.1111/sltb.12103

Android

IOS

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Does it Work? Recent Email

-- "I wasn't sure who to contact about this. I was going to leave a comment on the Facebook post about this, and maybe still will, just feeling a little sensitive and not sure how much to share on such a public forum. Anyway, I just wanted to say a huge thank you for putting the VHB out and for whomever posted it on fb when they did. The last few weeks have been especially hard. I suffer from PTSD and have been going through a lot of trauma therapy. The past 3-4 days I have come to the point of suicide. Made all the plans, wrote the notes, etc. Then I came across the VHB post. Now I know I am not a clinician, but I looked [at] the guide and downloaded the app anyway. I use the PE Coach regularly and thought why not see what the VHB is about. As I started adding pictures and videos and songs I found myself smiling and feeling better. I started thinking, okay maybe life isn't so bad that I need to end it. I knew I needed to just get through this hard time and that the sun will shine again. I am rambling, but I sincerely wanted to thank you. You and your company and what you guys are putting out here for those that suffer from mental illnesses is saving lives. You saved mine today."

(T2 followed up with this individual and ensured they put a good safety plan in place. In addition they facilitated a visit to the person’s therapist).

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References

• Bush NE, Dobscha SK, Crumpton R, et al. A Virtual Hope Box Smartphone App as an Accessory to Therapy: Proof-of-Concept in a Clinical Sample of Veterans. Suicide & Life-Threatening Behavior. 2014. DOI: 10.1111/sltb.12103

• Bush NE, Wheeler WM. Personal Technology Use by US Military Service Members and Veterans: An Update. Telemedicine and eHealth. 2014; In Press

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Amanda Stewart, Ph.D.amanda.e.stewart7.civ@mail.mil

Nigel Bush, Ph.D.nigel.e.bush.civ@mail.mil

http://t2health.dcoe.mil/

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Product Brief

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Questions?

Submit questions via the Q&A box located on the screen.

The Q&A box is monitored and questions will be forwarded to our presenters for response.

We will respond to as many questions as time permits.

DCoE Contact Info

DCoE Outreach Center

866-966-1020 (toll-free)

dcoe.mil

resources@dcoeoutreach.org

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Save the Date

Next DCoE Behavioral Health Technology Webinar:Wednesday December 17th, 2014, 1-2:30pm EST Evidence base for using Technology Solutions in Behavioral Health CarePresenters: Nancy Skopp, Ph.D. & Jae Osenbach, Ph.D.

Next DCoE TBI Webinar:Thursday, November 13th, 2014, 1-2:30pm EST Technology Interventions for TBIPresenter: David Cooper, PsyD

Next DCoE Psychological Health Webinar:Thursday, November 20th, 2014 1-2:30pm EST Technology Interventions for Psychological HealthPresenters: Robert Ciulla, Ph.D. & Don Workman, Ph.D.