Smartphone-Based Digital Interventions to Improve Mood during Blended Treatment for Cancer Survivors: Results from a Nested Randomized Clinical Trial Component (Preprint)

BACKGROUND Cancer is related to physical but also mental suffering. Notably, body image disturbances are highly relevant cancer-related changes, often persisting beyond recovery from cancer. Scalable and low-barrier interventions that can be blended with face-to-face psychotherapy for cancer survivors are highly warranted. OBJECTIVE To examine the effect of digital smartphone-based bodily interventions on mood in cancer survivors. METHODS We recruited cancer patients in two Swiss hospitals and conducted daily, fully automated smartphone-based interventions six times a week for five consecutive weeks, blended with weekly face-to-face group body psychotherapy. We applied two types of smartphone-based interventions, using a within-subject design, randomly assigning patients daily to either bodily interventions or to fairy tales. Each intervention type was presented three times a week. We estimated three-level mixed models, with mood assessed by the three ‘Multidimensional Mood Questionnaire‘ (MDMQ) subscales for mood, wakefulness, and calmness as primary outcome, and experience of presence, vitality, and burden assessed with visual analog scales (VAS) as secondary outcome. RESULTS Based on data from s=732 interventions performed by 36 participants, mood improved (b=0.27; 95% confidence interval (CI) 0.062–0.483) and participants became calmer (b=0.98; 95%CI 0.740–1.211) following smartphone-based interventions. Wakefulness did not significantly change from pre- to post-smartphone-based intervention (b=0.17; 95%CI -0.081–0.412). This was true for both intervention types. There was no interaction effect of intervention type with change in mood (b=-0.01; 95%CI -0.439–0.417), calmness (b=0.22; 95%CI -0.228–0.728), or wakefulness (b=0.14; 95%CI -0.354–0.644). Experience of presence (b=0.34; 95%CI 0.271–0.417) and vitality (b=0.35; 95%CI 0.268–0.426) increased from pre- to post-smartphone-based intervention, while experience of burden decreased (b=-0.40; 95%CI -0.481–0.311). Again, these effects were present for both intervention types. There were no significant interaction effects of intervention type with pre- to post-intervention changes in experience of presence (b=0.14; 95%CI -0.104–0.384), experience of vitality (b=0.06; 95%CI -0.152–0.265), and experience of burden (b=-0.16; 95%CI -0.358–0.017). CONCLUSIONS Results suggest that both, smartphone-based audio-guided bodily interventions and fairy tales have potential to improve mood of cancer survivors. CLINICALTRIAL ClinicalTrials.gov NCT03707548 INTERNATIONAL REGISTERED REPORT RR2-10.1186/s40359-019-0357-1