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Northwestern University Feinberg School of Medicine
Center for Behavioral Intervention Technologies

Workbooks & Protocols

Beating Depression: Cognitive Behavioral Therapy Patient Workbook

Workbooks for patients in psychotherapy have long been found to be useful as an adjunctive tool to help provide guidance and support between sessions. We wrote the Beating Depression: Cognitive Behavioral Therapy Patient Workbook to support telephone administered therapy. This workbook-supported treatment has been validated in several randomized trials. We have made this workbook freely available to patients and therapists to be used to support psychotherapy. However, as it is copyrighted, we ask that it not be modified without prior agreement.

Download the Beating Depression: Cognitive Behavioral Therapy Patient Workbook.

References

  • Mohr DC, Ho J, Duffecy J, et al. Effect of telephone-administered vs face-to-face cognitive behavioral therapy on adherence to therapy and depression outcomes among primary care patients: a randomized trial. JAMA. 2012;307(21):2278-2285.
  • Mohr DC, Lattie EG, Tomasino KN, et al. A randomized noninferiority trial evaluating remotely-delivered stepped care for depression using internet cognitive behavioral therapy (CBT) and telephone CBT. Behav Res Ther. 2019;123:103485.
  • Mohr DC, Hart SL, Marmar CM. Telephone administered cognitive-behavioral therapy for the treatment of depression in a rural primary care clinic. Cognitive Therapy and Research. 2006;30:29-37.
  • Mohr DC, Hart SL, Julian L, et al. Telephone-administered psychotherapy for depression. Arch Gen Psychiatry. 2005;62(9):1007-1014.
  • Mohr DC, Likosky W, Bertagnolli A, et al. Telephone-administered cognitive-behavioral therapy for the treatment of depressive symptoms in multiple sclerosis. J Consult Clin Psychol. 2000;68(2):356-361.

Supportive Accountability Coaching Manual

The Supportive Accountability Model describes the elements of coaching that produce greater patient engagement with digital mental health tools. Accountability is defined as knowing that one will have to communicate with another person in the future about whether they performed the agreed-upon actions, such as the use of a digital mental health application. The 2011 paper (see references) has become one of the most highly cited papers on digital mental health coaching. We provide our first Supportive Accountability Coaching Manual free of charge to be used, but, as it is copyrighted, we ask that it not be modified without prior agreement.

Download the Supportive Accountability Coaching Manual.

References

  • Mohr DC, Cuijpers P, Lehman K. Supportive Accountability: A Model for Providing Human Support to Enhance Adherence to eHealth Interventions. J Med Internet Res. 2011;13(1):e30.
  • Mohr DC, Duffecy J, Jin L, et al. Multimodal e-mental health treatment for depression: a feasibility trial. J Med Internet Res. 2010;12(5):e48.

The ThinkFeelDo Internet Intervention Coaching Manual

There is a growing body of evidence that Supportive Accountability increases patient engagement with digital tools, however, the effect of Supportive Accountability on clinical outcomes has been mixed. This led to our creation of the Efficiency Model (see reference below), which extends Supportive Accountability by incorporating therapist attention to ensuring that the patient understands the psychological strategies provided, the psychological strategies are a good fit with the needs and preferences of the patient and the patient is implementing these strategies in the course of their lives, independent of their use of the digital tool. This manual was first developed to operationalize the Efficiency Model for use with our web-based intervention for depression, ThinkFeelDo (more information on that intervention can be found under ThinkFeelDo and Stepped Care). This manual is free to download and use, however, as it is copyrighted, we ask that it not be modified without prior agreement.

Download the ThinkFeelDo Internet Intervention Coaching Manual.

References

  • Schueller SM, Tomasino KN, Mohr DC. Integrating Human Support into Behavioral Intervention Technologies: The Efficiency Model of Support. Clinical Psychology: Science and Practice. 2016(24):27-45.
  • Mohr DC, Lattie EG, Tomasino KN, et al. A randomized noninferiority trial evaluating remotely-delivered stepped care for depression using internet cognitive behavioral therapy (CBT) and telephone CBT. Behav Res Ther. 2019;123:103485.
  • Tomasino KN, Lattie EG, Wilson RE, Mohr DC. Coaching Manual for the ThinkFeelDo Internet Intervention Program. In: Chicago, IL: Northwestern University; 2017.

IntelliCare Coaching Manual

The IntelliCare Coaching Manual was created to support users of our IntelliCare Platform, which is a suite of apps designed to treat depression and anxiety (see the IntelliCare page for more information). This manual relies primarily on our Supportive Accountability model. Coaches provide an initial phone call, aimed at establishing a supportive relationship and ensuring that the main Hub App is properly installed on the user’s phone. All subsequent communication is conducted via brief messaging, although users may be offered a second 10-minute after four weeks. The manual is free to download and use, however, as it is copyrighted, we ask that it not be modified without prior agreement. 

Download the IntelliCare Study Coaching Manual.

References

  • Noth KN, Bardsley L, Lattie EG, Mohr DC. IntelliCare Study Coaching Manual. In: Chicago, IL: Northwestern University; 2018.
  • Mohr DC, Tomasino KN, Lattie EG, et al. IntelliCare: An Eclectic, Skills-Based App Suite for the Treatment of Depression and Anxiety. J Med Internet Res. 2017;19(1):e10.
  • Mohr DC, Schueller SM, Tomasino KN, et al. Comparison of the Effects of Coaching and Receipt of App Recommendations on Depression, Anxiety, and Engagement in the IntelliCare Platform: Factorial Randomized Controlled Trial. J Med Internet Res. 2019;21(8):e13609.
  • Graham AK, Greene CJ, Kwasny MJ, et al. Coached Mobile App Platform for the Treatment of Depression and Anxiety Among Primary Care Patients: A Randomized Clinical Trial. JAMA Psychiatry. 2020.

Learning to Self-Inject: A Cognitive Behavioral Approach to Overcoming Injection Anxiety

Many medications require self-injection for administration. Blood-injection-injury phobia is experienced by 3 to 5 percent of the population, however, far more people likely experience anxiety sufficient to interfere with that ability to perform self-injection. The prevalence and severity of self-injection anxiety, can vary with how the injection is administered  For example, difficulties with intramuscular injections are likely more common than difficulties with subcutaneous injection. We developed a self-injection workbook for people with multiple sclerosis, who were prescribed medications that required intramuscular injections, but were unable to perform these injections themselves due to anxiety. This manual has been validated in the context of brief treatments provided by psychologists and nurses. The manual is free to download and use, however, as it is copyrighted, we ask that modifications to the manual not be made without prior agreement.

Download the Self-Injection Anxiety Treatment Manual.

References

  • Mohr DC, Boudewyn AC, Likosky W, Levine E, Goodkin DE. Injectable medication for the treatment of multiple sclerosis: the influence of self-efficacy expectations and injection anxiety on adherence and ability to self-inject. Ann Behav Med. 2001;23(2):125-132.
  • Mohr DC, Cox D, Epstein L, Boudewyn A. Teaching patients to self-inject: pilot study of a treatment for injection anxiety and phobia in multiple sclerosis patients prescribed injectable medications. J Behav Ther Exp Psychiatry. 2002;33(1):39-47.
  • Cox D, Mohr DC. Managing difficulties with adherence to injectable medications due to blood, injection, and injury phobia and self-injection anxiety. Am J Drug Deliv. 2003;1(3):215-221.
  • Cox D, Mohr, D.C. & Epstein, L. . Treating self-injection phobia in patients prescribed injectable medications: Case examples illustrating a six-session treatment model. Cognitive and Behavioral Practice. 2004;11:278-283.
  • Mohr DC, Cox D, Merluzzi N. Self-injection anxiety training: a treatment for patients unable to self-inject injectable medications. Mult Scler. 2005;11(2):182-185.
  • Mohr DC, Cox D. Learning to Self-Inject: A Cognitive Behavioral Approach to Overcoming Injection Anxiety. In: Chicago, IL: Northwestern University; 2003.

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