title: Online and smartphone based cognitive behavioral therapy for bariatric surgery patients: Initial pilot study.
abstract: BACKGROUND
  The respective rates of obesity in Canada and the United states are estimated to be 24.1% and 34.1%. Due to the increased incidence of obesity, Bariatric surgery has been recognized as one of the treatment options. Despite the success of Bariatric surgery, studies have proposed that it has neglected the contributions of other factors, such as psychological factors in the causation as well as the maintenance of obesity amongst individuals. Cognitive behavioral therapy (CBT) is largely a psychosocial intervention that has been shown to be efficacious, as studies have demonstrated that even brief CBT interventions could help in the reduction of binge eating and maintenance of weight loss. Previously identified problems with regards to the integration and the provision of such interventions include that of geographical barriers. In order to overcome the geographical barriers, telephone-based CBT has been conceptualized. Over the past decade, there has been massive advancement and development in Internet, Web-based and smartphone technologies, but there is still a paucity of applications in this area.
  
  
  OBJECTIVE
  Our current research objective is to determine if bariatric surgery patients will be receptive towards an online and smartphone based CBT intervention.
  
  
  METHODS
  The Bariatric Surgery Online CBT portal and Smartphone companion application was developed between July 2013 and December 2013. A low-cost methodology of developing the online portal was adopted. In terms of development, 4 core development phases were adopted. These included that of: a) Formulation of users' requirements, b) System design and development, c) System evaluation and d) System deployment and pilot application. The bariatric surgery workgroup from the Toronto Western Hospital helped with the recruitment of the subjects from the outpatient specialist service. Links to the web-portal was provided to each of the participants recruited.
  
  
  RESULTS
  Since the inception of the online portal to date, in terms of usage rates, there have been a total of 2408 visitors to the online portal. The majority of the visitors are from Canada (n= 1879). From the analytics, a total of 8 users have participated in the pre-assessment questionnaire and have attempted and tried to use the individual modules. Since the inception of the pilot study from January 2014 till October 2014, 4 individuals have completed at least 3 modules available on the online portal.
  
  
  CONCLUSIONS
  This is one of the first few studies that have demonstrated the potential feasibility of having an online and smartphone cognitive behavioral portal to serve the psychological needs of bariatric surgery patients.
authors.affiliation: National HealthCare Group, Singapore.
authors.forename: Melvyn W B
authors.initials: MW
authors.lastname: Zhang
authors.affiliation: Department of Psychological Medicine, National University Healthcare Systems, Singapore.
authors.forename: Roger C M
authors.initials: RC
authors.lastname: Ho
authors.affiliation: Department of Psychology, Ryerson University, Toronto, ON, Canada.
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Cassin
authors.affiliation: Centre for Mental Health, University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Raed
authors.initials: R
authors.lastname: Hawa
authors.affiliation: Centre for Mental Health, University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sockalingam
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000379:methods* / Q000523:psychology*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D020377:Self Efficacy; D000068997:Smartphone
keywords: Bariatric psycho-social care; CBT; online interventions; psychiatry; smartphone