title: A Virtual Hope Box: Randomized Controlled Trial of a Smartphone App for Emotional Regulation and Coping With Distress.
abstract: OBJECTIVE
  The purpose of this study was to assess the impact of the Virtual Hope Box (VHB), a smartphone app to improve stress coping skills, suicidal ideation, and perceived reasons for living among patients at elevated risk of suicide and self-harm.
  
  
  METHODS
  The authors conducted a parallel-group randomized controlled trial with two groups of U.S. service veterans in active mental health treatment who had recently expressed suicidal ideation. Between March 2014 and April 2015, 118 patients were enrolled in the study. Participants were assigned to use the VHB (N=58) or to a control group that received printed materials about coping with suicidality (N=60) to supplement treatment as usual over a 12-week period. Three measures-the Coping Self-Efficacy Scale, Beck Scale for Suicidal Ideation, and Brief Reasons for Living Inventory-were collected at baseline (before randomization) and three, six, and 12 weeks. Secondary measures-the Interpersonal Needs Questionnaire, Perceived Stress Scale, and Columbia-Suicide Severity Rating Scale-were collected at baseline and 12 weeks.
  
  
  RESULTS
  VHB users reported significantly greater ability to cope with unpleasant emotions and thoughts (Coping Self-Efficacy Scale) at three (b=2.41, 95% confidence interval [CI]=.29-4.55) and 12 weeks (b=2.99, 95% CI=.08-5.90) compared with the control group. No significant advantage was found on other outcome measures for treatment augmented by the VHB.
  
  
  CONCLUSIONS
  The VHB is a demonstrably useful accessory to treatment-an easily accessible tool that can increase stress coping skills. Because the app is easily disseminated across a large population, it is likely to have broad, positive utility in behavioral health care.
authors.affiliation: Dr. Bush, Dr. Smolenski, and Ms. Thomas are with the National Center for Telehealth and Technology, U.S. Department of Defense, Joint Base Lewis-McChord, Tacoma, Washington (e-mail: nigel.e.bush.civ@mail.mil ). Dr. Denneson and Ms. Williams are with the Center to Improve Veteran Involvement in Care, U.S. Department of Veterans Affairs (VA) Portland Health Care System, Portland, Oregon, where Dr. Dobscha is with the Mental Health Division. Dr. Dobscha is also with the Department of Psychiatry, Oregon Health and Science University, Portland.
authors.forename: Nigel E
authors.initials: NE
authors.lastname: Bush
authors.affiliation: Dr. Bush, Dr. Smolenski, and Ms. Thomas are with the National Center for Telehealth and Technology, U.S. Department of Defense, Joint Base Lewis-McChord, Tacoma, Washington (e-mail: nigel.e.bush.civ@mail.mil ). Dr. Denneson and Ms. Williams are with the Center to Improve Veteran Involvement in Care, U.S. Department of Veterans Affairs (VA) Portland Health Care System, Portland, Oregon, where Dr. Dobscha is with the Mental Health Division. Dr. Dobscha is also with the Department of Psychiatry, Oregon Health and Science University, Portland.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Smolenski
authors.affiliation: Dr. Bush, Dr. Smolenski, and Ms. Thomas are with the National Center for Telehealth and Technology, U.S. Department of Defense, Joint Base Lewis-McChord, Tacoma, Washington (e-mail: nigel.e.bush.civ@mail.mil ). Dr. Denneson and Ms. Williams are with the Center to Improve Veteran Involvement in Care, U.S. Department of Veterans Affairs (VA) Portland Health Care System, Portland, Oregon, where Dr. Dobscha is with the Mental Health Division. Dr. Dobscha is also with the Department of Psychiatry, Oregon Health and Science University, Portland.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Denneson
authors.affiliation: Dr. Bush, Dr. Smolenski, and Ms. Thomas are with the National Center for Telehealth and Technology, U.S. Department of Defense, Joint Base Lewis-McChord, Tacoma, Washington (e-mail: nigel.e.bush.civ@mail.mil ). Dr. Denneson and Ms. Williams are with the Center to Improve Veteran Involvement in Care, U.S. Department of Veterans Affairs (VA) Portland Health Care System, Portland, Oregon, where Dr. Dobscha is with the Mental Health Division. Dr. Dobscha is also with the Department of Psychiatry, Oregon Health and Science University, Portland.
authors.forename: Holly B
authors.initials: HB
authors.lastname: Williams
authors.affiliation: Dr. Bush, Dr. Smolenski, and Ms. Thomas are with the National Center for Telehealth and Technology, U.S. Department of Defense, Joint Base Lewis-McChord, Tacoma, Washington (e-mail: nigel.e.bush.civ@mail.mil ). Dr. Denneson and Ms. Williams are with the Center to Improve Veteran Involvement in Care, U.S. Department of Veterans Affairs (VA) Portland Health Care System, Portland, Oregon, where Dr. Dobscha is with the Mental Health Division. Dr. Dobscha is also with the Department of Psychiatry, Oregon Health and Science University, Portland.
authors.forename: Elissa K
authors.initials: EK
authors.lastname: Thomas
authors.affiliation: Dr. Bush, Dr. Smolenski, and Ms. Thomas are with the National Center for Telehealth and Technology, U.S. Department of Defense, Joint Base Lewis-McChord, Tacoma, Washington (e-mail: nigel.e.bush.civ@mail.mil ). Dr. Denneson and Ms. Williams are with the Center to Improve Veteran Involvement in Care, U.S. Department of Veterans Affairs (VA) Portland Health Care System, Portland, Oregon, where Dr. Dobscha is with the Mental Health Division. Dr. Dobscha is also with the Department of Psychiatry, Oregon Health and Science University, Portland.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Dobscha
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology*; D000328:Adult; D004644:Emotions / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063731:Mobile Applications; D017063:Outcome Assessment, Health Care; D020377:Self Efficacy; D016728:Self-Injurious Behavior / Q000517:prevention & control*; D000068997:Smartphone; D014728:Veterans
keywords: Behavior therapy; Military psychiatry; Mobile health; Mobile technology; Smartphone