Evidence map›Paper›PMID 41616858›Full record

ArticleJournal of affective disorders2026

Quality of engagement with in-the-moment digital CBT during periods of distress: A study of patients with suicidal thoughts and behaviors.

Molly I Ball, Matthew J Flics, Joseph S Maimone, Stuart Beck, Michelle B Stein, Matthew K Nock, Kate H Bentley, Evan M Kleiman

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of affective disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Molly I BallDepartment of Psychology, Rutgers University, 53 Avenue E, 6(th) floor, Piscataway, NJ, 08854, USA. Electronic address: molly.ball@rutgers.edu.
Matthew J FlicsDepartment of Psychology, Harvard University, 33 Kirkland St, 12(th) floor, Cambridge, MA, 02138, USA; Department of Psychiatry, Massachusetts General Hospital, 185 Cambridge Street, 2(nd) floor, Boston, MA, 02114, USA.
Joseph S MaimoneDepartment of Psychological and Brain Sciences, Boston University, 64 Cummington Mall # 149, Boston, MA, 02215, USA.
Stuart BeckDepartment of Psychiatry, Massachusetts General Hospital, 185 Cambridge Street, 2(nd) floor, Boston, MA, 02114, USA.
Michelle B SteinDepartment of Psychiatry, Massachusetts General Hospital, 185 Cambridge Street, 2(nd) floor, Boston, MA, 02114, USA.
Matthew K NockDepartment of Psychology, Harvard University, 33 Kirkland St, 12(th) floor, Cambridge, MA, 02138, USA; Department of Psychiatry, Massachusetts General Hospital, 185 Cambridge Street, 2(nd) floor, Boston, MA, 02114, USA.
Kate H BentleyDepartment of Psychology, Harvard University, 33 Kirkland St, 12(th) floor, Cambridge, MA, 02138, USA; Department of Psychiatry, Massachusetts General Hospital, 185 Cambridge Street, 2(nd) floor, Boston, MA, 02114, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
Evan M KleimanDepartment of Psychology, Rutgers University, 53 Avenue E, 6(th) floor, Piscataway, NJ, 08854, USA.

Funding

Digital Monitoring of Agitation for Short-Term Suicide Risk PredictionK23MH120436 · NIMH · MASSACHUSETTS GENERAL HOSPITAL · PI BENTLEY, KATE H. · 2019 to 2024
$1.0M
Telehealth Supplement to Realtime Intervention for Suicide Risk ReductionR34MH113757 · NIMH · RUTGERS, THE STATE UNIV OF N.J. · PI KLEIMAN, EVAN · 2018 to 2020
$815k
NIMH NIH HHS K23 MH120436NIMH NIH HHS R34 MH113757
6 · The paper itself

Abstract

Practicing CBT skills outside of therapy sessions is a core component of effective treatment, yet meaningful engagement can be difficult during periods of elevated psychological distress. Smartphone-based ecological momentary interventions (EMIs) offer a promising approach to support real-time skill use, but most research has focused on frequency rather than quality of engagement. This study examined the quality of CBT skills practice in a 28-day smartphone-based EMI following inpatient discharge and explored its associations with internal context and intervention effectiveness. Twenty-three adults hospitalized for suicidal thoughts and behaviors participated, selecting and practicing one of three guided CBT skills exercises (Mindful Emotional Awareness, Countering Emotional Behavior, or Cognitive Flexibility) up to three times daily. A structured coding system was used to rate the completeness and relevance of 945 total exercises (0-2 scale). Quality varied primarily within individuals and was lower during moments of high suicidal intent and urge. When combining across all skills, quality was not associated with proximal change. However, higher-quality Countering Emotional Behavior practice predicted greater reductions in suicidal intent, and higher-quality Countering Emotional Behavior and Cognitive Flexibility practice predicted greater reductions in anger. These findings suggest that momentary distress can impact engagement quality, and that the short-term impact of skills practice may depend on both the specific CBT strategy and type of distress targeted. Understanding and enhancing engagement quality is a key step toward optimizing mobile interventions for individuals in the midst of psychological distress.

Indexed as

Cognitive Behavioral TherapyPsychological DistressStress, PsychologicalSuicidal IdeationAdultCognitive FlexibilityCoping SkillsEcological Momentary AssessmentEmotionsFemaleHumansMaleMiddle AgedSmartphoneTreatment OutcomeCognitive behavioral therapyEcological momentary interventionEmotion regulationEngagementSkills practiceSuicidal thoughts

Identifiers

PMID41616858
PMCPMC13347286

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.