Characterizing Behavioral Engagement in Smartphone Cognitive Behavioral Therapy for Obsessive Compulsive Disorder: Secondary Analysis of a Randomized Controlled Trial

Digital mental health interventions (DMHIs) are increasingly popular for their ability to disseminate evidence-based treatments in a scalable, accessible way. Engagement with digital treatments is critical for effectiveness but remains poorly defined and measured. Most studies rely on subjective self-reports or 1 or 2 objective metrics, overlooking the multidimensional nature of how users interact with DMHIs.

This exploratory secondary analysis applied a road map for comprehensive behavioral engagement measurement, developed for a prior smartphone cognitive behavioral therapy program for body dysmorphic disorder, to a 12-week randomized controlled trial of smartphone cognitive behavioral therapy for obsessive compulsive disorder (OCD; N=60). Aims were to (1) comprehensively characterize behavioral engagement using 21 objective app analytics-based variables, (2) identify distinct behavioral engagement profiles via cluster analysis, (3) assess whether profiles were differentially associated with OCD symptom change, and (4) evaluate associations between profiles and pretreatment credibility, expectancy, posttreatment satisfaction, and perceived app quality.