--- title: "Smartphone-assisted just-in-time support for in vivo exposure in anxiety disorders: trial protocol" id: "bmj-open-5-maximising-the-efficacy-of-in-vivo-exposure-therapy-using-smartphone-assisted" canonical_url: "https://medichelpline.com/clinical-feed/bmj-open-5-maximising-the-efficacy-of-in-vivo-exposure-therapy-using-smartphone-assisted" content_type: "clinical_feed_article" specialty: "General" source_name: "BMJ Open" source_url: "http://bmjopen.bmj.com/cgi/content/short/16/9/e117124?rss=1" published_at: "2026-09-22T17:11:09.000Z" evidence_level: "Journal Feed" license: "CC-BY-NC-4.0 / Informational Use" --- # Smartphone-assisted just-in-time support for in vivo exposure in anxiety disorders: trial protocol ## Provenance & Clinical Metadata - **Canonical URL:** https://medichelpline.com/clinical-feed/bmj-open-5-maximising-the-efficacy-of-in-vivo-exposure-therapy-using-smartphone-assisted - **Specialty:** [General](https://medichelpline.com/clinical-feed/general.md) - **Primary Source:** BMJ Open - **Source URL:** [Original Journal Publication](http://bmjopen.bmj.com/cgi/content/short/16/9/e117124?rss=1) - **Published At:** 2026-09-22T17:11:09.000Z - **Evidence Rating:** Journal Feed ## Executive GIST (TL;DR) - This randomized controlled trial protocol evaluates an app, **SyMptOMS-ET**, designed to support **in vivo exposure (IVE)** within cognitive-behavioural therapy (**CBT**) for anxiety disorders. - The app delivers a **just-in-time ecological intervention** using smartphone sensors and interactive features to monitor, guide and prompt patients during exposure tasks according to their momentary condition and context. - The trial will recruit 158 adult volunteers meeting DSM-5 criteria for anxiety disorders: specific phobia, agoraphobia, panic disorder and social anxiety. - Participants are randomized 1:1 to CBT with traditional IVE (n=79) or CBT with IVE supported by SyMptOMS-ET (n=79). - Diagnostic assessment uses the Diagnostic Interview for DSM, Fourth Edition, Text Revision (DSM-IV-TR) anxiety disorder modules; primary outcomes include interference and fear scales from the Anxiety Disorders Interview Schedule for DSM-IV and individualized target behaviours. - Secondary measures include acceptability, satisfaction, usability and app quality. Assessments occur at baseline, post-treatment, and at 1-, 6- and 12-month follow-ups. - Analyses will be conducted both per-protocol and by intention-to-treat. - The study has ethical approval from Universitat Jaume I Ethics Committee (CEISH/51/2024) and is registered (NCT06788119). - The investigators plan dissemination via manuscripts and conference presentations. - The trial aims to determine whether a smartphone-based, adaptive, momentary intervention can make the exposure component of CBT more accessible and effective for patients with **anxiety disorders**. ## Clinical Analysis & Structured Key Points Introduction For anxiety disorders (ADs), the preferred treatment is cognitive-behavioural therapy (CBT), with in vivo exposure (IVE) as its main component. IVE aims to gradually expose the patient to feared stimuli and situations to encourage habituation. Despite its effectiveness, it is a hard component for patients, especially when applied on their own. Therefore, a (co-)therapist usually supports the exposure requiring considerable time and resources. Meanwhile, smartphones have become a promising tool to complement and deliver psychological treatments. Methods and analysis The study presents the protocol of a randomised controlled trial to evaluate the efficacy of an app (SyMptOMS-ET) to support IVE for ADs. The app provides a just-in-time momentary ecological intervention by profiting from advanced smartphone features to monitor, interact and guide the patient through the exposure based on their condition and context. Participants (158) will be adult volunteers suffering from Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) ADs (specific phobia, agoraphobia, panic disorder and social anxiety). They will be randomly allocated to (1) CBT with traditional IVE (79) and (2) CBT with IVE using SyMptOMS-ET (79). The Diagnostic Interview for DSM, Fourth Edition, Text Revision (DSM-IV-TR) ADs will be used as a diagnostic measure. Primary outcome measures will be assessed with interference and fear scales from the Anxiety Disorders Interview Schedule for DSM-IV and with target behaviours; acceptability, satisfaction, usability and app quality will also be measured. Patients will be assessed at baseline, after treatment and at 1-month, 6-month and 12-month follow-ups. Data will be analysed both per-protocol and by intention-to-treat. It will contribute to the knowledge of just-in-time interventions, making the exposure component more accessible to patients. Ethics and dissemination The Universitat Jaume I Ethics Committee (Castellón, Spain) granted approval for the study (CEISH/51/2024). The results from this study will be actively disseminated through manuscript publications and presentations at national and international conferences. 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