Momentary effects of Temstem, an app for voice-hearing individuals: Results from naturalistic data from 1048 users

Alyssa Jongeneel; Ilan Libedinsky; Anouk Reinbergen; Nynke Tromp; Philippe Delespaul; Heleen Riper; Mark van der Gaag; David van den Berg

doi:10.1016/j.invent.2022.100580

Momentary effects of Temstem, an app for voice-hearing individuals: Results from naturalistic data from 1048 users

Internet Interv. 2022 Oct 5:30:100580. doi: 10.1016/j.invent.2022.100580. eCollection 2022 Dec.

Authors

Alyssa Jongeneel^{1

2}, Ilan Libedinsky¹, Anouk Reinbergen², Nynke Tromp³, Philippe Delespaul^{4

5}, Heleen Riper^{1

6}, Mark van der Gaag¹, David van den Berg^{1

2}

Affiliations

¹ Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands.
² Mark van der Gaag Research Centre, Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN Den Haag, Netherlands.
³ Department of Industrial Design, Delft University of Technology, Landbergstraat 15, 2628 CE Delft, Netherlands.
⁴ Department of Psychiatry and Neuropsychology, University of Maastricht, Maastricht, Netherlands.
⁵ Mondriaan Mental Health Trust, Maastricht and Heerlen, Netherlands.
⁶ Department of Research and Innovation, GGZ InGeest Specialized Mental Health Care, Amsterdam, Netherlands.

Abstract

Background: Temstem is a mobile application developed in cooperation with voice-hearing persons to help them cope with distressing voices. After psychoeducation about voice hearing, Temstem offers two functions: Silencing is a mode designed to inhibit voice activity through the processing of incompatible language; the Challenging mode introduces dual tasking (as used in eye movement desensitisation and reprocessing) designed to reduce the emotionality and vividness of a voice memory. Two different language games, Lingo Tapper and Word Link, are provided, containing both functions. This study aimed to explore the momentary effects of Temstem on voice-hearing distress, emotionality and vividness in a naturalistic sample of voice-hearing app users.

Method: Temstem is freely available in the Netherlands. We collected data through the app from 1048 individual users who had given informed consent for the study. We assessed changes in pre- and post-session scores on distress, emotionality and vividness, and we evaluated differences in outcomes between the games and whether effects remained stable over multiple sessions.

Results: Users had been hearing voices for an average of 4.95 years; 79 % had been informed about Temstem by a mental health therapist or coach. After a Silencing session, voice-hearing distress was reduced, t(958) = 27.12, p < .001, d = 0.49; the degree of reduction remained stable after repeated use, F(1, 7905.57) = 1.91, p = .167. After a Challenging session, emotionality, t(651) = 23.16, p < .001, d = 0.74, and the vividness of voice memories were reduced, t(651) = 22.20, p < .001, d = 0.71; both diminished slightly with frequent use, F(1, 2222.86) = 7.21, p < .05; F(1, 2289.92) = 4.25, p < .05. In comparison with Lingo Tapper, larger reductions were seen for a Word Link game: emotionality t(226) = 2.88, p < .005, d = 0.21; vividness t(226) = 2.29, p < .05, d = 0.17.

Discussion: In this heterogeneous sample of voice-hearing individuals, Temstem appeared to be a promising coping tool; momentary voice-hearing distress and the emotionality and vividness of voice statements were reduced after a Temstem session. Despite important limitations and the need for more research, naturalistic studies of user app data may yield interesting and generalisable findings.

Keywords: App; Auditory verbal hallucinations; Naturalistic data; User data; Voice hearing; eHealth.