202202151510 Consider the second order changes needed for sustained changes [[Augmenting Psychoeducation with a Mobile Intervention for Bipolar Disorder A Randomized Controlled Trial]] - **Question. How come at week 24, the effect is the same as the control group?**: - We speculate that once participants in the PRISM condition returned the mobile phones at week 12 and stopped receiving prompts, the behaviors surrounding monitoring, awareness of symptoms, and implementation of positive coping wane. - it is possible that participants assigned to the paper-and-pencil condition continued to participate in mood charting on their own, despite not having been instructed to or provided materials with which to do so. ==Thus user become dependent on apps, and don't know how to self-monitor without the app?== - If this is the case, mobile interventions designed similarly to PRISM may be effective in prompting positive coping behavior but not necessarily in inculcating self- initiated symptom recognition and use of coping strategies. ==Need to target the 2nd order change i.e deeper beliefs to create sustainable changes. == - This would mean that either this type of mobile intervention should be designed for indefinite use (e.g., as electronic medication reminders are designed) or should more specifically target intervening variables that may create more sustainable changes (e.g., as interventions that target beliefs about medications are designed to do).