Tobias Kowatsch

Tobias Kowatsch

Title

Prof. Dr.

Last Name

Kowatsch

First name

Tobias

Email

tobias.kowatsch@unisg.ch

ORCID

0000-0001-5939-4145

Phone

+41 71 224 7244

Homepage

www.c4dhi.org

Now showing 1 - 10 of 270

Non-pharmaceutical interventions and epigenetic aging in adults: Protocol for a scoping review

( 2024)
Alina Liebich
;
Shenglin Zheng
;
Theresa Schachner
;
Jacqueline Mair
;
Mia Jovanova
;
Falk Müller-Riemenschneider
;
Tobias Kowatsch
;
Victor Manuel Mendoza-Nuñez

Introduction Aging is the strongest risk factor for most chronic diseases. The rising burden of an aging population and non-communicable diseases (NCDs), contributes to escalating costs for society. Several non-pharmaceutical interventions can lower the risk of NCDs, including common mental disorders (CMDs), and may slow down biological aging, as evidenced by outcome markers such as epigenetic clocks. However, a comprehensive overview of whether and which non-pharmaceutical interventions may impact human epigenetic aging is missing. Synthesizing evidence of interventions on epigenetic aging that can be adopted by a wider population is key to guide healthy aging initiatives and to reduce the burden of NCDs and CMDs. This scoping review will identify and assess non-pharmaceutical interventions aimed to slow down epigenetic aging, including their intervention components, and the mode used for intervention delivery. Methods and analysis This protocol will include single- and multicomponent intervention studies that target individuals ≥ 18 years of age and use epigenetic clocks as primary or secondary outcomes. Five electronic databases will be searched for studies between July 2011 until December 2023. The final search will include the search terms adults, non-pharmaceutical interventions, epigenetic aging and their respective synonyms. We will include randomized controlled trials, non-randomized controlled studies, cohort studies, and case-control studies. Additionally, the reference list of other reviews will be screened for relevant articles. Study selection is carried out based on the defined eligibility criteria by two authors. Quality and risk of bias for the included studies will be assessed using the Critical Appraisal Skills Programme (CASP) checklist. Data extraction will include generic key information such as the research question and results, the intervention components, and specific epigenetic outcome measures used. Further data regarding the delivery mode of the treatment protocol will be collected. Ethics and dissemination This scoping review will summarize the characteristics of non-pharmaceutical intervention studies on epigenetic aging. This review will be the first step to formally identify key intervention components and delivery modes to guide future research on healthy aging interventions. The results will be disseminated through a peer-reviewed publication and presented at relevant conferences. This review will synthesize information from available publications and does not require further ethical approval. Registration details

Type: journal article

Journal: PLOS ONE

Volume: 19

Issue: 8

DOI: 10.1371/journal.pone.0301763

URI: https://www.alexandria.unisg.ch/handle/20.500.14171/120680
The Effects of the Connecting all Generations Through the Gerontech (CARETech) Program on Motivating Young People to Enter the Elderly Care Sector

( 2024)
Arkers Kwan Ching Wong
;
Jonathan Bayuo
;
Ho Yi Wong
;
Karen Kit Sum Chow
;
Siu Man Wong
;
Bonnie Bo Wong
;
Bob Chung Man Liu
;
David Chi Ho Lau
;
Tobias Kowatsch

Purpose This study aims to organize an intergenerational program to provide unemployed young people with operational skills related to gerontechnology and the experience required to deliver digital outreach rehabilitation services to community-dwelling older people. Methods A quasi-experimental research design was adopted. The young participants received a 12-session training program on the management of common chronic diseases, communication with older people, the functions and use of interactive games, and techniques to teach and match interactive games with older people. The perception of elderly outcomes (i.e., knowledge and attitude toward elderly care, willingness to care for the elderly), personal outcomes (i.e., life satisfaction, self-efficacy), and desired vocational outcomes (i.e., hours worked in the nongovernmental organization’s center, hours spent with older people) were evaluated preprogram and postprogram. Results Fifty-one young people joined the program. A statistically significant improvement was seen from preprogram to postprogram in their willingness to care for the elderly (p = .016) and life satisfaction (p = .005), as well as in the number of hours that they spent in the community center volunteering or engaged in social services for older people. Discussion The findings proved that the program could improve the willingness of young people to care for older people, as well as improve their own life satisfaction. Using gerontechnology can serve to bridge the intergenerational gap and bring benefits to both young adults and older people. It may provide policy makers with a way to address the manpower shortage in elderly care services and help frail older people to age in place.

Type: journal article

Journal: Journal of Adolescent Health

DOI: 10.1016/j.jadohealth.2024.06.015

URI: https://www.alexandria.unisg.ch/handle/20.500.14171/120636
Proactive behavior in voice assistants: A systematic review and conceptual model

( 2024)
Caterina Bérubé
;
Marcia Nissen
;
Rasita Vinay
;
Alexa Geiger
;
Tobias Budig
;
Aashish Bhandari
;
Catherine Rachel Pe Benito
;
Nathan Ibarcena
;
Olivia Pistolese
;
Pan Li
;
Abdullah Bin Sawad
;
Elgar Fleisch
;
Christoph Stettler
;
Bronwyn Hemsley
;
Shlomo Berkovsky
;
Tobias Kowatsch
;
A. Baki Kocaballi

Voice assistants (VAs) are increasingly integrated into everyday activities and tasks, raising novel challenges for users and researchers. One emergent research direction concerns proactive VAs, who can initiate interaction without direct user input, offering unique benefits including efficiency and natural interaction. Yet, there is a lack of review studies synthesizing the current knowledge on how proactive behavior has been implemented in VAs and under what conditions proactivity has been found more or less suitable. To this end, we conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. We searched for articles in the ACM Digital Library, IEEExplore, and PubMed, and included primary research studies reporting user evaluations of proactive VAs, resulting in 21 studies included for analysis. First, to characterize proactive behavior in VAs we developed a novel conceptual model encompassing context, initiation, and action components: Activity/status emerged as the primary contextual element, direct initiation was more common than indirect initiation, and suggestions were the primary action observed. Second, proactive behavior in VAs was predominantly explored in domestic and in-vehicle contexts, with only safety-critical and emergency situations demonstrating clear benefits for proactivity, compared to mixed findings for other scenarios. The paper concludes with a summary of the prevailing knowledge gaps and potential research avenues.

Type: journal article

Journal: Computers in Human Behavior Reports

URL: https://www.sciencedirect.com/science/article/pii/S2451958824000447

DOI: 10.1016/j.chbr.2024.100411

URI: https://www.alexandria.unisg.ch/handle/20.500.14171/119758

Scopus© Citations 2
Impact of digital assistive technologies on the quality of life for people with dementia: a scoping review

( 2024)
Charlotte Schneider
;
Marcia Nissen
;
Tobias Kowatsch
;
Rasita Vinay

Background Digital assistive technologies (DATs) have emerged as promising tools to support the daily life of people with dementia (PWD). Current research tends to concentrate either on specific categories of DATs or provide a generic view. Therefore, it is of essence to provide a review of different kinds of DATs and how they contribute to improving quality of life (QOL) for PWD. Design Scoping review using the framework proposed by Arksey and O’Malley and recommendations from Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Data sources Cochrane, Embase, PubMed, Scopus and Web of Science (January 2013 to May 2023). Eligibility criteria for selecting studies Completed scientific literature with a primary focus on DATs for PWD, perspectives of caregivers, family members or healthcare workers in relation to a PWD, people living in diverse settings and all severities of dementia. Data extraction and synthesis Screening and data extraction were conducted, followed by quantitative and qualitative analyses using thematic analysis principles and Digital Therapeutics Alliance categories for DAT grouping. Results The literature search identified 6083 records, with 1056 duplicates. After screening, 4560 full texts were excluded, yielding 122 studies of different designs. The DATs were categorised into digital therapeutics (n=109), patient monitoring (n=30), digital diagnostics (n=2), care support (n=2) and health system clinical software (n=1). These categories were identified to impact various aspects of QOL: preserving autonomy, engagement, and social interaction, health monitoring and promotion, improving activities of daily living, improving cognition, maintaining dignity, managing behavioural and psychological symptoms of dementia and safety/surveillance. Conclusions Various DATs offer extensive support, elevating the QOL of PWD. Digital therapeutics are predominantly used for ageing-in-place and independent living through assistance with daily tasks. Future research should focus on less-represented digital health technology categories, such as care support, health & wellness or software solutions. Observing ongoing DAT developments and their long-term effects on QOL remains essential.

Type: journal article

Journal: BMJ Open

Volume: 14 (2)

URL: https://bmjopen.bmj.com/content/14/2/e080545

DOI: https://doi.org/10.1136/bmjopen-2023-080545

URI: https://www.alexandria.unisg.ch/handle/20.500.14171/119479
Self-efficacy effects on symptom experiences in daily life and early treatment success in anxiety patients

( 2024)
Christina Paersch
;
Dominique Recher
;
Ava Schulz
;
Heininger Mirka
;
Barbara Schlup
;
Florian Künzler
;
Stephanie Homan
;
Tobias Kowatsch
;
Aaron Fisher
;
Andrea B. Horn
;
Birgit Kleim

Self-efficacy is a key construct in behavioral science affecting mental health and psychopathology. Here, we expand on previously demonstrated between-persons self-efficacy effects. We prompted 66 patients five times daily for 14 days before starting cognitive behavioral therapy (CBT) to provide avoidance, hope, and perceived psychophysiological-arousal ratings. Multilevel logistic regression analyses confirmed self-efficacy’s significant effects on avoidance in daily life (odds ratio [OR] = 0.53, 95% confidence interval [CI] = [0.34, 0.84], p = .008) and interaction effects with anxiety in predicting perceived psychophysiological arousal (OR = 0.79, 95% CI = [0.62, 1.00], p = .046) and hope (OR = 1.21, 95% CI = [1.03, 1.42], p = .02). More self-efficacious patients also reported greater anxiety-symptom reduction early in treatment. Our findings assign a key role to self-efficacy for daily anxiety-symptom experiences and for early CBT success. Self-efficacy interventions delivered in patients’ daily lives could help improve treatment outcome.

Type: journal article

Journal: Clinical Psychological Science

DOI: 10.1177/21677026231205

URI: https://www.alexandria.unisg.ch/handle/20.500.14171/117883
Less stick more carrot? Increasing the uptake of deposit contract financial incentives for physical activity: A randomized controlled trial

( 2024)
David R. de Buisonjé
;
Thomas Reijnders
;
Talia R. Cohen Rodrigues
;
Prabhakaran Santhanam
;
Tobias Kowatsch
;
Linda D. Breeman
;
Veronica R. Janssen
;
Roderik A. Kraaijenhagen
;
Hareld M.C. Kemps
;
Andrea W.M. Evers

Background Financial incentives are a promising tool to help people increase their physical activity, but they are expensive to provide. Deposit contracts are a type of financial incentive in which participants pledge their own money. However, low uptake is a crucial obstacle to the large-scale implementation of deposit contracts. Therefore, we investigated whether (1) matching the deposit 1:1 (doubling what is deposited) and (2) allowing for customizable deposit amounts increased the uptake and short term effectiveness of a deposit contract for physical activity. Methods In this randomized controlled trial, 137 healthy students (age M = 21.6 years) downloaded a smartphone app that provided them with a tailored step goal and then randomized them to one of four experimental conditions. The deposit contract required either a €10 fixed deposit or a customizable deposit with any amount between €1 and €20 upfront. Furthermore, the deposit was either not matched or 1:1 matched (doubled) with a reward provided by the experiment. During 20 intervention days, daily feedback on goal progress and incentive earnings was provided by the app. We investigated effects on the uptake (measured as agreeing to participate and paying the deposit) and effectiveness of behavioral adoption (measured as participant days goal achieved). Findings Overall, the uptake of deposit contracts was 83.2%, and participants (n = 113) achieved 14.9 out of 20 daily step goals. A binary logistic regression showed that uptake odds were 4.08 times higher when a deposit was matched (p = .010) compared to when it was not matched. Furthermore, uptake odds were 3.53 times higher when a deposit was customizable (p = .022) compared to when it was fixed. Two-way ANCOVA showed that matching (p = .752) and customization (p = .143) did not impact intervention effectiveness. However, we did find a marginally significant interaction effect of deposit matching X deposit customization (p = .063, ηp2 = 0.032). Customization decreased effectiveness when deposits were not matched (p = .033, ηp2 = 0.089), but had no effect when deposits were matched (p = .776, ηp2 = 0.001). Conclusions We provide the first experimental evidence that both matching and customization increase the uptake of a deposit contract for physical activity. We recommend considering both matching and customization to overcome lack of uptake, with a preference for customization since matching a deposit imposes significant additional costs. However, since we found indications that customizable deposits might reduce effectiveness (when the deposits are not matched), we urge for more research on the effectiveness of customizable deposit contracts. Finally, future research should investigate which participant characteristics are predictive of deposit contract uptake and effectiveness.

Type: journal article

Journal: Psychology of Sport and Exercise

Volume: 70

DOI: 10.1016/j.psychsport.2023.102532

URI: https://www.alexandria.unisg.ch/handle/20.500.14171/118201
Network analyses of ecological momentary emotion and avoidance assessments before and after cognitive behavioral therapy for anxiety disorders

( 2024)
Laura E. Meine
;
Miriam Müller-Bardorff
;
Dominique Recher
;
Christina Paersch
;
Ava Schulz
;
Tobias Spiller
;
Isaac Galatzer-Levy
;
Tobias Kowatsch
;
Aaron J. Fisher
;
Birgit Kleim

Negative emotions and associated avoidance behaviors are core symptoms of anxiety. Current treatments aim to resolve dysfunctional coupling between them. However, precise interactions between emotions and avoidance in patients’ everyday lives and changes from pre- to post-treatment remain unclear. We analyzed data from a randomized controlled trial where patients with anxiety disorders underwent 16 sessions of cognitive behavioral therapy (CBT). Fifty-six patients (68 % female, age: M = 33.31, SD = 12.45) completed ecological momentary assessments five times a day on 14 consecutive days before and after treatment, rating negative emotions and avoidance behaviors experienced within the past 30 min. We computed multilevel vector autoregressive models to investigate contemporaneous and time-lagged associations between anxiety, depression, anger, and avoidance behaviors within patients, separately at pre- and post-treatment. We examined pre-post changes in network density and avoidance centrality, and related these metrics to changes in symptom severity. Network density significantly decreased from pre- to post-treatment, indicating that after therapy, mutual interactions between negative emotions and avoidance were attenuated. Specifically, contemporaneous associations between anxiety and avoidance observed before CBT were no longer significant at post-treatment. Effects of negative emotions on avoidance assessed at a later time point (avoidance instrength) decreased, but not significantly. Reduction in avoidance instrength positively correlated with reduction in depressive symptom severity, meaning that as patients improved, they were less likely to avoid situations after experiencing negative emotions. Our results elucidate mechanisms of successful CBT observed in patients’ daily lives and may help improve and personalize CBT to increase its effectiveness.

Type: journal article

Journal: Journal of Anxiety Disorders

Volume: 106

DOI: 10.1016/j.janxdis.2024.102914

URI: https://www.alexandria.unisg.ch/handle/20.500.14171/120654
Perceived responsiveness in suicidal ideation: an experience sampling study in psychiatric patients

( 2024)
Laura Sels
;
Stephanie Homan
;
Harry Reis
;
Andrea B Horn
;
Jordan Revol
;
Urte Scholz
;
Tobias Kowatsch
;
Birgit Kleim

Introduction Perceived responsiveness, or the extent to which one feels understood, validated and cared for by close others, plays a crucial role in people's well-being. Can this interpersonal process also protect people at risk? We assessed whether fluctuations in suicidal ideation were associated with fluctuations in the degree of perceived responsiveness that psychiatric patients (admitted in the context of suicide or indicating suicidal ideation) experienced in daily interactions immediately after discharge. Methods Fifty-seven patients reported on suicidal ideation (5 times a day) and perceived responsiveness (daily) for four consecutive weeks. The effects of established risk factors—thwarted belongingness, perceived burdensomeness, and hopelessness—were assessed as well. Results The more patients felt that close others had been responsive to them, the less suicidal ideation they reported. At low levels of thwarted belongingness, perceived burdensomeness, or hopelessness, perceived responsiveness seemed to play a protective role, negatively co-occurring with suicidal ideation. When thwarted belongingness, perceived burdensomeness, and hopelessness were high, perceived responsiveness did not have an effect. Conclusion Perceived responsiveness could be a protective factor for suicidal ideation for people at risk only when they are experiencing low levels of negative perceptions. When experiencing highly negative perceptions, however, perceived responsiveness seems to matter less.

Type: journal article

Journal: Suicide and Life-Threatening Behavior

DOI: 10.1111/sltb.13095

URI: https://www.alexandria.unisg.ch/handle/20.500.14171/120239
Smartwatches for non‐invasive hypoglycaemia detection during cognitive and psychomotor stress

( 2024)
Martin Maritsch
;
Simon Föll
;
Vera Lehmann
;
Naïma Styger
;
Caterina Bérubé
;
Mathias Kraus
;
Stefan Feuerriegel
;
Tobias Kowatsch
;
Thomas Züger
;
Elgar Fleisch
;
Felix Wortmann
;
Christoph Stettler

Type: journal article

Journal: Diabetes, Obesity and Metabolism

Volume: 26 (3)

DOI: 10.1111/dom.15402

URI: https://www.alexandria.unisg.ch/handle/20.500.14171/118950

Scopus© Citations 1
Optimizing Outcomes in Psychotherapy for Anxiety Disorders Using Smartphone-Based and Passive Sensing Features: Protocol for a Randomized Controlled Trial

( 2024)
Miriam Müller-Bardorff
;
Ava Schulz
;
Christina Paersch
;
Dominique Recher
;
Barbara Schlup
;
Erich Seifritz
;
Iris Tatjana Kolassa
;
Tobias Kowatsch
;
Aaron Fisher
;
Isaac Galatzer-Levy
;
Birgit Kleim

Background Psychotherapies, such as cognitive behavioral therapy (CBT), currently have the strongest evidence of durable symptom changes for most psychological disorders, such as anxiety disorders. Nevertheless, only about half of individuals treated with CBT benefit from it. Predictive algorithms, including digital assessments and passive sensing features, could better identify patients who would benefit from CBT, and thus, improve treatment choices. Objective This study aims to establish predictive features that forecast responses to transdiagnostic CBT in anxiety disorders and to investigate key mechanisms underlying treatment responses. Methods This study is a 2-armed randomized controlled clinical trial. We include patients with anxiety disorders who are randomized to either a transdiagnostic CBT group or a waitlist (referred to as WAIT). We index key features to predict responses prior to starting treatment using subjective self-report questionnaires, experimental tasks, biological samples, ecological momentary assessments, activity tracking, and smartphone-based passive sensing to derive a multimodal feature set for predictive modeling. Additional assessments take place weekly at mid- and posttreatment and at 6- and 12-month follow-ups to index anxiety and depression symptom severity. We aim to include 150 patients, randomized to CBT versus WAIT at a 3:1 ratio. The data set will be subject to full feature and important features selected by minimal redundancy and maximal relevance feature selection and then fed into machine leaning models, including eXtreme gradient boosting, pattern recognition network, and k-nearest neighbors to forecast treatment response. The performance of the developed models will be evaluated. In addition to predictive modeling, we will test specific mechanistic hypotheses (eg, association between self-efficacy, daily symptoms obtained using ecological momentary assessments, and treatment response) to elucidate mechanisms underlying treatment response. Results The trial is now completed. It was approved by the Cantonal Ethics Committee, Zurich. The results will be disseminated through publications in scientific peer-reviewed journals and conference presentations. Conclusions The aim of this trial is to improve current CBT treatment by precise forecasting of treatment response and by understanding and potentially augmenting underpinning mechanisms and personalizing treatment.

Type: journal article

Journal: JMIR Research Protocols

Volume: 13

DOI: 10.2196/42547

URI: https://www.alexandria.unisg.ch/handle/20.500.14171/120221

Scopus© Citations 1

Tobias Kowatsch

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