Square2 Systems, Inc.

We were founded by internationally recognized leaders in the development, evaluation, and implementation of science-based, technology-delivered therapeutic tools. Located in Hanover, NH our headquarters are a stone's throw from Dartmouth College and Dartmouth-Hitchcock Hospital.

Everyday actions can have a huge impact on our physical health, emotional well-being and overall happiness. Most of us can think of something we'd rather be doing, or should be doing, but so far have lacked the wherewithal to make it happen.

Fortunately, the principles and processes of effective behavior change are well understood. Unfortunately, the tools to apply these principles in our everyday lives are in short supply.

We founded Square2 to put scientifically-validated and cost-effective behavior change tools into the pockets of anyone who is looking to change their life for the better.

How we got here


2021

Square2 Testing Laddr with Added Social Features

Following up on the 2017 launch of Laddr, Square2 is testing the efficacy of new features designed to allow friends, family, and partners to support Laddr users with:

  • Collaborative exercises based on shared lists that users can edit together in real-time
  • Laddr users and their supporters can share progress
  • Psychoeducational guides based on Community Reinforcement Approach and Motivational Interviewing designed to give supporters the knowledge to provide therapeutic help to Laddr users

2021: National study with Laddr wins Award from National Academy of Medicine of Colombia.

2021: “Take Charge of Pain” program reduces pain catastrophizing which reduces aberrant opioid-taking behavior.

Citation:

Xie, H., Guarino, H., Moore, S. K., Acosta, M., Budney, A. J., Rosenblum, A., Marsch, L. A., & Fong, C. (2021). Web-based cognitive behavior therapy for chronic pain patients with aberrant drug-related behavior: How did it work and for whom? J Behav Med . 2021 44(5), 704-714. PMID: 33846875.

2020: Laddr shown to be effective in the treatment of depression and unhealthy alcohol use.

Citation:

Torrey, W.C., Cepeda, M., Castro, S., Bartels, S.M., Cubillos, L., Suárez-Obando, F., Camblor, P.M., Uribe-Restrepo, J.M., Williams, M., Gómez-Restrepo, C., Marsch, L.A. (2020). Implementing technology-supported depression and alcohol care in primary care in Colombia: Preliminary findings. Psychiatr Serv . 2020 Mar 10:appips201900457. doi: 10.1176/appi.ps.201900457. PMID: 32151216.

2018: Rebranded version of TES is FDA-authorized as a prescription digital therapeutic for opioid use disorder.

2017-2020: Laddr deployed nationwide in primary care systems in Colombia for the treatment of depression and unhealthy alcohol use.

Citation:

Marsch, L.A., Gómez-Restrepo, C., Bartels, S.M., Bell, K., Camblor, P.M., Castro, S., Cárdenas Charry, M.P., Cepeda, M., Cubillos, L., John, D., Jassir, M.P., Lemley, S.M., Suarez-Obando, F., Torrey, W.C., Uribe, J.M., & Williams, M.J. (2021). Scaling up science-based care for depression and unhealthy alcohol use in Colombia: An implementation science project. Psychiatr Serv . 2021 Aug 4:appips202000041. doi: 10.1176/appi.ps.202000041. Epub ahead of print. PMID: 34347504.

2017-2021: Randomized clinical trial shows POP4Teens program is effective in the prevention of prescription opioid use among teens.

Citation:

Marsch, L.A., Moore, S.K., Grabinski, M., Bessen, S.Y., Borodovsky, J., Scherer, E. (2021). Evaluating the effectiveness of a web-based program (POP4Teens) to prevent prescription opioid misuse among adolescents: Randomized controlled trial. JMIR Public Health Surveill . 2021 Feb 25;7(2):e18487. doi: 10.2196/18487. PMID: 33629961.

Moore, S.K., Grabinski, M., Bessen, S., Borodovsky, J.T., & Marsch, L.A. (2019). Web-based prescription opioid abuse prevention for adolescents: Program development and formative evaluation. JMIR Formative Research . 2019 Jul 19;3(3):e12389. doi: 10.2196/12389. PMID: 31325289.

2017

Laddr Launched

Laddr is the culmination of almost 20 years of research. It is the only digital therapeutic to tackle a wide range of issues with a common set of validated tools. Laddr addresses the root problem of self-regulation at the core of many behavior-driven problems, including:

  • Depression
  • Anxiety and panic
  • Alcohol misuse
  • Binge eating
  • Substance abuse
  • Smoking cessation
  • Pain manangement
  • Chronic disease management

2017: Rebranded version of TES is the first prescription digital therapeutic authorized by the FDA.

2010-2017: Randomized clinical trial demonstrating effectiveness of “Take Charge of Pain” program in controlling aberrant opioid-taking behavior and reducing emergency room visits among chronic pain patients.

Citation for randomized, controlled trial:

Guarino, H., Fong, C., Marsch, L.A., Acosta, M., Syckes, C., Moore, S.K., Cruciani, R., Portenoy, R., Turk, D., & Rosenblum, A. (2018). Web-based cognitive behavior therapy for chronic pain patients with aberrant drug-related behavior: Outcomes from a randomized, controlled trial. Pain Med . doi: 10.1093/pm/pnx334. PMID: 29346579.

2017: Nationwide randomized clinical trial demonstrates mōtiv8 effectively promotes smoking cessation.

Citation:

Dallery, J., Raiff, B.R., Kim, S.J., Marsch, L.A., Stitzer, M., & Grabinski, M.J. (2017). Nationwide access to an internet-based contingency management intervention to promote smoking cessation: A randomized controlled trial. Addiction, 112, 875-883. PMCID: PMC5382065.

2017: TES equally effective among diverse racial and ethnic groups.

Citation:

Campbell, AN, Montgomery, L, Sanchez, K, Pavlicova, M, Hu, M, Newville, H, Weaver, L, Nunes, EV (2017). Racial/ethnic subgroup differences in outcomes and acceptability of an Internet-delivered intervention for substance use disorders. Journal of Ethnicity in Substance Abuse, 16(4), 460-478. PMCID: PMC5624812.

2016: Randomized clinical trial demonstrates TES is as effective as clinician-delivered treatment among incarcerated individuals.

Citation:

Chaple, M., Sacks, S., McKendrick, K., Marsch, L.A., Belenko, S., Leukefeld, C., Prendergast, M., and French, M. (2016). A Comparative Study of the Therapeutic Education System (TES) for Incarcerated Substance Abusing Offenders. The Prison Journal, 96, 485-508 . doi:10.1177/0032885516636858

2012: Launch of randomized clinical trial evaluating the effectiveness and cost-effectiveness of a mobile intervention for substance use disorder treatment compared to standard addiction treatment.

2011-2013: Study demonstrating preliminary effectiveness of mōtiv8 in increasing walking in sedentary adults.

Citation:

Kurti, A.N., & Dallery, J. (2013). Internet-based contingency management increases walking in sedentary adults. Journal of Applied Behavior Analysis, 46, 568-81. PMID: 24114220.

2011-2013: Randomized clinical trial demonstrating effectiveness of mōtiv8 in promoting smoking cessation.

Citation:

Dallery, J., Raiff, B.R., & Grabinski, M.J. (2013). Internet-based contingency management to promote smoking cessation: A randomized, controlled study. Journal of Applied Behavior Analysis, 46, 750-64. PMID: 24114862. PMCID: PMC4570245.

2011:TES is acceptable to Native Americans with substance use disorders.

Citation:

Campbell, A.N., Turrigiano, E., Moore, M., Miele, G.M., Rieckmann, T., Hu, M.C., Kropp, F., Ringor-Carty, R., Nunes, E.V. (2015). Acceptability of a web-based community reinforcement approach for substance use disorders with treatment-seeking American Indians/Alaska Natives. Community Mental Health Journal, 51(4); 393-403. doi: 10.1007/s10597-014-9764-1. Epub 2014 Jul 15. PMID:25022913; PMCID: PMC4295007.

2010

National 10-site Clinical Trial

2010-2014: Randomized clinical trial showing that partially replacing clinician-delivered counseling with TES improves patient outcomes among diverse populations with substance use disorders.

Citation for randomized, controlled trial:

Campbell AN, Nunes EV, Matthews AG, Stitzer M, Miele GM, Polsky D, Turrigiano E, Walters S, McClure EA, Kyle TL, Wahle A, Van Veldhuisen P, Goldman B,Babcock D, Stabile PQ, Winhusen T, Ghitza UE. (2014). Internet-delivered treatment for substance abuse: a multisite randomized controlled trial. American Journal of Psychiatry. Jun;171(6):683-90. doi: 10.1176/appi.ajp.2014.13081055.

2010-2011:TES effective even among individuals mandated to addiction treatment by criminal justice system.

Citation:

Lee, J.D, Tofighi, B., McDonald, R., Campbell, A., Hu, M.C., & Nunes, E. (2017). Acceptability and effectiveness of a web-based psychosocial intervention among criminal justice involved adults. Health Justice, 5(1).3. doi: 10.1186/s40352-017-0048-z. Epub 2017 Mar 11. PMID: 28285466; PMCID: PMC5346353.

2010-2011:TES teaches effective coping strategies that lead to reductions in drug use.

Citation:

Lévesque, A., Campbell, A.N., Pavlicova, M., Hu, M.C., Walker, R., McClure, E.A., Ghitze, U.E., Bailey, G., Stitzer, M., Nunes, E.V. (2017). Coping strategies as a mediator of internet-delivered psychosocial treatment: Secondary analysis from a NIDA CTN multisite effectiveness trial. Addictive Behaviors, 65; 75-80. doi: 10.1016/j.addbeh.2016.09.012. Epub 2016 Sep 30. PMID:27776269; PMCID: PMC5483182.

2010-2011:TES is equally effective among males and females in addiction treatment.

Citation:

Campbell, A.N., Nunes, E.V., Pavlicova, M., Hatch-Maillette, M., Hu, M.C., Bailey, G.L., Sugarman, D.E., Miele, G.M., Rieckmann, T., Shores-Wilson, K., Turrigiano, E., & Greenfield, S.F. (2015). Gender-based outcomes and acceptability of a computer-assisted psychosocial intervention for substance use disorders. Journal of Substance Abuse Treatment, 53: 9-15. doi: 10.1016/j.jsat.2014.12.006. PMID:25613105; PMCID: PMC4414709.

2010-2011:TES was highly acceptable to patients in addiction treatment even among persons with no Internet access.

Citation:

Tofighi, B., Campbell, A.N., Pavlicova, M., Hu, M.C., Lee, J.D., & Nunes, E.V. (2016). Recent Internet Use and Associations with Clinical Outcomes among Patients Entering Addiction Treatment Involved in a Web-Delivered Psychosocial Intervention Study. Journal of Urban Health, 93(5); 871-883. DOI:10.1007/s11524-016-0077-2; PMID: 27653383; PMCID: PMC5052150.

2010-2015: Randomized clinical trial demonstrating the feasibility and initial efficacy of mōtiv8 in promoting smoking cessation among adolescent smokers living in rural locations.

Citation:

Reynolds, B., Harris, M., Slone, S.A., Shelton, B.J., Dallery, J., Stroops, W., & Lewis, R. (2015). A feasibility study of home-based contingency management with adolescent smokers of rural Appalachia. Experimental and Clinical Psychopharmacology, August 17, 2015. [Epub ahead of print]. PMID: 26280592.

2010-2015: “Moving Forward” program developed and randomized clinical trial demonstrating effectiveness of program in reducing alcohol abuse among veterans.

Citations for randomized, clinical trial:

Possemato, K., Acosta, M., Fuentes, J., Lantinga, L., Marsch, L.A., Maisto, S., & Rosenblum, A. (2015). A web-based self-management program for recent combat veterans with PTSD and substance misuse: Program development and veteran feedback. Cognitive and Behavioral Practice. 22, 345-58. PMID: 26120269; PMCID: PMC4480783.

Acosta, MC, Possemato, K., Maisto, SA., Marsch, LA, Barrie, K., Lantinga, L, Fong, C., Xie, H., Grabinski, M., & Rosenblum, A. (2017). Web-delivered CBT reduces heavy drinking in OEF-OIF Veterans in Primary care with symptomatic substance use and PTSD. Behavior Therapy. PMID: 28270335

2010-2013: “Take Charge of Pain” program developed for controlling aberrant opioid-taking behavior and reducing emergency room visits among chronic pain patients.

Citation:

Moore, S.K., Guarino, H., Acosta, M.C., Marsch, L.A., Rosenblum, A., Aronson, I., Grabinski, M., Cruciani, R., & Turk, D.C. (2013). Patients as collaborators: Using focus groups and feedback sessions to develop an interactive, web-based self-management intervention for chronic pain. Pain Medicine, 14, 1730-40. PMID: 23859438; PMCID: PMC3834126.

2010-2013: Randomized clinical trial showing TES produces comparable addiction treatment outcomes to clinician-delivered behavioral therapy.

Citation for randomized, controlled trial:

Chaple, M., Sacks, S., McKendrick, K., Marsch, L.A., Belenko, S., Leukefeld, K., Prendergast, M., & French, M. (2013). Feasibility of a Computerized Intervention for Offenders with Substance Use Disorders: A research note. Journal of Experimental Criminology,1-23. PMID: 24634641; PMCID: PMC3945711.

Chaple, M., Sacks, S., McKendrick, K., Marsch, L.A., Belenko, S., Leukefeld, C., Prendergast, M., & French, M. (2016). A Comparative Study of the Therapeutic Education System (TES) for Incarcerated Substance Abusing Offenders. The Prison Journal. doi:10.1177/0032885516636858.

2009

First Mobile Phone-based Intervention Developed

Our first foray into mobile behavioral interventions featured a minimal set of self-management tools and skills training modules. The program proved to be effective and highlighted the power of even minimal “in the moment” interventions. Later versions took advantage of enchanced capabilities afforded by smart-phones versus the feature phones in common use in 2009.

2009-2015: Randomized clinical trial showing comparable HIV prevention outcomes from TES compared to clinician-delivered care.

Citation for randomized, controlled trial:

Marsch, L.A., Guarino, H., Grabinski, M.J., Melnikow, C., Dillingham, E.T., Xie, H., Crosier, B.S. (2015). Comparative Effectiveness of web-based vs. educator-delivered HIV prevention for adolescent substance users. Journal of Substance Abuse Treatment. PMID: 26293644.

2009-2015: “Step Up” program developed and Randomized clinical trial demonstrating feasibility, acceptability, and preliminary effectiveness of program in the treatment of adolescent substance use disorders.

Citation:

Acosta, M.C., Marsch, L.A., Grabinski, M.J., Xie, H., Kim, S.J., Kaminer, Y., & Godley, S. (Under Review). The Step Up Program: development and evaluation of a web-based psychosocial treatment for adolescents with substance use disorders. Journal of Substance Abuse Treatment.

2009-2015: Study demonstrating increased drug abstinence and increased treatment retention when mobile phone based behavior change tool is added to outpatient addiction treatment.

Citation:

Guarino, H., Acosta, A., Marsch, L.A., Xie, H., & Aponte-Melendez, Y. (2016). A Mixed-methods Evaluation of the Feasibility and Acceptability of a Mobile Phone-based Intervention for Methadone Maintenance Clients. Psychology of Addictive Behaviors. PMID: 26618796 PMCID: PMC4924621

2009-2011: Study demonstrating feasibility and acceptability of embedding Social Media support in mōtiv8.

Citation:

Meredith, S.E., Grabinski, M.J., & Dallery, J., (2011). Internet-based group contingency management to promote abstinence from cigarette smoking: A feasibility study. Drug and Alcohol Dependence, 118, 23-30. PMID: 21414733.

2009-2010: Study demonstrating feasibility, acceptability, and preliminary effectiveness of mōtiv8 in the self-monitoring of blood glucose among teens with diabetes.

Citation:

Raiff, B.R., & Dallery, J. (2010). Internet-based contingency management to improve adherence to blood glucose testing recommendations for teens with Type 1 diabetes. Journal of Applied Behavior Analysis, 43, 487-91. PMCID: PMC2938951

2006-2014: Randomized clinical trial showing that partially replacing clinician-delivered counseling with TES produces better patient outcomes in opioid addiction treatment.

Citation for randomized, controlled trial:

Marsch, L.A., Guarino, H., Acosta, M., Aponte-Melendez, Y., Cleland, C., Grabinski, M., Brady, R., & Edwards, J. (2014). Web-based Behavioral Treatment for Substance Use Disorders as a Partial Replacement of Standard Methadone Maintenance Treatment. Journal of Substance Abuse Treatment. PMID:24060350; PMCID: PMC3839618

2006-2014: Randomized clinical trial showing TES was effective for even persons with a history of multiple addiction treatment episodes.

Citation:

Kim, S.J., Marsch, L.A., Acosta, M.C., Guarino, H., & Aponte-Melendez, Y. (2016). Can persons with a history of multiple addiction treatment episodes benefit from technology delivered behavior therapy? A moderating role of treatment history at baseline. Addictive Behaviors. PMID: 26657820; PMCID: PMC4713265.

2006-2014: Randomized clinical trial showing that TES was effective for even the most challenging of patients (including those who were highly anxious and ambivalent about substance use).

Citation:

Kim, S.J., Marsch, L.A., Guarino, H., Acosta, M.C., & Aponte-Melendez, Y. (2015). Predictors of outcome from computer-based treatment for substance use disorders: Results from a randomized clinical trial. Drug and Alcohol Dependence. PMID: 26433562; PMCID: PMC4663155.

2006-2014:Randomized clinical trial showing TES was effective even among persons with low cognitive functioning.

Citation for randomized, controlled trial:

Acosta, M.C., Marsch, L.A., Xie, H., Guarino, H. & Aponte-Melendez, Y. (2012): A Web-Based Behavior Therapy Program Influences the Association Between Cognitive Functioning and Retention and Abstinence in Clients Receiving Methadone Maintenance Treatment, Journal of Dual Diagnosis, 8:4, 283-293. PMID: 23671409; PMCID: PMC3650891.

2005

Mōtiv8 Applied to Smoking Cessation

2006-2009: Study Demonstrating the feasibility and short-term efficacy of mōtiv8 as a smoking cessation intervention among rural smokers.

Citation:

Stoops, W.W., Dallery, J., Fields, N.M., Nuzzo, P.A., Schoenberg, N.E., Martin, C.A., Casey, B., & Wong, C.J. (2009). An Internet-based abstinence reinforcement smoking cessation intervention in rural smokers. Drug and Alcohol Dependence, 105, 56-62. PMCID: PMC2743786

2006-2008: Study demonstrating preliminary effectiveness of mōtiv8 in adolescent smoking cessation.

Citation:

Reynolds, B., Dallery, J., Shroff, P., Patak, M., & Leraas, K. (2008). A web-based contingency management program with adolescent smokers. Journal of Applied Behavior Analysis, 41, 597-601. PMCID: PMC2606598

2005-2007: Study demonstrating mōtiv8 was more effective than the nicotine patch in promoting smoking cessation.

Citation:

Glenn, I.M., & Dallery, J. (2007). Effects of Internet-based Voucher Reinforcement and a Transdermal Nicotine Patch on Cigarette Smoking. Journal of Applied Behavior Analysis. 40, 1-13. PMCID: PMC1868814

2005-2007: Study demonstrating mōtiv8’s feasibility and promise of effectiveness in promoting smoking cessation.

Citation:

Dallery, J., Glenn, IM, & Raiff, BR. (2007). An Internet-based abstinence reinforcement treatment for cigarette smoking. Drug and Alcohol Dependence, 86, 230-8. PMID: 16930854.

2010-2014: Randomized, controlled trial demonstrating effectiveness of Motiv8 in promoting smoking cessation across the U.S.

Citation for randomized, controlled trial:

Dallery, J., Raiff, B.R., Kim, S.J., Marsch, L.A., Stitzer, M., & Grabinski, M.J. (2016). Nationwide access to an internet-based contingency management intervention to promote smoking cessation: A randomized, controlled trial. Addiction. PMID: 27923264.

2003-2014: Randomized clinical trial showing TES improves addiction treatment outcomes beyond the effects of medication and incentives.

Citation for randomized, controlled trial:

Christensen, D.R., Landes, R.D., Jackson, L., Chopra, M.P., Marsch, L.A., Mancino, M. & Bickel, W.K. (2014). The Effects of an Internet-Delivered Therapy When Added to Buprenorphine and Contingency Management in the Treatment of Opioid Dependence Journal of Consulting and Clinical Psychology. PMID:25090043. PMCID:PMC4244262.

2002-2011: Randomized clinical trial showing TES outcomes improves HIV prevention outcomes beyond clinician-delivered care.

Citation for randomized, controlled trial:

Marsch, L.A., Grabinski, M.J., Bickel, W.K., Desrosiers, A., Guarino, H., Muehlbach, B., Solhkhah, R., Talfique, S., & Acosta, M. (2011). Computer-Assisted HIV Prevention for Youth with Substance Use Disorders. Substance Use and Misuse, 46, 46-56. PMID: 21190405; PMCID: PMC3091163.

2000

Therapeutic Education System (TES) Developed

Built on the mōtiv8 back-end, TES is composed of over 65 interactive, multimedia modules focused on cognitive behavioral skills training and a broad range of life skills. TES is a self-directed program that includes a module teaching patients how to use the system and a "customization module" to build an individualized treatment plan for patients.

Square2 benefits from insights and experience gained in over 15 years of developing and studying TES.

2000-2008: Randomized clinical trial showing TES with minimal therapist time is as effective as science-based clinician-delivered therapy for addiction treatment.

Citation for randomized, controlled trial:

Bickel, W.K., Marsch, L.A., Buchhalter, A., & Badger, G. (2008). Computerized behavior therapy for opioid dependent outpatients: A randomized, controlled trial. Experimental and Clinical Psychopharmacology, 16, 132-143. PMID:18489017; PMCID: PMC2746734.

1998

Mōtiv8 Platform Developed

Mōtiv8 began as a web-based platform to facilitate positive behavior change by delivering customized motivational incentives in response to a user’s objectively measured actions. The techniques employed in mōtiv8 are the basis for Square2’s motivational system.

The ability to collect verified, video-based samples in 2004 lead to its application in changing a range of health behaviors, including smoking cessation utilizing home monitoring of breath carbon monoxide (CO) levels, diabetes management via blood glucose monitoring and promoting increased activity levels among sedentary adults.

In 2008, we embedded a group reward system and social-media communication features bringing to bear powerful social contingencies for promoting and sustaining healthy behaviors.

Who We Are

Meet the team that makes it happen

Dr. Lisa Marsch

Founder & CEO

Michael Grabinski

Founder & CTO

Mohit Jain

Principal Developer

Madison Dickson

Mobile & Web UX/UI

Bharat Sharma

Senior Developer

Janet Cromley, MS

Writer/Content Developer
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