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Engagement with online mental health interventions: An exploratory clinical study of a treatment for depression

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Online mental health interventions can benefit people experiencing a range of psychological difficulties, but attrition is a major problem in real-world deployments. We discuss strategies to reduce attrition, and present SilverCloud, a platform designed to provide more engaging online experiences. The paper presents the results of a practice-based clinical study in which 45 clients and 6 therapists used an online Cognitive Behavioural Therapy programme for depression. Pre and post-treatment assessments, using the Beck Depression Inventory, indicate a statistically significant improvement in depressive symptoms, with a large effect size, for the moderate-to-severe clinical sub-sample receiving standalone online treatment (n=18). This group was the primary target for the intervention. A high level of engagement was also observed compared to a prior online intervention used within the same service. We discuss strategies for design in this area and consider how the quantitative and qualitative results contribute towards our understanding of engagement.
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... Such work includes novel affective interfaces intended to support real-time awareness of emotions or their regulation [3][4][5][6][7], novel design approaches emphasizing the importance of the human body such as soma design [8], novel technologies supporting reflection and meaning making [9], and those intended to train meditation or mindfulness skills [10] or to conceptualize meaning [11]. Other strands of HCI work have focused on ill-health, such as mobile apps for cognitive behavioral therapy [12] and empirical studies exploring ways to support vulnerable users; such as those living with depression [13], dementia [14], addiction, or the compulsive use of technology; including screen time research [15,16]. Much of such work frames mental well-being as "positive emotional, psychological and social health" [17], whereas digital well-being is broadly seen as the result of being able to use technologies in productive and healthy ways without the negative consequences of dependency, distraction, or risks to users' privacy [18]. ...
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