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Internet Interventions for Mental Health and Addictions: Current Findings and Future Directions



Over the last several years, there has been a substantial increase in the number of publications reporting on Internet interventions for mental health and addictions. This paper provides a summary of the recent research on Internet interventions for the most common mental health and addictions concerns-depression, anxiety, alcohol and smoking. There is considerable evidence for the effectiveness of Internet-based interventions targeting depression, anxiety disorders, alcohol use and smoking. Small to moderate effect sizes have been reported for interventions targeting depression, anxiety and alcohol use, and smoking interventions have shown large effects. The addition of human support to depression and anxiety interventions has generally resulted in larger treatments effects, but this trend has not been observed in trials of interventions targeting alcohol use. There is some evidence that online interventions can be as effective as face-to-face therapies, at least for anxiety disorders. Despite a proliferation of research activity in this area, gaps in knowledge remain. Future research should focus on the development and evaluation of interventions for different platforms (e.g. smartphone applications), examining the long-term impacts of these interventions, determining active intervention components and identifying methods for enhancing tailoring and engagement. Careful consideration should be given to the ongoing technical and clinical expertise required to ensure that Internet interventions are delivered safely and professionally in a rapidly changing technology environment.
Internet Interventions for Mental Health and Addictions: Current
Findings and Future Directions
John A. Cunningham &Amelia Gulliver &Lou Farrer &
Kylie Bennett &Bradley Carron-Arthur
#Springer Science+Business Media New York 2014
Abstract Over the last several years, there has been a sub-
stantial increase in the number of publications reporting on
Internet interventions for mental health and addictions. This
paper provides a summary of the recent research on Internet
interventions for the most common mental health and addic-
tions concernsdepression, anxiety, alcohol and smoking.
There is considerable evidence for the effectiveness of
Internet-based interventions targeting depression, anxiety dis-
orders, alcohol use and smoking. Small to moderate effect
sizes have been reported for interventions targeting depres-
sion, anxiety and alcohol use, and smoking interventions have
shown large effects. The addition of human support to depres-
sion and anxiety interventions has generally resulted in larger
treatments effects, but this trend has not been observed in trials
of interventions targeting alcohol use. There is some evidence
that online interventions can be as effective as face-to-face
therapies, at least for anxiety disorders. Despite a proliferation
of research activity in this area, gaps in knowledge remain.
Future research should focus on the development and evalu-
ation of interventions for different platforms (e.g. smartphone
applications), examining the long-term impacts of these inter-
ventions, determining active intervention components and
identifying methods for enhancing tailoring and engagement.
Careful consideration should be given to the ongoing techni-
cal and clinical expertise required to ensure that Internet
interventions are delivered safely and professionally in a
rapidly changing technology environment.
Keywords Internet interventions .Review .Depression .
Anxiety .Alcohol .Tobacc o
Internet interventions for common mental health problems
including addiction are beginning to enter the mainstream.
Early examples of intervention websites appeared approximate-
ly 20 years ago and were first published on in the late 1990s and
early 2000s [13]. Thus, it appears that Internet interventions,
as with most other health-care innovations, have followed the
knowledge translation path that it takes about 17 years for an
innovation to achieve widespread acceptance [4,5]. Evidence
of this adoption can be seen through the availability of different
numerous websites providing interventions and the existence of
compendiums (online and others) that review and rate the
quality of these websites (e.g., and through
evidence that consumers endorse the Internet as a common
means of accessing health-care information [68].
Further evidence of the increased acceptance of Internet
interventions is the explosion of research on their efficacy. The
goal of this paper is to summarise some of these more recent
findings for common mental health problems and addiction
(depression, anxiety, alcohol and smoking).
Several reviews conducted within the last 5 years have
amassed considerable evidence for the effectiveness of Inter-
net interventions for depression in adults. Five meta-analyses
[9,10,11,12,13] and two systematic reviews [14,15]have
This article is part of the Topical Collection on Psychiatry in the Digital
J. A. Cunningham (*):A. Gulliver :L. Farrer :K. Bennett :
B. Carron-Arthur
National Institute for Mental Health Research, Australian National
University, Building 63Acton 0200 Canberra, Australia
J. A. Cunningham
Centre for Addiction and Mental Health, Toronto, Canada
Curr Psychiatry Rep (2014) 16:521
DOI 10.1007/s11920-014-0521-5
examined randomised controlled trials (RCTs) evaluating pre-
dominantly Internet-based cognitive behaviour therapy
(iCBT) interventions. Spek et al. [13] investigated studies
comparing iCBTwith waitlist, treatment as usual and attention
placebo control groups and reported a mean Cohensdeffect
size of 0.27 for depression symptoms. Andersson and
Cuijpers [9] found an overall effect size of d=0.37 for
Internet-based depression interventions relative to control
groups overall, with smaller effects for interventions com-
pared with treatment as usual control groups (d=0.23) and
larger effects for interventions compared with waitlist controls
(d=0.56). They also identified larger effect sizes for interven-
tions with professional support (d=0.61), compared to inter-
ventions without professional support (d=0.18). In a meta-
analysis, Andrews et al. [10] found a large overall effect of
Hedgesg=0.78 for Internet-based depression interventions.
All but one of the studies included in this meta-analysis
involved therapist support. Cuijpers et al. [16] conducted a
meta-analysis of purely self-guided depression Internet inter-
ventions and reported a small effect of d=0.28. A systematic
review of online depression interventions targeting individ-
uals with clinically significant symptoms found effect size
differences between treatment and control groups ranging
from 0.42 to 0.65 [14]. Overall, there appears to be at least a
small to moderate effect associated with Internet-based de-
pression interventions. The variability observed across meta-
analyses is largely due to differences in study inclusion
criteria. There is also evidence that the addition of professional
support increases the effectiveness of Internet-based depres-
sion interventions, although this may only be true for individ-
uals with more severe symptoms of depression [17]and
support may not necessarily need to be provided by a therapist
[18]. Two recent reviews [11,15] have examined the non-
inferiority of online depression treatments to face-to-face
treatments. Neither review reported robust evidence of the
equivalence of iCBT and face-to-face CBT. However, one of
the reviews included only studies of participants with a diag-
nosable mood disorder, and a recent trial [19] of general
community members with mild to moderate depression symp-
toms found that iCBT is non-inferior to group-based face-to-
face CBT. Other recent directions in Internet-based depression
treatment research have focused on the development and
evaluation of non-CBT-based treatments, such as psychody-
namic psychotherapy [20], acceptance and commitment ther-
apy and mindfulness [21]. Results from these preliminary
studies are promising; however, the quality of this evidence
to date has been rated as very low [11].
Anxiety Interventions
There is considerable evidence for Internet interventions
targeting anxiety with CBT identified as the dominant therapy
[22,23]. Several reviews of Internet-based anxiety interven-
tions have been conducted including a recent paper by
Mewton et al. [23]thatreviewed37RCTsofiCBTinterven-
tions for anxiety. The majority of trials targeted social phobia
and panic disorder, with substantially less focus on other
disorders, which has also been reflected in other reviews
[24,25]. Mewton et al.s[23] study demonstrated that iCBT
was effective in treating a range of anxiety disorders and
showed overall between-group effect sizes of 0.27 to 1.47.
iCBT was superior to all attention control groups and all but
one waitlist control groups (effect size=0.382.53) and was
also equivalent to other types of therapy including individual
face-to-face therapy (effect size=0.010.19) [23]. Similarly,
a meta-analysis by Reger and Gahm [26]demonstratedthat
Internet-based or computerised therapy for anxiety across a
range of disorders such as social phobia, specific phobia and
panic disorder was superior to waitlist and attention control
conditions (d=0.491.14) and also showed equivalent effects
to therapist-delivered treatment. Another meta-analytic review
by Cuijpers et al. [24] demonstrated a large overall mean
effect size of 1.08 for Internet-based psychotherapy for anxi-
ety disorders compared with control conditions. This review
also indicated that Internet-based therapy was as effective as
face-to-face therapy. Finally, a meta-analysis by Andrews
et al. [27] for anxiety (GAD, panic and social phobia) dem-
onstrated mean effect sizes (Hedgesg) ranging from 0.83 to
1.12 for iCBT. This evidence is strongly in support of the
effectiveness of Internet-based anxiety interventions.
Overall, Internet-based anxiety interventions are effica-
cious and comparable to face-to-face therapy. However, there
are some key areas of research that should be further devel-
oped including determining the optimal level of therapist
support, increasing participant engagement and determining
the effective elements of iCBT [23]. Additionally, the devel-
opment of mobile phone applications [23] and further high-
quality studies specifically including attention-control condi-
tions with larger sample sizes are needed [26].
Recent years have seen a substantial growth in published
RCTs evaluating Internet interventions for alcohol. While
the majority of earlier reviews examined interventions
targeting university students [2831]a potential problem
when estimating the impact of such interventions in the gen-
eral populationmore recent publications have reported on a
number of trials with non-student samples. A recent system-
atic review by Riper et al. [32] identified 16 RCTs with
general population samples. The meta-analysis found a mod-
est effect size of these interventions on hazardous drinking
(Hedgesg= 0.20, 95 % confidence interval (CI) 0.130.27).
Of note, there was no observable difference in the effect size
521, Page 2 of 5 Curr Psychiatry Rep (2014) 16:521
for trials incorporating clinician contact with an Internet inter-
vention compared to trials that evaluated fully automated
interventions. This finding emphasises that Internet interven-
tions are amenable to application in a variety of different
settingswhether directly accessed by problem drinkers
who are not engaging with specialised care or in conjunction
with existing health services. Topics requiring more research
include the need to establish long-term impacts of Internet
intervention for hazardous alcohol use as well as studies
examining whether extended interventions can have an addi-
tional impact above and beyond brief, personalised feedback
interventionsthe latter being the focus of the majority of
trials thus far. Finally, large-scale multisite trials, such as the
recent publication by Kypri et al. [33] in university students,
are needed to assess the effectiveness of Internet interventions
for alcohol in the general population.
The most recent systematic review of Internet interventions
for smoking cessation included 28 RCTs [34] and identified a
high level of statistical heterogeneity between trials. A post
hoc subgroup analysis of tailored and interactive interventions
found the interventions to be significantly more effective than
usual care or written self-help materials (risk ratio= 1.48, 95 %
CI 1.11 to 2.78) [34]. A significant pooled effect was not
found for tailored and interactive Internet interventions over
their generic and static counterparts. The authors stated [34]
that future research should focus on these factors as they show
promise for engagement, particularly in young people.
Further research conducted since this review has investi-
gated the active ingredientsof smoking cessation Internet
interventions [35,36,37]. In a randomised factorial trial,
reading content written in a motivational tone, ability to freely
navigate the site and receiving proactive email reminders
promoted greater engagement with the intervention in the first
2 months compared to the contrasted level of each factor.
Tailored testimonials did not [36]. At 1 year, however, none
of these factors significantly increased smoking cessation
[37]. The authors recommended that future research should
continue to investigate active components of interventions. In
addition, further factors to investigate include the dose-
response relationship between abstinence and quantity of
programme components [38] and the impact of an extraneous
variable created by participants who use non-assigned Internet
interventions in comparison conditions [39].
A novel research area for tobacco cessation is the dissem-
ination of interventions via applications (apps) in Facebook. A
survey of young adults (N=30) found one third of the sample
said they would be willing to use Facebook to help quit
smoking; however, there were concerns about privacy [40].
Five RCTs using the messaging functionality of mobile
phones as part of an intervention have proven to be effective
(risk ratio=1.71, 95 % CI 1.47 to 1.99) [41]. To date, there
have been no RCTs which have investigated the use of a
smartphone apps for smoking cessation [42].
Current Limitations and Future Directions
There are a number of high quality Internet interventions for
the more common mental health and addictions concerns. Fast
developing are Internet interventions for less prevalent con-
cerns, although the evidence base for these newer interven-
tions is understandably limited. Despite promising effective-
ness evidence, there are a number of limitations of Internet
interventions that will no doubt be addressed over the next
several years. Primarily, common questions that are asked of
health-care interventions need answeringhow sustainable is
the impact of the intervention, is the intervention generalizable
(i.e. will it work for everyone or just some sub-groupsand if
so, for whom), is the intervention scalable and/or customiz-
able to specific populations and how cost effective is the
delivery of interventions?
A potential limitation of Internet interventions that also
needs to be considered is the intrinsic requirement for ongoing
expertise and resources to adapt and securely deliver interven-
tions within a technology environment that will change into
the future. In order to protect user privacy (and hence public
confidence in the use of Internet interventions), developers
and designers of interventions must necessarily address a
number of security issues [43], but even a well-considered
intervention will require ongoing maintenance and possibly
additional development or reimplementation throughout its
delivery. Ongoing development of the intervention may be
required in order to adapt to new security threats or to promote
accessibility through compliance with new web standards,
compatibility with new kinds of devices or interaction with
emerging technology trends.
The requirement for ongoing technological adaptability is a
limitation that can be overcome with appropriate resourcing,
but highlights a key question for the future of Internet inter-
ventionshow is the delivery of Internet interventions funded
on an ongoing basis? Internet interventions can clearly only
move from research projects to publicly delivered mental
health and addition services with adequate investment in
technological as well as clinical capacity.
There are also important questions to be addressed regard-
ing ways to improve the impact of Internet interventions.
Firstly, how do we promote engagement with the interven-
tions? Many research studies report lack of adherence and
high user drop-out from Internet interventions compared to
face-to-face interventions. Although some evidence points to
improved adherence by the involvement of therapist support,
it is clear that future development of Internet interventions
Curr Psychiatry Rep (2014) 16:521 Page 3 of 5, 521
(guided and unguided) will need to focus on new ways to
engage users in order to maximise exposure to the interven-
tion. Additionally, can the interventions be made more acces-
sible and available, in different languages and on different
platforms? Researchers also need to explore which compo-
nents of the interventions are most effective for different
disorders or client sub-groups and how to ensure that the most
appropriate intervention is offered to individual users. Unlike
in face-to-face treatment where the therapeutic approach may
be adjusted according to the clients changing circumstances,
personal preferences or response to the intervention, Internet
interventions rarely offer this level of continuous tailoring.
Related to this is the complex question of how best to integrate
Internet interventions with the larger continuum of health-care
services provided to people with mental health and addictions
Surrounding all of these questions will be the opportunity
to take advantage of new technological capabilities. Internet
interventions of the future are likely to include increasingly
sophisticated interactivity, more opportunities for tailoring to
individualspreferences or needs, new ways of monitoring
and delivery and greater potential for integration within health
care systems. Ongoing technological advances, combined
with an ever-expanding Internet intervention research base,
will drive the continued development of innovative ways of
providing health care for mental health and addiction
Compliance With Ethics Guidelines
Conflict of Interest John A Cunningham, Amelia Gulliver, Lou Farrer,
Kylie Bennett and Bradley Carron-Arthur declare that they have no
conflict of interest.
Human and Animal Rights and Informed Consent This article does
not contain any studies with human or animal subjects performed by any
of the authors.
Papers of particular interest, published recently, have been
highlighted as:
Of importance
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... Some of the common recommended treatments of IAD are reality therapy, art therapy, recreation therapy, equine therapy, dialectical behavior therapy (DBT), cognitive behavioral therapy (CBT), behavior modification and individual, group or family therapy [11]. ...
... Adolescents who are addicted to the Internet are more likely to develop mental health problems than other adolescents, who are classified as normal Internet users. Sadness, feeling down, having a loss of interest in daily activities are some of the symptoms [11,12]. ...
... Further, online treatment formats enable the easy utilization of peer support with moderated online forums (e.g., BCT and GHO), although it remains unclear how helpful participants perceive reading and contributing to forum discussions to be. In sum, it is important to tailor the modality of interventions to meet the needs of subgroups, support adherence where needed, minimize the drop-out rate, identify the mechanisms of change in interventions, and evaluate the duration of beneficial effects of interventions, as also noted previously (Cunningham, Gulliver, Farrer, Bennett, & Carron-Arthur, 2014). ...
Full-text available
Background and aims Research recognizes the extent of harm experienced by concerned significant others (CSOs) of gamblers. This systematic review’s aims are to examine the interventions for CSOs, evaluate potential benefits, and thematically describe treatment processes. The Stress-Strain-Coping-Support model (SSCS) served as the theoretical framework. Methods Database searches were conducted in: MEDLINE, CINAHL Complete, Web of Science Core Collection, Social Services Abstracts, Applied Social Science Index and Abstracts, Cochrane Central Register of Controlled Trials, and APA PsycInfo (between 01/Jan 2011–10/Jun 2021). Other search methods were also utilized. Inclusion criteria: interventions for CSOs with CSO specific outcomes. The Evidence Project Risk of Bias Tool was used for assessment. Results 19/768 records were included. Nine interventions were utilized: 3 CSO directed, 4 for couples, and 2 low threshold online interventions. A quantitative synthesis ( N = 7 studies) of effect size estimates for depression and anxiety measures didn’t indicate any intervention to have better outcomes than others. Core themes in the treatment process identified in the qualitative synthesis ( N = 7) included: information and understanding, social support, coping skills, communication, and strain. Limitations in the evidence related to sampling, control-conditions and outcome measurements. Discussion and conclusion Several interventions were identified, yet no specific interventions appeared more beneficial than others. Using the SSCS model, commonalities and differences in intervention content were identified, along with themes that influence treatment processes. The need for tailored interventions is discussed. Future treatment efficacy research should carefully select study designs and outcome measurements. PROSPERO (CRD42021229408).
... To address this substantial unmet need for treatment and alleviate the overall disease burden, mental health professionals began exploring ways technology could provide support. With the ubiquity of digital devices of computers first and web-based devices, such as laptops, tablets, and smartphones eventually, digital health has become increasingly widespread (Cunningham, Gulliver, Farrer, Bennett, & Carron-Arthur, 2014;Ebert et al., 2018). Internet-and mobile-based interventions can be implemented through various delivery modes: (1) interactive self-help lessons, (2) virtual or augmented reality, (3) serious-games, (4) avatar-led sessions, (5) automated memory, feedback, and reinforcement interventions, (6) phone-and wearable sensors . ...
Society is facing a global mental health crisis; most people will suffer from mental health problems either directly or by extension through family and friends. Although evidence-based psychological treatments exist, the majority of individuals in need remain untreated due to structural and attitudinal barriers. Digital mental health has great potential to bridge this treatment gap. While many digital interventions have been proven to be effective, there still remain challenges such as high comorbidity and heterogeneity of mental disorders, low adherence rates, lack of involvement of patient perspectives and needs, unclear efficacy of internet interventions for highly burdened individuals, and the unknown efficacy of smartphones apps for mental health. To address these challenges, this dissertation aims to provide insight into innovations in digital mental health, particularly (1) transdiagnostic internet-based treatment and prevention, (2) patient perspectives in internet interventions, (3) effect modifiers of internet interventions, and (4) standalone smartphone apps for mental health. These innovations are addressed in six publications. Publication 1, 2, and 3 refer to a transdiagnostic individually tailored internet-based and mobile-supported intervention for depression and anxiety which was newly developed. This intervention was tested in different settings, from prevention to treatment, for individuals with a range from subclinical disorders to full-blown disorders of anxiety and depression, with two different guidance formats, unguided and guided. Publication 1 is a study protocol describing the treatment rationale and evaluation protocol for the prevention of depression and anxiety for individuals with subclinical depression and anxiety, as well as research design of the multinational, three-armed randomized controlled trial (N = 954) evaluating the efficacy and costeffectiveness of the intervention and assessing risk factors for the development of depression and anxiety. Publication 2 is a study protocol which describes the study design of a randomized controlled trial (N = 200) aiming to evaluate the efficacy, cost-effectiveness, and moderators of the intervention to treat depression for individuals with a clinical diagnosis of a major depressive disorder with and without comorbid anxiety. Publication 3 is a mixed-methods study examining the user experience of individuals (N = 49) with an anxiety disorder through a qualitative and quantitative process evaluation in a pilot feasibility trial. The qualitative interviews (N = 43) provided insights into participation motivation, helpful and hindering factors, and positive and negative effects. The qualitative findings were strengthened by the quantitative data, indicating that the intervention is feasible and acceptable with potential effects on reducing symptoms of anxiety and depression and anxiety disorder occurrence. Publication 4 describes the investigation of differential treatment effects in individual participant data of three randomized controlled trials (N = 791) evaluating an internet-based and mobile-supported stress management intervention. The results showed that individuals benefitted greatly from participation and those with higher symptom severity had even greater reductions of disease burden. Publication 5 focuses on exploring differential treatment effects of a guided internetbased intervention for individuals with diabetes and comorbid depression. Participants greatly improved depression symptom severity even those with high levels of depression at intervention begin. The effect was not moderated by symptom severity. Publication 6 is a systematic literature review and meta-analysis on the efficacy of smartphone apps for mental health which were evaluated in randomized controlled trials. In total, 19 studies were identified for varying psychological disorders. Small and significant pooled effects on depression and smoking behavior were found while no primary pooled effects were found on anxiety, suicidal ideation, self-injury, or alcohol use. Risk of bias was high for the majority of studies and an investigation of employed app components suggests that the unique app potential is not yet being exploited. Overall, the studies in this dissertation provide evidence that (1) transdiagnostic internet-based approaches are promising with high acceptability and results indicating the potential effects on anxiety and comorbid depression symptom severity, (2) exploring user experience through qualitative interviews can provide in-depth insights for intervention development and dissemination, and complement quantitative findings on effects and impact, (3) highly burdened individuals can benefit greatly from internet-based interventions reducing levels of stress, depression, and anxiety, (4) more research is needed on smartphone apps for mental health which currently cannot be recommended as psychological standalone treatment for most psychological disorders. Future research should focus on evaluating transdiagnostic treatment approaches in naturalistic settings and fostering implementation into routine care. User experience should be taken into account when developing, implementing, and disseminating digital mental health. To better understand underlying psychological mechanisms a process-oriented approach should be taken focusing on identifying predictors, mediators, and moderators of treatment outcome of digital health interventions, as well as risk factors for the development of psychological disorders. More research is needed to understand the unique features and potential of smartphone apps for mental health, which could positively influence their efficacy. Overall, digital mental health can be a low-threshold access point to destigmatize, educate, approach, and help individuals improve their mental health.
... The first two decades of the twenty-first century have seen the flourishing of digital/information technology healthcare interventions. Information technology (i.e., the use of technology to create, collect, store and exchange information) presents opportunities to improve healthcare through novel interventions, personalization, data management, support for clinicians, and better access to treatment [1][2][3]. This Addiction Science & Clinical Practice special issue advances our understanding of information technology (IT) substance use intervention efficacy, patients' perspectives, and how IT can be used to improve substance use healthcare and research. ...
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Background Information technology can be used to advance addiction science and clinical practice. Main body This special issue, “Information technology (IT) interventions to advance treatment for opioid and other addictions” presents studies that expand our understanding of IT intervention efficacy, patients’ perspectives, and how IT can be used to improve substance use health care and research. This editorial introduces the topics addressed in the special issue and focuses on some of the challenges that the field is currently facing, such as attrition and treatment retention, transferability of intervention paradigms, and the challenge to keep pace with rapidly changing technologies. Conclusions Increasing treatment reach is particularly crucial in the addiction field. IT empowers researchers and clinicians to reach large portions of the population who might not otherwise access standard treatment modalities, because of geographical limitations, logistical constraints, stigma, or other reasons. The use of information technology may help reduce the substance use treatment gap and contribute to public health efforts to diminish the impact of substance use and other addictive behaviors on population health.
... A further important aspect is that the highprevalence of comorbidity is to date not adequately addressed by e-mental health applications, as these applications commonly target specific disorders. Finally, issues related to user privacy have to be considered, which is relevant for data collection and storage, especially when smartphone applications are used (Andersson & Titov, 2014;Cunningham et al., 2014). Therefore, future studies are needed to assess the potential of e-mental health applications to replace psychotherapy, both during and after the COVID-19 pandemic. ...
The outbreak of the novel coronavirus disease (COVID-19) creates significant challenges not only for mental health but also for mental health care services. The measures implemented to combat the rapid spread of the virus have created severe barriers to patients accessing in-person, face-to-face psychotherapy services around the world. As direct contact with others should be avoided where possible to prevent virus transmission, adaptations in the therapeutic settings are necessary. Therefore, remote psychotherapy became a valuable option for continuity of mental health care during the COVID-19 pandemic. This article reviews recent studies on the transition to remote psychotherapy during the COVID-19 pandemic. Studies conducted in Austria, the Czech Republic, Germany and Slovakia revealed a strong increase in the provision of psychotherapy via the internet or telephone during the pandemic as compared to the months before. Several differences emerged with regard to country and gender, while the therapeutic orientation was of minor importance. In central Denmark, referrals to psychiatric services declined considerably during the lockdown. But in a psychotherapy program at a public hospital in Mas-sachusetts, a switch to remote psychotherapy led to a reduction in the number of missed appointments. Results imply that the necessary supply of mental health care services could not be sufficiently maintained in all countries during the COVID-19 situation, and that measures are required to further facilitate the provision of mental health care during and after the pandemic.
... A challenge for addressing unhealthy alcohol use is that few with unhealthy alcohol use actively seek treatment [18]. Information technology has the potential to reach large parts of the general population [19,22]. Compared to face-to-face interventions, interventions using information technology have a greater reach, can be more easily implemented, and are more consistent [42]. ...
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Background: Unhealthy alcohol use is a leading cause of morbidity and mortality among young people, including university students. Delivering secondary prevention interventions against unhealthy alcohol use is challenging. Information technology has the potential to reach large parts of the general population. The present study is proposed to test a proactive secondary prevention smartphone-based intervention against unhealthy alcohol use. Methods: This is a parallel-group, randomized controlled trial (1:1 allocation ratio) among 1696 university students with unhealthy alcohol use, identified by screening and followed up at 3, 6, and 12 months. Participants will be randomized to receive access to a smartphone-based intervention or to a no intervention control condition. The primary outcome will be self-reported volume of alcohol drunk over the past 30 days, reported as the mean number of standard drinks per week over the past 30 days, measured at 6 months. Secondary outcomes will be number of heavy drinking days over the past 30 days, at 6 months. Additional outcomes will be maximum number of drinks on any day over the past 30 days, alcohol-related consequences (measured using the Short Inventory of Problems (SIP-2R), and academic performance. Discussion: The aim of this trial is to close the evidence gap on the efficacy of smartphone-based secondary prevention interventions. If proven effective, smartphone-based interventions have the potential to reach a large portion of the population, completing what is available on the Internet. Trial registration: ISRCTN, 10007691. Registered on 2 December 2019. Recruitment will start in April 2020.
... Nevertheless, caution is required as it has been found that disclosure in the absence of a controlled setting may be less effective or harmful (Sheffield, Duncan, Thomson, & Johal, 2002). This has been one of the primary concerns of clinicians regarding the ethical use of the internet for providing mental health services (Cunningham, Gulliver, Farrer, Bennett, & Carron-Arthur, 2014). While there is evidence of positive impact of journaling mental health experiences, interventions using web-based journaling may need user specific instructions, including frequency of blog entry, length of time spent on an entry, or specific instructions for entry content. ...
The aim of this scoping review of the available research evidence was to explore the experiences and perceptions of people with mental health difficulties through the use of blogs. A search of relevant electronic databases was undertaken from January 2009 to February 2019. Selected studies included people who blog about their mental health difficulties online. The PRISMA system was used to present the results of the searches. Following the application of specific inclusion and exclusion criteria, the final number of included studies was eleven. Following data analysis, the subordinate categories in the public category were moderation, confidentiality and boundaries. The subordinate categories in the private sphere included catharsis, enhanced coping strategies and social connectedness. The implications for mental health practice developments and research, are presented and discussed.
... 12 Há comprovação considerável da eficácia de intervenções pela internet que visam a problemas de saúde e dependência. 13 Estudos promissores indicam que os programas telessaúde de prevenção para adolescentes em escolas têm potencial para reduzir o uso de drogas. 14 Uma análise sistemática recente mostrou que há comprovação de intervenções para os pais pela internet para prevenção do consumo de álcool. ...
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Objectives Programs for parents have been found to have a direct positive impact on reducing the consumption of psychoactive substances by adolescents, as well as having an indirect impact on reducing risk factors and increasing protective factors. The present study aimed to verify if a telehealth prevention program based on a brief motivational intervention helps to reduce parental risk practices and increase parental protective practices for drug use in comparison with psychoeducation. Methods A pilot randomized controlled trial was performed at the National Service of Guidance and Information on Drug Use (Ligue 132), from September 2014 to December 2015, with the parents of adolescents (n = 26). The outcome measures were parental style, risk, and protective parental practices. Results The brief motivational intervention was found to be more effective than psychoeducation in reducing the negligent behavior of parents. Furthermore, when comparing pre‐ and post‐intervention data, the brief motivational intervention helped to change parental style and the large majority of parental practices: increasing positive monitoring, as well as decreasing physical abuse, relaxed discipline, inconsistent punishment, and negative monitoring. Conclusions These results demonstrate that the telehealth intervention is effective in modifying the parental practices known to help in preventing drug use. Studies with more number of subjects are required so that the results can be substantiated and generalized.
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Purpose of Review Provision of mental health services through digital technologies (e-mental health) can potentially expand access to treatments for personality disorders (PDs). We evaluated studies on e-mental health for PDs published over the last 3 years (2019–2022). Recent Findings Studies published in English that used e-mental health to treat people with PDs or PD-related symptoms were identified. We identified 19 studies, including four randomized controlled trials and one meta-analysis. Most interventions were based on Dialectical Behavior Therapy and delivered through smartphone applications for adults with Borderline Personality Disorder [BPD] or related symptoms. User experiences of the interventions were generally positive. Evidence for efficacy was limited. Summary The current literature on e-mental health for PDs is limited in scope. Research in understudied populations and randomized controlled trials designed to establish efficacy are warranted. It is not yet clear whether e-mental health may be helpful for the treatment of PDs.
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Background Greater access to evidence-based psychological treatments is needed. This review aimed to evaluate whether internet-delivered psychological treatments for mood and anxiety disorders are efficacious, noninferior to established treatments, safe, and cost-effective for children, adolescents and adults. Methods We searched the literature for studies published until March 2013. Randomized controlled trials (RCTs) were considered for the assessment of short-term efficacy and safety and were pooled in meta-analyses. Other designs were also considered for long-term effect and cost-effectiveness. Comparisons against established treatments were evaluated for noninferiority. Two reviewers independently assessed the relevant studies for risk of bias. The quality of the evidence was graded using an international grading system. Results A total of 52 relevant RCTs were identified whereof 12 were excluded due to high risk of bias. Five cost-effectiveness studies were identified and three were excluded due to high risk of bias. The included trials mainly evaluated internet-delivered cognitive behavioral therapy (I-CBT) against a waiting list in adult volunteers and 88% were conducted in Sweden or Australia. One trial involved children. For adults, the quality of evidence was graded as moderate for the short-term efficacy of I-CBT vs. waiting list for mild/moderate depression (d = 0.83; 95% CI 0.59, 1.07) and social phobia (d = 0.85; 95% CI 0.66, 1.05), and moderate for no efficacy of internet-delivered attention bias modification vs. sham treatment for social phobia (d = −0.04; 95% CI −0.24, 0.35). The quality of evidence was graded as low/very low for other disorders, interventions, children/adolescents, noninferiority, adverse events, and cost-effectiveness. Conclusions I-CBT is a viable treatment option for adults with depression and some anxiety disorders who request this treatment modality. Important questions remain before broad implementation can be supported. Future research would benefit from prioritizing adapting treatments to children/adolescents and using noninferiority designs with established forms of treatment.
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A recent meta-analysis of Internet interventions for smoking cessation found mixed evidence regarding effectiveness. One explanation may be differential use of non-assigned cessation treatments-including other Internet programs-that either amplify or mask study intervention effects. We examined the impact of non-assigned treatment use on cessation outcomes in The iQUITT Study, a randomized trial of Internet and telephone treatment for smoking cessation. Participants were randomized to a basic Internet (BI) comparison condition (N = 675), enhanced Internet (EI: N = 651), or EI plus telephone counseling (EI+P: N = 679). The primary outcome was 30-day point prevalence abstinence (ppa) at 3 and 6 months. "Assigned" intervention use was assessed with automated tracking data. Assessment of "non-assigned" treatments included pharmacotherapy, behavioral, alternative, and non-study Internet treatments. Univariate and multivariate logistic regression models examined whether non-assigned treatment use was associated with 30-day ppa. About 70% of participants used at least one non-assigned treatment. A higher rate of non-study Internet treatment among BI participants was the only treatment group difference at both 3 and 6 months. Multivariate models controlling for condition and baseline predictors of non-assigned treatment use showed that high-intensity non-study Internet treatment was positively associated with 30-day ppa at 3 and 6 months, and pharmacotherapy and behavioral treatment use was negatively associated with 30-day ppa at 6 months. Non-assigned treatment use is an important factor to consider in evaluating Internet cessation interventions. Results highlight methodological issues in selecting a comparison condition. Researchers should report non-assigned treatment use alongside main trial outcomes.
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The news committee for the SRNT Treatment Network would like to welcome you to our inaugural "Treatment Hot Topics" newsletter. The vision of the committee is to summarize and effectively disseminate a quarterly newsletter that will contain breakthrough scientific and sociopolitical hot topics and how these affect treatment of tobacco use disorders. This month's newsletter focuses on smoking and special populations as well as novel smoking cessation treatments. These two pertinent topics were selected from a pool of topics of interests, which were requested by SRNT members on an online survey carried out by the SRNT Treatment network. Subsequent topics that will be covered in forthcoming newsletters will include e-cigarettes, updates in novel treatments, and policy issues, which affect nicotine/tobacco treatment and research.
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Research needs to systematically identify which components increase online intervention effectiveness (i.e., "active ingredients"). This study explores the effects of 4 potentially important design features in an Internet-based, population-level smoking intervention. Smokers (n = 1,865) were recruited from a large health care organization, regardless of readiness to quit. Using a full factorial design, participants were randomized to 1 of the 2 levels of each experimental factor (message tone [prescriptive vs. motivational], navigation autonomy [dictated vs. not], e-mail reminders [yes vs. no], and receipt of personally tailored testimonials [yes vs. no]) and provided access to the online intervention. Primary outcomes were self-reported seven-day point-prevalent smoking abstinence and confirmed utilization of adjunct treatment (pharmacotherapy or phone counseling) available through the health plan at one year. Outcomes were also assessed at two and six months and were examined among all enrolled participants (intent-to-treat [ITT]) and all who viewed the intervention (modified ITT). At one year, 13.7% were abstinent and 26.0% utilized adjunct treatment. None of the contrasting factor levels differentially influenced abstinence or treatment utilization at 12 months. In the modified ITT sample, smokers receiving testimonials were less likely to use adjunct treatment at six months (odds ratio = 0.54, 95% confidence interval = 0.30-0.98, p = .04). None of the design features enhanced treatment outcome. The negative effect observed for testimonials is provocative, but it should be viewed with caution. This study offers a model for future research testing the "active ingredients" of online interventions.
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Unhealthy alcohol use is a leading contributor to the global burden of disease, particularly among young people. Systematic reviews suggest efficacy of web-based alcohol screening and brief intervention and call for effectiveness trials in settings where it could be sustainably delivered. To evaluate a national web-based alcohol screening and brief intervention program. A multisite, double-blind, parallel-group, individually randomized trial was conducted at 7 New Zealand universities. In April and May of 2010, invitations containing hyperlinks to the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screening test were e-mailed to 14,991 students aged 17 to 24 years. Participants who screened positive (AUDIT-C score ≥4) were randomized to undergo screening alone or to 10 minutes of assessment and feedback (including comparisons with medical guidelines and peer norms) on alcohol expenditure, peak blood alcohol concentration, alcohol dependence, and access to help and information. A fully automated 5-month follow-up assessment was conducted that measured 6 primary outcomes: consumption per typical occasion, drinking frequency, volume of alcohol consumed, an academic problems score, and whether participants exceeded medical guidelines for acute harm (binge drinking) and chronic harm (heavy drinking). A Bonferroni-corrected significance threshold of .0083 was used to account for the 6 comparisons and a sensitivity analysis was used to assess possible attrition bias. Of 5135 students screened, 3422 scored 4 or greater and were randomized, and 83% were followed up. There was a significant effect on 1 of the 6 prespecified outcomes. Relative to control participants, those who received intervention consumed less alcohol per typical drinking occasion (median 4 drinks [interquartile range {IQR}, 2-8] vs 5 drinks [IQR 2-8]; rate ratio [RR], 0.93 [99.17% CI, 0.86-1.00]; P = .005) but not less often (RR, 0.95 [99.17% CI, 0.88-1.03]; P = .08) or less overall (RR, 0.95 [99.17% CI, 0.81-1.10]; P = .33). Academic problem scores were not lower (RR, 0.91 [99.17% CI, 0.76-1.08]; P = .14) and effects on the risks of binge drinking (odds ratio [OR], 0.84 [99.17% CI, 0.67-1.05]; P = .04) and heavy drinking (OR, 0.77 [99.17% CI, 0.56-1.05]; P = .03) were not significantly significant. In a sensitivity analysis accounting for attrition, the effect on alcohol per typical drinking occasion was no longer statistically significant. A national web-based alcohol screening and brief intervention program produced no significant reductions in the frequency or overall volume of drinking or academic problems. There remains a possibility of a small reduction in the amount of alcohol consumed per typical drinking occasion. Identifier: ACTRN12610000279022.
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The aim of the current review is to provide a summary of research into Internet-delivered cognitive behavioral therapy (iCBT) for anxiety disorders. We include 37 randomized controlled trials that examined the efficacy of iCBT programs in adults (aged over 18 years), as compared with waiting list or active control. The included studies were identified from Medline searches and from reference lists, and only published data were included. Several trials of iCBT for generalized anxiety disorder, panic disorder, and social phobia were identified. Two trials of iCBT for obsessive-compulsive disorder were identified, whilst one trial each was identified for hypochondriasis, specific phobia (spiders), and post-traumatic stress disorder. Finally, there were five trials that focused on transdiagnostic therapy for either a range of comorbid anxiety disorders or comorbid anxiety and depression. Between-group effect sizes were moderate to large for all disorders, and ranged from 0.30 to 2.53. iCBT was found to be commensurate with face-to-face cognitive behavioral therapy whether delivered individually or in group format. Guidance may not be necessary for iCBT to be effective for immediate gains, but may be more important in longer-term maintenance of symptom improvement and maximizing patient adherence. The clinical experience of the individual providing guidance does not appear to impact treatment outcomes. Future research needs to focus on the optimal level of guidance required to generate maximum patient benefits, whilst balancing the efficient use of clinician time and resources. Evidence-based contraindications to iCBT should also be developed so that the choice of treatment modality accurately reflects patients' needs. Further research should be conducted into the effective elements of iCBT, as well as the extent to which therapy enhancers and advancing technology can be accommodated into established iCBT frameworks.
Purpose: To determine whether young adults are interested in a Facebook intervention for smoking cessation and to inform the design of such an intervention. Design: Mixed-methods. Setting: Participants throughout the United States were recruited through Facebook. Participants: Young adults aged 18 to 25 years who had smoked at least once in the past month. Method: Participants (N = 570) completed an online survey of tobacco and social media use. A subset of 30 survey completers, stratified by motivation to quit smoking, agreed to participate in a structured interview over online chat. Themes were identified by using grounded theory. Results: Approximately a third of the full sample (31%) reported they would want to get help to quit smoking by using Facebook. Interest in using Facebook to quit was greater among those who were more motivated to quit (χ(2) = 75.2, p < .001), had made a quit attempt in the past year (χ(2) = 16.0, p < .001), and had previously used the Internet for assistance with a quit attempt (χ(2) = 6.2, p = .013). In qualitative interviews, social support and convenience were identified as strengths of a Facebook intervention, while privacy was the main issue of concern. Conclusion: Nearly one in three young adult smokers on Facebook expressed interest in using Facebook for quitting smoking. Social media approaches that respect privacy and tailor to readiness to quit are likely to maximize participation.