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The efficacy of app‐supported smartphone interventions for mental health problems: a meta‐analysis of randomized controlled trials
Abstract
Although impressive progress has been made toward developing empirically‐supported psychological treatments, the reality remains that a significant proportion of people with mental health problems do not receive these treatments. Finding ways to reduce this treatment gap is crucial. Since app‐supported smartphone interventions are touted as a possible solution, access to up‐to‐date guidance around the evidence base and clinical utility of these interventions is needed. We conducted a meta‐analysis of 66 randomized controlled trials of app‐supported smartphone interventions for mental health problems. Smartphone interventions significantly outperformed control conditions in improving depressive (g=0.28, n=54) and generalized anxiety (g=0.30, n=39) symptoms, stress levels (g=0.35, n=27), quality of life (g=0.35, n=43), general psychiatric distress (g=0.40, n=12), social anxiety symptoms (g=0.58, n=6), and positive affect (g=0.44, n=6), with most effects being robust even after adjusting for various possible biasing factors (type of control condition, risk of bias rating). Smartphone interventions conferred no significant benefit over control conditions on panic symptoms (g=–0.05, n=3), post‐traumatic stress symptoms (g=0.18, n=4), and negative affect (g=–0.08, n=5). Studies that delivered a cognitive behavior therapy (CBT)‐based app and offered professional guidance and reminders to engage produced larger effects on multiple outcomes. Smartphone interventions did not differ significantly from active interventions (face‐to‐face, computerized treatment), although the number of studies was low (n≤13). The efficacy of app‐supported smartphone interventions for common mental health problems was thus confirmed. Although mental health apps are not intended to replace professional clinical services, the present findings highlight the potential of apps to serve as a cost‐effective, easily accessible, and low intensity intervention for those who cannot receive standard psychological treatment.
... Available apps for PTSD are rarely scientifically evaluated (Anthes, 2016;Olff, 2015;Sander et al., 2020). Studies of trauma-related self-management apps have been criticized on the basis of inadequate sample size (Anthes, 2016;Wickersham et al., 2019), short scope of follow-up (Wickersham et al., 2019), and absence of monitoring of short and long-term negative effects (Linardon et al., 2019;Sander et al., 2020;Wickersham et al., 2019). Goreis et al. (2020) argue that self-management apps are unsuitable as stand-alone interventions, but may complement face-to-face care. ...
... A systematic review of five randomized controlled trial (RCT) studies that evaluated apps that target posttraumatic stress found that the interventions were promising, but that results regarding efficacy were inconsistent (Wickersham et al., 2019). A meta-analysis found no benefit of self-management apps over controls for posttraumatic stress, which may be an issue of power or inadequate intervention design (Linardon et al., 2019). A meta-analysis of six studies (mainly regarding the app PTSD Coach) found a moderate within-group effect of reduced posttraumatic stress and small effect of reduced depressive symptoms, but no between-group effect in randomized controlled trials (Goreis et al., 2020). ...
... However, we did not explore the actual use of PTSD Coach modules. Other researchers argue that the inclusion of avatars (a digital embodiment of a person), interactive social support or automated support, in app interventions could improve efficacy of interventions (Goreis et al., 2020;Linardon et al., 2019). Passive and active data collection within mental health apps could permit detailed observation and investigation of effective mechanisms as they unfold in everyday life. ...
Apps that target posttraumatic stress are rarely evaluated and long-term examination of symptom change is rare. In a waitlist-controlled randomized controlled trial, we found that the Swedish version of the self-management app PTSD Coach confers benefits on posttraumatic stress and depressive symptoms after three months use. Here, we aimed to evaluate between-group effects on functional disability as well as within-group changes on mental health, somatic illness and functional disability after access to the Swedish PTSD Coach app during 9 months. In addition, we described negative effects, helpfulness and satisfaction with the app. Among the 179 trauma-exposed adults (92 % women) randomized to instant access or delayed access to PTSD Coach, symptoms of posttraumatic stress, depression, somatic illness and functional disability decreased and were maintained within 3 to 9 months of app access. Posttraumatic stress continued to improve during follow-up. PTSD Coach was considered slightly to moderately helpful and satisfactory and 43 % reported any negative effect related to using the app. PTSD Coach is an effective self-management intervention for trauma-related distress. Future research should investigate mechanisms of change, as well as individual characteristics that predict symptom reduction after access to PTSD Coach in order to inform clinical practice.
... One subtype of E-health is the delivery of structured health programmes via the internet or smartphone applications, termed digital interventions (DI). DI supports mental and physical health by helping people to engage in behaviours that may prevent the development of illness (13)(14)(15)(16), facilitating early detection (15,17,18), and improving the management of chronic conditions (19)(20)(21). For physical health, DI can support people to engage in exercise and healthy eating (13,14), to better self-manage their health or chronic illnesses (19)(20)(21), and improve medication adherence (21). ...
... One subtype of E-health is the delivery of structured health programmes via the internet or smartphone applications, termed digital interventions (DI). DI supports mental and physical health by helping people to engage in behaviours that may prevent the development of illness (13)(14)(15)(16), facilitating early detection (15,17,18), and improving the management of chronic conditions (19)(20)(21). For physical health, DI can support people to engage in exercise and healthy eating (13,14), to better self-manage their health or chronic illnesses (19)(20)(21), and improve medication adherence (21). ...
... For physical health, DI can support people to engage in exercise and healthy eating (13,14), to better self-manage their health or chronic illnesses (19)(20)(21), and improve medication adherence (21). For mental health, DI can support people to engage in well-being behaviours as prevention (15,16) and help people who would not meet the threshold for secondary or tertiary services (15,17,18). Likewise, DI can deliver evidence-based psychological techniques that improve mental health (15,(22)(23)(24). ...
Background
Digital interventions deliver healthcare via the internet or smartphone application to support people's well-being and health. Yet uptake is relatively poor. Furthermore, several studies exploring attitudes towards digital interventions have found inconsistent attitudes. In addition to this, regional and cultural nuances may further influence attitudes to digital interventions.Objective
This study aimed to understand New Zealand adults' attitudes towards digital interventions and their influences.ResultsA mixed-method design consisting of a cross-sectional survey and semi-structured interviews found that New Zealand adults hold varied and complex attitudes towards digital interventions. Attitudes were found to be influenced by group membership and the scenarios in which digital interventions are made available. In addition, beliefs about the benefits and concerns surrounding digital interventions, knowledge, perceived views of others, and previous experience and confidence influenced these attitudes.Conclusions
Findings indicated that digital interventions would be acceptable if offered as part of the healthcare service rather than a standalone intervention. Key modifiable factors that could positively influence attitudes were identified and could be leveraged to increase the perceived acceptability of digital interventions.
... Digital technologies are omnipresent worldwide: this is particularly characterised by almost pervasive use of smartphone technology and widespread internet connectivity. There is growing interest in the use of smartphone technology, through the use of applications (apps), to deliver or supplement interventions for different health needs [20][21][22]. There is some evidence of the clinical utility of smartphone applications for mental health problems; there is evidence that they are a beneficial self-management tool among those with depression [20] and may also reduce anxiety [21]. ...
... There is some evidence of the clinical utility of smartphone applications for mental health problems; there is evidence that they are a beneficial self-management tool among those with depression [20] and may also reduce anxiety [21]. A meta-analysis of randomised controlled trials found that smartphone interventions achieved comparable impacts with face-to-face interventions in terms of mental health outcomes [22], highlighting their usefulness in assisting those with poor access to standard psychological treatment, for example among those who cannot afford treatment or those living/working remotely. The use of app-based smartphone interventions offer significant benefits by enabling participants to engage with content when and where it suits, and may facilitate engagement with groups who are otherwise difficult to reach or who are reluctant to engage with health services, including men [23]. ...
... There is growing evidence of the utility of digital technologies including smartphone applications and web-based interventions in supporting the treatment and management of depressive symptoms [38,39]. Meta-analyses and systematic reviews have also reported promising evidence of the effectiveness of smartphone applications for symptoms of depression and anxiety [20][21][22]. The tentative evidence that the MATESmobile smartphone application improved intentions to seek help from MATES workers/Connectors comports with these studies. ...
Purpose
In Australia and elsewhere, suicide rates among construction workers remain high. Construction workplaces are thus an important setting for targeted suicide prevention programs. This study aimed to compare suicide prevention literacy and help-seeking intentions among participants receiving face-to-face suicide prevention training, with those receiving face-to-face training augmented by a smartphone application.
Methods
A two-arm randomised controlled trial of a smartphone suicide prevention intervention was conducted among construction workers in four Australian states (trial registration number: ACTRN12619000625178). All participants received face-to-face training and were randomised to the control condition (face-to-face only, n = 575), or MATESmobile condition (face-to-face + smartphone application,n = 509). Surveys administered at baseline and 3-month follow-up measured suicide prevention literacy and help-seeking intentions for personal/emotional problems and suicidal thoughts. A mixed-model repeated measures (MMRM) analysis included all 1084 randomised participants.
Results
Outcomes did not differ significantly for suicide prevention literacy, nor help-seeking intentions from formal sources, informal sources outside the workplace, or no one (did not intend to seek help from anyone). However, relative to those in the control condition, those in the MATESmobile group showed greater increase in help-seeking intentions for emotional problems from a MATES worker/Connector (mean difference 0.54, 95% CI 0.22–0.87) and help-seeking intentions for suicidal thoughts from a workmate (mean difference 0.47, 95% CI 0.10–0.83) or MATES worker/Connector (mean difference 0.47, 95% CI 0.09–0.85).
Conclusion
Results indicate that the MATESmobile application, together with face-to-face training, is beneficial in enhancing help-seeking intentions from MATES workers/Connectors and workmates to a greater extent than face-to-face training only. While this research provides some evidence that smartphone applications may support suicide prevention training, further research is needed.
... principles, and include methods to cope with stress, such as journaling or tracking thoughts, feelings, and behaviors [1,7]. DMHIs can include mental health mobile applications (MHapps) and computerbased interventions [8][9][10], which deliver on-demand support ranging from behavioral strategies (e.g., self-monitoring) to more complex therapeutic approaches (e.g., cognitive-behavioral therapy) [8][9][10][11][12][13]. ...
... This can increase motivation, takes less time than providing direct service, and can be done via both synchronous and asynchronous channels. There is growing evidence that human support of this nature can increase users' engagement with technologydelivered interventions [39] as well intervention outcomes [7,37]. For example, a meta-analysis of 66 unique experimental comparisons showed that when DMHI use was supplemented by synchronous or asynchronous support, the effects were double compared to unsupported DMHI use [7]. ...
... There is growing evidence that human support of this nature can increase users' engagement with technologydelivered interventions [39] as well intervention outcomes [7,37]. For example, a meta-analysis of 66 unique experimental comparisons showed that when DMHI use was supplemented by synchronous or asynchronous support, the effects were double compared to unsupported DMHI use [7]. ...
Background:
Digital mental health interventions (DMHIs) have been increasingly deployed to bridge gaps in mental health care, particularly given their promising efficacy. Nevertheless, attrition among DMHI users remains high. In response, human support has been studied as a means of improving retention to and outcomes of DMHIs. Although a growing number of studies and meta-analyses have investigated the effects of human support for DMHIs on mental health outcomes, systematic empirical evidence of its effectiveness across mental health domains remains scant.
Objective:
We aimed to summarize the results of meta-analyses of human support versus no support for DMHI use across various outcome domains, participant samples, and support providers.
Methods:
We conducted a systematic meta-review of meta-analyses, comparing the effects of human support with those of no support for DMHI use, with the goal of qualitatively summarizing data across various outcome domains, participant samples, and support providers. We used MEDLINE, PubMed, and PsycINFO electronic databases. Articles were included if the study had a quantitative meta-analysis study design; the intervention targeted mental health symptoms and was delivered via a technology platform (excluding person-delivered interventions mediated through telehealth, text messages, or social media); the outcome variables included mental health symptoms such as anxiety, depression, stress, posttraumatic stress disorder symptoms, or a number of these symptoms together; and the study included quantitative comparisons of outcomes in which human support versus those when no or minimal human support was provided.
Results:
The results of 31 meta-analyses (505 unique primary studies) were analyzed. The meta-analyses reported 45 effect sizes; almost half (n=22, 48%) of them showed that human-supported DMHIs were significantly more effective than unsupported DMHIs. A total of 9% (4/45) of effect sizes showed that unsupported DMHIs were significantly more effective. No clear patterns of results emerged regarding the efficacy of human support for the outcomes assessed (including anxiety, depression, posttraumatic stress disorder, stress, and multiple outcomes). Human-supported DMHIs may be more effective than unsupported DMHIs for individuals with elevated mental health symptoms. There were no clear results regarding the type of training for those providing support.
Conclusions:
Our findings highlight the potential of human support in improving the effects of DMHIs. Specifically, evidence emerged for stronger effects of human support for individuals with greater symptom severity. There was considerable heterogeneity across meta-analyses in the level of detail regarding the nature of the interventions, population served, and support delivered, making it difficult to draw strong conclusions regarding the circumstances under which human support is most effective. Future research should emphasize reporting detailed descriptions of sample and intervention characteristics and describe the mechanism through which they believe the coach will be most useful for the DMHI.
... Behandlet lidelse (klientgruppe) Andrews et al. (2018) Angst og depressionslidelser ( Som det fremgår af tabel 1, viser en raekke af de nyeste metastudier, at digitale løsninger -sammenlignet med kontrolbetingelser -generelt er forbundet med reduktion af en raekke psykiske og somatiske symptomer blandt voksne (Andrews et al., 2018;Firth et al., 2017;Linardon et al., 2019;Olthuis et al., 2016;Zachariae et al., 2016). Også blandt børn og unge har man fundet relevante effekter på eksempelvis traethed, hovedpine og angstsymptomer (Vigerland et al., 2016). ...
... I den direkte sammenligning med faceto-face-løsninger har internetbaserede programmer (g=0,05) og videokonference (g=0,03) vist sammenlignelige effekter i behandlingen af forskellige psykiatriske og somatiske tilstande blandt voksne (Carlbring et al., 2018;Norwood et al., 2018). Såkaldte moderationsanalyser fra ovennaevnte metastudier demonstrerede desuden, at højere grad af personligt leveret støtte fra terapeuten, mere personlig feedback og laengere varighed af terapien var forbundet med større effekter (Andrews et al., 2018;Firth et al., 2017;Linardon et al., 2019;Zachariae et al., 2016). ...
... Personaliseringen af digitalt leveret psykoterapi vil formentlig styrkes i de kommende år. Kunstig intelligens og maskinlaering har potentiale til at understøtte individuelt tilpassede forløb, eksempelvis ved at variere graden af terapeutinvolvering, personalisere omfanget af påmindelser og tilpasse typen af terapeutiske redskaber til den enkelte klients faerdigheder og behov (Damholdt et al., 2016;Linardon et al., 2019;Stoll et al., 2020). Endelig tilbyder digitalt leveret psykoterapi en højere grad af fleksibilitet. ...
Digitalt leveret psykoterapi tilbydes i stigende grad som alternativ eller supplement til konventionel face-to-face-terapi i behandlingen af en række psykiske og somatiske problemstillinger. Men hvad er konsekvenserne af at flytte dele af psykoterapien fra det fysiske rum med direkte klientkontakt over i detdigitale rum? Digitale løsninger mindsker geografiske barrierer, muliggør hjælp til personer med begrænset mobilitet og tilbyder fleksible, individualiserede behandlingsforløb. Omvendt er digitalt leveret psykoterapi måske utilstrækkeligt sensitiv over for alvorlige psykiske udsving blandt klienterne, ligesomonline allianceopbygning og -fastholdelse kræver særlige terapeutiske virkemidler. Spørgsmålet er ikke, om der vil ske en øget digitalisering af psykoterapi, men snarere hvordan den kliniske psykologi vil høste gevinsterne og håndtere de faglige og etiske udfordringer forbundet med den stigende digitalisering.Grænserne for, hvilke lidelser og klienttyper som kan behandles effektivt og etisk forsvarligt gennem digitale interventioner, bør udforskes, ligesom forskning i optimering og implementering er nødvendig for at kvalitetssikre udbuddet på det digitale psykoterapi-marked.
... Recent systematic reviews have also supported the efficacy of these digital apps for workplace well-being, namely employees' psychological resilience and affective states. In a meta-analysis of 66 randomised controlled trials (RCTs) of smartphone interventions, Linardon et al. 12 found that mHealth apps significantly outperformed active and waitlist control conditions on depressive symptoms (g = 0.28, n = 54), anxiety symptoms (g = 0.30, n = 39), and positive affect (g = 0.44, n = 6). These findings complemented an earlier meta-analysis of web-based RCTs delivered in occupational settings, which also derived small effect sizes on alleviation of negative affect symptoms (depression: g = 0.28; anxiety: g = 0.29). ...
... 20 To our knowledge, few studies have reported dynamic associations between daily app engagement and employee's well-being. For example, the meta-analyses by Carolan et al. 13 and Linardon et al. 12 did not examine any digital interventions with EMAs. Contrary to the large effects on trait resilience, internet interventions with pre-post assessments on dynamic resilience revealed much smaller effect sizes (g = 0.29). ...
Evidence-based mobile health (mHealth) applications on smartphones are a cost-effective way for employees to take proactive steps to improve well-being and performance. However, little is known about what sustains engagement on these applications and whether they could dynamically improve occupational outcomes such as resilience and mood. Using real-world data, this intensive longitudinal study examines (a) which employees would continually engage with a cognitive behavioural therapy-informed mHealth application (‘Intellect’); and (b) if daily engagement of ‘Intellect’ would relate to better occupational outcomes on the following day. A total of 515 working adults in Singapore and Hong Kong ( M age = 32.4, SD age = 8.17) completed daily in-app items on mood and resilience components (i.e. sleep hours, sleep quality, physical activity, and stress levels). Our results revealed that employees with lower baseline resilience (β = −0.048, odds ratio (OR) = 0.953, p < 0.01), specifically poorer sleep quality (β = −0.212, OR = 0.809, p = 0.001) and/or higher stress levels (β = −0.255, OR = 0.775, p = 0.05), were more likely to resume engagement on the application. Among the 150 active users (i.e. ≥3 consecutive days of engagement) ( M age = 32.2, SD age = 8.17), daily engagement predicted higher resilience (β = 0.122; 95% confidence interval (CI) 0.039–0.206), specifically lower stress levels (β = 0.018; 95% CI 0.004–0.032), higher physical activity (β = 0.079; 95% CI 0.032–0.126), and mood levels (β = 0.020; 95% CI 0.012–0.029) on the following day even after controlling for same-day outcomes. Our preliminary findings suggest that engaging with a mHealth application was associated with higher dynamic resilience and emotional well-being in employees.
... and depressive symptoms (g = 0.28-0.38) [21,30,31]. However, comparisons against Active Control often yield significantly weaker and inconsistent results [21,30,32]. ...
... [21,30,31]. However, comparisons against Active Control often yield significantly weaker and inconsistent results [21,30,32]. Nevertheless, scaled at population level, small effects can meaningfully impact public mental health. ...
Digital self-guided mobile health [mHealth] applications are cost-effective, accessible, and well-suited to improve mental health at scale. This randomized controlled trial [RCT] evaluated the efficacy of a recently developed mHealth programme based on cognitive-behavioral therapy [CBT] principles in improving worry and anxiety. We also examined psychological mindedness [PM] as a mediator by which app engagement is thought to improve outcomes. The Intervention group completed a 2-week "Anxiety and Worry" programme with daily CBT-informed activities, while the active waitlist-control completed a matched 2-week mHealth programme on procrastination. Participants filled out the Generalized Anxiety Disorder [GAD-7], Patient Health Questionnaire [PHQ-9], and Psychological Mindedness Scale [PMS] at baseline, post-intervention, and 2-week follow-up. App engagement was measured at post-intervention only. Contrary to prediction, the Intervention group did not perform better than the Active Control group; both groups showed significant improvements on anxiety and depressive symptoms from baseline to follow-up. From post-intervention to follow-up, only the Intervention group showed further improvements for anxiety symptoms. Higher engagement with the mHealth app predicted lower anxiety and depressive symptoms at follow-up, and this relationship was fully mediated by psychological mindedness. This study provides evidence that [a] engaging in a CBT mHealth programme can reduce anxiety and worry, and [b] Psychological mindedness is a potential pathway by which engaging with a mHealth app improves anxiety and depressive symptoms. While overall effect sizes were small, at the population level, these can make significant contributions to public mental health.
... The model includes providing mentees with supportive encouragement and accountability for engaging with resources, which can include campusspecific resources or digital mental health technologies. Recent literature on technology-delivered interventions suggests that providing human support for intervention use can lead to positive associated outcomes (e.g., Andersson & Cuijpers, 2009;Linardon et al., 2019), supporting the use of supportive accountability models in college-level mentoring programs to ensure students' use of targeted resources. ...
... As alluded to, researchers are finding higher engagement and effect sizes when a form of human support is provided for the individual's use of the intervention (i.e. Andersson & Cuijpers, 2009;Domhardt et al., 2019;Heber et al., 2017;Linardon et al., 2019), hence explaining the increased attention human support and supportive accountability has received. ...
Unlabelled:
COVID-19 forced college administrators to reassess how they provide students with the most effective methods of support. This project examined the first year of a novel digital peer mentoring program with the goal of connecting diverse students to campus resources they needed to navigate the transition to and through their first year of college. MentorHub, a referral and supportive accountability mobile application, was implemented with first-year undergraduates at a large, private university in the northeastern region of the USA. MentorHub tracked students' current challenges and connected them with trained peer mentors who provided students with support and referrals to campus resources (e.g., mental health, financial, academic). Analyses were not hypothesis-driven, but instead were exploratory and intended for improving the platform. In the first year of the program (August 2021 to June 2022), 47% (N = 3141) students logged onto the platform at least once. Patterns of self-reported challenges revealed that career concerns were the most challenging at the beginning of the fall semester, and that academic habits were most challenging over the course of the year. Referrals (N = 756) were made by mentors, 13% of which were for health and well-being. First-generation and underrepresented minority students showed distinct patterns in referrals. Findings revealed distinct patterns in self-reported challenges across the academic year. Students' use of MentorHub and responses to in-app questions allowed for a real-time understanding of student challenges and patterns of engagement with peer mentors. Implications for a stepped-care approach to addressing student challenges are discussed.
Supplementary information:
The online version contains supplementary material available at 10.1007/s41347-023-00303-8.
... Mak et al. (2018) concluded that mindfulness, self-compassionate, and cognitive behavioural psychoeducation delivered through a mobile app was appropriate for improving mental well-being and reducing stress over the long-term. Linardon et al. (2019) reviewed the recent literature and in his meta-analytic review concluded that self-compassion and mindfulness could be elevated through MHapps. Orosa-Duarte et al. (2021) compared the effect of the mindfulness MHapp versus face-to-face mindfulness intervention among a student healthcare population. ...
... This creates an effective, but time-consuming and expensive solution to the problem (Chandrashekar, 2018). Like previous studies (Finlay-Jones et al., 2016;Eriksson et al., 2018;Mak et al., 2018;Linardon et al., 2019) we found that it is possible to increase self-compassion and reduce self-criticism by offering short online mobile apps or online-based apps. These are a cost-effective easy-to-administer solution that has a positive effect by raising self-compassion, mindfulness, and wellbeing and by reducing depression, anxiety, and psychological distress (MacBeth and Gumley, 2012;Kirby et al., 2017). ...
Introduction:
Being self-compassionate is considered a beneficial emotion regulation strategy. Therefore, the acquisition of emotional skills can raise self-compassion levels and consequently reduce self-criticism.
Methods:
Hence, the goal of the current study was to develop a mobile app based on the empirically proven group version of Emotion-Focused Training for Emotional Coaching (EFT-EC) and test its effectiveness in reducing self-criticism and raising self-compassion and self-protection. The sample consisted of 85 participants, of whom 22.4% were men and 77.6% were women. The mean age was 32.53 (SD = 14.51), ranging from 18 to 74 years. The participants filled out the following scales immediately before and after using the fourteen-day mobile app: The Forms of Self-Criticizing/Attacking & Self-Reassuring Scale (FSCRS), The Sussex-Oxford Compassion for the Self Scale (SOCS-S), and The Short-form Version of The Scale for interpersonal behaviour (s-SIB).
Results:
Use of the 14-day EFT-EC mobile app significantly improved self-compassion and self-reassurance and significantly reduced self-criticism compared to pre- and post-measurements.
Discussion:
The results are promising as self-criticism is a transdiagnostic phenomenon observed in various kinds of psychopathology and reducing it may prevent the emergence of psychopathologies. Moreover, the mobile app intervention can easily be accessed by a wide range of users, without requiring the services of a mental health professional, and thereby reduces the potential risk of shame or stigmatization.
... These mobile stress management applications are easily accessible via the smartphone and individuals can use them independently without accompanying therapy (Ebert et al. 2016). Despite its promising effectiveness in reducing chronic stress (Linardon et al. 2019), the adoption remains low and many of those who started, soon stopped using the application (Linardon and Fuller-Tyszkiewicz 2020). Limited adoption and use hinder these applications from being effective. ...
... Reaching a more significant portion of individuals comes with only a tiny increase in resources (Ebert et al. 2016). Substantial empirical evidence confirms the effectiveness of mobile stress management applications in reducing stress (Ebert et al. 2016;Linardon et al. 2019). Besides others, these applications have empirically shown to reduce perceived stress levels, depression, emotional exhaustion, and sleeping problems. ...
Chronic stress is a burden on mental and physical health. Despite the development and effectiveness of mobile stress management applications, their adoption and continued use remain low. Given that research revealed systematic differences in usage behavior among user types, we aim to investigate what drives these differences. We extend the affordance perspective and argue that accounting for psychological needs, actualized affordances, and actualization costs across different user types provides a deeper understanding of the factors driving the adoption and use of mobile stress management applications. The qualitative interview study of our mixed-methods study reveals eight affordances, eight actualization costs, and initial evidence for systematic differences among the user types. The quantitative questionnaire study will uncover the psychological needs, actualized affordances, and perceived actualization costs of the six user types. This work contributes a new theoretical perspective to overcome the gap in the adoption and usage of mobile stress management applications.
... 14-16 A large-scale metaanalysis of smartphone apps for mental health found a positive effect over control conditions on depression when participants were given health tips or other resource information. 17 However, low engagement plagues many applications. [18][19] Most of the specialty mental health applications studied had such low active users as to make a wide-ranging analysis of outcomes impossible. ...
Mental health is a crisis for learners globally, and digital support is increasingly seen as a critical resource. Concurrently, Intelligent Social Agents receive exponentially more engagement than other conversational systems, but their use in digital therapy provision is nascent. A survey of over 1000 student users of the Intelligent Social Agent, Replika, investigated participants’ loneliness, perceived social support, use patterns, and beliefs about Replika. We found participants were more lonely than typical student populations but still perceived high social support. Many used Replika in multiple, overlapping ways - as a friend, a therapist, and an intellectual mirror. Many also held overlapping and often conflicting beliefs about Replika - calling it a machine, an intelligence, and a human. Critically, 3% reported Replika halted their suicidal ideation. Comparative analysis of this group with the wider participant population is provided.
... It is encouraging that orthopedic team members reported positive perceptions regarding the feasibility and acceptability of a digital intervention because: (1) this modality can provide at-home access to mental health tools when a patient's mobility is limited due to a musculoskeletal condition, (2) there is growing evidence of effectiveness of digital mental health interventions, sometimes comparable to in-person mental health intervention [46,47], and (3) there is increasing momentum for third party payers to subsidize digital interventions. Although some clinicians voiced medicolegal concerns related to offering a digital mental health intervention, the COVID-19 pandemic has accelerated the national push to facilitate seamless prescription of effective digital therapeutics, and we anticipate these concerns will lessen as clarity from governing bodies is achieved [48][49][50][51]]. ...
Background
Although depressive and anxious symptoms negatively impact musculoskeletal health and orthopedic outcomes, a gap remains in identifying modalities through which mental health intervention can realistically be delivered during orthopedic care. The purpose of this study was to understand orthopedic stakeholders’ perceptions regarding the feasibility, acceptability, and usability of digital, printed, and in-person intervention modalities to address mental health as part of orthopedic care.
Methods
This single-center, qualitative study was conducted within a tertiary care orthopedic department. Semi-structured interviews were conducted between January and May 2022. Two stakeholder groups were interviewed using a purposive sampling approach until thematic saturation was reached. The first group included adult orthopedic patients who presented for management of ≥ 3 months of neck or back pain. The second group included early, mid, and late career orthopedic clinicians and support staff members. Stakeholders’ interview responses were analyzed using deductive and inductive coding approaches followed by thematic analysis. Patients also performed usability testing of one digital and one printed mental health intervention.
Results
Patients included 30 adults out of 85 approached (mean (SD) age 59 [14] years, 21 (70%) women, 12 (40%) non-White). Clinical team stakeholders included 22 orthopedic clinicians and support staff members out of 25 approached (11 (50%) women, 6 (27%) non-White). Clinical team members perceived a digital mental health intervention to be feasible and scalable to implement, and many patients appreciated that the digital modality offered privacy, immediate access to resources, and the ability to engage during non-business hours. However, stakeholders also expressed that a printed mental health resource is still necessary to meet the needs of patients who prefer and/or can only engage with tangible, rather than digital, mental health resources. Many clinical team members expressed skepticism regarding the current feasibility of scalably incorporating in-person support from a mental health specialist into orthopedic care.
Conclusions
Although digital intervention offers implementation-related advantages over printed and in-person mental health interventions, a subset of often underserved patients will not currently be reached using exclusively digital intervention. Future research should work to identify combinations of effective mental health interventions that provide equitable access for orthopedic patients.
Trial registration
Not applicable.
... Además, las intervenciones terapéuticas específicas, como la terapia cognitivo-conductual, la terapia de la compasión y la rehabilitación social, pueden ser beneficiosas para abordar y mejorar las dificultades emocionales y sociales en pacientes con estos trastornos. (29) Tratamientos farmacológicos y sus efectos en la función cognitiva El manejo de la depresión y el trastorno bipolar implica un enfoque combinado de tratamiento farmacológico y psicoterapéutico. ...
La interacción entre la mente y el cerebro es un tema de gran interés y relevancia en el campo de la salud mental. La comprensión de cómo funciona el cerebro y cómo influye en nuestros pensamientos, emociones y comportamientos puede ayudarnos a desarrollar tratamientos más efectivos y personalizados para diversos trastornos mentales, como la depresión, la ansiedad, el trastorno bipolar y otros.
... However, the efficacy of mobile app-based CBT interventions highly depends on user retention and engagement [32]. Nevertheless, a recent meta-analysis by Linardon et al [33] summarizes that even though mobile app-based mental health interventions are not intended to replace face-to-face consultations, they provide a cost-effective and highly accessible intervention for those in need. ...
Background:
An increase in depression, anxiety, and stress symptoms worldwide, attributed to the COVID-19 pandemic, has been reported. If not treated, it may negatively affect a person's everyday life by altering physical and social well-being and productivity and increasing expenditure on health care. Cognitive behavioral therapy (CBT)-based interventions are gaining popularity as a means to reduce stress and alleviate anxiety and depression symptoms. Moreover, CBT delivered through a mobile app has the same elements as traditional CBT training (eg, guided discovery). However, unlike conventional training, users of mobile apps are allowed to tailor their own experience at their own speed and schedule.
Objective:
This study aims to analyze Sensa users' retrospective data and explore the dose-duration effect to find the optimal usage time when the user showed results.
Methods:
The study cohort comprised 381 consecutive community-based nonclinical users who started using Sensa between October 2021 and March 2022. All users included in the study took the Depression Anxiety Stress Scale-21 (DASS-21) assessment at least 2 times. Other parameters from the database containing all self-reported data were gender, number of active days, total time of use, and age. The primary outcome of the study was a change in the DASS-21 score. Statistical analyses were performed using GraphPad Prism (version 9, GraphPad Software). In addition, a logistic regression model was created to predict how the obtained independent parameters influenced the DASS-21 score.
Results:
The main finding of our study was that the majority of participants who started using Sensa were experiencing depression, anxiety, and stress symptoms (92.13%, 80.05%, and 87.93%, respectively). There was a statistically significant decrease of the DASS-21 subdomain scores after the use of the application (anxiety: mean 7.25, SD 4.03 vs mean 6.12, SD 4.00; P=.001; depression: mean 11.05, SD 4.26 vs mean 9.01, SD 4.77; P=.001; stress: mean 11.42, SD 3.44 vs mean 9.96, SD 3.65; P<.001). Finally, the logistic regression model showed that users who were using the app for more than 24 days and had at least 12 active days during that time had 3.463 (95% CI 1.142-11.93) and 2.644 (95% CI 1.024-7.127) times higher chances to reduce their DASS-21 subdomain scores of depression and anxiety, respectively.
Conclusions:
Using the Sensa mobile app was related to decreased depression, anxiety, and stress symptoms.
... Other factors contributing to the variability in the results of unaccompanied interventions include study design characteristics including the use of clinical interviews (Titov et al., 2016), automated reminders (Titov et al., 2013) (Titov et al., 2013), and the clinical setting (Massoudi et al., 2019), as well as participant characteristics like the severity of the disorder (Karyotaki et al., 2021). Meta-analyses confirm the effectiveness of digital interventions not only in reducing symptoms but also in improving quality of life (Linardon et al., 2019) and there is also some evidence that such intervention can reduce self-stigma (Farrer et al., 2012;Griffiths et al., 2004;Taylor-Rodgers & Batterham, 2014) and improve health-promoting behaviors (Christensen et al., 2006). Overall, digital interventions can help close the treatment gap for mental disorders including depression. ...
BACKGROUND
Depression is one of the most prevalent mental disorders and frequently co-occurs with other mental disorders. Despite the high direct and indirect costs to both individuals and society, more than 80% remain with their primary care physician and don’t receive specialized treatment. Unguided digital interventions have been shown to improve depression and due to their scalability have a large potential public health impact. Current digital interventions often focus on specific disorders, while recent research suggests that transdiagnostic approaches are more suitable.
OBJECTIVE
The study aims to assess the efficacy of an unguided transdiagnostic app-based self-management intervention in patients with mild or moderate depression with and without comorbid mental disorders.
METHODS
Approximately 570 patients with mild or moderate depression will be randomized to receive the intervention in addition to care as usual, or care as usual only. Data will be collected at baseline as well as 8 weeks and 6 months after randomisation. The primary outcome will be depression symptom severity after 8 weeks. Secondary outcomes will be quality of life, anxiety symptom severity, and patient sovereignty and self-management behaviors. Data will be analyzed using multiple imputation, employing the intention-to-treat principle, while sensitivity analyses will be based on additional imputation strategies and a per-protocol analysis.
RESULTS
Recruitment for the trial started on February, 7th, 2023, the first participant was randomized on February, 14th, 2023.
CONCLUSIONS
Data from this efficacy trial will be used to establish whether access to the intervention is associated with an improvement of depression symptoms in individuals diagnosed with mild or moderate depression. The study will contribute to the evidence base on transdiagnostic digital interventions.
CLINICALTRIAL
The trial has been registered in the DRKS trial register (DRKS00030852); Pre-results.
... Only trials that received a low-risk rating on all 7 criteria were considered to have a low risk of bias. Trials were considered to have a high risk of bias if they were rated high in any bias domain other than performance bias, as blinding of participants and personnel is almost impossible in CAIs studies [68]. The risk of bias graph was drawn using Review Manager (version 5.4; The Cochrane Collaboration). ...
Background
Mental health problems are a crucial global public health concern. Owing to their cost-effectiveness and accessibility, conversational agent interventions (CAIs) are promising in the field of mental health care.
Objective
This study aims to present a thorough summary of the traits of CAIs available for a range of mental health problems, find evidence of efficacy, and analyze the statistically significant moderators of efficacy via a meta-analysis of randomized controlled trial.
Methods
Web-based databases (Embase, MEDLINE, PsycINFO, CINAHL, Web of Science, and Cochrane) were systematically searched dated from the establishment of the database to October 30, 2021, and updated to May 1, 2022. Randomized controlled trials comparing CAIs with any other type of control condition in improving depressive symptoms, generalized anxiety symptoms, specific anxiety symptoms, quality of life or well-being, general distress, stress, mental disorder symptoms, psychosomatic disease symptoms, and positive and negative affect were considered eligible. This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data were extracted by 2 independent reviewers, checked by a third reviewer, and pooled using both random effect models and fixed effects models. Hedges g was chosen as the effect size.
Results
Of the 6900 identified records, a total of 32 studies were included, involving 6089 participants. CAIs showed statistically significant short-term effects compared with control conditions in improving depressive symptoms (g=0.29, 95% CI 0.20-0.38), generalized anxiety symptoms (g=0.29, 95% CI 0.21-0.36), specific anxiety symptoms (g=0.47, 95% CI 0.07-0.86), quality of life or well-being (g=0.27, 95% CI 0.16-0.39), general distress (g=0.33, 95% CI 0.20-0.45), stress (g=0.24, 95% CI 0.08-0.41), mental disorder symptoms (g=0.36, 95% CI 0.17-0.54), psychosomatic disease symptoms (g=0.62, 95% CI 0.14-1.11), and negative affect (g=0.28, 95% CI 0.05-0.51). However, the long-term effects of CAIs for the most mental health outcomes were not statistically significant (g=−0.04 to 0.39). Personalization and empathic response were 2 critical facilitators of efficacy. The longer duration of interaction with conversational agents was associated with the larger pooled effect sizes.
Conclusions
The findings show that CAIs are research-proven interventions that ought to be implemented more widely in mental health care. CAIs are effective and easily acceptable for those with mental health problems. The clinical application of this novel digital technology will conserve human health resources and optimize the allocation of mental health services.
Trial Registration
PROSPERO CRD42022350130; https://tinyurl.com/mvhk6w9p
... Second, participants in the BEAM program will receive three weekly push notifications via the BEAM App as well as a weekly reminder via email. Engagement notifications contribute to increased mental health benefits of mHealth interventions [45]. Third, those in the BEAM program will also be contacted by their clinical coach if they have not attended a weekly telehealth group session. ...
Background
Drastic increases in the rates of maternal depression and anxiety have been reported since the COVID-19 pandemic began. Most programs aim to improve maternal mental health or parenting skills separately, despite it being more effective to target both concurrently. The Building Emotional Awareness and Mental health (BEAM) program was developed to address this gap. BEAM is a mobile health program aiming to mitigate the impacts of pandemic stress on family well-being. Since many family agencies lack infrastructure and personnel to adequately treat maternal mental health concerns, a partnership will occur with Family Dynamics (a local family agency) to address this unmet need. The study’s objective is to examine the feasibility of the BEAM program when delivered with a community partner to inform a larger randomized controlled trial (RCT).
Methods
A pilot RCT will be conducted with mothers who have depression and/or anxiety with a child 6–18 months old living in Manitoba, Canada. Mothers will be randomized to the 10 weeks of the BEAM program or a standard of care (i.e., MoodMission). Back-end App data (collected via Google Analytics and Firebase) will be used to examine feasibility, engagement, and accessibility of the BEAM program; cost-effectiveness will also be examined. Implementation elements (e.g., maternal depression [Patient Health Questionnaire-9] and anxiety [Generalized Anxiety Disorder-7]) will be piloted to estimate the effect size and variance for future sample size calculations.
Discussion
In partnership with a local family agency, BEAM holds the potential to promote maternal-child health via a cost-effective and an easily accessible program designed to scale. Results will provide insight into the feasibility of the BEAM program and will inform future RCTs.
Trial registration {2a}
This trial was retrospectively registered with ClinicalTrial.gov (NCT05398107) on May 31st, 2022.
... Research on Internet-based interventions provides promising results and new trends in improving access to mental health services [28], while at the same time, the evidence for the outcomes of Internet-based interventions for youth is very limited [29][30][31]. This RCT aims to evaluate the efficacy of the Internet-based stress recovery intervention for adolescents (FOREST-A). ...
Background
Research reveals a high prevalence of stressors in adolescence. Mental health in adolescence is highly related to life-stressors exposure and difficulties in adjusting to stressors. Therefore, interventions for recovery from stress are in high demand. The study aims to evaluate the efficacy of the Internet-based stress recovery intervention for adolescents.
Methods
A two-arm randomized controlled trial (RCT) on the efficacy of the FOREST-A—an Internet-based stress recovery intervention for adolescents—will be conducted. The FOREST-A is an adapted version of stress recovery intervention initially developed for healthcare workers. FOREST-A is a third-wave cognitive behavioral therapy and mindfulness-based Internet-delivered 4-week psychosocial intervention, which comprises six modules: Introduction, Relaxation, Psychological detachment, Mastery, Control, and Summary. The intervention will be evaluated using the two-arm RCT with intervention and care as usual (CAU) condition at pre-test, post-test, and 3-month follow-up. The measured outcomes will be stress recovery, adjustment disorder, generalized anxiety and depression symptoms, psychological well-being, and perceived positive social support.
Discussion
The study will contribute to the development of Internet interventions—easily and broadly accessible tools—for the enhancement of adolescents’ stress recovery skills. Based on the study’s findings, further development of the FOREST-A, including upscaling and implementation, is foreseen.
Trial registration
ClinicalTrials.gov NCT05688254. Registered on January 6, 2023.
... Digital interventions that are empirically driven and incorporate elements of cognitive behavioral therapy are typically referred to as internet-based cognitive behavioral therapy (iCBT) [9]. People benefit from iCBT when paired with therapist support or used alone, although the magnitude of the effect is often higher for programs with therapist assistance [10,11] (for more conservative findings on the comparative benefit of therapist support with iCBT, see the study by Bernstein et al [12]). Although iCBT programs are effective for a variety of anxiety, mood, and substance use disorders [13,14], studies have consistently reported their underutilization by the public [15,16]. ...
Background:
Acceptability of digital mental health interventions is a significant predictor of treatment-seeking behavior and engagement. However, acceptability has been conceptualized and operationalized in various ways, which decreases measurement precision and leads to heterogeneous conclusions about acceptability. Standardized self-report measures of acceptability have been developed, which have the potential to ameliorate these problems, but none have demonstrated evidence for validation among Black communities, which limits our understanding of attitudes toward these interventions among racially minoritized groups with well-documented barriers to mental health treatment.
Objective:
This study aims to examine the psychometric validity and reliability of one of the first and most widely used measures of acceptability, the Attitudes Towards Psychological Online Interventions Questionnaire, among a Black American sample.
Methods:
Participants (N=254) were recruited from a large southeastern university and the surrounding metropolitan area and completed the self-report measure via a web-based survey. A confirmatory factor analysis using mean and variance adjusted weighted least squares estimation was conducted to examine the validity of the underlying hierarchical 4-factor structure proposed by the original authors of the scale. An alternative, hierarchical 2-factor structure model and bifactor model were examined for comparative fit.
Results:
The findings indicated that the bifactor model demonstrated a superior fit (comparative fit index=0.96, Tucker-Lewis index=0.94, standardized root mean squared residual=0.03, and root mean square error of approximation=0.09) compared with both 2- and 4-factor hierarchical structure models.
Conclusions:
The findings suggest that, within a Black American sample, there may be greater utility in interpreting the Attitudes Towards Psychological Online Interventions Questionnaire subscales as attitudinal constructs that are distinct from the global acceptability factor. The theoretical and practical implications for culturally responsive measurements were explored.
... e-Mental health apps e-Mental health apps are smartphone apps aim to improve quality and increase access to mental health care (Bakker, 2016). (Linardon, 2019) "We conducted a metaanalysis of 66 randomized controlled trials of app-supported smartphone interventions for mental health problems." ...
This is the protocol for a Campbell evidence and gap map. The objective of the map is to map available systematic reviews on the effectiveness of treatments for depressive disorders among adults. Specifically, this EGM includes studies on the effectiveness of treatments across a range of outcome domains.
... The BEAM program also included a number of interactive components which provided participants with the ability to engage in different components of the program, depending on their needs and preferences. Strategies such as engagement reminder emails and app notifications were also incorporated, which have been found to contribute to greater mental health benefits from e-health interventions [84,85] and increase the effectiveness of online parenting programs [86]. Furthermore, the digital delivery of the BEAM program helps to circumvent birthing parents' identified barriers to traditional mental health services, including lack of childcare [37]. ...
Background
Maternal mental health concerns and parenting stress in the first few years following childbirth are common and pose significant risks to maternal and child well-being. The COVID-19 pandemic has led to increases in maternal depression and anxiety and has presented unique parenting stressors. Although early intervention is crucial, there are significant barriers to accessing care.
Methods
To inform a larger randomized controlled trial, the current open-pilot trial investigated initial evidence for the feasibility, acceptability, and efficacy of a newly developed online group therapy and app-based mental health and parenting program (BEAM) for mothers of infants. Forty-six mothers 18 years or older with clinically elevated depression scores, with an infant aged 6–17 months old, and who lived in Manitoba or Alberta were enrolled in the 10-week program (starting in July 2021) and completed self-report surveys.
Results
The majority of participants engaged in each of the program components at least once and participants indicated relatively high levels of app satisfaction, ease of use, and usefulness. However, there was a high level of attrition (46%). Paired-sample t-tests indicated significant pre- to post-intervention change in maternal depression, anxiety, and parenting stress, and in child internalizing, but not externalizing symptoms. Effect sizes were in the medium to high range, with the largest effect size observed for depressive symptoms (Cohen’s d = .93).
Discussion
This study shows moderate levels of feasibility and strong preliminary efficacy of the BEAM program. Limitations to program design and delivery are being addressed for testing in adequately powered follow-up trials of the BEAM program for mothers of infants.
Trial registration
NCT04772677. Registered on February 26 2021.
... The findings obtained from previous research found that CBT was successful in reducing PTSD symptoms in children, trauma-related psychopathology (false beliefs, depression), and generalized anxiety [64]. Other research has shown that children are able to engage in positive activities to prevent PTSD problems [65]. Any gains obtained are maintained in follow-up so that PTSD problems do not return in children who have received therapy [58]. ...
Violence against children can cause psychological problems such as post-traumatic syndrome disorder (PTSD). The negative impact of violence on children is psychological and physical problems and risk of suicide. Nurses have a role to provide comprehensive nursing care such as cognitive behavior therapy for reducing PTSD symptoms. The purpose of this study was to describe the methods of cognitive behavior therapy to reduce symptoms of PTSD in children who are victims of violence. This study used the scoping review method. The databases use for the literature review in this study were CINAHL, PubMed, and Scopus. The keywords used in English were “cognitive behavioral therapy OR CBT” AND “violence OR abuse” AND “post-traumatic stress disorder OR PTSD” AND “child OR children”. The inclusion criteria were full text, randomized control trial or quasi-experimental research design, English language, the sample was children, and the publication period was for the last 10 years (2013–2022). We found 10 articles discussing CBT intervention on children who experienced victim abuse to reduce symptoms of PTSD. Most of the articles in this study used randomized control trial design. Several samples in this study are from the USA. The total sample was 47–320 respondents. This study showed three methods of CBT, namely psychoeducation, self-management, and coping strategies. CBT interventions can be carried out face-to-face or online. The activities carried out by the participants were relaxing, participating in training, counseling, problem-solving discussions, and therapy to improve sleep quality. Cognitive behavioral therapy is an intervention that can be carried out to reduce the traumatic impact on child victims of violence by taking into account the characteristics and development of the children.
... The easy opportunity for users to access online psychoeducational resources from anywhere and at any time of the day makes this intervention modality potentially appealing to those who want to receive a source of support and to increase their motivation to change [13]. There is evidence that online psychoeducational interventions can improve mental health literacy, promote help-seeking, and effectively address a range of mental health problems [14,15]. The impact of online services aimed at improving the self-management of those with eating disorders can reduce the harmful effects of social media and forum groups such as pro-ana and pro-mia, limiting their dissemination and spread. ...
In recent years, there has been a noticeable increase in online self-help treatments and peer-support programs for eating disorders. The possibility of easily accessing them anytime makes these programs an important support tool and an influencing source for increasing motivation to change. The aim of this work is to describe the #How can we help you? project, its initial feedback received from users, and its future directions. Researchers and clinicians developed an Instagram profile (Dicci Come Aiutarti) based on psychoeducation, aimed at orienting those suffering from a self-reported eating disorder towards clinical care, providing information about eating concerns and related constructs, and increasing motivation for treatment and illness awareness. The contents shared are based on narratives about people who had recovered from an eating disorder, importance and ability to change, and nutrition management. We have provided an overview of the needs of the Instagram profile users, a description of the main interactions recorded since the profile was opened, and examples of the unmet needs shared by users in direct messages. Future directions of the project concern the definition and formalization of the type of support provided by developing a psychoeducational and integrated program and also, the formulation of a research protocol able to assess the usability, effectiveness, and satisfaction of the Instagram profile.
... It is encouraging that orthopedic team members reported positive perceptions regarding the feasibility and acceptability of a digital intervention because: 1) this modality can provide at-home access to mental health tools when a patient's mobility is limited due to a musculoskeletal condition, 2) there is growing evidence of effectiveness of digital mental health interventions, sometimes comparable to in-person mental health intervention (39,40), and 3) there is increasing momentum for third party payers to subsidize digital interventions. Although some clinicians voiced medicolegal concerns related to offering a digital mental health intervention, the COVID-19 pandemic has accelerated the national push to facilitate seamless prescription of effective digital therapeutics, and we anticipate these concerns will lessen as clarity from governing bodies is achieved (41-44). ...
Background
Although depressive and anxious symptoms negatively impact musculoskeletal health and orthopedic outcomes, a gap remains in identifying modalities through which mental health intervention can realistically be delivered during orthopedic care. The purpose of this study was to understand orthopedic stakeholders’ perspectives regarding the feasibility, acceptability, and usability of digital, printed, and in-person intervention modalities to address mental health as part of orthopedic care.
Methods
This single-center, qualitative study was conducted within the orthopedic department of a tertiary care center. Semi-structured interviews were conducted between January and May 2022. Two stakeholder groups were interviewed using a purposive sampling approach until thematic saturation was reached. The first group included adult orthopedic patients who presented for management of ≥ 3 months of neck or back pain. The second group included early, mid, and late career orthopedic clinicians and support staff members. Stakeholders’ interview responses were analyzed using deductive and inductive coding approaches followed by thematic analysis. Patients also performed usability testing of one digital and one printed mental health intervention.
Results
Patients included 30 adults out of 85 approached (mean (SD) age 59 (14) years, 21 (70%) women, 12 (40%) non-White). Clinical team stakeholders included 22 orthopedic clinicians and support staff members out of 25 approached (11 (50%) women, 6 (27%) non-White). Clinical team members perceived a digital mental health intervention to be feasible and scalable to implement, and many patients appreciated that the digital modality offered privacy, immediate access to resources, and the ability to engage during non-business hours. However, stakeholders also expressed that a printed mental health resource is still necessary to meet the needs of patients who prefer and/or can only engage with tangible, rather than digital, mental health resources. Many clinical team members expressed skepticism regarding the current feasibility of scalably incorporating in-person mental health support into orthopedic care.
Conclusions
Although digital intervention offers implementation-related advantages over printed and in-person mental health interventions, a subset of often underserved patients will not currently be reached using exclusively digital intervention. Future research should work to identify combinations of effective mental health interventions that provide equitable access for orthopedic patients.
Trial registration
Not applicable.
... Previous research in clinical settings has focused primarily on examining the effective-ness and efficacy of an intervention as a whole [46,47]. In addition, Human-Computer Interaction (HCI) research has focused primarily on examining factors that affect user experience by involving participants during the design process or by collecting retrospec-tive data after app use. ...
The growing number of mental health smartphone applications has led to increased interest in how these tools might support users in different models of care. However, research on the use of these interventions in real-world settings has been scarce. It is important to understand how apps are used in a deployment setting, especially among populations where such tools might add value to current models of care. The objective of this study is to explore the daily use of commercially-available mobile apps for anxiety that integrate CBT, with a focus on understanding reasons for and barriers for app use and engagement. This study recruited 17 young adults (age M = 24.17 years) while on a waiting list to receive therapy in a Student Counselling Service. Participants were asked to select up to two of a list of three selected apps (Wysa, Woebot, and Sanvello) and instructed to use the apps for two weeks. Apps were selected because they used techniques from cognitive behavioral therapy, and offer diverse functionality for anxiety management. Qualitative and quantitative data were gathered through daily questionnaires to capture participants’ experiences with the mobile apps. In addition, eleven semi-structured interviews were conducted at the end of the study. We used descriptive statistics to analyze participants’ interaction with different app features and used a general inductive approach to analyze the collected qualitative data. The results highlight that users form opinions about the apps during the first days of app use. A number of barriers to sustained use are identified including cost-related issues, inadequate content to support long-term use, and a lack of customization options for different app functions. The app features used differ among participants with self-monitoring and treatment elements being the most used features.
... Mobile technology represents an available and attractive channel for health interventions (Donker et al., 2013;Beiwinkel et al., 2017). Digital health technologies have been utilized to manage numerous psychological symptoms such as depression, anxiety, and stress, major mood disorders, substance use, eating disorders, self-harm, and suicidal ideation (Witt et al., 2017;Hwang and Jo, 2019;Storm et al., 2021;Torous et al., 2021;Amanvermez et al., 2022); nonetheless, therapist supported/guided or blended interventions appeared more effective than unguided approaches (Harrer et al., 2018;Linardon et al., 2019;Taylor et al., 2021). ...
Mobile health platforms have shown promise in the management of various mental health conditions (including stress, anxiety, and depression) and cognitive behavioral strategies emerged as a popular and effective option offered by the platforms. This paper presents the protocol of a study aimed to test the effectiveness of a mobile platform that uses cognitive-behavioral strategies for stress self-management in the Tuscany region (Italy). The mobile app is adapted to the specific needs of each vulnerable population for which it is designed: young and older people, healthcare professionals, entrepreneurs. The app will be evaluated on the following outcomes: (i) perceived susceptibility and severity of the pandemic situation, perceived benefits, and costs of preventive health behaviors, (ii) knowledge about Covid-19 preventive behaviors and negative consequences of social distancing, (iii) stress and psychopathological symptoms (i.e., anxiety, depression, and post-traumatic stress symptoms) and cognitive distortions. If successful, we expect that the platform could give various groups clinical benefits by providing symptom self-monitoring and early intervention, consolidating the number of mental health programs available, and decreasing barriers to treatment-seeking. This population-level approach has the potential to improve mental health outcomes in pandemic periods for many people.
... In recent years, digital health technologies have made remarkable progress, and fully automated apps for the treatment and prevention of mental illnesses have emerged. App interventions are effective in improving depressive symptoms and generalised anxiety in the general population [9]. Furthermore, the NICE recommends computerised cognitive behavioural therapy (CCBT) for mild to moderate depression in the general population. ...
Background
This study aimed to assess whether automated apps are effective in preventing postpartum depression.
Methods
We conducted an article search on the electronic databases of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via Ovid, Scopus, PsycINFO, CINAHL, and ProQuest Dissertations & Theses A&I on March 26th, 2020. We also searched the International Clinical Trials Platform Search Portal (ICTRP), and Clinical Trials.
Results
We identified 1581 references, and seven studies were ultimately included in this review. Only one study has assessed the onset of postpartum depression as an outcome. This indicated that after the app intervention, the proportion of women who developed postpartum depression was significantly lower in the intervention group than in the control group (6 weeks postpartum risk ratio (RR)0.79, 95% confidence intervals (95%CI)0.58–1.06; 3 months postpartum RR0.74, 95%CI0.50–1.09; 6 months postpartum RR0.73, 95%CI0.49–1.11 RR0.73, 95%CI0.49–1.11). We performed a meta-analysis of Edinburgh Postnatal Depression Scale (EPDS) scores at each time point. During the immediate (0–8 weeks postpartum) period, the intervention group had significantly lower EPDS scores than the control group (mean differences (MD) -0.59; 95%CI -1.00 to -0.18; P = 0.005). In the short term (9–16 weeks postpartum), there was no significant difference between the intervention and control groups in terms of EPDS score (MD -0.32; 95%CI -10.82 to 1.17; P = 0.20).
Limitations
Only one randomized controlled trial (RCT) measured the onset of postpartum depression as an outcome; we performed a meta-analysis only on the EPDS scores. Additionally, there was a high risk of incomplete outcome data due to the high attrition rates in the study.
Conclusion
The apps, including an automated component for the prevention of postpartum depression, improved the EPDS score; furthermore, they may prevent postpartum depression.
... Smartphone technology has become profuse in daily life, such that users have been found to use their phones an average of 84 times per day, totalling approximately five hours daily [178]. App-based digital mental health interventions have been shown to be efficacious for a range of psychological disorders, including mood disorders, anxiety disorders, and psychosis prevention [179][180][181][182]. To our knowledge, none of the empirically supported eTherapies for EDs discussed in Section 4.1.1. ...
Bulimia nervosa is an eating disorder characterised by marked impairment to one's physical health and social functioning, as well as high rates of chronicity and comorbidity. This literature review aims to summarise existing academic research related to the symptom profile of BN, the costs and burden imposed by the illness, barriers to the receipt of care, and the evidence base for available psychological treatments. As a consequence of well-documented difficulties in accessing evidence-based treatments for eating disorders, efforts have been made towards developing innovative, diverse channels to deliver treatment, with several of these attempting to harness the potential of digital platforms. In response to the increasing number of trials investigating the utility of online treatments, this paper provides a critical review of previous attempts to examine digital interventions in the treatment of eating disorders. The results of a focused literature review are presented, including a detailed synthesis of a knowledgeable selection of high-quality articles with the aim of providing an update on the current state of research in the field. The results of the review highlight the potential for online self-help treatments to produce moderately sized reductions in core behavioural and cognitive symptoms of eating disorders. However, concern is raised regarding the methodological limitations of previous research in the field, as well as the high rates of dropout and poor adherence reported across most studies. The review suggests directions for future research, including the need to replicate previous findings using rigorous study design and methodology, as well as further investigation regarding the utility of clinician support and interactive digital features as potential mechanisms for offsetting low rates of engagement with online treatments.
... Working hours must be carefully defined. Moreover, a user needs to pay attention to self-care measures, such as having enough breaks to rest while working, mindfulness, relaxation, or meditation exercises (Carissoli et al., 2015;Gaggioli et al., 2019;Linardon et al., 2019;Golu, 2021). In their study that measures the levels of coping with online course (Zoom) fatigue of preservice teachers in the emergency remote teaching process, Bayindir and Gokce (2021) mentioned some actions taken by teachers to mitigate the effect of Zoom fatigue such as resting, exercising, having snacks, and relaxing. ...
Technology has invaded all spheres of life, including education and providing a lot of facilities. It has played a great role in managing education during the COVID-19 crisis. However, technology might prove detrimental if there is too much of it which may negatively affect its users in some way. This study aimed to investigate final-year students’ technology fatigue in distance project-based learning environments during the coronavirus disease (COVID-19) pandemic. The study employed an online survey approach to collect data from 86 final-year students. The results showed that technology does not highly fatigue final-year students in distance project-based learning environments. Still, the study reported some factors that contribute to increasing and decreasing final-year students’ technology fatigue level, which may inform project supervisors and decision-makers on the best practice for implementing distance project-based learning without putting students under great pressure and fatigue resulting from technology. This study adds to a limited yet growing body of literature on a very important topic, technology fatigue, that has recently arisen in the academic sector especially during the COVID-19 pandemic when technology was the quickest and most ideal response to the global lockdown.
... For public health concerns, such as stress reduction and well-being increase, mHealth apps have delivered numerous useful stress-management solutions, many of them working as standalone apps. As in the case of computerized and web-based interventions, the best results, according to the latest meta-analyses, come from guided mHealth interventions [15]. However, standard mHealth solutions seem to have lost their initial momentum due to a still limited user-interface interactivity, lack of an individualized approach, and limited computational power [10], and more innovative solutions are needed to harness the portability potential. ...
... Both technologies also have unique features that could bolster intervention effects. Apps have few spatial or temporal restrictions: Participants can use them whenever and wherever they want to, including in the home environment [22]. A major advantage of implementing an intervention through an app, therefore, is the possibility of daily exposure to intervention content. ...
Background
Short-term mindsets are associated with self-defeating behaviors, such as delinquency and alcohol use. In contrast, people who consider the longer-term consequences of their decisions tend to report positive outcomes, like feeling more competent and enhanced goal achievement. We evaluate an intervention, FutureU, that aims to stimulate future-oriented thinking, increase goal achievement, and reduce self-defeating behavior, by strengthening people’s identification with their future self. The intervention will be delivered through a smartphone application (app) or immersive Virtual Reality (VR). We test the effectiveness of FutureU for both delivery methods, examine working mechanisms, and identify potential moderators of intervention effects.
Methods
In this Randomized Controlled Trial, a total of 240 first-year university students ( n = 80 per condition) will be randomized into one of three conditions: (1) a smartphone condition, (2) a VR condition, and (3) an active control condition. We will assess proximal (i.e., future self-identification) and distal intervention outcomes (e.g., future orientation, self-defeating behaviors, goal achievement), user engagement, and examine usage data and goal content. Assessments will take place at baseline, during the intervention, immediately after the intervention, and at 3- and 6-months follow-up.
Discussion
This study will provide information on the effectiveness of the intervention and allows for comparisons between delivery methods using novel technologies, a smartphone app versus immersive VR. Knowledge gained through this study can be used for further intervention development as well as theory building.
Trial registration This trial is registered on Clinicaltrials.gov (NCT05578755) on 13 October 2022.
... Among these, the Ecological Momentary Interventions (EMIs), defined as a set of methods associated with clinical treatment in an ecological context [2], intervene notably on various psychological and psychiatric problems such as anxiety, depression, OCD (i.e. Obsessive Compulsive Disorder) and post-traumatic stress [3,4,5]. The EMIs, experiencing an expansive increase in the market [3,6], can take many forms, ranging from simple clinical recommendations (e.g., relaxation techniques in stressful periods), to more formal and structured interventions (e.g., recall and motivational messages during the withdrawal phase of smoking). ...
Based on ICT, specifically smartphones and their mobile apps, this exploratory study questions the impact of EMIs on employees’ perceived stress during work days. A sample of 15 workers, working at least 3 days a week - divided into one control groups (n=5) and one experimental group (n=10) - have used an EMI application “Mon Sherpa” for one-week length. Participants responded to two questionnaires at the beginning of the study: a sociodemographic questionnaire and the PSM-9 (Psychological Stress Measure). They completed the PSM-9 once again in the middle and at the end of the experiment, to compare the score’s evolution depending on the formed groups. Additionally, semi-structured interviews have been conducted with participants of the experimental group (n=9) to identify their application’s perception. Statistics results indicate no effects of the EMIs. However, interviews indicated somatic, behavioral, and cognitive evolutions throughout the experiment in the field of stress, anxiety, and invasive thoughts. These conflicting results might be explained by an immediate but not lasting effect of EMI’s on work-related stress. It may also be partly explained by some limitations of the study. More cross-disciplinary and larger research is required.
... Engagement notifications contribute to increased mental health benefits of mHealth interventions (45). Third, those in the BEAM program will also be contacted by their clinical coach if they have not attended a weekly telehealth group session. ...
Background: Drastic increases in the rates of maternal depression and anxiety have been reported since the COVID-19 pandemic began. Most programs aim to improve maternal mental health or parenting skills separately, despite it being more effective to target both concurrently. The Building Emotional Awareness and Mental health (BEAM) program was developed to address this gap. BEAM is a mobile health program aiming to mitigate the impacts of pandemic stress on family well-being. Since many family agencies lack infrastructure and personnel to adequately treat maternal mental health concerns, a partnership will occur with Family Dynamics (a local family agency) to address this unmet need. The study’s objective is to examine the feasibility of the BEAM program when delivered with a community partner to inform a larger randomized controlled trial (RCT).
Methods: A pilot randomized controlled trial will be conducted with mothers who have depression and/or anxiety with a child 6-18 months old living in Manitoba, Canada. Mothers will be randomized to the 10 weeks of the BEAM program or a standard of care. Back-end App data (collected via Google Analytics and Firebase) will be used to examine feasibility, engagement, and accessibility of the BEAM program; cost-effectiveness will also be examined. Implementation elements (e.g., maternal depression [Patient Health Questionnaire-9] and anxiety [Generalized Anxiety Disorder-7]) will be piloted to estimate the effect size and variance for future sample size calculations.
Discussion: In partnership with a local family agency, BEAM holds the potential to promote maternal-child health via a cost-effective and easily accessible program designed to scale. Results will provide insight into the feasibility of the BEAM program and will inform future RCTs of the BEAM program.
Trial Registration: This trial was retrospectively registered with ClinicalTrial.gov (NCT05398107) on May 31st, 2022. https://clinicaltrials.gov/ct2/show/NCT05398107
... These outcomes serve as strong evidence that clinically validated interventions, such as BodyPositive, have the potential for adaptation to reach a much broader audience (Fitzsimmons-Craft et al., 2021). This finding is an extension of previous studies on the feasibility of using social media for user recruitment and the effectiveness of Internet-delivered prevention interventions for EDs (Linardon et al., 2019;Munsch et al., 2019;Naslund et al., 2019). Our findings give confidence that this type of body image intervention can be utilized more broadly to impact the many individuals that are currently facing body image issues and lack the ability to identify a need for help. ...
Many young individuals at risk for eating disorders spend time on social media and frequently search for information related to their body image concerns. In a large randomized study, we demonstrated that a guided chat-based intervention could reduce weight and shape concerns and eating disorder pathology. The goal of the current study was to determine if a modified single session mini-course, derived from the aforementioned chat-based intervention, could reduce body image concerns among individuals using eating disorder related search terms on a social media platform. Over a two-month period of prompting individuals, 525 people followed the link to the web-based application where the intervention was hosted and subsequently completed the mini-course. This resulted in a significant improvement on the one-time body image satisfaction question pre-to post intervention (p < .001) with a moderate effect size (Cohen's d = 0.54). Additionally, individuals completing the program showed significant improvement on motivation to change their body image (p < .001) with a small effect size (Cohen's d = 0.28). Additionally, users reported that the program was enjoyable and easy to use. These results suggest that a single session micro-intervention, offered to individuals on social media, can help improve body image.
Background:
Unemployment is associated with substantially greater depression and anxiety, constituting a considerable public health concern. The current review provides the most comprehensive synthesis to date, and first meta-analysis, of controlled intervention trials aimed at improving depression and anxiety outcomes during unemployment.
Methods:
Searches were conducted within PsycInfo, Cochrane Central, PubMed and Embase from their inception to September 2022. Included studies conducted controlled trials of interventions focused on improving mental health within unemployed samples, and reported on validated measures of depression, anxiety, or distress (mixed depression and anxiety). Narrative syntheses and random effects meta-analyses were conducted among prevention- and treatment-level interventions for each outcome.
Results:
A total of 39 articles reporting on 33 studies were included for review (sample sizes ranging from 21 to 1801). Both prevention and treatment interventions tended to be effective overall, with treatment interventions producing larger effect sizes than prevention interventions. The clearest evidence for particular intervention approaches emerged for prevention-level Cognitive Therapy/CBT, followed by prevention-level work-related interventions, although neither produced entirely consistent effects.
Limitations:
Risk of bias was generally high across studies. Low numbers of studies within subgroups precluded any comparisons between long-term and short-term unemployment, limited comparisons among treatment studies, and reduced the power of meta-analyses.
Conclusions:
Both prevention- and treatment-level mental health-focused interventions have merit for reducing symptoms of anxiety and depression among those experiencing unemployment. Cognitive Therapy/CBT and work-related interventions hold the most robust evidence base, which can inform both prevention and treatment strategies implemented by clinicians, employment services providers, and governments.
The COVID-19 pandemic necessitated remote cancer care delivery via the internet and telephone, rapidly accelerating an already growing care delivery model and associated research. This scoping review of reviews characterised the peer-reviewed literature reviews on digital health and telehealth interventions in cancer published from database inception up to May 1, 2022, from PubMed, Cumulated Index to Nursing and Allied Health Literature, PsycINFO, Cochrane Reviews, and Web of Science. Eligible reviews conducted a systematic literature search. Data were extracted in duplicate via a pre-defined online survey. Following screening, 134 reviews met the eligibility criteria. 77 of those reviews were published since 2020. 128 reviews summarised interventions intended for patients, 18 addressed family caregivers, and five addressed health-care providers. 56 reviews did not target a specific phase of the cancer continuum, whereas 48 reviews tended to address the active treatment phase. 29 reviews included a meta-analysis, with results showing positive effects on quality of life, psychological outcomes, and screening behaviours. 83 reviews did not report intervention implementation outcomes but when reported, 36 reported acceptability, 32 feasibility, and 29 fidelity outcomes. Several notable gaps were identified in these literature reviews on digital health and telehealth in cancer care. No reviews specifically addressed older adults, bereavement, or sustainability of interventions and only two reviews focused on comparing telehealth to in-person interventions. Addressing these gaps with rigorous systematic reviews might help guide continued innovation in remote cancer care, particularly for older adults and bereaved families, and integrate and sustain these interventions within oncology.
Background:
Chronic (ie, long-term) elevated stress is associated with a number of mental and physical health conditions. Mindfulness meditation mobile apps are a promising tool for stress self-management that can overcome several barriers associated with in-person interventions; however, to date, poor app-based intervention adherence has limited the efficacy of these mobile health tools. Anchoring, or pairing, a new behavior with an existing routine has been shown to effectively establish habits that are maintained over time, but this strategy typically only works for those with high initial motivation and has yet to be tested for maintaining meditation with a mobile app.
Objective:
This study will test novel combinations of behavioral economics-based incentives with the anchoring strategy for establishing and maintaining adherence to an effective dose of meditation with a mobile app.
Methods:
This 16-week study will use a 5-arm, parallel, partially blinded (participants only), randomized controlled design. We will implement a fractional factorial study design that varies the use of self-monitoring messages and financial incentives to support participants' use of their personalized anchoring strategy for maintaining adherence to a ≥10 minute-per-day meditation prescription during an 8-week intervention period, followed by an 8-week postintervention observation period. Specifically, we will vary the use of self-monitoring messages of either the target behavior (ie, meditation tracking) or the outcome associated with the target behavior (ie, mood symptom tracking). We will also vary the use of financial incentives conditional on either meditation at any time of day or meditation performed at approximately the same time of day as participants' personalized anchors.
Results:
Continuous meditation app use data will be used to measure weekly meditation adherence over the 16-week study period as a binary variable equal to 1 if participants complete ≥10 minutes of meditation for ≥4 days per week and 0 otherwise. We will measure weekly anchoring plan adherence as a binary variable equal to 1 if participants complete ≥10 minutes of meditation within +1 or -1 hour of the timing of their chosen anchor on ≥4 days per week and 0 otherwise. In addition to these primary measures of meditation and anchoring plan adherence, we will also assess the secondary measures of stress, anxiety, posttraumatic stress disorder, sleep disturbance, and meditation app habit strength at baseline, week 8, and week 16.
Conclusions:
This study will fill an important gap in the mobile health literature by testing novel intervention approaches for establishing and maintaining adherence to app-based mindfulness meditation. If successful, this study will identify an accessible and scalable stress self-management intervention that can help combat stress in the United States.
Trial registration:
ClinicalTrials.gov NCT05217602; https://clinicaltrials.gov/ct2/show/NCT05217602.
International registered report identifier (irrid):
DERR1-10.2196/39930.
Anxiety and depression symptoms are a significant mental health challenge for women in the reproductive age and midlife. Cognitive behavioral therapy (CBT) based mobile health (mHealth) interventions may be a viable solution for addressing the treatment gap for women at these ages. We collected real world data of women using the CBT based app “OCD.app - Anxiety, Mood & Sleep” from October 2020 to January 2023. Women’s levels of anxiety (GAD-7) and depression (PHQ-9) were evaluated prior to the intervention (T0), at the payment barrier (T1), and upon completion of the intervention (T-Final). Women’s dropout rates were associated with younger age and more severe symptoms. Large effect-size reductions were found at T1 (n = 1,554; Cohen’s d = 0.702) and T-Final (n = 491; Cohen’s d = 0.774) with 37.9% reaching clinically significant improvement in anxiety symptoms (GAD-7 change > 4). Similar analyses of women’s PHQ-9 scores indicated small effect-size reductions at T1 (n = 512; Cohen’s d = 0.34) and moderate effect-size decreases at T-Final (n = 140; Cohen’s d = 0.489) with 23.6% of women reaching clinically significant improvement in depression symptoms (PHQ-9 change > 5). Results support the effectiveness of brief CBT-based mHealth interventions for women with depression and anxiety symptoms in real world settings.
Background
Despite its efficacy in treating comorbid insomnia and depression, cognitive behavioral therapy for insomnia (CBT-I) is limited in its accessibility and, in many countries, cultural compatibility. Smartphone-based treatment is a low-cost, convenient alternative modality. This study evaluated a self-help smartphone-based CBT-I in alleviating major depression and insomnia.
Methods
A parallel-group randomized, waitlist-controlled trial was conducted with 320 adults with major depression and insomnia. Participants were randomized to receive either a 6-week CBT-I via a smartphone application, proACT-S , or waitlist condition. The primary outcomes included depression severity, insomnia severity, and sleep quality. The secondary outcomes included anxiety severity, subjective health, and acceptability of treatment. Assessments were administered at baseline, post-intervention (week 6) follow-up, and week 12 follow-up. The waitlist group received treatment after the week 6 follow-up.
Results
Intention to treat analysis was conducted with multilevel modeling. In all but one model, the interaction between treatment condition and time at week 6 follow-up was significant. Compared with the waitlist group, the treatment group had lower levels of depression [Center for Epidemiologic Studies Depression Scale (CES-D): Cohen's d = 0.86, 95% CI (−10.11 to −5.37)], insomnia [Insomnia Severity Index (ISI): Cohen's d = 1.00, 95% CI (−5.93 to −3.53)], and anxiety [Hospital Anxiety and Depression Scale – Anxiety subscale (HADS-A): Cohen's d = 0.83, 95% CI (−3.75 to −1.96)]. They also had better sleep quality [Pittsburgh Sleep Quality Index (PSQI): Cohen's d = 0.91, 95% CI (−3.34 to −1.83)]. No differences across any measures were found at week 12, after the waitlist control group received the treatment.
Conclusion
proACT-S is an efficacious sleep-focused self-help treatment for major depression and insomnia.
Trial registration
ClinicalTrials.gov, NCT04228146. Retrospectively registered on 14 January 2020. https://clinicaltrials.gov/ct2/show/NCT04228146
The increasing availability and use of mobile technology have allowed for innovative solutions to address a range of issues, especially in relation to health behaviour change. Such technological advances have also created opportunities within the justice context and the past decade has seen the development and use of mobile technology in the criminal justice system. Yet, little systematic research exists in this area. This study begins to fill this gap, through a rapid evidence assessment of the use of technologies, especially mobile applications and text message reminders, which support behaviour change amongst people in the criminal justice system.
Background. Mental health in adolescence are highly related to life-stressors exposure and difficulties in adjusting to stressors. Research reveals a high prevalence of stressors in adolescence. Therefore, interventions for recovery from stress are in high demand. The study aims to evaluate the efficacy of the internet-based stress recovery intervention for adolescents.
Methods: A two-arm randomized controlled trial (RCT) on the efficacy of the FOREST-A – an internet-based stress recovery intervention for adolescents – will be conducted. The FOREST-A is an adapted version of stress recovery intervention initially developed for healthcare workers. FOREST-A is a third-wave cognitive behavioral therapy and mindfulness-based internet-delivered 4-week psychosocial intervention, which comprises six modules: Introduction, Relaxation, Psychological detachment, Mastery, Control, and Summary. The intervention will be evaluated using the two-arm RCT with intervention and care as usual (CAU) condition at pre-test, post-test, and 3-month follow-up. The measured outcomes will be stress recovery, adjustment disorder, generalized anxiety and depression symptoms, psychological well-being, and perceived positive social support.
Discussion: The study will contribute to the development of internet interventions – easily and broadly accessible tools – for the enhancement of adolescents' recovery from stress skills. Based on the study's findings, further development of the FOREST-A, including upscaling and implementation, is foreseen.
Trial registration: ClinicalTrials.gov NCT05688254. Registered on January 6, 2023.
Background:
Across a range of age, educational and clinical characteristics, adults experiencing depression and anxiety already use digital technology to manage their symptoms. Although several reviews and meta-analyses indicated feasibility and efficacy for adults with depression and anxiety, digital treatments are poorly accessed and disseminated. This review illustrates potentials and limitations of interventions that specifically leveraged unique features of digital technology and were grounded in the principles of Cognitive Behavioral Therapy (CBT).
Methods:
This systematic review followed the PRISMA guidelines. An electronic database search was conducted in October 2021. Peer-reviewed, English-language studies were included if i) they reported data from RCTs for adults aged 18+ who engaged with CBT-informed digital interventions targeting primarily depression and anxiety; ii) they used at least PHQ-9 or GAD-7 as standardized and validated assessment self-report measures for depression and anxiety.
Results:
Findings from 35 RCTs examining 33 interventions (25 internet-based, 6 mobile-based, a2 mobile/web) are discussed. The quality of the evidence differed widely as many small-scale RCTs reported only short-term feasibility and preliminary efficacy. Effects of CBT-informed digital interventions were substantially larger when compared to waitlist than active control conditions. Greater therapeutic benefits were observed for interventions that offered clinical assistance or were used in combination with other treatments.
Conclusions:
CBT-informed digital interventions have accumulated enough scientific evidence to be positioned today as: i) a low-intensity tool for those with subclinical levels of symptoms; ii) a first step in a stepped-care approach to service delivery iii) a low-cost, easily accessible option for targeted preventive programs.
Objective
In this randomized controlled trial, we investigated the effectiveness, side effects and user satisfaction of the self-help smartphone app “MCT & More” among inpatients with a diagnosis of depression after their discharge from a psychiatric hospital over a period of 4 weeks.
Methods
A total of 159 inpatients were recruited in four German psychiatric hospitals three days before hospital discharge (intervention group: n = 79; treatment as usual: n = 80). Based on the vulnerability model (low self-esteem contributes to depression), self-esteem represented the primary outcome, quality of life and depressive symptoms the secondary outcomes.
Results
Intention-to-treat analyzes showed no statistical significance for the primary and secondary outcome parameters, except for the subscale self-competence in favor of the intervention group (with a small effect size of d = 0.35), in the context of an exploratory approach (post hoc). The more positive the attitude toward mobile-based interventions and the more positive the treatment expectations, the more frequently the app was used (r = .35, p = .008; r = .34, p = .009).
Conclusion
Further symptom reduction could not be obtained. However, the results suggest that an effect on improvement in self-competence could be achieved by low-threshold aftercare programs. Future studies should include long-term assessments to examine the impact of mobile-based aftercare on relapse.
Trial registration: DRKS00022559.
Background:
Mobile health interventions are being widely tried because of their attractive advantages. However, there is not enough evidence for its effectiveness.
Objective:
This study aimed to evaluate the effects of mobile app-based stress management intervention (mSMI) on highly stressed workers.
Methods:
A sample of 82 white-collar workers with elevated symptoms of perceived stress (Perceived Stress Scale-10≥22) were randomly assigned to the intervention or control group. The mSMI consisted of three modules: self-management including a work diary, counseling based on cognitive behavioral therapy and interventions focused on music, meditation, relaxation and image healings. Self-report data were collected at the baseline and post-intervention. Study outcomes analyzed perceived stress, anxiety, depression, and work engagement. Data were assessed using analysis of covariance with covariates.
Results:
There was significantly reduced perceived stress from baseline to 6 weeks in mSMI (t = 5.788, p < 0.001) and control group (t = 3.184, p = 0.003). After adjusting for covariates, the between-group difference in the perceived stress was significantly different (F = 4.051, p = 0.048); however, the effect size was small. There was no significant intervention effect on anxiety, depression, and work engagement. The process evaluation indicated that most participants (85.3%) were satisfied with the intervention and their mental health benefited.
Conclusion:
This study found that mobile health intervention facilitated perceived stress management for highly stressed workers. Further studies should address job-related outcomes and mental health symptoms in workers by applying the latest information technology and addressing the limitations of mobile interventions.
We present the results of a pre-registered randomised controlled trial (RCT) that tested whether two smartphone-based mindfulness meditation applications (apps) lead to improvements in mental health. University students (n = 208, aged 18 to 49) were randomly assigned to use one of the three apps: Headspace, Smiling Mind, or Evernote (control group). Participants were instructed to use their assigned app for 10 min each day for 10 days, after which they received an extended 30 days’ access to continue practicing at their discretion. Participants completed measures of depressive symptoms, anxiety, stress, college adjustment, flourishing, resilience, and mindfulness at baseline, after the 10-day intervention, and after the 30-day continued access period. App usage was measured by self-report. Mindfulness app usage was high during the 10-day period (used on 8 of 10 days), but low during the 30-day extended use period (less than 20% used the app 2+ times per week). Mindfulness app users showed significant improvements in depressive symptoms, college adjustment, resilience (Smiling Mind only), and mindfulness (Headspace only) from baseline to the end of 10 days relative to control participants. Participants who continued to use the app frequently were more likely to maintain improvements in mental health, e.g. in depressive symptoms and resilience (Headspace only), until the end of the 30-day period. Thus, brief mobile mindfulness meditation practice can improve some aspects of negative mental health in the short term and may strengthen positive mental health when used regularly. Further research is required to examine the long-term effects of these apps.
Background:
Mindfulness-based interventions, self-compassion training, and cognitive behavioral therapy have garnered much evidence in its salutary effects on mental health. With increasing application of smartphone and mobile technology on health promotion, this study investigated the efficacy and possible moderators of mindfulness, self-compassion, and cognitive behavioral psychoeducation training mobile apps in the improvement of mental health.
Objective:
The aim of this study was to examine the efficacy of 3 mobile app-based programs: mindfulness-based program, self-compassion program, and cognitive behavioral psychoeducation program in improving mental well-being and reducing psychological distress. Changes in mindful awareness and self-compassion were also assessed. To further delineate the suitability of each program for different types of individuals, individual difference variables (ie, discomfort with emotions and tolerance for ambiguity) were explored for potential moderation.
Methods:
This study was a 3-arm, randomized, controlled, noninferiority trial examining the efficacy of mindfulness-based program, self-compassion program, and cognitive behavioral psychoeducation. Participants were randomized into either 1 of the 3 conditions. Throughout the 4-week, 28-session program, participants spent 10-15 min daily reviewing the course content and practicing various related exercises. At preprogram, postprogram, and 3-month follow-up, participants also completed Web-based measures of mental well-being, psychological distress, mindful-awareness, and self-compassion as well as the proposed moderators.
Results:
Among the 2161 study participants, 508 and 349 completed the post- and 3-month follow-up assessment, respectively. All 3 conditions (mindfulness-based program: N=703; cognitive behavioral psychoeducation: N=753; self-compassion program: N=705) were found to be efficacious in improving mental well-being and reducing psychological distress. All conditions enhanced mindful awareness at postprogram. Significant interaction effect was found on self-compassion; cognitive behavioral psychoeducation and self-compassion program, but not mindfulness-based program, significantly enhanced self-compassion at postprogram. No significant differences regarding usage and users' satisfaction were found among the 3 conditions. None of the proposed moderators were found to be significant.
Conclusions:
Mindfulness-based, self-compassion, and cognitive behavioral psychoeducation mobile apps were efficacious in improving mental well-being and reducing psychological distress among adults at postprogram and 3-month follow-up. Future app-based psychological training programs should consider gamification and personalization of content or feedback to enhance engagement and mitigate the high attrition rates that are common in app-based health promotion programs.
Trial registration:
Chinese Clinical Trial Registry (ChiCTR) ChiCTR-TRC-13003468; http://www.chictr.org.cn/hvshowproject.aspx?id=6220 (Archived by WebCite at http://www.webcitation.org/734PlOz50).
Background
Psychotherapy can alleviate mental distress and improve quality of life, but little is known about its potential negative effects and how to determine their frequency.
Aims
To present a commentary on the current understanding and future research directions of negative effects in psychotherapy.
Method
An anonymous survey was distributed to a select group of researchers, using an analytical framework known as strengths, weaknesses, opportunities and threats.
Results
The researchers perceive an increased awareness of negative effects in psychotherapy in recent years, but also discuss some of the unresolved issues in relation to their definition, assessment and reporting. Qualitative methods and naturalistic designs are regarded as important to pursue, although a number of obstacles to using such methods are identified.
Conclusion
Negative effects of psychotherapy are multifaceted, warranting careful considerations in order for them to be monitored and reported in research settings and routine care.
Declaration of interest
None.
There are ongoing questions regarding the similarities and differences in the clinical impact and processes of change for cognitive restructuring and cognitive defusion. This clinical component test compared 87 adults high in self-criticism randomized to a cognitive defusion mobile app, restructuring app, or waitlist condition for 2 weeks. Equivalent improvements were found from the defusion and restructuring apps relative to the waitlist on self-criticism and distress as well as decentering, self-compassion, and dysfunctional attitudes. However, the defusion condition had a more consistent pattern of improvements relative to waitlist. Improvements in cognitive decentering, self-compassion, and dysfunctional attitudes mediated effects for cognitive defusion relative to waitlist. These mediators were inconsistent for cognitive restructuring. Improvements in self-compassion and cognitive decentering correlated with improvements in outcomes in the defusion condition, but not the restructuring condition. Overall, these results suggest mobile apps providing cognitive defusion and cognitive restructuring strategies are equally effective, but work through distinct processes of change. © 2018 Springer Science+Business Media, LLC, part of Springer Nature
Background:
Most people living with HIV (PLWH) reside in middle- and low-income countries with limited access to health services. Thus, cost-effective interventions that can reach a large number of PLWH are urgently needed.
Objective:
The objective of our study was to assess the feasibility and acceptability of an mHealth intervention among PLWH in China.
Methods:
Based on previous formative research, we designed an mHealth intervention program that included sending weekly reminders to participants via text messages (short message service, SMS) and articles on HIV self-management three times a week via a popular social media app WeChat. A total of 62 PLWH recruited from an HIV outpatient clinic were randomly assigned to intervention or control group. The intervention lasted for 3 months, and all participants were assessed for their medication adherence, presence of depression, quality of life (QoL), and CD4 (cluster of differentiation 4) counts. Upon completing the intervention, we interviewed 31 participants to further assess the feasibility and acceptability of the study.
Results:
At baseline, the intervention and control groups did not differ in terms of demographic characteristics or any of the major outcome measures. About 85% (53/62) of the participants completed the intervention, and they provided valuable feedback on the design and content of the intervention. Participants preferred WeChat as the platform for receiving information and interactive communication for ease of access. Furthermore, they made specific recommendations about building trust, interactive features, and personalized feedback. In the follow-up assessment, the intervention and control groups did not differ in terms of major outcome measures.
Conclusions:
This pilot study represents one of the first efforts to develop a text messaging (SMS)- and WeChat-based intervention that focused on improving the medication adherence and QoL of PLWH in China. Our data indicates that an mHealth intervention is feasible and acceptable to this population. The data collected through this pilot study will inform the future designs and implementations of mHealth interventions in this vulnerable population. We recommend more innovative mHealth interventions with rigorous designs for the PLWH in middle- and low-income countries.
Trial registration:
Chinese Clinical Trial Registry ChiCTR1800017987; http://www.chictr.org.cn/showprojen.aspx?proj=30448 (Archived by WebCite at http://www.webcitation.org/71zC7Pdzs).
Registered report ientifier:
RR1-10.2196/.
We investigated whether a mindfulness meditation program delivered via a smartphone application could improve psychological well-being, reduce job strain, and reduce ambulatory blood pressure during the workday. Participants were 238 healthy employees from two large United Kingdom companies that were randomized to a mindfulness meditation practice app or a wait-list control condition. The app offered 45 prerecorded 10- to 20-min guided audio meditations. Participants were asked to complete one meditation per day. Psychosocial measures and blood pressure throughout one working day were measured at baseline and eight weeks later; a follow-up survey was also emailed to participants 16 weeks after the intervention start. Usage data showed that during the 8-week intervention period, participants randomized to the intervention completed an average of 17 meditation sessions (range 0–45 sessions). The intervention group reported significant improvement in well-being, distress, job strain, and perceptions of workplace social support compared to the control group. In addition, the intervention group had a marginally significant decrease in self-measured workday systolic blood pressure from pre- to post-intervention. Sustained positive effects in the intervention group were found for well-being and job strain at the 16-week follow-up assessment. This trial suggests that short guided mindfulness meditations delivered via smartphone and practiced multiple times per week can improve outcomes related to work stress and well-being, with potentially lasting effects.
Background: Mental health problems are highly prevalent among college students. Most students with poor mental health, however, do not receive professional help. Internet-based self-help formats may increase the utilization of treatment.
Objective: The aim of this randomized controlled trial was to evaluate the efficacy of an internet-based, app-supported stress management intervention for college students.
Methods: College students (n=150) with elevated levels of stress (Perceived Stress Scale 4-item version, PSS-4 ≥8) were randomly assigned to either an internet- and mobile-based stress intervention group with feedback on demand or a waitlist control group. Self-report data were assessed at baseline, posttreatment (7 weeks), and 3-month follow-up. The primary outcome was perceived stress posttreatment (PSS-4). Secondary outcomes included mental health outcomes, modifiable risk and protective factors, and college-related outcomes. Subgroup analyses were conducted in students with clinically relevant symptoms of depression (Center for Epidemiological Studies’ Depression Scale >17).
Results: A total of 106 participants (76.8%) indicated that they were first-time help-seekers, and 77.3% (intervention group: 58/75; waitlist control group: 58/75) showed clinically relevant depressive symptoms at baseline. Findings indicated significant effects of the intervention compared with the waitlist control group for stress (d=0.69; 95% CI 0.36-1.02), anxiety (d=0.76; 95% CI 0.43-1.09), depression (d=0.63; 95% CI 0.30-0.96), college-related productivity (d=0.33; 95% CI 0.01-0.65), academic work impairment (d=0.34; 95% CI 0.01-0.66), and other outcomes after 7 weeks (posttreatment). Response rates for stress symptoms were significantly higher for the intervention group (69%, 52/75) compared with the waitlist control group (35%, 26/75, P<.001; number needed to treat=2.89, 95% CI 2.01-5.08) at posttest (7 weeks). Effects were sustained at 3-month follow-up, and similar findings emerged in students with symptoms of depression.
Conclusions: Internet- and mobile-based interventions could be an effective and cost-effective approach to reduce consequences of college-related stress and might potentially attract students with clinically relevant depression who would not otherwise seek help.
Objective: Perseverative cognition (e.g. worry) and unconscious stress are suggested to be important mediators in the relation between stressors and physiological health. We examined whether a smartphone-based worry-reduction training improved a physiological marker of stress (i.e. increased heart rate variability [HRV]) and unconscious stress.
Design: Randomised-controlled trial was conducted with individuals reporting work stress (n = 136). Participants were randomised to the experimental, control or waitlist condition (resp. EC, CC, WL). The EC and CC registered emotions five times daily for four weeks. The EC additionally received a worry-reduction training with mindfulness exercises.
Main Outcome Measures: Primary outcome was 24-h assessments of HRV measured at pre-, mid- and post-intervention. Secondary outcomes were implicit affect and stress. Effects on heart rate and other psychological outcomes were explored.
Results: A total of 118 participants completed the study. No change from pre- to post-intervention was observed for the primary or secondary outcomes. The change over time was not different between conditions.
Conclusion: Findings suggest that the training was ineffective for improving HRV or psychological stress. Future studies may focus on alternative smartphone-based stress interventions, as stress levels are high in society. There is need for easy interventions and smartphones offer possibilities for this.
Objective:
Internet-based cognitive-behavioral treatments (ICBT) have shown promise for various mental disorders, including social anxiety disorder (SAD). Most of these treatments have been delivered on desktop computers. However, the use of smartphones is becoming ubiquitous and could extend the reach of ICBT into users' everyday life. Only a few studies have empirically examined the efficacy of ICBT delivered through a smartphone app and there is no published study on mobile app delivered ICBT for SAD. This three-arm randomized-controlled trial (RCT) is the first to compare the efficacy of guided ICBT for smartphones (app) and conventional computers (PC) with a wait list control group (WL).
Method:
A total of 150 individuals meeting the diagnostic criteria for SAD were randomly assigned to one of the three conditions. Primary endpoints were self-report measures and diagnostic status of SAD.
Results:
After 12 weeks of treatment, both active conditions showed superior outcome on the composite of all SAD measures (PC vs. WL: d = 0.74; App vs. WL: d = 0.89) and promising diagnostic response rates (NNTPC = 3.33; NNTApp = 6.00) compared to the WL. No significant between-groups effects were found between the two active conditions on the composite score (Cohen's d = 0.07). Treatment gains were maintained at 3-month follow-up. Program use was more evenly spread throughout the day in the mobile condition, indicating an integration of the program into daily routines.
Conclusions:
ICBT can be delivered effectively using smartphones. (PsycINFO Database Record
Objective:
The aim of this study was to assess whether an in-person mindfulness-based resilience training (MBRT) program or a smartphone-delivered resiliency-based intervention improved stress, well-being, and burnout in employees at a major tertiary health care institution.
Methods:
Sixty participants were randomized to a 6-week MBRT, a resiliency-based smartphone intervention, or an active control group. Stress, well-being, and burnout were assessed at baseline, at program completion, and 3 months postintervention.
Results:
Both the MBRT and the smartphone groups showed improvements in well-being, whereas only the MBRT group showed improvements in stress and emotional burnout over time. The control group did not demonstrate sustained improvement on any outcome.
Conclusion:
Findings suggest that brief, targeted interventions improve psychological outcomes and point to the need for larger scale studies comparing the individual and combined treatments that can inform development of tailored, effective, and low-cost programs for health care workers.
Background:
One in five Canadians experience mental health issues with those in the age range of 15 to 24 years being most at risk of a mood disorder. University students have shown significantly higher rates of mental health problems than the general public. Current university support services are limited by factors such as available staff and finances, and social stigma has frequently been identified as an additional barrier that prevents students from accessing these resources. Mobile health (mHealth) apps are one form of alternative health support that is discrete and accessible to students, and although they are recognized as a promising alternative, there is limited research demonstrating their efficacy.
Objective:
The aim of this study was to evaluate a mindfulness-based app's ("DeStressify") efficacy on stress, anxiety, depressive symptomology, sleep behavior, work or class absenteeism, work or school productivity, and quality of life (QoL) among university students.
Methods:
Full-time undergraduate students at a Canadian university with smartphones and Internet access were recruited through in-class announcements and on-campus posters. Participants randomized into an experimental condition were given and instructed to use the DeStressify app 5 days a week for 4 weeks. Control condition participants were wait-listed. All participants completed pre- and postintervention Web-based surveys to self-assess stress, anxiety, depressive symptomatology, sleep quality, and health-related QoL.
Results:
A total of 206 responses were collected at baseline, with 163 participants completing the study (86 control, 77 experimental). Using DeStressify was shown to reduce trait anxiety (P=.01) and improve general health (P=.001), energy (P=.01), and emotional well-being (P=.01) in university students, and more participants in the experimental condition believed their productivity improved between baseline and postintervention measurements than the number of participants expected to believe so randomly by chance (P=.01). The app did not significantly improve stress, state anxiety, physical and social functioning, and role limitations because of physical or emotional health problems or pain (P>.05).
Conclusions:
Mindfulness-based apps may provide an effective alternative support for university students' mental health. Universities and other institutions may benefit from promoting the use of DeStressify or other mindfulness-based mHealth apps among students who are interested in methods of anxiety management or mindfulness-based self-driven health support. Future steps include examining DeStressify and similar mHealth apps over a longer period and in university staff and faculty.
Mobile apps may be useful in teaching psychological skills in a high-frequency, low-intensity intervention. The acceptance and commitment therapy (ACT) matrix is a visual tool to help develop psychological flexibility by categorizing moment-to-moment experience and is well suited to a mobile app. This pilot study tested the effects of a simple and complex version of a novel app using the ACT matrix in two distinct samples: help-seeking individuals ( n = 35) and students receiving SONA credit ( n = 63). Findings indicated no differences between app conditions and a waitlist condition in the SONA credit sample. However, in the help-seeking sample, improvements were found on well-being and valued action in participants who used the app, with greater improvements and app adoption for those using a complex version with additional skills. A mobile app based on the ACT matrix has benefits for help-seeking individuals, but supplementary features may be necessary to support consistent use and benefits.
During the last two decades, Internet-delivered cognitive behavior therapy (ICBT) has been tested in hundreds of randomized controlled trials, often with promising results. However, the control groups were often waitlisted, care-as-usual or attention control. Hence, little is known about the relative efficacy of ICBT as compared to face-to-face cognitive behavior therapy (CBT). In the present systematic review and meta-analysis, which included 1418 participants, guided ICBT for psychiatric and somatic conditions were directly compared to face-to-face CBT within the same trial. Out of the 2078 articles screened, a total of 20 studies met all inclusion criteria. Results showed a pooled effect size at post-treatment of Hedges g = .05 (95% CI, -.09 to .20), indicating that ICBT and face-to-face treatment produced equivalent overall effects. Study quality did not affect outcomes. While the overall results indicate equivalence, there have been few studies of the individual psychiatric and somatic conditions so far, and for the majority, guided ICBT has not been compared against face-to-face treatment. Thus, more research, preferably with larger sample sizes, is needed to establish the general equivalence of the two treatment formats.
The rapid advances and adoption of smartphone technology presents a novel opportunity for delivering mental health interventions on a population scale. Despite multi-sector investment along with wide-scale advertising and availability to the general population, the evidence supporting the use of smartphone apps in the treatment of depression has not been empirically evaluated. Thus, we conducted the first meta-analysis of smartphone apps for depressive symptoms. An electronic database search in May 2017 identified 18 eligible randomized controlled trials of 22 smartphone apps, with outcome data from 3,414 participants. Depressive symptoms were reduced significantly more from smartphone apps than control conditions (g=0.38, 95% CI: 0.24-0.52, p<0.001), with no evidence of publication bias. Smartphone interventions had a moderate positive effect in comparison to inactive controls (g=0.56, 95% CI: 0.38-0.74), but only a small effect in comparison to active control conditions (g=0.22, 95% CI: 0.10-0.33). Effects from smartphone-only interventions were greater than from interventions which incorporated other human/computerized aspects along the smartphone component, although the difference was not statistically significant. The studies of cognitive training apps had a significantly smaller effect size on depression outcomes (p=0.004) than those of apps focusing on mental health. The use of mood monitoring softwares, or interventions based on cognitive behavioral therapy, or apps incorporating aspects of mindfulness training, did not affect significantly study effect sizes. Overall, these results indicate that smartphone devices are a promising self-management tool for depression. Future research should aim to distil which aspects of these technologies produce beneficial effects, and for which populations.
Background
This study is one of the first randomized controlled trials investigating cognitive behavioral therapy for insomnia (CBT-I) delivered by a fully automated mobile phone app. Such an app can potentially increase the accessibility of insomnia treatment for the 10% of people who have insomnia.
Objective
The objective of our study was to investigate the efficacy of CBT-I delivered via the Sleepcare mobile phone app, compared with a waitlist control group, in a randomized controlled trial.
Methods
We recruited participants in the Netherlands with relatively mild insomnia disorder. After answering an online pretest questionnaire, they were randomly assigned to the app (n=74) or the waitlist condition (n=77). The app packaged a sleep diary, a relaxation exercise, sleep restriction exercise, and sleep hygiene and education. The app was fully automated and adjusted itself to a participant’s progress. Program duration was 6 to 7 weeks, after which participants received posttest measurements and a 3-month follow-up. The participants in the waitlist condition received the app after they completed the posttest questionnaire. The measurements consisted of questionnaires and 7-day online diaries. The questionnaires measured insomnia severity, dysfunctional beliefs about sleep, and anxiety and depression symptoms. The diary measured sleep variables such as sleep efficiency. We performed multilevel analyses to study the interaction effects between time and condition.
Results
The results showed significant interaction effects (P<.01) favoring the app condition on the primary outcome measures of insomnia severity (d=–0.66) and sleep efficiency (d=0.71). Overall, these improvements were also retained in a 3-month follow-up.
Conclusions
This study demonstrated the efficacy of a fully automated mobile phone app in the treatment of relatively mild insomnia. The effects were in the range of what is found for Web-based treatment in general. This supports the applicability of such technical tools in the treatment of insomnia. Future work should examine the generalizability to a more diverse population. Furthermore, the separate components of such an app should be investigated. It remains to be seen how this app can best be integrated into the current health regimens.
Trial Registration
Netherlands Trial Register: NTR5560; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5560 (Archived by WebCite at http://www.webcitation.org/6noLaUdJ4)
Background
Depression in the workplace creates a significant burden on employees and employers in terms of lost productivity and related costs. myStrength provides a robust, holistic Web- and mobile-based solution empowering users to learn, practice, and implement a range of evidence-based psychological interventions.
Objective
The main aim of this study was to demonstrate improvement in depressive symptoms among employees at risk of depression through myStrength use.
Methods
A 26-week, parallel-arm, pilot, randomized controlled trial was designed to assess the effectiveness of myStrength compared to a series of informational “Depression Tip/Fact of the Week” emails as the active control arm. Study participants (n=146) were commercially insured employees of a mid-sized financial software solutions firm. The primary outcome was self-reported change in depression score as best fit by a linear random effects model accounting for individual baseline symptoms.
Results
The final sample consisted of 78 participants in the experimental arm, myStrength, and 68 participants in the active control arm. myStrength users demonstrated significantly steeper and more rapid reduction in depressive symptoms over time compared to the active control (P<.001), suggesting that the intervention generated improvement in behavioral health symptoms, even in a nonclinical sample.
Conclusions
This pilot study builds foundational support for the scalable deployment of myStrength as a complementary behavioral health offering to promote overall mental health and well-being in the workplace.
Background: Stress has been identified as one of the major public health issues in this century. New technologies offer
opportunities to provide effective psychological interventions on a large scale.
Objective: The aim of this study is to investigate the efficacy of Web- and computer-based stress-management interventions
in adults relative to a control group.
Methods: A meta-analysis was performed, including 26 comparisons (n=4226). Cohen d was calculated for the primary outcome
level of stress to determine the difference between the intervention and control groups at posttest. Analyses of the effect on
depression, anxiety, and stress in the following subgroups were also conducted: risk of bias, theoretical basis, guidance, and length
of the intervention. Available follow-up data (1-3 months, 4-6 months) were assessed for the primary outcome stress.
Results: The overall mean effect size for stress at posttest was Cohen d=0.43 (95% CI 0.31-0.54). Significant, small effects
were found for depression (Cohen d=0.34, 95% CI 0.21-0.48) and anxiety (Cohen d=0.32, 95% CI 0.17-0.47). Subgroup analyses
revealed that guided interventions (Cohen d=0.64, 95% CI 0.50-0.79) were more effective than unguided interventions (Cohen
d=0.33, 95% CI 0.20-0.46; P=.002). With regard to the length of the intervention, short interventions (≤4 weeks) showed a small
effect size (Cohen d=0.33, 95% CI 0.22-0.44) and medium-long interventions (5-8 weeks) were moderately effective (Cohen
d=0.59; 95% CI 0.45-0.74), whereas long interventions (≥9 weeks) produced a nonsignificant effect (Cohen d=0.21, 95% CI
–0.05 to 0.47; P=.006). In terms of treatment type, interventions based on cognitive behavioral therapy (CBT) and third-wave
CBT (TWC) showed small-to-moderate effect sizes (CBT: Cohen d=0.40, 95% CI 0.19-0.61; TWC: Cohen d=0.53, 95% CI
0.35-0.71), and alternative interventions produced a small effect size (Cohen d=0.24, 95% CI 0.12-0.36; P=.03). Early evidence
on follow-up data indicates that Web- and computer-based stress-management interventions can sustain their effects in terms of
stress reduction in a small-to-moderate range up to 6 months.
Conclusions: These results provide evidence that Web- and computer-based stress-management interventions can be effective
and have the potential to reduce stress-related mental health problems on a large scale.
Objectives
Rates of youth suicide in Australian Indigenous communities are 4 times the national youth average and demand innovative interventions. Historical and persistent disadvantage is coupled with multiple barriers to help seeking. Mobile phone applications offer the opportunity to deliver therapeutic interventions directly to individuals in remote communities. The pilot study aimed to evaluate the effectiveness of a self-help mobile app (ibobbly) targeting suicidal ideation, depression, psychological distress and impulsivity among Indigenous youth in remote Australia.
Setting
Remote and very remote communities in the Kimberley region of North Western Australia.
Participants
Indigenous Australians aged 18–35 years.
Interventions
61 participants were recruited and randomised to receive either an app (ibobbly) which delivered acceptance-based therapy over 6 weeks or were waitlisted for 6 weeks and then received the app for the following 6 weeks.
Primary and secondary outcome measures
The primary outcome was the Depressive Symptom Inventory—Suicidality Subscale (DSI-SS) to identify the frequency and intensity of suicidal ideation in the previous weeks. Secondary outcomes were the Patient Health Questionnaire 9 (PHQ-9), The Kessler Psychological Distress Scale (K10) and the Barratt Impulsivity Scale (BIS-11).
Results
Although preintervention and postintervention changes on the (DSI-SS) were significant in the ibobbly arm (t=2.40; df=58.1; p=0.0195), these differences were not significant compared with the waitlist arm (t=1.05; df=57.8; p=0.2962). However, participants in the ibobbly group showed substantial and statistically significant reductions in PHQ-9 and K10 scores compared with waitlist. No differences were observed in impulsivity. Waitlist participants improved after 6 weeks of app use.
Conclusions
Apps for suicide prevention reduce distress and depression but do not show significant reductions on suicide ideation or impulsivity. A feasible and acceptable means of lowering symptoms for mental health disorders in remote communities is via appropriately designed self-help apps.
Trial registration number
ACTRN12613000104752.
The psychological treatment of mental health problems is beginning to undergo a sea-change driven by the widespread availability of digital technology. In this paper we provide an overview of the developments to date and those in the pipeline. We describe the various uses of digital interventions and consider their likely impact on clinical practice, clinical services and the global dissemination of psychological treatments. We note the importance of online clinics, blended treatment, digital assessment and digital training.
Background
Mobile apps for mental health have the potential to overcome access barriers to mental health care, but there is little information on whether patients use the interventions as intended and the impact they have on mental health outcomes.
Objective
The objective of our study was to document and compare use patterns and clinical outcomes across the United States between 3 different self-guided mobile apps for depression.
Methods
Participants were recruited through Web-based advertisements and social media and were randomly assigned to 1 of 3 mood apps. Treatment and assessment were conducted remotely on each participant’s smartphone or tablet with minimal contact with study staff. We enrolled 626 English-speaking adults (≥18 years old) with mild to moderate depression as determined by a 9-item Patient Health Questionnaire (PHQ-9) score ≥5, or if their score on item 10 was ≥2. The apps were (1) Project: EVO, a cognitive training app theorized to mitigate depressive symptoms by improving cognitive control, (2) iPST, an app based on an evidence-based psychotherapy for depression, and (3) Health Tips, a treatment control. Outcomes were scores on the PHQ-9 and the Sheehan Disability Scale. Adherence to treatment was measured as number of times participants opened and used the apps as instructed.
Results
We randomly assigned 211 participants to iPST, 209 to Project: EVO, and 206 to Health Tips. Among the participants, 77.0% (482/626) had a PHQ-9 score >10 (moderately depressed). Among the participants using the 2 active apps, 57.9% (243/420) did not download their assigned intervention app but did not differ demographically from those who did. Differential treatment effects were present in participants with baseline PHQ-9 score >10, with the cognitive training and problem-solving apps resulting in greater effects on mood than the information control app (χ22=6.46, P=.04).
Conclusions
Mobile apps for depression appear to have their greatest impact on people with more moderate levels of depression. In particular, an app that is designed to engage cognitive correlates of depression had the strongest effect on depressed mood in this sample. This study suggests that mobile apps reach many people and are useful for more moderate levels of depression.
ClinicalTrial
Clinicaltrials.gov NCT00540865; https://www.clinicaltrials.gov/ct2/show/NCT00540865 (Archived by WebCite at http://www.webcitation.org/6mj8IPqQr)
Background:
Veterans with history of deployment in the Global War on Terror face significant and ongoing challenges with high prevalences of adverse psychological, physical, spiritual, and family impacts. Together, these challenges contribute to an emerging public health crisis likely to extend well into the future. Innovative approaches are needed that reach veterans and their family members with strategies they can employ over time in their daily lives to promote improved adjustment and well-being.
Objective:
The objective of this study was to evaluate effects of use of a Web-based, self-directed program of instruction in mind- and body-based wellness skills to be employed by Global War on Terror veterans and their significant relationship partners on mental health and wellness outcomes associated with postdeployment readjustment.
Methods:
We recruited 160 veteran-partner dyads in 4 regions of the United States (San Diego, CA; Dallas, TX; Fayetteville, NC; and New York, NY) through publicity by the Iraq and Afghanistan Veterans of America to its membership. Dyads were randomly allocated to 1 of 4 study arms: Mission Reconnect (MR) program alone, MR plus the Prevention and Relationship Enhancement Program (PREP) for Strong Bonds weekend program for military couples, PREP alone, and waitlist control. We administered a battery of standardized and investigator-generated instruments assessing mental health outcomes at baseline, 8 weeks, and 16 weeks. Dyads in the MR arms were provided Web-based and mobile app video and audio instruction in a set of mindfulness-related stress reduction and contemplative practices, as well as partner massage for reciprocal use. All participants provided weekly reports on frequency and duration of self-care practices for the first 8 weeks, and at 16 weeks.
Results:
During the first 8-week reporting period, veterans and partners assigned to MR arms used some aspect of the program a mean of 20 times per week, totaling nearly 2.5 hours per week, with only modest declines in use at 16 weeks. Significant improvements were seen at 8 and 16 weeks in measures of posttraumatic stress disorder, depression, sleep quality, perceived stress, resilience, self-compassion, and pain for participants assigned to MR arms. In addition, significant reductions in self-reported levels of pain, tension, irritability, anxiety, and depression were associated with use of partner massage.
Conclusions:
Both veterans and partners were able to learn and make sustained use of a range of wellness practices taught in the MR program. Home-based, self-directed interventions may be of particular service to veterans who are distant from, averse to, or prohibited by schedule from using professional services. Leveraging the partner relationship may enhance sustained use of self-directed interventions for this population. Use of the MR program appears to be an accessible, low-cost approach that supports well-being and reduces multiple symptoms among post-9/11 veterans and their partners.
Trial registration:
Clinicaltrials.gov NCT01680419; https://clinicaltrials.gov/ct2/show/NCT01680419 (Archived by WebCite at http://www.webcitation.org/6jJuadfzj).