1
|
Steinberg JS, Fitzpatrick OM, Khurana S, Kim MY, Mair P, Schleider JL, Hatzenbuehler ML, Weisz JR. Is There a Place for Cognitive Restructuring in Brief, Self-Guided Interventions? Randomized Controlled Trial of a Single-Session, Digital Program for Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024:1-21. [PMID: 39120779 DOI: 10.1080/15374416.2024.2384026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
OBJECTIVE Self-guided digital mental health interventions (DMHIs) teaching empirically supported skills (e.g. behavioral activation) have demonstrated efficacy for improving youth mental health, but we lack evidence for the complex skill of cognitive restructuring (CR). METHOD We conducted the first-ever RCT testing a CR DMHI ("Project Think") against an active control (supportive therapy; "Project Share") in collaboration with public schools. Pre-registered outcomes were DMHI acceptability and helpfulness post-intervention, as well as internalizing symptoms and CR skills use from baseline to seven-month follow-up, in the full sample and the subsample with elevated symptoms. RESULTS Participants (N = 597; MAge = 11.99; 48% female; 68% White) rated both programs highly on acceptability and helpfulness. Both conditions were associated with significant internalizing symptom reductions across time in both samples, with no significant condition differences. CR skills use declined significantly across time for Project Share youths but held steady across time for Project Think youths in both samples; this pattern produced a significant condition difference favoring Project Think within the elevated sample at seven-month follow-up. CONCLUSION Internalizing symptoms declined comparably for Think and Share participants. Consequently, future research should examine whether encouraging youths to share their feelings produces symptom improvements, and whether a single-session, self-guided CR DMHI produces beneficial effects relative to more inert control conditions. Further, the decline in CR skills use for Project Share youths versus sustained CR use by Project Think youths raises questions about the natural time course of youths' CR use and the impact of these DMHIs on that course. ClinicalTrials.gov Registration: NCT04806321.
Collapse
|
2
|
Cohen KA, Ito S, Ahuvia IL, Yang Y, Zhang Y, Renshaw TL, Larson M, Cook C, Hill S, Liao J, Rapoport A, Smock A, Yang M, Schleider JL. Brief School-Based Interventions Targeting Student Mental Health or Well-Being: A Systematic Review and Meta-Analysis. Clin Child Fam Psychol Rev 2024:10.1007/s10567-024-00487-2. [PMID: 38884838 DOI: 10.1007/s10567-024-00487-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 06/18/2024]
Abstract
Brief, school-based mental health interventions hold promise for reducing barriers to mental health support access, a critical endeavor in light of increasing rates of mental health concerns among youth. However, there is no consensus on whether or not brief school-based interventions are effective at reducing mental health concerns or improving well-being. This systematic review and meta-analysis aims to provide consensus and determine directions for future work. Articles were included if they examined a brief (≤ four sessions or 240 min of intervention time) psychosocial intervention, were conducted within a Pre-K through 12th-grade school setting, included at least one treatment outcome evaluating mental health or well-being, and were published since 2000. A total of 6,702 papers were identified through database searching, of which 81 papers (k studies = 75) were ultimately selected for inclusion. A total of 40,498 students were included across studies and a total of 75 unique interventions were examined. A total of 324 effect sizes were extracted. On average, interventions led to statistically significant improvements in mental health/well-being outcomes versus control conditions up to one-month (g = .18, p = .004), six-month (g = .15, p = .006), and one-year (g = .10, p = .03) post-intervention. There may be benefits to brief school-based interventions from a preventative public health standpoint; future research may focus on how to optimize their real-world utility. Prospero pre-registration: CRD42021255079.
Collapse
Affiliation(s)
- Katherine A Cohen
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Sakura Ito
- Department of Psychology, Stony Brook University, Stony Brook, USA
| | - Isaac L Ahuvia
- Department of Psychology, Stony Brook University, Stony Brook, USA
| | | | - Yanchen Zhang
- Department of Psychological and Quantitative Foundations, University of Iowa, Iowa, USA
| | | | | | | | - Shannon Hill
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Jessica Liao
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Andy Rapoport
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Amanda Smock
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Michelle Yang
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Jessica L Schleider
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, USA.
| |
Collapse
|
3
|
Behnke M, Lakens D, Petrova K, Chwiłkowska P, Białek SJ, Kłoskowski M, Krzyżaniak W, Maciejewski P, Kaczmarek LD, Szymański K, Jamieson JP, Gross JJ. Applying a synergistic mindsets intervention to an esports context. ROYAL SOCIETY OPEN SCIENCE 2024; 11:240691. [PMID: 39157427 PMCID: PMC11328966 DOI: 10.1098/rsos.240691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 08/20/2024]
Abstract
Affective responses during stressful, high-stakes situations can play an important role in shaping performance. For example, feeling shaky and nervous at a job interview can undermine performance, whereas feeling excited during that same interview can optimize performance. Thus, affect regulation-the way people influence their affective responses-might play a key role in determining high-stakes outcomes. To test this idea, we adapted a synergistic mindsets intervention (SMI) (Yeager et al. 2022 Nature 607, 512-520 (doi:10.1038/s41586-022-04907-7)) to a high-stakes esports context. Our approach was motivated by the idea that (i) mindsets both about situations and one's stress responses to situations can be shaped to help optimize stress responses, and (ii) challenge versus threat stress responses will be associated with improved outcomes. After a baseline performance task, we randomly assigned gamers (n = 300) either to SMI or a control condition in which they learned brain facts. After two weeks of daily gaming, gamers competed in a cash-prize tournament. We measured affective experiences before the matches and cardiovascular responses before and throughout the matches. Contrary to predictions, gamers did not experience negative affect (including feeling stressed), thus limiting the capacity for the intervention to regulate physiological responses and optimize performance. Compared with the control participants, synergistic mindsets participants did not show greater challenge responses or improved performance outcomes. Though our adaptation of Yeager et al.'s SMI did not optimize esports performance, our findings point to important considerations regarding the suitability of an intervention such as this to different performance contexts of varying degrees of stressfulness.
Collapse
Affiliation(s)
- Maciej Behnke
- Faculty of Psychology and Cognitive Science, Adam Mickiewicz University, Poznan, Poland
- Cognitive Neuroscience Center, Adam Mickiewicz University, Poznan, Poland
| | - Daniel Lakens
- Human-Technology Interaction Group, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Kate Petrova
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Patrycja Chwiłkowska
- Faculty of Psychology and Cognitive Science, Adam Mickiewicz University, Poznan, Poland
| | - Szymon Jęśko Białek
- Faculty of Psychology and Cognitive Science, Adam Mickiewicz University, Poznan, Poland
| | - Maciej Kłoskowski
- Faculty of Psychology and Cognitive Science, Adam Mickiewicz University, Poznan, Poland
| | - Wadim Krzyżaniak
- Faculty of Psychology and Cognitive Science, Adam Mickiewicz University, Poznan, Poland
| | - Patryk Maciejewski
- Faculty of Psychology and Cognitive Science, Adam Mickiewicz University, Poznan, Poland
| | - Lukasz D. Kaczmarek
- Faculty of Psychology and Cognitive Science, Adam Mickiewicz University, Poznan, Poland
| | - Kacper Szymański
- Faculty of Psychology and Cognitive Science, Adam Mickiewicz University, Poznan, Poland
| | | | - James J. Gross
- Department of Psychology, Stanford University, Stanford, CA, USA
| |
Collapse
|
4
|
Schafer KM, Joiner TE. A Comparison of Patients Presenting with Suicide Attempts, Psychopathology Symptoms, or Pain within Emergency Departments. Arch Suicide Res 2024; 28:512-522. [PMID: 36994500 DOI: 10.1080/13811118.2023.2192765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Previous suicide attempts, psychopathology symptoms, and pain significantly increase risk of suicide, a leading cause of death. It is possible that patients across these three groups exhibit key differences that could provide insights into unique interventions for suicide-related outcomes. Data were collected using a standardized form at 432 emergency departments (EDs; 14,018 participants [females, n = 8,042; 57.4%; males, n = 5,976; 42.6%]). We conducted a series of ANOVAs to investigate if patients presenting for (1) suicide attempts (n = 33; 0.2%), (2) psychopathology symptoms (n = 1,104; 7.9%), or (3) pain (n = 12,881; 91.9%) varied across a variety of healthcare-relevant variables. Findings indicated that patients presenting with suicide attempts were seen with more urgency (F[2,12054] = 66.41, p < .001) and were more likely to be admitted to hospitalization (F[2,14015] = 187.296, p < .001), observation unit overall (F[2,14015] = 78.572, p < .001), or transferred to another hospital (F[2,14015] = 406.568, p < .001); they also required longer visits (F [2, 12054] = 66.41, p < .001) as compared to patients with psychopathology symptoms or pain. Notably, potentially important similarities between groups emerged: groups did not differ across leaving without medical screening, leaving against medical advice, or contact with healthcare providers in the long-term (i.e., twelve months) or short-term (i.e., 72 hours) preceding ED admission. These findings in particular indicate that there could be ample time (1) prior to admission to intervene and (2) during care in EDs to connect patients to goal-oriented, time-limited evidence based psychotherapies at a time when they may be particularly willing to engage in care.
Collapse
|
5
|
Lorenzo-Luaces L. Does the unified protocol really change personality more than other interventions? Probably little if at all: a commentary on a recently-published study. Front Psychiatry 2023; 14:1280905. [PMID: 38025471 PMCID: PMC10666260 DOI: 10.3389/fpsyt.2023.1280905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Lorenzo Lorenzo-Luaces
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IL, United States
| |
Collapse
|
6
|
Cohen ZD, Schueller SM. Expanding, improving, and understanding behaviour research and therapy through digital mental health. Behav Res Ther 2023; 167:104358. [PMID: 37418857 DOI: 10.1016/j.brat.2023.104358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Affiliation(s)
- Zachary D Cohen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA.
| | - Stephen M Schueller
- Department of Psychological Science, University of California, Irvine, USA; Department of Informatics, University of California, Irvine, USA
| |
Collapse
|
7
|
Lorenzo-Luaces L, Howard J. Efficacy of an Unguided, Digital Single-Session Intervention for Internalizing Symptoms in Web-Based Workers: Randomized Controlled Trial. J Med Internet Res 2023; 25:e45411. [PMID: 37418303 PMCID: PMC10362424 DOI: 10.2196/45411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/31/2023] [Accepted: 05/10/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND The Common Elements Toolbox (COMET) is an unguided digital single-session intervention (SSI) based on principles of cognitive behavioral therapy and positive psychology. Although unguided digital SSIs have shown promise in the treatment of youth psychopathology, the data are more mixed regarding their efficacy in adults. OBJECTIVE This study aimed to investigate the efficacy of COMET-SSI versus a waiting list control in depression and other transdiagnostic mental health outcomes for Prolific participants with a history of psychopathology. METHODS We conducted an investigator-blinded, preregistered randomized controlled trial comparing COMET-SSI (n=409) with an 8-week waiting list control (n=419). Participants were recruited from the web-based workspace Prolific and assessed for depression, anxiety, work and social functioning, psychological well-being, and emotion regulation at baseline and at 2, 4, and 8 weeks after the intervention. The main outcomes were short-term (2 weeks) and long-term (8 weeks) changes in depression and anxiety. The secondary outcomes were the 8-week changes in work and social functioning, well-being, and emotion regulation. Analyses were conducted according to the intent-to-treat principle with imputation, without imputation, and using a per-protocol sample. In addition, we conducted sensitivity analyses to identify inattentive responders. RESULTS The sample comprised 61.9% (513/828) of women, with a mean age of 35.75 (SD 11.93) years. Most participants (732/828, 88.3%) met the criteria for screening for depression or anxiety using at least one validated screening scale. A review of the text data suggested that adherence to the COMET-SSI was near perfect, there were very few inattentive respondents, and satisfaction with the intervention was high. However, despite being powered to detect small effects, there were negligible differences between the conditions in the various outcomes at the various time points, even when focusing on subsets of individuals with more severe symptoms. CONCLUSIONS Our results do not support the use of the COMET-SSI in adult Prolific participants. Future work should explore alternate ways of intervening with paid web-based participants, including matching individuals to SSIs they may be most responsive to. TRIAL REGISTRATION ClinicalTrials.gov NCT05379881, https://clinicaltrials.gov/ct2/show/NCT05379881.
Collapse
Affiliation(s)
- Lorenzo Lorenzo-Luaces
- Department of Psychological and Brain Sciences, Indiana University-Bloomington, Bloomington, IN, United States
| | | |
Collapse
|
8
|
Ding X, Wuerth K, Sakakibara B, Schmidt J, Parde N, Holsti L, Barbic S. Understanding Mobile Health and Youth Mental Health: Scoping Review. JMIR Mhealth Uhealth 2023; 11:e44951. [PMID: 37220197 PMCID: PMC10278734 DOI: 10.2196/44951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/30/2023] [Accepted: 05/16/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND A total of 75% of people with mental health disorders have an onset of illness between the ages of 12 and 24 years. Many in this age group report substantial obstacles to receiving quality youth-centered mental health care services. With the rapid development of technology and the recent COVID-19 pandemic, mobile health (mHealth) has presented new opportunities for youth mental health research, practice, and policy. OBJECTIVE The research objectives were to (1) synthesize the current evidence supporting mHealth interventions for youths who experience mental health challenges and (2) identify current gaps in the mHealth field related to youth's access to mental health services and health outcomes. METHODS Guided by the methods of Arksey and O'Malley, we conducted a scoping review of peer-reviewed studies that used mHealth tools to improve youth mental health (January 2016-February 2022). We searched MEDLINE, PubMed, PsycINFO, and Embase databases using the following key terms: (1) mHealth; (2) youth and young adults; and (3) mental health. The current gaps were analyzed using content analysis. RESULTS The search produced 4270 records, of which 151 met inclusion criteria. Included articles highlight the comprehensive aspects of youth mHealth intervention resource allocation for targeted conditions, mHealth delivery methods, measurement tools, evaluation of mHealth intervention, and youth engagement. The median age for participants in all studies is 17 (IQR 14-21) years. Only 3 (2%) studies involved participants who reported their sex or gender outside of the binary option. Many studies (68/151, 45%) were published after the onset of the COVID-19 outbreak. Study types and designs varied, with 60 (40%) identified as randomized controlled trials. Notably, 143 out of 151 (95%) studies came from developed countries, suggesting an evidence shortfall on the feasibility of implementing mHealth services in lower-resourced settings. Additionally, the results highlight concerns related to inadequate resources devoted to self-harm and substance uses, weak study design, expert engagement, and the variety of outcome measures selected to capture impact or changes over time. There is also a lack of standardized regulations and guidelines for researching mHealth technologies for youths and the use of non-youth-centered approaches to implementing results. CONCLUSIONS This study may be used to inform future work as well as the development of youth-centered mHealth tools that can be implemented and sustained over time for diverse types of youths. Implementation science research that prioritizes youths' engagement is needed to advance the current understanding of mHealth implementation. Moreover, core outcome sets may support a youth-centered measurement strategy to capture outcomes in a systematic way that prioritizes equity, diversity, inclusion, and robust measurement science. Finally, this study suggests that future practice and policy research are needed to ensure the risk of mHealth is minimized and that this innovative health care service is meeting the emerging needs of youths over time.
Collapse
Affiliation(s)
- Xiaoxu Ding
- Faculty of Medicine, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
- Faculty of Graduate Studies, Rehabilitation Science, University of British Columbia, Vancouver, BC, Canada
| | - Kelli Wuerth
- Foundry, Providence Health Care, Vancouver, BC, Canada
| | - Brodie Sakakibara
- Faculty of Medicine, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
- Faculty of Graduate Studies, Rehabilitation Science, University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada
| | - Julia Schmidt
- Faculty of Medicine, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
- Faculty of Graduate Studies, Rehabilitation Science, University of British Columbia, Vancouver, BC, Canada
| | - Natalie Parde
- Department of Computer Science, University of Illinois Chicago, Chicago, IL, United States
- Natural Language Processing Laboratory, University of Illinois Chicago, Chicago, IL, United States
| | - Liisa Holsti
- Faculty of Medicine, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
- Faculty of Graduate Studies, Rehabilitation Science, University of British Columbia, Vancouver, BC, Canada
| | - Skye Barbic
- Faculty of Medicine, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
- Faculty of Graduate Studies, Rehabilitation Science, University of British Columbia, Vancouver, BC, Canada
- Foundry, Providence Health Care, Vancouver, BC, Canada
- Centre for Health Evaluation & Outcome Sciences, Vancouver, BC, Canada
| |
Collapse
|
9
|
Lepage S, Conway A, Goodson N, Wicks P, Flight L, Devane D. Online randomised trials with children: A scoping review. PLoS One 2023; 18:e0280965. [PMID: 37228143 DOI: 10.1371/journal.pone.0280965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Paediatric trials must contend with many challenges that adult trials face but often bring additional obstacles. Decentralised trials, where some or all trial methods occur away from a centralised location, are a promising strategy to help meet these challenges. This scoping review aims to (a) identify what methods and tools have been used to create and conduct entirely online-decentralised trials with children and (b) determine the gaps in the knowledge in this field. This review will describe the methods used in these trials to identify their facilitators and the gaps in the knowledge. METHODS The methods were informed by guidance from the Joanna Briggs Institute and the PRISMA extension for scoping reviews. We systematically searched MEDLINE, CENTRAL, CINAHL, and Embase databases, trial registries, pre-print servers, and the internet. We included randomised and quasi-randomised trials conducted entirely online with participants under 18 published in English. A risk of bias assessment was completed for all included studies. RESULTS Twenty-one trials met our inclusion criteria. The average age of participants was 14.6 years. Social media was the most common method of online recruitment. Most trials employed an external host website to store and protect their data. Duration of trials ranged from single-session interventions up to ten weeks. Fourteen trials compensated participants. Eight trials involved children in their trial design process; none reported compensation for this. Most trials had a low risk of bias in "random sequence generation", "selective reporting", and "other". Most trials had a high risk of bias in "blinding participants and personnel", "blinding of outcome assessment", and "incomplete outcome data". "Allocation concealment" was unclear in most studies. CONCLUSIONS There was a lack of transparent reporting of the recruitment, randomisation, and retention methods used in many of the trials included in this review. Patient and public involvement (PPI) was not common, and the compensation of PPI partners was not reported in any study. Consent methods and protection against fraudulent entries to trials were creative and thoroughly discussed by some trials and not addressed by others. More work and thorough reporting of how these trials are conducted is needed to increase their reproducibility and quality. ETHICS AND DISSEMINATION Ethical approval was not necessary since all data sources used are publicly available.
Collapse
Affiliation(s)
- Simone Lepage
- Health Research Board-Trials Methodology Research Network (HRB-TMRN), University of Galway, Galway, Ireland
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Aislinn Conway
- Evidence Synthesis Ireland, University of Galway, Galway, Ireland
| | - Noah Goodson
- Data & Analytics, Thread Research, Tustin, California, United States of America
| | - Paul Wicks
- Wicks Digital Health, Lichfield, Staffordshire, United Kingdom
| | - Laura Flight
- National Institute for Health and Care Excellence, Piccadilly Plaza, Manchester, United Kingdom
| | - Declan Devane
- Health Research Board-Trials Methodology Research Network (HRB-TMRN), University of Galway, Galway, Ireland
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland, University of Galway, Galway, Ireland
- Cochrane Ireland, University of Galway, Galway, Ireland
| |
Collapse
|
10
|
Schleider JL, Smith AC, Ahuvia I. Realizing the untapped promise of single-session interventions for eating disorders. Int J Eat Disord 2023; 56:853-863. [PMID: 36815724 PMCID: PMC10159985 DOI: 10.1002/eat.23920] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/12/2023] [Accepted: 02/12/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Multilevel treatment barriers prevent up to 80% of individuals experiencing eating disorders (EDs) from accessing care. This treatment gap creates a critical need to identify interventions that are accessible, easily completable, and optimized for effectiveness by targeting core mechanisms linked to ED onset and maintenance. We propose single-session interventions (SSIs) as a promising path toward catalyzing innovation in the development of accessible, effective ED interventions. SSIs are structured programs that intentionally involve one encounter with a program or provider; they may serve as stand-alone or adjunctive clinical supports. All SSIs are built to acknowledge that any session might be someone's last-and that any single session can nonetheless yield meaningful clinical benefit. METHOD We define SSIs, summarize research supporting their utility for ED symptoms and other mental health problems, and recommend future directions for work in this domain. RESULTS Single-session interventions may hold promise to reduce some ED symptoms and risk factors, including restrictive eating and negative body image. Steps toward realizing this promise include (1) testing whether existing evidence-based SSIs (e.g., for depression) can also reduce EDs, risk factors, and symptoms; (2) developing novel SSIs that target modifiable ED risk factors and symptoms largely unaddressed by SSIs, such as purging and binge eating; (3) studying diverse implementation pathways; (4) capitalizing on SSIs' transdiagnostic utility to broaden funding opportunities; and (5) educating ED researchers and clinicians about SSIs. DISCUSSION Understanding the strengths and limits of mechanism-targeted SSIs for ED-related problems could be a low-risk, high-reward avenue toward reducing EDs at scale. PUBLIC SIGNIFICANCE Most individuals experiencing EDs never access any form of treatment, creating an urgent need to identify ED interventions built to overcome barriers to engaging with care. This Forum article introduces SSIs as a promising path to rapidly developing and testing accessible, evidence-based ED supports; supplementing existing ED treatment models; and reducing the individual, familial, and societal burdens of EDs at scale.
Collapse
Affiliation(s)
| | | | - Isaac Ahuvia
- Department of Psychology, Stony Brook University
| |
Collapse
|
11
|
Hart MJ, Sung JY, McQuillin SD, Schleider JL. Expanding the reach of psychosocial services for youth: Untapped potential of mentor-delivered single session interventions. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:1255-1272. [PMID: 36017616 DOI: 10.1002/jcop.22927] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 07/30/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
At present, the mental healthcare system cannot meet the demand for services, and the need-to-access gap is widest among children and adolescents. Single session interventions (SSIs) are brief, intentional, and mechanism-targeted programs that have shown promise in increasing the reach of effective, evidence-based services; yet, a wide gap still remains due to structural barriers (e.g., lack of awareness, workforce shortages). The present paper posits the integration of SSIs and mentor-delivered programs as a promising future step to further overcome the inaccessibility of youth mental health services. Capitalizing on the advantages of mentoring relationships (e.g., the associated interpersonal benefits and mentors' pre-existence in most community settings) has the potential to complement and enhance the value of SSIs, and to expand the acceptability and reach of evidence-based mental health services. In this paper, we discuss the anticipated benefits of mentor-delivered SSIs, as well as cautionary considerations related to the proposed model. To conclude, we highlight the necessary implementation and research implications.
Collapse
Affiliation(s)
- Mackenzie J Hart
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - Jenna Y Sung
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Samuel D McQuillin
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - Jessica L Schleider
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| |
Collapse
|
12
|
Van Lieshout RJ, Layton H, Savoy CD, Xie F, Brown JSL, Huh K, Bieling PJ, Streiner DL, Ferro MA, Haber-Evans E. In-person 1-day cognitive behavioral therapy-based workshops for postpartum depression: a randomized controlled trial. Psychol Med 2023; 53:1-11. [PMID: 36878891 PMCID: PMC10600825 DOI: 10.1017/s0033291723000454] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 01/29/2023] [Accepted: 02/06/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Postpartum depression (PPD) affects up to one in five mothers and birthing parents, yet as few as 10% access evidence-based treatment. One-day cognitive behavioral therapy (CBT)-based workshops for PPD have the potential to reach large numbers of sufferers and be integrated into stepped models of care. METHODS This randomized controlled trial of 461 mothers and birthing parents in Ontario, Canada with Edinburgh Postnatal Depression Scale (EPDS) scores ⩾10, age ⩾18 years, and an infant <12 months of age compared the effects of a 1-day CBT-based workshop plus treatment as usual (TAU; i.e. care from any provider(s) they wished) to TAU alone at 12-weeks post-intervention on PPD, anxiety, the mother-infant relationship, offspring behavior, health-related quality of life, and cost-effectiveness. Data were collected via REDCap. RESULTS Workshops led to meaningful reductions in EPDS scores (m = 15.77 to 11.22; b = -4.6, p < 0.01) and were associated with three times higher odds of a clinically significant decrease in PPD [odds ratio (OR) 3.00, 95% confidence interval (CI) 1.93-4.67]. Anxiety also decreased and participants had three times the odds of clinically significant improvement (OR 3.20, 95% CI 2.03-5.04). Participants reported improvements in mother-infant bonding, infant-focused rejection and anger, and effortful control in their toddlers. The workshop plus TAU achieved similar quality-adjusted life-years at lower costs than TAU alone. CONCLUSIONS One-day CBT-based workshops for PPD can lead to improvements in depression, anxiety, and the mother-infant relationship and are cost-saving. This intervention could represent a perinatal-specific option that can treat larger numbers of individuals and be integrated into stepped care approaches at reasonable cost.
Collapse
Affiliation(s)
- Ryan J. Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Haley Layton
- Health Research Methodology Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Calan D. Savoy
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - June S. L. Brown
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kathryn Huh
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Peter J. Bieling
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - David L. Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Mark A. Ferro
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Erika Haber-Evans
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
13
|
Shroff A, Roulston C, Fassler J, Dierschke NA, Todd JSP, Ríos-Herrera Á, Plastino KA, Schleider JL. A Digital Single-Session Intervention Platform for Youth Mental Health: Cultural Adaptation, Evaluation, and Dissemination. JMIR Ment Health 2023; 10:e43062. [PMID: 36787180 PMCID: PMC9975917 DOI: 10.2196/43062] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/09/2023] [Accepted: 01/09/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Despite the proliferation of evidence-based digital mental health programs for young people, their low uptake and inconsistent implementation preclude them from benefiting youths at scale. Identifying effective implementation strategies for evidence-based supports is especially critical in regions where treatment access is lowest owing to mental health provider shortages. OBJECTIVE The goal of this academic-community partnership, funded by the City of San Antonio Metropolitan Health District, was to culturally adapt, disseminate, and gauge the acceptability and utility of an evidence-based digital mental health platform-Project Youth Empowerment and Support (YES)-among English- and Spanish-speaking youths living in south Texas. METHODS Project YES is an open-access, anonymous platform containing 3 evidence-based, self-guided interventions for youth mental health. Project YES was culturally adapted via focus groups and co-design sessions with San Antonio youths with lived experience of depression and anxiety; translated into Spanish; and disseminated throughout San Antonio, Texas, via community and school partnerships. RESULTS During the project period (April 2021 to December 2021), 1801 San Antonio youths began and 894 (49.64%) of them completed a 30-minute, single-session intervention within Project YES (aged 11-17 years; n=718, 39.87% male; n=961, 53.36% female; and n=3, 0.17% intersex; n=1477, 82.01% Hispanic; n=77, 4.28% non-Hispanic White; n=113, 6.27% Black; n=28, 1.55% Asian; and n=93, 5.16% other). This completion rate (49.64%) surpassed those previously observed for Project YES (eg, 34% when disseminated via social media). San Antonio youths rated Project YES as highly acceptable across all metrics, both in English and Spanish. In addition, the youths who completed Project YES-ENGLISH reported significant improvements in hopelessness (Cohen d=0.33; P<001), self-hate (Cohen d=0.27; P<001), and perceived agency (Cohen d=0.25; P<001) from before to after the intervention, and the youths who completed Project YES-SPANISH reported significant improvements in self-hate (Cohen d=0.37; P=.049) from before to after the intervention. CONCLUSIONS The results indicate that Project YES-an open-access, free, and anonymous web-based single-session intervention platform-is an acceptable, accessible, and applicable mental health support for English- and Spanish-speaking San Antonio youths.
Collapse
Affiliation(s)
- Akash Shroff
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Chantelle Roulston
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Julia Fassler
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Nicole A Dierschke
- University of Texas Teen Health, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Jennifer San Pedro Todd
- University of Texas Teen Health, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Ámbar Ríos-Herrera
- University of Texas Teen Health, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Kristen A Plastino
- University of Texas Teen Health, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | | |
Collapse
|
14
|
Mavragani A, Whitlock J, Chapman J, Bhandari A, Bazarova N. Young Adults' Perceptions of 2 Publicly Available Digital Resources for Self-injury: Qualitative Study of a Peer Support App and Web-Based Factsheets. JMIR Form Res 2023; 7:e41546. [PMID: 36633896 PMCID: PMC9880808 DOI: 10.2196/41546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Digital resources have the potential to bridge the gaps in mental health services for young people who self-injure. Most research on digital resources for this population has involved observational studies of content in web-based communities or formative studies focused on the design and early evaluation of new interventions. Far less research has sought to understand young people's experiences with publicly available digital resources or to identify specific components of these resources that are perceived to be of value in their recovery. OBJECTIVE This study aimed to understand young people's experiences with 2 publicly available digital resources for self-injury-a peer support app and web-based factsheets-and to disentangle potential explanatory mechanisms associated with perceived benefits and harms. METHODS Participants were 96 individuals (aged 16-25 years) with nonsuicidal self-injury behavior in the past month, who recently completed a pilot randomized controlled trial designed to assess the efficacy of a peer support app as compared with web-based factsheets to reduce self-injury behavior. The trial showed that participants using the peer support app reported less self-injury behavior relative to those receiving the web-based factsheets over 8 weeks. In this study, we used a conventional approach to content analysis of responses to 2 open-ended questions delivered at the end of the trial with the aims of exploring participants' overall experiences with these resources and identifying the qualities of these resources that were perceived to be beneficial to or harmful for participants' recovery. RESULTS Overall, participants were more likely to report benefits than harms. Participants who used the peer support app reported more harms than those who received the web-based factsheets. In the open coding phase, clear benefits were also derived from repeated weekly surveys about self-injury. Key benefits across digital resources included enhanced self-knowledge, reduction in self-injury activity, increased outreach or informal conversations, improved attitudes toward therapy, improved mood, and feeling supported and less alone. Key challenges included worsened or unchanged self-injury activity, diminished mood, and increased barriers to outreach. The most prominent benefit derived from the web-based factsheets and weekly surveys was improved self-understanding. However, the way this manifested differed, with factsheets providing insight on why participants engage in self-injury and the function it serves them and surveys making the frequency and severity of participants' behaviors more apparent. The benefits perceived from using the peer support app were general improvements in mood and feeling less alone. CONCLUSIONS Findings contribute a nuanced understanding of young people's experiences with these digital resources and have implications for the optimization of existing platforms and the design of novel resources to support individuals who self-injure.
Collapse
Affiliation(s)
| | - Janis Whitlock
- Department of Communication, Cornell University, Ithaca, NY, United States
| | - Julia Chapman
- Department of Communication, Cornell University, Ithaca, NY, United States
| | - Aparajita Bhandari
- Department of Communication, Cornell University, Ithaca, NY, United States
| | - Natalya Bazarova
- Department of Communication, Cornell University, Ithaca, NY, United States
| |
Collapse
|
15
|
Yun J, Shin J, Lee H, Kim DJ, Choi IY, Kim M. Characteristics and Potential Challenges of Digital-Based Interventions for Children and Young People: Scoping Review (Preprint). J Med Internet Res 2023; 25:e45465. [PMID: 37058340 PMCID: PMC10148209 DOI: 10.2196/45465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/15/2023] [Accepted: 02/27/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Digital health technologies are becoming increasingly available to children and young people and their families. However, there are no scoping reviews that provide both an overview of the characteristics of digital interventions for children and young people and potential challenges to be considered when developing and implementing them. OBJECTIVE This study aimed to systematically review scientific publications to identify the current characteristics and potential complications of digital interventions for children and young people. METHODS This scoping review was conducted using the framework of Arksey and O'Malley and adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews. A search of 5 databases (PubMed, Scopus, Embase, MEDLINE, and CINAHL) and Google Scholar was performed for eligible clinical trials published between January 1, 2018, and August 19, 2022. RESULTS The initial search of the 5 databases yielded 3775 citations; duplicates and those not meeting the inclusion criteria were eliminated. In total, 34 articles were included in the final review and relevant information, such as the descriptive characteristics and potential challenges, were classified. Mental health (26/34, 76%) was the most common target for the digital intervention for children and young people, exceeding physical health (8/34, 24%) by more than 3 times. In addition, a substantial number of digital interventions were dedicated solely to children and young people. Digital interventions for children and young people were more likely to be delivered via computers (17/34, 50%) rather than smartphones (13/34, 38%). More than one-third of the studies (13/34, 38%) applied cognitive behavioral theory as the theory of digital interventions. The duration of the digital intervention for children and young people was more likely to vary depending on the target user rather than the target disease. Intervention components were classified into 5 categories: guidance, task and activity, reminder and monitoring, supportive feedback, and reward system. Potential challenges were subcategorized into ethical, interpersonal, and societal challenges. For ethical challenges, the consent of children and young people or caregivers, potential risk of adverse events, and data privacy issues were considered. For interpersonal challenges, the engagement of children and young people was affected by the preference or barrier of caregivers to participate in studies. For societal challenges, restricted ethnicity in recruitment, limited availability of digital technology, differences in internet use patterns between girls and boys, unified clinical settings, and language barriers were described. CONCLUSIONS We identified potential challenges and provided suggestions about ethical, interpersonal, and societal aspects to consider when developing and deploying digital-based interventions for children and young people. Our findings provide a thorough overview of the published literature and may serve as a comprehensive, informative foundation for the development and implementation of digital-based interventions for children and young people.
Collapse
Affiliation(s)
- Jinsoo Yun
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Jaeyong Shin
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Hyerim Lee
- Department of Psychology, College of Liberal Arts, Yonsei University, Seoul, Republic of Korea
| | - Dai-Jin Kim
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In-Young Choi
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Meelim Kim
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, United States
- Health IT Center, Yonsei University Health System, Seoul, Republic of Korea
| |
Collapse
|
16
|
Kruzan KP, Reddy M, Washburn JJ, Mohr DC. Developing a Mobile App for Young Adults with Nonsuicidal Self-Injury: A Prototype Feedback Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16163. [PMID: 36498234 PMCID: PMC9739032 DOI: 10.3390/ijerph192316163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/23/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
Nonsuicidal self-injury (NSSI) affects approximately 13% of young adults. Though evidence-based treatments for NSSI exist, most young adults do not receive treatment. Digital interventions can provide access to evidence-based treatments for NSSI at scale. Further, preliminary research suggests the acceptability, feasibility, and potential efficacy of digital interventions for NSSI. To date, however, there are few publicly available digital interventions developed specifically for young adults who engage in NSSI. The aim of this study was to solicit young adults' impressions of early app prototypes to identify ways of improving interactive features and content needs. Building on a prior interview study which explored young adults' self-management of NSSI and their use of technology in self-management, this study involved three waves of iterative app prototype feedback sessions with 10 young adults with past month NSSI. In general, participants responded favorably and provided feedback to augment the app to better meet their needs, including adding new features and functionality as well as increasing opportunities for personalization. We discuss two key design challenges related to the roles of tracking and temporality in digital interventions for NSSI, and then frame design considerations related to these challenges within the lived informatics model.
Collapse
Affiliation(s)
- Kaylee Payne Kruzan
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Madhu Reddy
- Department of Informatics, Donald Bren School of Information & Computer Sciences, University of California Irvine, Irvine, CA 92697, USA
| | - Jason J. Washburn
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - David C. Mohr
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| |
Collapse
|
17
|
Community Initiated Care: A blue-print for the practical realization of contextual behavioral science. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
|
18
|
Abstract
PURPOSE OF THE REVIEW The rate of youth suicidal behaviors has gradually increased over the last 15 years and continues to grow during the COVID-19 pandemic. This trend burdens mental health services and demands significant developments in risk detection and delivery of interventions to reduce the risk. In this article we outline significant advances and recent findings in youth suicide research that may facilitate strategies for identifying and preventing suicide risk among youth at risk in general and in specific risk groups. RECENT FINDINGS The rise in suicide and suicidal behaviors is most likely to affect young people of racial, ethnic, sexual, and gender identity minorities and those living in poverty or experiencing maltreatment. The suicide rate in children is rising and demands special attention. Proximal risk factors for suicidal behavior compared with suicidal ideation have been suggested to identify near-term suicidal risk. Effective and scalable prevention strategies were identified, and the role of new technologies in suicide prevention among youth is to be determined. SUMMARY To reach broader suicide prevention in youth and reduce the pressure on mental healthcare, public health approaches and improved service access for minority youth and those living in underserved areas of the world are needed.
Collapse
Affiliation(s)
- Shira Barzilay
- Department of Community Mental Health, University of Haifa
| | - Alan Apter
- Schneider Children's Medical Center of Israel, Petach Tikva
- Ivcher School of Psychology, Reichman University, Herzliya, Israel
| |
Collapse
|
19
|
Whaibeh E, Vogt EL, Mahmoud H. Addressing the Behavioral Health Needs of Sexual and Gender Minorities During the COVID-19 Pandemic: a Review of the Expanding Role of Digital Health Technologies. Curr Psychiatry Rep 2022; 24:387-397. [PMID: 35841471 DOI: 10.1007/s11920-022-01352-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW To review the role of digital health technologies in behavioral health treatment and promotion for sexual and gender minorities (SGM). RECENT FINDINGS Digital technologies have advantages and limitations at multiple levels in addressing SGM's behavioral health needs. For patients, digital technologies improve convenience and may reduce stigma; however, privacy concerns in the home may limit their utilization. Providers also benefit from the convenience of these technologies; however, not all providers are comfortable delivering virtual care to SGM. For society, digital technologies reduce transportation-related costs and increase access to healthcare in an increasingly hostile political climate for SGM; however, these advantages are limited by technological access and anti-SGM policies. Digital technologies can improve the behavioral health of SGM at the patient, provider, and systemic levels. Further efforts are necessary to standardize provider training, improve SUD-specific care delivery, and increase quality and accessibility of these technologies.
Collapse
Affiliation(s)
- Emile Whaibeh
- Department of Public Health, University of Balamand, Beirut, Lebanon.,École Doctorale Sciences Et Santé, Saint Joseph University, Beirut, Lebanon
| | - Emily L Vogt
- University of Michigan Medical School, Ann Arbor, MI, USA.
| | | |
Collapse
|
20
|
Dobias ML, Morris RR, Schleider JL. Single-Session Interventions Embedded Within Tumblr: Acceptability, Feasibility, and Utility Study. JMIR Form Res 2022; 6:e39004. [PMID: 35877163 PMCID: PMC9361144 DOI: 10.2196/39004] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 02/06/2023] Open
Abstract
Background Existing mental health treatments are insufficient for addressing mental health needs at scale, particularly for teenagers, who now seek mental health information and support on the web. Single-session interventions (SSIs) may be particularly well suited for dissemination as embedded web-based support options that are easily accessible on popular social platforms. Objective We aimed to evaluate the acceptability and effectiveness of three SSIs, each with a duration of 5 to 8 minutes (Project Action Brings Change, Project Stop Adolescent Violence Everywhere, and REFRAME)—embedded as Koko minicourses on Tumblr—to improve three key mental health outcomes: hopelessness, self-hate, and the desire to stop self-harm behavior. Methods We used quantitative data (ie, star ratings and SSI completion rates) to evaluate acceptability and short-term utility of all 3 SSIs. Paired 2-tailed t tests were used to assess changes in hopelessness, self-hate, and the desire to stop future self-harm from before to after the SSI. Where demographic information was available, the analyses were restricted to teenagers (13-19 years). Examples of positive and negative qualitative user feedback (ie, written text responses) were provided for each program. Results The SSIs were completed 6179 times between March 2021 and February 2022. All 3 SSIs generated high star ratings (>4 out of 5 stars), with high completion rates (approximately 25%-57%) relative to real-world completion rates among other digital self-help interventions. Paired 2-tailed t tests detected significant pre-post reductions in hopelessness for those who completed Project Action Brings Change (P<.001, Cohen dz=−0.81, 95% CI −0.85 to −0.77) and REFRAME (P<.001, Cohen dz=−0.88, 95% CI −0.96 to −0.80). Self-hate significantly decreased (P<.001, Cohen dz=−0.67, 95% CI −0.74 to −0.60), and the desire to stop self-harm significantly increased (P<.001, Cohen dz=0.40, 95% CI 0.33 to 0.47]) from before to after the completion of Project Stop Adolescent Violence Everywhere. The results remained consistent across sensitivity analyses and after correcting for multiple tests. Examples of positive and negative qualitative user feedback point toward future directions for SSI research. Conclusions Very brief SSIs, when embedded within popular social platforms, are one promising and acceptable method for providing free, scalable, and potentially helpful mental health support on the web. Considering the unique barriers to mental health treatment access that many teenagers face, this approach may be especially useful for teenagers without access to other mental health supports.
Collapse
Affiliation(s)
- Mallory L Dobias
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | | | - Jessica L Schleider
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| |
Collapse
|
21
|
Bilsky SA, Olson EK, Luber MJ, Petell JA, Friedman HP. An initial examination of the associations between appearance-related safety behaviors, socioemotional, and body dysmorphia symptoms during adolescence. J Adolesc 2022; 94:939-954. [PMID: 35821622 DOI: 10.1002/jad.12074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/28/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Adolescence is characterized by the onset of a relatively specific set of socioemotional disorders (i.e., depression, generalized anxiety disorder, social anxiety disorder, and eating disorders) as well as body dysmorphia symptoms. Appearance-related concerns are a central feature of these disorders. Emerging evidence in adults suggests that appearance-related safety behaviors may play an instrumental role in the onset and maintenance of a number of disorders. To date, no work has examined appearance-related safety behaviors during adolescence. The present study examined the extent to which appearance-related safety behaviors may be associated with socioemotional and body dysmorphia symptoms during adolescence. METHODS Adolescents between the ages of 13 and 17 years old (N = 387, Mage = 14.82 years, 31.3% identified as male, 47.0% identified as female, and 19.1% identified as nonbinary/third gender, 2.6% declined to report gender identity) completed measures assessing negative affect, anxiety-relevant safety behavior use, cognitive reappraisal, expressive suppression, appearance-related safety behaviors, body dysmorphia symptoms, and socioemotional symptoms. Structural Equation Modeling was used to test hypotheses. RESULTS The results of this study suggest that appearance-related safety behaviors evidenced associations with latent factors corresponding to affective (i.e., depression, generalized anxiety disorder, social anxiety), eating disorders, and body dysmorphia symptoms after controlling for previously established vulnerability factors. CONCLUSIONS These findings demonstrate that appearance-related safety behaviors may evidence transdiagnostic associations with socioemotional symptoms and body dysmorphia symptoms during adolescence.
Collapse
Affiliation(s)
- Sarah A Bilsky
- Department of Psychology, University of Mississippi, Oxford, Mississippi, USA
| | - Emily K Olson
- Department of Psychology, University of Mississippi, Oxford, Mississippi, USA
| | - Maxwell J Luber
- Department of Psychology, University of Mississippi, Oxford, Mississippi, USA
| | - Jennifer A Petell
- Department of Psychology, University of Mississippi, Oxford, Mississippi, USA
| | - Hannah P Friedman
- Department of Psychology, University of Mississippi, Oxford, Mississippi, USA
| |
Collapse
|
22
|
A growth mindset intervention to promote resilience against online peer victimization: A randomized controlled trial. COMPUTERS IN HUMAN BEHAVIOR 2022. [DOI: 10.1016/j.chb.2022.107373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
23
|
Adolescent dropout from brief digital mental health interventions within and beyond randomized trials. Internet Interv 2022; 27:100496. [PMID: 35257001 PMCID: PMC8897204 DOI: 10.1016/j.invent.2022.100496] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/09/2022] [Accepted: 01/14/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Many adolescents struggle to access appropriate mental health care due to structural or psychological barriers. Although traditional barriers to participation (e.g., location, cost) are hypothetically reduced or removed in internet interventions, low retention reduces the likelihood that adolescents will receive the intervention dosage intended to produce beneficial effects. It is therefore key to determine what factors are associated with dropout in digital mental health interventions with adolescents both within and beyond the context of research studies. METHODS We compare completion rates from two projects evaluating self-guided, online single-session mental health interventions (SSIs) for adolescents. One was a randomized controlled trial (RCT) in which participants were paid for participation. The other was a program evaluation project in which participants were not paid for participation. We additionally compare SSI completion rates across various demographic groups and across baseline hopelessness levels. RESULTS There was a statistically significant difference in SSI completion status between the RCT (84.75% full-completers) and the program evaluation (36.86% full-completers), X 2 (2, N = 2436) = 583.5, p < 0.05. There were no significant differences in the baseline hopelessness scores across completion statuses in either study. There were no significant differences in full-completion rates across demographic groups in either project. CONCLUSION Adolescents may be more likely to complete a brief digital mental health intervention in a paid, research-based context than in an unpaid, naturalistic context. Additionally, it is possible that the brevity of SSIs reduces demographic disparities related to retention by minimizing the time required to complete an intervention.
Collapse
|
24
|
Schleider JL, Beidas RS. Harnessing the Single-Session Intervention approach to promote scalable implementation of evidence-based practices in healthcare. FRONTIERS IN HEALTH SERVICES 2022; 2:997406. [PMID: 36925822 PMCID: PMC10012621 DOI: 10.3389/frhs.2022.997406] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022]
Abstract
Effective implementation of evidence-based practices often involves multi-level strategies targeting individual-, organizational-, and system-level determinants of change. Although these multi-level implementation approaches can successfully facilitate EBP uptake, they tend to be complex and resource intensive. Accordingly, there is a need for theory-driven, generalizable approaches that can enhance efficiency, cost-effectiveness, and scalability of existing implementation approaches. We propose the Single-Session Intervention approach as an unexplored path to developing low-cost and scalable implementation strategies, especially those targeting individual-level behavior change. We argue that single-session strategies (S3) for implementation, which can simultaneously target myriad barriers to individual behavior change, may promote clinicians' EBP uptake and sustainment in a manner that is low-resource and scalable. We first overview the evidence-base supporting the Single-Session Intervention approach for patient-level outcomes; situate this approach within the implementation science literature by outlining its intersections with a leading framework, the Theoretical Domains Framework (TDF), as an exemplar; and illustrate how the TDF might directly inform the design and evaluation of single-session strategies for EBP implementation. Overall, single-session strategies (S3) for implementation reflect a promising but yet-to-be-tested means of streamlining and scaling individual-level behavior change efforts in healthcare settings. Future partnered research is needed to gauge the potential of this approach across diverse clinical and community contexts.
Collapse
Affiliation(s)
- Jessica L Schleider
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Rinad S Beidas
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, United States.,Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PA, United States.,Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States
| |
Collapse
|