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Bernstein EE, Greenberg JL, Weingarden H, Snorrason I, Summers B, Williams J, Quist R, Curtiss J, Harrison O, Wilhelm S. The use of coaching in smartphone app-based cognitive behavioral therapy for body dysmorphic disorder. Internet Interv 2024; 36:100743. [PMID: 38660465 PMCID: PMC11039337 DOI: 10.1016/j.invent.2024.100743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 03/14/2024] [Accepted: 04/17/2024] [Indexed: 04/26/2024] Open
Abstract
Background Body dysmorphic disorder (BDD) is severe and undertreated. Digital mental health could be key to expanding access to evidence-based treatments, such as cognitive behavioral therapy for BDD (CBT-BDD). Coach guidance is posited to be essential for effective uptake of digital interventions. However, little is known about how different patients may use coaching, what patterns correspond to meaningful outcomes, and how to match coaching to patient needs. Methods Participants were 77 adults who received a 12-week guided smartphone CBT-BDD. Bachelor's-level coaches were available via asynchronous messaging. We analyzed the 400 messages sent by users to coaches during treatment. Message content was coded using the efficiency model of support (i.e., usability, engagement, fit, knowledge, and implementation). We aimed to clarify when and for what purposes patients with BDD used coaching, and if we can meaningfully classify patients by these patterns. We then assessed potential baseline predictors of coach usage, and whether distinct patterns relate to clinical outcomes. Results Users on average sent 5.88 messages (SD = 4.51, range 1-20) and received 9.84 (SD = 5.74, range 2-30). Regarding frequency of sending messages, latent profile analysis revealed three profiles, characterized by: (1) peak mid-treatment (16.88 %), (2) bimodal/more communication early and late in treatment (10.39 %), and (3) consistent low/no communication (72.73 %). Regarding content, four profiles emerged, characterized by mostly (1) engagement (51.95 %), (2) fit (15.58 %), (3) knowledge (15.58 %), and (4) miscellaneous/no messages (16.88 %). There was a significant relationship between frequency profile and age, such that the early/late peak group was older than the low communication group, and frequency profile and adherence, driven by the mid-treatment peak group completing more modules than the low contact group. Regarding content, the engagement and knowledge groups began treatment with more severe baseline symptoms than the fit group. Content profile was associated with dropout, suggesting higher dropout rates in the miscellaneous/no contact group and reduced rates in the engagement group. There was no relationship between profile membership and other outcomes. Discussion The majority of participants initiated little contact with their coach and the most common function of communications was to increase engagement. Results suggest that older individuals may prefer or require more support than younger counterparts early in treatment. Additionally, whereas individuals using coaching primarily for engagement may be at lower risk of dropping out, those who do not engage at all may be at elevated risk. Findings can support more personalized, data-driven coaching protocols and more efficient allocation of coaching resources.
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Affiliation(s)
- Emily E. Bernstein
- Massachusetts General Hospital, United States of America
- Harvard Medical School, United Kingdom
| | - Jennifer L. Greenberg
- Massachusetts General Hospital, United States of America
- Harvard Medical School, United Kingdom
| | - Hilary Weingarden
- Massachusetts General Hospital, United States of America
- Harvard Medical School, United Kingdom
| | - Ivar Snorrason
- Massachusetts General Hospital, United States of America
- Harvard Medical School, United Kingdom
| | - Berta Summers
- Massachusetts General Hospital, United States of America
| | | | - Rachel Quist
- Massachusetts General Hospital, United States of America
| | - Joshua Curtiss
- Massachusetts General Hospital, United States of America
- Northeastern University, United States of America
| | | | - Sabine Wilhelm
- Massachusetts General Hospital, United States of America
- Harvard Medical School, United Kingdom
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Kolaas K, Berman AH, Hedman-Lagerlöf E, Lindsäter E, Hybelius J, Axelsson E. Internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety or both: a systematic review with meta-analysis of randomised controlled trials. BMJ Open 2024; 14:e075796. [PMID: 38569713 PMCID: PMC11015301 DOI: 10.1136/bmjopen-2023-075796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 02/26/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE Depression and anxiety are major public health problems. This study evaluated the effects of internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety, or both. DESIGN Systematic review with meta-analysis. DATA SOURCES Medline (Ovid), Cochrane Library (Wiley), the Web of Science Core Collection (Clarivate), and PsycInfo (EBSCO) were searched on 24 May 2021, with an update on 6 February 2023. ELIGIBILITY CRITERIA Randomised controlled trials of internet-delivered transdiagnostic psychological treatments, open to both participants with primary depression and participants with primary anxiety. This review concerned all treatment frameworks, both guided and unguided formats and all age groups. DATA EXTRACTION AND SYNTHESIS In random-effects meta-analysis, we estimated pooled effects on depression symptoms and anxiety in terms of Hedges' g with 95% CIs. Absolute and relative heterogeneity was quantified as the τ2 and I 2. RESULTS We included 57 trials with 21 795 participants. Nine trials (16%) recruited exclusively from routine care, and three (5%) delivered treatment via video. For adults, large within-group reductions were seen in depression (g=0.90; 95% CI 0.81 to 0.99) and anxiety (g=0.87; 95% CI 0.78 to 0.96). Compared with rudimentary passive controls, the added effects were moderate (depression: g=0.52; 95% CI 0.42 to 0.63; anxiety: g=0.45; 95% CI 0.34 to 0.56) and larger in trials that required all participants to meet full diagnostic criteria for depression or an anxiety disorder. Compared with attention/engagement controls, the added effects were small (depression: g=0.30; 95% CI 0.07 to 0.53; anxiety: g=0.21; 95% CI 0.01 to 0.42). Heterogeneity was substantial, and the certainty of the evidence was very low. Two trials concerned adolescents and reported mixed results. One trial concerned older adults and reported promising results. CONCLUSION Internet-delivered transdiagnostic treatments for depression and anxiety show small-to-moderate added effects, varying by control condition. Research is needed regarding routine care, the video format, children and adolescents and older adults. PROSPERO REGISTRATION NUMBER CRD42021243172.
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Affiliation(s)
- Karoline Kolaas
- Centre for Psychiatry Research, Karolinska Institute Department of Clinical Neuroscience, Stockholm, Stockholm, Sweden
- Liljeholmen University Primary Health Care Center, Region Stockholm, Academic Primary Care Centre, Stockholm, Stockholm, Sweden
| | - Anne H Berman
- Centre for Psychiatry Research, Karolinska Institute Department of Clinical Neuroscience, Stockholm, Stockholm, Sweden
- Department of Psychology, Uppsala Universitet, Uppsala, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Karolinska Institute Department of Clinical Neuroscience, Stockholm, Stockholm, Sweden
- Gustavsberg University Primary Health Care Center, Academic Primary Care Centre, Stockholm, Stockholm, Sweden
| | - Elin Lindsäter
- Division of Psychology, Karolinska Institute Department of Clinical Neuroscience, Stockholm, Stockholm, Sweden
- Gustavsberg University Primary Health Care Center, Academic Primary Care Centre, Stockholm, Stockholm, Sweden
| | - Jonna Hybelius
- Liljeholmen University Primary Health Care Center, Region Stockholm, Academic Primary Care Centre, Stockholm, Stockholm, Sweden
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Stockholm, Sweden
| | - Erland Axelsson
- Liljeholmen University Primary Health Care Center, Region Stockholm, Academic Primary Care Centre, Stockholm, Stockholm, Sweden
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Stockholm, Sweden
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Lee H, Choi EH, Shin JU, Kim TG, Oh J, Shin B, Sim JY, Shin J, Kim M. The Impact of Intervention Design on User Engagement in Digital Therapeutics Research: Factorial Experiment With a Mixed Methods Study. JMIR Form Res 2024; 8:e51225. [PMID: 38335015 PMCID: PMC10891489 DOI: 10.2196/51225] [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: 07/25/2023] [Revised: 12/08/2023] [Accepted: 12/22/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND User engagement is crucial for digital therapeutics (DTx) effectiveness; due to variations in the conceptualization of engagement and intervention design, assessment and retention of engagement remain challenging. OBJECTIVE We investigated the influence of the perceived acceptability of experimental intervention components and satisfaction with core intervention components in DTx on user engagement, while also identifying potential barriers and facilitators to user engagement. METHODS We conducted a mixed methods study with a 2 × 2 factorial design, involving 12 outpatients with atopic dermatitis. Participants were randomized into 4 experimental groups based on push notification ("basic" or "advanced") and human coach ("on" or "off") experimental intervention components. All participants engaged in self-monitoring and learning courses as core intervention components within an app-based intervention over 8 weeks. Data were collected through in-app behavioral data, physician- and self-reported questionnaires, and semistructured interviews assessed at baseline, 4 weeks, and 8 weeks. Descriptive statistics and thematic analysis were used to evaluate user engagement, perceived acceptability of experimental intervention components (ie, push notification and human coach), satisfaction with core intervention components (ie, self-monitoring and learning courses), and intervention effectiveness through clinical outcomes. RESULTS The primary outcome indicated that group 4, provided with "advanced-level push notifications" and a "human coach," showed higher completion rates for self-monitoring forms and learning courses compared to the predetermined threshold of clinical significance. Qualitative data analysis revealed three key themes: (1) perceived acceptability of the experimental intervention components, (2) satisfaction with the core intervention components, and (3) suggestions for improvement in the overall intervention program. Regarding clinical outcomes, the Perceived Stress Scale and Dermatology Life Quality Index scores presented the highest improvement in group 4. CONCLUSIONS These findings will help refine the intervention and inform the design of a subsequent randomized trial to test its effectiveness. Furthermore, this design may serve as a model for broadly examining and optimizing overall engagement in DTx and for future investigation into the complex relationship between engagement and clinical outcomes. TRIAL REGISTRATION Clinical Research Information Service KCT0007675; http://tinyurl.com/2m8rjrmv.
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Affiliation(s)
- Hyerim Lee
- Department of Psychology, College of Liberal Arts, Yonsei University, Seoul, Republic of Korea
| | - Eung Ho Choi
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jung U Shin
- Department of Dermatology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Tae-Gyun Kim
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jooyoung Oh
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bokyoung Shin
- Department of Integrative Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Yeon Sim
- Department of Medical Device Engineering and Management, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Jaeyong Shin
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Meelim Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, United States
- The Design Lab, University of California San Diego, San Diego, CA, United States
- Center for Wireless & Population Health Systems, Calit2's Qualcomm Institute, University of California San Diego, San Diego, CA, United States
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Lipschitz JM, Pike CK, Hogan TP, Murphy SA, Burdick KE. The engagement problem: A review of engagement with digital mental health interventions and recommendations for a path forward. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2023; 10:119-135. [PMID: 38390026 PMCID: PMC10883589 DOI: 10.1007/s40501-023-00297-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 02/24/2024]
Abstract
Purpose of the review Digital mental health interventions (DMHIs) are an effective and accessible means of addressing the unprecedented levels of mental illness worldwide. Currently, however, patient engagement with DMHIs in real-world settings is often insufficient to see clinical benefit. In order to realize the potential of DMHIs, there is a need to better understand what drives patient engagement. Recent findings We discuss takeaways from the existing literature related to patient engagement with DMHIs and highlight gaps to be addressed through further research. Findings suggest that engagement is influenced by patient-, intervention- and systems-level factors. At the patient-level, variables such as sex, education, personality traits, race, ethnicity, age and symptom severity appear to be associated with engagement. At the intervention-level, integrating human support, gamification, financial incentives and persuasive technology features may improve engagement. Finally, although systems-level factors have not been widely explored, the existing evidence suggests that achieving engagement will require addressing organizational and social barriers and drawing on the field of implementation science. Summary Future research clarifying the patient-, intervention- and systems-level factors that drive engagement will be essential. Additionally, to facilitate improved understanding of DMHI engagement, we propose the following: (a) widespread adoption of a minimum necessary 5-element engagement reporting framework; (b) broader application of alternative clinical trial designs; and (c) directed efforts to build upon an initial parsimonious conceptual model of DMHI engagement.
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Affiliation(s)
- Jessica M Lipschitz
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Chelsea K Pike
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
- Peter O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX
| | | | - Katherine E Burdick
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
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Berger M, Schäfer R, Schmidt M, Regal C, Gimpel H. How to prevent technostress at the digital workplace: a Delphi study. JOURNAL OF BUSINESS ECONOMICS 2023:1-63. [PMID: 38625156 PMCID: PMC10153052 DOI: 10.1007/s11573-023-01159-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/02/2023] [Indexed: 12/01/2023]
Abstract
Technostress is a rising issue in the changing world of digital work. Technostress can cause severe adverse outcomes for individuals and organizations. Thus, organizations face the moral, legal, and economic responsibility to prevent employees' excessive technostress. As technostress develops over time, it is crucial to prevent it throughout the process of its emergence instead of only reacting after adverse outcomes occur. Contextualizing the Theory of Preventive Stress management to technostress, we synthesize and advance existing knowledge on inhibiting technostress. We develop a set of 24 technostress prevention measures from technostress inhibitor literature, other technostress literature, and based on qualitative and quantitative contributions from a Delphi study. Based on expert feedback, we characterize each measure and, where possible, assess its relevance in addressing specific technostressors. Our paper contributes to research by transferring the Theory of Preventive Stress Management into the context of technostress and presenting specific measures to prevent technostress. This offers a complementary view to technostress inhibitors by expanding the theoretical grounding and adding a time perspective through the implementation of primary, secondary, and tertiary prevention measures. For practice, we offer a comprehensive and applicable overview of measures organizations can implement to prevent technostress.
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Affiliation(s)
- Michelle Berger
- FIM Research Center for Information Management, 86159 Augsburg, Germany
- Branch Business & Information Systems Engineering of the Fraunhofer FIT, Alter Postweg 101, 86159 Augsburg, Germany
- Department of Digital Management, University of Hohenheim, Schloss Hohenheim 1, 70599 Stuttgart, Germany
| | - Ricarda Schäfer
- FIM Research Center for Information Management, 86159 Augsburg, Germany
- University of Augsburg, Universitätsstraße 2, 86158 Augsburg, Germany
| | - Marco Schmidt
- FIM Research Center for Information Management, 86159 Augsburg, Germany
- Branch Business & Information Systems Engineering of the Fraunhofer FIT, Alter Postweg 101, 86159 Augsburg, Germany
| | - Christian Regal
- FIM Research Center for Information Management, 86159 Augsburg, Germany
- Branch Business & Information Systems Engineering of the Fraunhofer FIT, Alter Postweg 101, 86159 Augsburg, Germany
- Department of Digital Management, University of Hohenheim, Schloss Hohenheim 1, 70599 Stuttgart, Germany
| | - Henner Gimpel
- FIM Research Center for Information Management, 86159 Augsburg, Germany
- Branch Business & Information Systems Engineering of the Fraunhofer FIT, Alter Postweg 101, 86159 Augsburg, Germany
- Department of Digital Management, University of Hohenheim, Schloss Hohenheim 1, 70599 Stuttgart, Germany
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Weerasekara M, Smedberg ÅB. Exploration of user needs and design requirements of a digital stress management intervention for software employees in Sri Lanka: a qualitative study. BMC Public Health 2023; 23:566. [PMID: 36973795 PMCID: PMC10041489 DOI: 10.1186/s12889-023-15480-7] [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: 03/18/2022] [Accepted: 03/18/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Digital stress management interventions are considered promising additions to the spectrum of the programs companies use to support the well-being of their employees. However, a series of constraints are identified that hinder the potential benefits of such interventions. These constraints include a lack of user engagement and personalisation, poor adherence and high attrition. Understanding the specific user needs and requirements is essential to increase the likelihood of success in implementing ICT (Information and Communication Technology)-supported stress management interventions. Thus, following the findings from a previous quantitative study, the proposed study aimed to further explore the user needs and requirements for designing digital stress management interventions for software employees in Sri Lanka. METHODS The study used a qualitative approach based on three focus groups with 22 software employees in Sri Lanka. The focus group discussions were conducted online and recorded digitally. Inductive thematic analysis was used to analyse the collected data. The consolidated criteria for reporting qualitative studies (COREQ)-32 items were followed for reporting this study. RESULTS The analysis revealed three major themes: self-help in a personal space, social support in a collaborative space, and general design considerations for achieving success. The first theme revealed the users' preference for having a personal space where they could engage in individual activities without support from an external party. The second theme elaborated on the importance of adding a collaborative platform to seek help from peers and professionals. The final theme explored the user-desired design features that could increase user engagement and adherence. CONCLUSIONS This study used a qualitative approach to further explore the findings of a previous quantitative study. The focus group discussions confirmed the results of the previous study and provided the opportunity to better understand user needs and yield new insights. Such insights revealed user preference for embedding personal and collaborative platforms in a single intervention, embedding gamified elements, the provision of passive content generation via sensory systems, and the need for personalisation. These empirical findings will feed into the design of ICT-supported interventions for occupational stress management among Sri Lankan software employees.
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Affiliation(s)
- Manoja Weerasekara
- Department of Computer and Systems Sciences (DSV), Stockholm University, Stockholm, Sweden.
- Department of Information and Systems Sciences, NSBM Green University, Homagama, Sri Lanka.
| | - Åsa B Smedberg
- Department of Computer and Systems Sciences (DSV), Stockholm University, Stockholm, Sweden
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Radin RM, Epel ES, Mason AE, Vaccaro J, Fromer E, Guan J, Prather AA. Impact of digital meditation on work stress and health outcomes among adults with overweight: A randomized controlled trial. PLoS One 2023; 18:e0280808. [PMID: 36857330 PMCID: PMC9977041 DOI: 10.1371/journal.pone.0280808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 12/16/2022] [Indexed: 03/02/2023] Open
Abstract
Mindfulness meditation may improve well-being at work; however, effects on food cravings and metabolic health are not well known. We tested effects of digital meditation, alone or in combination with a healthy eating program, on perceived stress, cravings, and adiposity. We randomized 161 participants with overweight and moderate stress to digital meditation ('MED,' n = 38), digital meditation + healthy eating ('MED+HE,' n = 40), active control ('HE,' n = 41), or waitlist control ('WL,' n = 42) for 8 weeks. Participants (n = 145; M(SD) BMI: 30.8 (5.4) kg/m2) completed baseline and 8-week measures of stress (Perceived Stress Scale), cravings (Food Acceptance and Awareness Questionnaire) and adiposity (sagittal diameter and BMI). ANCOVAs revealed that those randomized to MED or MED+HE (vs. HE or WL) showed decreases in perceived stress (F = 15.19, p < .001, η2 = .10) and sagittal diameter (F = 4.59, p = .03, η2 = .04), with no differences in cravings or BMI. Those high in binge eating who received MED or MED+HE showed decreases in sagittal diameter (p = .03). Those with greater adherence to MED or MED+HE had greater reductions in stress, cravings, and adiposity (ps < .05). A brief digital mindfulness-based program is a low-cost method for reducing perceptions of stress and improving abdominal fat distribution patterns among adults with overweight and moderate stress. Future work should seek to clarify mechanisms by which such interventions contribute to improvements in health. Trial registration: Clinical trial registration http://www.ClinicalTrials.gov: identifier NCT03945214.
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Affiliation(s)
- Rachel M. Radin
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Elissa S. Epel
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Ashley E. Mason
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States of America
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA, United States of America
| | - Julie Vaccaro
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Elena Fromer
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Joanna Guan
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Aric A. Prather
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States of America
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Fernández O, Pérez JC, Fernández S, Krause M, Cáceres C, Espinosa-Duque D. Understanding the use/non-use of an internet-based intervention complementing standard depression treatment: A qualitative study of user's experiences. Digit Health 2023; 9:20552076231203920. [PMID: 37786403 PMCID: PMC10541756 DOI: 10.1177/20552076231203920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 09/11/2023] [Indexed: 10/04/2023] Open
Abstract
Introduction There is sufficient evidence about the effectiveness of internet-based interventions; however, the users' level of adoption and utilization remains low, with this phenomenon requiring adequate explanation. Objective The aim of this qualitative study was to explore the users' perceptions and experience of a web-based program (ASCENSO), designed to complement (usual) in-person depression treatment. Method Twelve participants of the ASCENSO program, comprised of adult individuals (M = 44.3, SD = 13.4) of both genders (67% women) undergoing treatment for depression, were interviewed through semi-structured interviews. The data obtained from these interviews were analyzed utilizing a constructivist grounded theory approach. The interviews were transcribed and analyzed by trained coders. A constant comparative analysis of emergent themes was conducted. Results These show that users employ and appreciate the program when their interaction with it emulates a "humanized relationship," that is, when the program is proactive in assisting users with their requests and when it responds in a pertinent and individualized manner to their emotional states and needs. Conclusions Our findings highlight the challenges associated with the development of algorithms capable of attracting different potential users. These should be designed to generate a virtual relationship that emulates human interaction and targets the characteristics of each user, for example, considering the specific phenomenology of their health condition, their present emotional states, and perceived needs. Elements that will vary as mental symptomatology evolve.
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Affiliation(s)
- Olga Fernández
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - J Carola Pérez
- Facultad de Psicología, Instituto de Bienestar Socioemocional, Universidad del Desarrollo, Santiago, Chile
| | - Sofía Fernández
- Escuela de Psicología, Facultad de Ciencias Sociales, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mariane Krause
- Escuela de Psicología, Facultad de Ciencias Sociales, Pontificia Universidad Católica de Chile, Santiago, Chile
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Pfaffinger KF, Reif JAM, Spieß E, Czakert JP, Berger R. Using digital interventions to reduce digitalisation-related stress-does it work? INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2022:1-16. [PMID: 35996884 DOI: 10.1080/10803548.2022.2115234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Digitalisation entails positive and negative consequences for employees. In a longitudinal, randomized control group design over 14 days (N = 95 participants), we piloted and expected each of three app-based interventions to positively influence general well-being, well-being related to information and communication technology (ICT), and recovery compared to the control group with no intervention. The meditation intervention significantly increased general well-being (satisfaction) and recovery (detachment) compared to the control group but did not reduce general stress. The cognitive-behavioural intervention significantly increased general well-being (less stress). The informational intervention however increased the general stress level. No intervention changed the level of ICT-specific well-being. Thus, classic stress interventions conveyed via ICTs (app-based) may be effective for addressing classic stress symptoms, but not yet for new forms of stress. Future research should investigate structural differences between classic stressors and new kinds of ICT-related stressors to identify starting points for new types of interventions.
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Affiliation(s)
- Katharina F Pfaffinger
- Economic and Organizational Psychology, Ludwig Maximilians-Universitaet Muenchen, Munich, Germany.
| | - Julia A M Reif
- Economic and Organizational Psychology, Universitaet der Bundeswehr Muenchen, Neubiberg, Germany
| | - Erika Spieß
- Economic and Organizational Psychology, Ludwig Maximilians-Universitaet Muenchen, Munich, Germany.
| | - Jan Philipp Czakert
- Department of Social and Quantitative Psychology, University of Barcelona, Barcelona, Spain.
| | - Rita Berger
- Department of Social and Quantitative Psychology, University of Barcelona, Barcelona, Spain.
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Scott S, Knott V, Finlay-Jones AL, Mancini VO. Australian Psychologists Experiences with Digital Mental Health: a Qualitative Investigation. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2022; 8:1-11. [PMID: 35991293 PMCID: PMC9381152 DOI: 10.1007/s41347-022-00271-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/11/2022] [Accepted: 07/21/2022] [Indexed: 11/28/2022]
Abstract
Digital mental health is changing the landscape of service delivery by addressing challenges associated with traditional therapy. However, practitioners' use of these resources remains underexamined. This study explored psychologists' attitudes and experiences with digital mental health intervention. Taking a qualitative exploratory approach via thematic analysis, the study sought to answer the following research questions: (i) How do psychologists perceive digital mental health? and (ii) What is their experience using digital mental health as part of routine practice? Ten practising psychologists participated in online semi-structured interviews (approximately 50 min), with interviews then transcribed verbatim. Interview data were analysed according to the six-phase approach to thematic analysis proposed by Braun and Clarke. Three themes were identified: (1) attitudes towards digital mental health; (2) use within routine practice; and (3) perspectives on an effective model for implementation. Practitioners play a major role in the design and delivery of digital mental health services. Barriers and facilitators at the practitioner-level (e.g. knowledge and competence with tools, perceptions on the utility of digital interventions) and the service-level (e.g. government support for digital health) should be considered in the future design of digital mental health resources and service delivery. Supplementary Information The online version contains supplementary material available at 10.1007/s41347-022-00271-5.
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Affiliation(s)
- Stephanie Scott
- Discipline of Psychological Sciences, Australian College of Applied Psychology (ACAP), Sydney, NSW Australia
| | - Vikki Knott
- Discipline of Psychological Sciences, Australian College of Applied Psychology (ACAP), Sydney, NSW Australia
| | - Amy L. Finlay-Jones
- School of Population Health, Curtin University, Perth, WA Australia
- Telethon Kids Institute, Perth, WA Australia
- UWA Medical School, Division of Paediatrics, University of Western Australia, Perth, WA Australia
| | - Vincent O. Mancini
- Discipline of Psychological Sciences, Australian College of Applied Psychology (ACAP), Sydney, NSW Australia
- School of Population Health, Curtin University, Perth, WA Australia
- Telethon Kids Institute, Perth, WA Australia
- UWA Medical School, Division of Paediatrics, University of Western Australia, Perth, WA Australia
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11
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Bernard RM, Toppo C, Raggi A, de Mul M, de Miquel C, Pugliese MT, van der Feltz-Cornelis CM, Ortiz-Tallo A, Salvador-Carulla L, Lukersmith S, Hakkaart-van Roijen L, Merecz-Kot D, Staszewska K, Sabariego C. Strategies for Implementing Occupational eMental Health Interventions: Scoping Review. J Med Internet Res 2022; 24:e34479. [PMID: 35648457 PMCID: PMC9201704 DOI: 10.2196/34479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 03/02/2022] [Accepted: 03/30/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The implementation of eMental health interventions, especially in the workplace, is a complex process. Therefore, learning from existing implementation strategies is imperative to ensure improvements in the adoption, development, and scalability of occupational eMental health (OeMH) interventions. However, the implementation strategies used for these interventions are often undocumented or inadequately reported and have not been systematically gathered across implementations in a way that can serve as a much-needed guide for researchers. OBJECTIVE The objective of this scoping review was to identify implementation strategies relevant to the uptake of OeMH interventions that target employees and detail the associated barriers and facilitation measures. METHODS A scoping review was conducted. The descriptive synthesis was guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework and the Consolidated Framework for Implementation Research. RESULTS A total of 31 of 32,916 (0.09%) publications reporting the use of the web-, smartphone-, telephone-, and email-based OeMH interventions were included. In all, 98 implementation strategies, 114 barriers, and 131 facilitators were identified. The synthesis of barriers and facilitators produced 19 facilitation measures that provide initial recommendations for improving the implementation of OeMH interventions. CONCLUSIONS This scoping review represents one of the first steps in a research agenda aimed at improving the implementation of OeMH interventions by systematically selecting, shaping, evaluating, and reporting implementation strategies. There is a dire need for improved reporting of implementation strategies and combining common implementation frameworks with more technology-centric implementation frameworks to fully capture the complexities of eHealth implementation. Future research should investigate a wider range of common implementation outcomes for OeMH interventions that also focus on a wider set of common mental health problems in the workplace. This scoping review's findings can be critically leveraged by discerning decision-makers to improve the reach, effectiveness, adoption, implementation, and maintenance of OeMH interventions.
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Affiliation(s)
| | - Claudia Toppo
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Marleen de Mul
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, Netherlands
| | - Carlota de Miquel
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Maria Teresa Pugliese
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | | | - Ana Ortiz-Tallo
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.,Department of Psychiatry, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Luis Salvador-Carulla
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia
| | - Sue Lukersmith
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia
| | | | | | - Kaja Staszewska
- Department of Health and Work Psychology, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Carla Sabariego
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.,Center for Rehabilitation in Global Health Systems, World Health Organization Collaborating Center, University of Lucerne, Lucerne, Switzerland
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12
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Yeager CM, Benight CC. Engagement, Predictors, and Outcomes of a Trauma Recovery Digital Mental Health Intervention: Longitudinal Study. JMIR Ment Health 2022; 9:e35048. [PMID: 35499857 PMCID: PMC9112079 DOI: 10.2196/35048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/28/2022] [Accepted: 03/05/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Worldwide, exposure to potentially traumatic events is extremely common, and many individuals develop posttraumatic stress disorder (PTSD) along with other disorders. Unfortunately, considerable barriers to treatment exist. A promising approach to overcoming treatment barriers is a digital mental health intervention (DMHI). However, engagement with DMHIs is a concern, and theoretically based research in this area is sparse and often inconclusive. OBJECTIVE The focus of this study is on the complex issue of DMHI engagement. On the basis of the social cognitive theory framework, the conceptualization of engagement and a theoretically based model of predictors and outcomes were investigated using a DMHI for trauma recovery. METHODS A 6-week longitudinal study with a national sample of survivors of trauma was conducted to measure engagement, predictors of engagement, and mediational pathways to symptom reduction while using a trauma recovery DMHI (time 1: N=915; time 2: N=350; time 3: N=168; and time 4: N=101). RESULTS Confirmatory factor analysis of the engagement latent constructs of duration, frequency, interest, attention, and affect produced an acceptable model fit (χ22=8.3; P=.02; comparative fit index 0.973; root mean square error of approximation 0.059; 90% CI 0.022-0.103). Using the latent construct, the longitudinal theoretical model demonstrated adequate model fit (comparative fit index 0.929; root mean square error of approximation 0.052; 90% CI 0.040-0.064), indicating that engagement self-efficacy (β=.35; P<.001) and outcome expectations (β=.37; P<.001) were significant predictors of engagement (R2=39%). The overall indirect effect between engagement and PTSD symptom reduction was significant (β=-.065; P<.001; 90% CI -0.071 to -0.058). This relationship was serially mediated by both skill activation self-efficacy (β=.80; P<.001) and trauma coping self-efficacy (β=.40; P<.001), which predicted a reduction in PTSD symptoms (β=-.20; P=.02). CONCLUSIONS The results of this study may provide a solid foundation for formalizing the nascent science of engagement. Engagement conceptualization comprised general measures of attention, interest, affect, and use that could be applied to other applications. The longitudinal research model supported 2 theoretically based predictors of engagement: engagement self-efficacy and outcome expectancies. A total of 2 task-specific self-efficacies-skill activation and trauma coping-proved to be significant mediators between engagement and symptom reduction. Taken together, this model can be applied to other DMHIs to understand engagement, as well as predictors and mechanisms of action. Ultimately, this could help improve the design and development of engaging and effective trauma recovery DMHIs.
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Affiliation(s)
- Carolyn M Yeager
- Lyda Hill Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, United States
| | - Charles C Benight
- Lyda Hill Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, United States
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13
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Stratton E, Lampit A, Choi I, Malmberg Gavelin H, Aji M, Taylor J, Calvo RA, Harvey SB, Glozier N. Are Organizational EHealth Interventions Becoming More Effective at Addressing Employee Mental Health; A Systematic Review and Meta-Analysis (Preprint). J Med Internet Res 2022; 24:e37776. [PMID: 36166285 PMCID: PMC9555335 DOI: 10.2196/37776] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/26/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Mental health conditions are considered the leading cause of disability, sickness absence, and long-term work incapacity. eHealth interventions provide employees with access to psychological assistance. There has been widespread implementation and provision of eHealth interventions in the workplace as an inexpensive and anonymous way of addressing common mental disorders. Objective This updated review aimed to synthesize the literature on the efficacy of eHealth interventions for anxiety, depression, and stress outcomes in employee samples in organizational settings and evaluate whether their effectiveness has improved over time. Methods Systematic searches of relevant articles published from 2004 to July 2020 of eHealth intervention trials (app- or web-based) focusing on the mental health of employees were conducted. The quality and bias of all studies were assessed. We extracted means and SDs from publications by comparing the differences in effect sizes (Hedge g) in standardized mental health outcomes. We meta-analyzed these data using a random-effects model. Results We identified a tripling of the body of evidence, with 75 trials available for meta-analysis from a combined sample of 14,747 articles. eHealth interventions showed small positive effects for anxiety (Hedges g=0.26, 95% CI 0.13-0.39; P<.001), depression (Hedges g=0.26, 95% CI 0.19-0.34; P<.001), and stress (Hedges g=0.25, 95% CI 0.17-0.34; P<.001) in employees’ after intervention, with similar effects seen at the medium-term follow-up. However, there was evidence of no increase in the effectiveness of these interventions over the past decade. Conclusions This review and meta-analysis confirmed that eHealth interventions have a small positive impact on reducing mental health symptoms in employees. Disappointingly, we found no evidence that, despite the advances in technology and the enormous resources in time, research, and finance devoted to this area for over a decade, better interventions are being produced. Hopefully, these small effect sizes do not represent optimum outcomes in organizational settings. Trial Registration PROSPERO CRD42020185859; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=185859
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Affiliation(s)
- Elizabeth Stratton
- Central Clinical School, Faculty of Health and Medicine, University of Sydney, Camperdown, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, Sydney, Australia
| | - Amit Lampit
- Academic Unit for Psychiatry of Old Age, University of Melbourne, Parkville, Australia
| | - Isabella Choi
- Central Clinical School, Faculty of Health and Medicine, University of Sydney, Camperdown, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, Sydney, Australia
| | - Hanna Malmberg Gavelin
- Academic Unit for Psychiatry of Old Age, University of Melbourne, Parkville, Australia
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Melissa Aji
- Central Clinical School, Faculty of Health and Medicine, University of Sydney, Camperdown, Australia
| | - Jennifer Taylor
- Central Clinical School, Faculty of Health and Medicine, University of Sydney, Camperdown, Australia
| | - Rafael A Calvo
- Dyson School of Design Engineering, Imperial College London, London, United Kingdom
| | - Samuel B Harvey
- School of Psychiatry, University of New South Wales, Sydney, Australia
- Black Dog Institute, Sydney, Australia
- St George Hospital, Sydney, Australia
| | - Nick Glozier
- Central Clinical School, Faculty of Health and Medicine, University of Sydney, Camperdown, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, Sydney, Australia
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14
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Manning JB, Blandford A, Edbrooke-Childs J. Digital Companion Choice to Support Teachers' Stress Self-management: Systematic Approach Through Taxonomy Creation. JMIR Form Res 2022; 6:e32312. [PMID: 35171106 PMCID: PMC8892277 DOI: 10.2196/32312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are thousands of digital companions designed for emotional well-being and stress, including websites, wearables, and smartphone apps. Although public evaluation frameworks and ratings exist, they do not facilitate digital companion choice based on contextual or individual information, such as occupation or personal management strategies. OBJECTIVE The aim of this study is to establish a process for creating a taxonomy to support systematic choice of digital companions for teachers' stress self-management. METHODS We used a 4-step study design. In step 1, we identified the dimension of stress self-management and strategic classifications. In step 2, we identified the dimension of the digital techniques and conceptual descriptions. In step 3, we created 6 criteria for the inclusion of digital companions. In step 4, we used the taxonomy framework created by steps 1 and 2 and populated it with digital companions for stress self-management, as identified in step 3. RESULTS First, in the dimension of stress self-management, we identified four classes of strategies: educational, physiological, cognitive, and social. Second, in the digital techniques dimension, we derived four conceptual descriptions for the digital companions' mechanisms of action: fostering reflection, suggesting treatment, peer-to-peer support, and entertainment. Third, we created six criteria for digital companion inclusion in the taxonomy: suitability, availability, evaluation, security, validity, and cost. Using the taxonomy framework and criteria, we populated it with digital companions for stress management ahead of presentation to teachers in a stress study workshop. CONCLUSIONS The elements of our approach can be generalized as principles for the creation of taxonomies for other occupations or conditions. Taxonomies such as this could be a valuable resource for individuals to understand which digital companion could be of help in their personal context.
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Affiliation(s)
- Julia B Manning
- Interaction Centre, Department of Computer Science, University College London, London, United Kingdom
| | - Ann Blandford
- Institute of Healthcare Engineering, University College London, London, United Kingdom
| | - Julian Edbrooke-Childs
- Evidence-based Practice Unit, University College London and Anna Freud Centre, London, United Kingdom
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15
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Nielsen K, Shepherd R. Understanding the outcomes of training to improve employee mental health: A novel framework for training transfer and effectiveness evaluation. WORK AND STRESS 2022. [DOI: 10.1080/02678373.2022.2028318] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Karina Nielsen
- Institute for Work Psychology, Sheffield University Management School, University of Sheffield, Sheffield, UK
| | - Rose Shepherd
- Institute for Work Psychology, Sheffield University Management School, University of Sheffield, Sheffield, UK
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16
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Gan DZQ, McGillivray L, Larsen ME, Christensen H, Torok M. Technology-supported strategies for promoting user engagement with digital mental health interventions: A systematic review. Digit Health 2022; 8:20552076221098268. [PMID: 35677785 PMCID: PMC9168921 DOI: 10.1177/20552076221098268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/12/2022] [Indexed: 01/12/2023] Open
Abstract
Background Although digital mental health interventions (DMHIs) offer a potential
solution for increasing access to mental health treatment, their integration
into real-world settings has been slow. A key reason for this is poor user
engagement. A growing number of studies evaluating strategies for promoting
engagement with DMHIs means that a review of the literature is now
warranted. This systematic review is the first to synthesise evidence on
technology-supported strategies for promoting engagement with DMHIs. Methods MEDLINE, EmbASE, PsycINFO and PubMed databases were searched from 1 January
1995 to 1 October 2021. Experimental or quasi-experimental studies examining
the effect of technology-supported engagement strategies deployed alongside
DMHIs were included, as were secondary analyses of such studies. Title and
abstract screening, full-text coding and quality assessment were performed
independently by two authors. Narrative synthesis was used to summarise
findings from the included studies. Results 24 studies (10,266 participants) were included. Engagement strategies ranged
from reminders, coaching, personalised information and peer support. Most
strategies were disseminated once a week, usually via email or telephone.
There was some empirical support for the efficacy of technology-based
strategies towards promoting engagement. However, findings were mixed
regardless of strategy type or study aim. Conclusions Technology-supported strategies appear to increase engagement with DMHIs;
however, their efficacy varies widely by strategy type. Future research
should involve end-users in the development and evaluation of these
strategies to develop a more cohesive set of strategies that are acceptable
and effective for target audiences, and explore the mechanism(s) through
which such strategies promote engagement.
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Affiliation(s)
- Daniel Z Q Gan
- Black Dog Institute, University of New South Wales, Australia
| | | | - Mark E Larsen
- Black Dog Institute, University of New South Wales, Australia
| | | | - Michelle Torok
- Black Dog Institute, University of New South Wales, Australia
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17
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Szigethy E, Tansel A, Pavlick AN, Marroquin MA, Serio CD, Silfee V, Wallace ML, Kingsley MJ, Levinthal DJ. A Coached Digital Cognitive Behavioral Intervention Reduces Anxiety and Depression in Adults With Functional Gastrointestinal Disorders. Clin Transl Gastroenterol 2021; 12:e00436. [PMID: 34874018 PMCID: PMC8751763 DOI: 10.14309/ctg.0000000000000436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Traditional cognitive behavioral interventions (CBIs) improve mood and gastrointestinal symptom severity in patients with functional gastrointestinal disorders (FGIDs) but face substantial barriers to implementation. Integrating behavioral health technology into medical clinic workflows could overcome these barriers. We evaluated the feasibility and impact of a coached digital CBI (dCBI) as a first-line intervention in a prospective cohort of emotionally distressed patients with FGID. METHODS Patients with anxiety and/or depressive symptoms were offered a dCBI (an app called RxWell) during routine clinic visits. RxWell provides cognitive behavioral techniques enhanced by within-app text messaging with a health coach. Both gastroenterology and behavioral health-care providers electronically prescribed RxWell. We tracked patient interactions with RxWell, and patients completed anxiety (General Anxiety Disorder-7) and depression (Personal Health Questionniare Depression Scale) measures through the app. Our primary study outcome was the change in General Anxiety Disorder-7 and Personal Health Questionniare Depression Scale scores. RESULTS Of 364 patients with FGID (mean age 43 years [SD 16 years]; 73.1% women) prescribed the dCBI, 48.4% enrolled (median use, 3 techniques [interquartile range 1-14]). About half of RxWell enrollees communicated with health coaches. The mean baseline anxiety score was 11.4 (SD 5.5), and the depression score was 11.5 (SD 6.1). RxWell users experienced improvements in anxiety (mean change 2.71 [t = 3.7, df = 58; P < 0.001]) and depression (mean change 2.9 [t = 4.2, df = 45; P < 0.001]) at 4 months. DISCUSSION Patients with FGIDs and moderately severe anxiety and depressive symptoms are willing to use dCBI tools recommended by their providers. Our pilot data demonstrate that dCBI usage is associated with clinically and statistically significant mood symptom reductions.
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Affiliation(s)
- Eva Szigethy
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA;
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA;
| | - Aylin Tansel
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA;
| | - Alexa N. Pavlick
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA;
| | - Maria A. Marroquin
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA;
| | - Catherine D. Serio
- University of Pittsburgh Medical Center Insurance Services Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Valerie Silfee
- University of Pittsburgh Medical Center Insurance Services Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Meredith L. Wallace
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA;
| | - Michael J. Kingsley
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA;
| | - David J. Levinthal
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA;
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18
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Gan DZQ, McGillivray L, Han J, Christensen H, Torok M. Effect of Engagement With Digital Interventions on Mental Health Outcomes: A Systematic Review and Meta-Analysis. Front Digit Health 2021; 3:764079. [PMID: 34806079 PMCID: PMC8599127 DOI: 10.3389/fdgth.2021.764079] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/29/2021] [Indexed: 01/19/2023] Open
Abstract
Digital mental health interventions (DMHIs) present a promising way to address gaps in mental health service provision. However, the relationship between user engagement and outcomes in the context of these interventions has not been established. This study addressed the current state of evidence on the relationship between engagement with DMHIs and mental health outcomes. MEDLINE, PsycINFO, and EmBASE databases were searched from inception to August 1, 2021. Original or secondary analyses of randomized controlled trials (RCTs) were included if they examined the relationship between DMHI engagement and post-intervention outcome(s). Thirty-five studies were eligible for inclusion in the narrative review and 25 studies had sufficient data for meta-analysis. Random-effects meta-analyses indicated that greater engagement was significantly associated with post-intervention mental health improvements, regardless of whether this relationship was explored using correlational [r = 0.24, 95% CI (0.17, 0.32), Z = 6.29, p < 0.001] or between-groups designs [Hedges' g = 0.40, 95% CI (0.097, 0.705), p = 0.010]. This association was also consistent regardless of intervention type (unguided/guided), diagnostic status, or mental health condition targeted. This is the first review providing empirical evidence that engagement with DMHIs is associated with therapeutic gains. Implications and future directions are discussed. Systematic Review Registration: PROSPERO, identifier: CRD 42020184706.
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Affiliation(s)
- Daniel Z Q Gan
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Lauren McGillivray
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Jin Han
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
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19
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Kuso S, Nitsch M, Zeiler M, Simek M, Adamcik T, Dey M, Berger T, Krieger T, Weisel KK, Zarski AC, Ebert DD, Schaub MP, Moser CT, Botella C, Baños R, Herrero R, Etchemendy E, Nacke B, Beintner I, Vollert B, Schmidt-Hantke J, Hütter K, Jacobi C, Waldherr K. Stakeholders' views on online interventions to prevent common mental health disorders in adults implemented into existing healthcare systems in Europe. Eur J Public Health 2021; 31:i55-i63. [PMID: 34240157 PMCID: PMC8495679 DOI: 10.1093/eurpub/ckab043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Online preventive interventions can help to reduce the incidence of mental disorders. Whereas knowledge on stakeholders' attitudes and factors relevant for successfully integrating online treatment into existing healthcare systems is available, knowledge is scarce for online prevention. METHODS Stakeholders from Germany, Switzerland, Austria and Spain were surveyed. Potential facilitators/delivery staff (e.g. psychologists, psychotherapists) completed an online questionnaire (n = 183), policy makers (i.e. from the governing sector or health insurance providers) participated in semi-structured interviews (n = 16) and target groups/potential users of mental illness prevention (n = 49) participated in ten focus groups. Thematic analysis was used to identify their experiences with and attitudes and needs regarding online programmes to prevent mental disorders. Additionally, it was examined which groups they consider underserved and which factors they consider as fostering and hindering for reach, adoption, implementation and maintenance (cf. RE-AIM model) when integrating online prevention into existing healthcare systems. RESULTS Main advantages of online mental illness prevention are perceived in low structural and psychological barriers. Lack of personal contact, security, privacy and trust concerns were discussed as disadvantages. Relevant needs are high usability and target group appropriateness, evidence for effectiveness and the use of motivational tools. CONCLUSIONS Positive attitudes among stakeholders are the key for successful integration of online mental illness prevention into existing healthcare systems. Potential facilitators/delivery staff must receive training and support to implement these programmes; the programmes must be attractive and continuously evaluated, updated and promoted to ensure ongoing reach; and existing infrastructure and contextual factors must be considered.
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Affiliation(s)
- Stefanie Kuso
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt 2700, Austria
| | - Martina Nitsch
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt 2700, Austria
| | - Michael Zeiler
- Department for Child and Adolescent Psychiatry, Medical University of Vienna, Vienna 1090, Austria
| | - Monika Simek
- Department for Child and Adolescent Psychiatry, Medical University of Vienna, Vienna 1090, Austria
| | - Tanja Adamcik
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt 2700, Austria
| | - Michelle Dey
- Swiss Research Institute for Public Health and Addiction ISGF, Associated to the University of Zurich, Zurich, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Tobias Krieger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kiona K Weisel
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Anna-Carlotta Zarski
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - David D Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction ISGF, Associated to the University of Zurich, Zurich, Switzerland
| | - Christian T Moser
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christina Botella
- Jaume I University, Castellón, Spain.,CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain
| | - Rosa Baños
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain.,Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Rocio Herrero
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain.,Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Ernestina Etchemendy
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain.,Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Barbara Nacke
- Department of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Ina Beintner
- Department of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Bianka Vollert
- Department of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | | | - Kristian Hütter
- Department of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Corinna Jacobi
- Department of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Karin Waldherr
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt 2700, Austria
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20
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Hogg B, Medina JC, Gardoki-Souto I, Serbanescu I, Moreno-Alcázar A, Cerga-Pashoja A, Coppens E, Tóth MD, Fanaj N, Greiner BA, Holland C, Kõlves K, Maxwell M, Qirjako G, de Winter L, Hegerl U, Pérez-Sola V, Arensman E, Amann BL. Workplace interventions to reduce depression and anxiety in small and medium-sized enterprises: A systematic review. J Affect Disord 2021; 290:378-386. [PMID: 34082284 DOI: 10.1016/j.jad.2021.04.071] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/14/2021] [Accepted: 04/25/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depression and anxiety are the most prevalent mental health difficulties in the workplace, costing the global economy $1 trillion each year. Evidence indicates that symptoms may be reduced by interventions in the workplace. This paper is the first to systematically review psychosocial interventions for depression, anxiety, and suicidal ideation and behaviours in small-to medium-size enterprises (SMEs). METHODS A systematic search following PRISMA guidelines, registered in PROSPERO (CRD42020156275), was conducted for psychosocial interventions targeting depression, anxiety, and suicidal ideation/behaviour in SMEs. The PubMed, PsycINFO, Scopus, and two specific occupational health databases were searched, as well as four databases for grey literature, without time limit until 2nd December 2019. RESULTS In total, 1283 records were identified, 70 were retained for full-text screening, and seven met the inclusion criteria: three randomised controlled trials (RCTs), three before and after designs and one non-randomised trial, comprising 5111 participants. Study quality was low to moderate according to the Quality Assessment Tool for Quantitative Studies. Five studies showed a reduction in depression and anxiety symptoms using techniques based on cognitive behavioural therapy (CBT), two reported no significant change. LIMITATIONS Low number and high heterogeneity of interventions and outcomes, high attrition and lack of rigorous RCTs. CONCLUSIONS Preliminary evidence indicates CBT-based interventions can be effective in targeting symptoms of depression and anxiety in SME employees. There may be unique challenges to implementing programmes in SMEs. Further research is needed in this important area.
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Affiliation(s)
- Bridget Hogg
- Centre Fòrum Research Unit, Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; PhD Programme, Department of Psychiatry and Forensic Medicine, School of Medicine Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Carles Medina
- Faculty of Psychology and Education Sciences, Universitat Oberta de Catalunya, Barcelona, Spain; Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain
| | - Itxaso Gardoki-Souto
- Centre Fòrum Research Unit, Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; PhD Programme, Department of Psychiatry and Forensic Medicine, School of Medicine Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ilinca Serbanescu
- European Alliance Against Depression e.V., Leipzig, Germany; Department of Clinical Psychology and Psychotherapy, University of Heidelberg, Heidelberg, Germany
| | - Ana Moreno-Alcázar
- Centre Fòrum Research Unit, Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBERSAM, Madrid, Spain; Department of Psychiatry and Forensic Medicine, School of Medicine Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arlinda Cerga-Pashoja
- Population Health, London School of Hygiene and Tropical Medicine, London, England; Global Public Health, Public Health England, United Kingdom
| | - Evelien Coppens
- LUCAS, Centre for Care Research and Consultancy, University of Leuven, Belgium
| | - Mónika Ditta Tóth
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
| | | | - Birgit A Greiner
- School of Public Health, College of Medicine and Health, National Suicide Research Foundation, University College Cork, Ireland
| | - Carolyn Holland
- National Suicide Research Foundation, Cork, Ireland; Health Service Executive, Cork, Ireland
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, Griffith University
| | - Margaret Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Scotland, United Kingdom
| | - Gentiana Qirjako
- Department of Public Health, Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Lars de Winter
- Phrenos Center of Expertise for severe mental illness, Utrecht, the Netherlands
| | - Ulrich Hegerl
- European Alliance Against Depression e.V., Leipzig, Germany; Research Centre of the German Depression Foundation, Leipzig, Germany; Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe-Universität Frankfurt, Frankfurt, Germany
| | - Victor Pérez-Sola
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBERSAM, Madrid, Spain; Department of Psychiatry and Forensic Medicine, School of Medicine Universitat Autònoma de Barcelona, Barcelona, Spain; Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Barcelona, Spain
| | - Ella Arensman
- School of Public Health, College of Medicine and Health, National Suicide Research Foundation, University College Cork, Ireland; National Suicide Research Foundation, Cork, Ireland; Australian Institute for Suicide Research and Prevention, Griffith University; International Association for Suicide Prevention (IASP), Washington DC, USA.
| | - Benedikt L Amann
- Centre Fòrum Research Unit, Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBERSAM, Madrid, Spain; Department of Psychiatry and Forensic Medicine, School of Medicine Universitat Autònoma de Barcelona, Barcelona, Spain; Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Barcelona, Spain
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21
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Daniels K, Watson D, Nayani R, Tregaskis O, Hogg M, Etuknwa A, Semkina A. Implementing practices focused on workplace health and psychological wellbeing: A systematic review. Soc Sci Med 2021; 277:113888. [PMID: 33865095 DOI: 10.1016/j.socscimed.2021.113888] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/21/2021] [Accepted: 03/27/2021] [Indexed: 02/08/2023]
Abstract
RATIONALE Workplace health and wellbeing practices (WHWPs) often fail to improve psychological health or wellbeing because of implementation failure. Thus, implementation should be evaluated to improve the effectiveness of WHWPs. OBJECTIVE We conducted a systematic review to identify critical success factors for WHWP implementation and gaps in the evidence. Doing so provides a platform for future theoretical development. METHODS We reviewed 74 separate studies that assessed the implementation of WHWPs and their effects on psychological health or psychological wellbeing. Most studies were from advanced industrial Western democracies (71). Intervention types included primary (e.g., work redesign, 37 studies; and health behavior change, 8 studies), secondary (e.g., mindfulness training, 11 studies), tertiary (e.g., focused on rehabilitation, 9 studies), and multifocal (e.g., including components of primary and secondary, 9 studies). RESULTS Tangible changes preceded improvements in health and wellbeing, indicating intervention success cannot be attributed to non-specific factors. Some interventions had beneficial effects through mechanisms not planned as part of the intervention. Three factors were associated with successful WHWP implementation: continuation, learning, and effective governance. CONCLUSIONS The review indicates future research could focus on how organizations manage conflict between WHWP implementation and existing organizational processes, and the dynamic nature of organizational contexts that affect and are affected by WHWP implementation. This systematic review is registered [PROSPERO: the International Prospective Register of Systematic Reviews ID: CRD42019119656].
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Affiliation(s)
- Kevin Daniels
- Employment Systems and Institutions Group, Norwich Business School, University of East Anglia, NR4 7TJ, United Kingdom.
| | - David Watson
- Employment Systems and Institutions Group, Norwich Business School, University of East Anglia, NR4 7TJ, United Kingdom
| | - Rachel Nayani
- Employment Systems and Institutions Group, Norwich Business School, University of East Anglia, NR4 7TJ, United Kingdom
| | - Olga Tregaskis
- Employment Systems and Institutions Group, Norwich Business School, University of East Anglia, NR4 7TJ, United Kingdom
| | - Martin Hogg
- Employment Systems and Institutions Group, Norwich Business School, University of East Anglia, NR4 7TJ, United Kingdom
| | - Abasiama Etuknwa
- Employment Systems and Institutions Group, Norwich Business School, University of East Anglia, NR4 7TJ, United Kingdom
| | - Antonina Semkina
- Employment Systems and Institutions Group, Norwich Business School, University of East Anglia, NR4 7TJ, United Kingdom
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22
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Borghouts J, Eikey E, Mark G, De Leon C, Schueller SM, Schneider M, Stadnick N, Zheng K, Mukamel D, Sorkin DH. Barriers to and Facilitators of User Engagement With Digital Mental Health Interventions: Systematic Review. J Med Internet Res 2021; 23:e24387. [PMID: 33759801 PMCID: PMC8074985 DOI: 10.2196/24387] [Citation(s) in RCA: 241] [Impact Index Per Article: 80.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/24/2020] [Accepted: 02/08/2021] [Indexed: 01/14/2023] Open
Abstract
Background Digital mental health interventions (DMHIs), which deliver mental health support via technologies such as mobile apps, can increase access to mental health support, and many studies have demonstrated their effectiveness in improving symptoms. However, user engagement varies, with regard to a user’s uptake and sustained interactions with these interventions. Objective This systematic review aims to identify common barriers and facilitators that influence user engagement with DMHIs. Methods A systematic search was conducted in the SCOPUS, PubMed, PsycINFO, Web of Science, and Cochrane Library databases. Empirical studies that report qualitative and/or quantitative data were included. Results A total of 208 articles met the inclusion criteria. The included articles used a variety of methodologies, including interviews, surveys, focus groups, workshops, field studies, and analysis of user reviews. Factors extracted for coding were related to the end user, the program or content offered by the intervention, and the technology and implementation environment. Common barriers included severe mental health issues that hampered engagement, technical issues, and a lack of personalization. Common facilitators were social connectedness facilitated by the intervention, increased insight into health, and a feeling of being in control of one’s own health. Conclusions Although previous research suggests that DMHIs can be useful in supporting mental health, contextual factors are important determinants of whether users actually engage with these interventions. The factors identified in this review can provide guidance when evaluating DMHIs to help explain and understand user engagement and can inform the design and development of new digital interventions.
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Affiliation(s)
| | - Elizabeth Eikey
- University of California San Diego, San Diego, CA, United States
| | - Gloria Mark
- University of California Irvine, Irvine, CA, United States
| | | | | | | | - Nicole Stadnick
- University of California San Diego, San Diego, CA, United States
| | - Kai Zheng
- University of California Irvine, Irvine, CA, United States
| | - Dana Mukamel
- University of California Irvine, Irvine, CA, United States
| | - Dara H Sorkin
- University of California Irvine, Irvine, CA, United States
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23
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Simmonds-Buckley M, Bennion MR, Kellett S, Millings A, Hardy GE, Moore RK. Acceptability and Effectiveness of NHS-Recommended e-Therapies for Depression, Anxiety, and Stress: Meta-Analysis. J Med Internet Res 2020; 22:e17049. [PMID: 33112238 PMCID: PMC7657731 DOI: 10.2196/17049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 05/18/2020] [Accepted: 07/24/2020] [Indexed: 12/13/2022] Open
Abstract
Background There is a disconnect between the ability to swiftly develop e-therapies for the treatment of depression, anxiety, and stress, and the scrupulous evaluation of their clinical utility. This creates a risk that the e-therapies routinely provided within publicly funded psychological health care have evaded appropriate rigorous evaluation in their development. Objective This study aims to conduct a meta-analytic review of the gold standard evidence of the acceptability and clinical effectiveness of e-therapies recommended for use in the National Health Service (NHS) in the United Kingdom. Methods Systematic searches identified appropriate randomized controlled trials (RCTs). Depression, anxiety, and stress outcomes at the end of treatment and follow-up were synthesized using a random-effects meta-analysis. The grading of recommendations assessment, development, and evaluation approach was used to assess the quality of each meta-analytic comparison. Moderators of treatment effect were examined using subgroup and meta-regression analysis. Dropout rates for e-therapies (as a proxy for acceptability) were compared against controls. Results A total of 24 studies evaluating 7 of 48 NHS-recommended e-therapies were qualitatively and quantitatively synthesized. Depression, anxiety, and stress outcomes for e-therapies were superior to controls (depression: standardized mean difference [SMD] 0.38, 95% CI 0.24 to 0.52, N=7075; anxiety and stress: SMD 0.43, 95% CI 0.24 to 0.63, n=4863), and these small effects were maintained at follow-up. Average dropout rates for e-therapies (31%, SD 17.35) were significantly higher than those of controls (17%, SD 13.31). Limited moderators of the treatment effect were found. Conclusions Many NHS-recommended e-therapies have not been through an RCT-style evaluation. The e-therapies that have been appropriately evaluated generate small but significant, durable, beneficial treatment effects. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) registration CRD42019130184; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=130184
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Affiliation(s)
| | - Matthew Russell Bennion
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom.,Department of Computer Science, The University of Sheffield, Sheffield, United Kingdom
| | - Stephen Kellett
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom.,Sheffield Health and Social Care NHS Foundation Trust, Sheffield, United Kingdom
| | - Abigail Millings
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom.,Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, United Kingdom
| | - Gillian E Hardy
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Roger K Moore
- Department of Computer Science, The University of Sheffield, Sheffield, United Kingdom
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24
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Cerga-Pashoja A, Doukani A, Gega L, Walke J, Araya R. Added value or added burden? A qualitative investigation of blending internet self-help with face-to-face cognitive behaviour therapy for depression. Psychother Res 2020; 30:998-1010. [PMID: 32024447 DOI: 10.1080/10503307.2020.1720932] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objectives: Numerous studies and reviews have explored the value of adding therapist support to internet self-help for improving client adherence and outcomes. This study is different as it explores the value of adding internet self-help to face-to-face therapy, from the perspective of practitioners who used both. This study explores practitioners' experiences of whether-and how-internet self-help blended with face-to-face therapy may confer an added value or become an added burden to their routine practice. Methods: Using a structured topic guide, we collected narrative data via 3 focus groups and 1 telephone interview from 11 practitioners across two sites in England. We carried out a thematic analysis within two domains, "value vs. burden". Results: Practitioners reported that internet self-help can confer added value to face-to-face therapy by: fostering client engagement with face-to-face sessions; making therapy ubiquitous beyond sessions; and preventing therapeutic drift between sessions. Conversely, internet self-help can add burden to face-to-face therapy when it is experienced as disruptive, overwhelming and time-consuming. Conclusions: Recognizing and mitigating factors that can turn internet self-help from an added value to an added burden will help practitioners adopt and make the most out of blended therapy.
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Affiliation(s)
- Arlinda Cerga-Pashoja
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Asmae Doukani
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lina Gega
- Department of Health Sciences & Hull York Medical School, University of York, York, UK
| | - Jennifer Walke
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ricardo Araya
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
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25
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Muroff J, Robinson W. Tools of Engagement: Practical Considerations for Utilizing Technology-Based Tools in CBT Practice. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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26
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Sundström C, Schell C, Wardell JD, Godinho A, Cunningham JA. Can Brief Email Guidance Enhance the Effects of an Internet Intervention for People with Problematic Alcohol Use? A Randomized Controlled Trial. Subst Use Misuse 2020; 55:2011-2019. [PMID: 32662699 DOI: 10.1080/10826084.2020.1788087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Some research suggests that internet interventions aimed at people with problematic alcohol use are more effective when provided with guidance from a therapist or coach. Purpose/Objectives: This trial intended to compare the effects of a previously evaluated internet intervention for people with problematic alcohol use when delivered with or without brief email guidance. Methods: Using online advertising, 238 participants, 18 years or older, were recruited and randomized to receive access to the Internet intervention Alcohol Help Center with or without brief email guidance from a health educator. The guidance consisted of at least four structured, slightly individualized emails delivered during the first two weeks after randomization. Participants were followed up at 3 and 6 months. Results: Number of log-ins did not differ significantly between groups throughout the follow-up period. The follow-up rate at 6 months was 47.0%. Generalized estimating equations run on the primary (standard drinks in preceding week/heavy drinking days in preceding week) and secondary outcome variables (AUDIT, AUDIT-C, quality of life) revealed no significant differences between the interventions on any of the outcomes. Conclusions/Importance: The study does not provide support for any added benefits of providing brief guidance via email in an internet intervention for problem drinkers.
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Affiliation(s)
- C Sundström
- Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden.,Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada
| | - C Schell
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada
| | - J D Wardell
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychology, York University, Toronto, Ontario, Canada
| | - A Godinho
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada
| | - J A Cunningham
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada
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27
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Mellifont D. Neuro magnifico! An exploratory study critically reviewing news text reporting of anxiety-related work performance strengths, challenges and support measures. Work 2019; 63:435-446. [PMID: 31282452 DOI: 10.3233/wor-192950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Progressive workplaces should be aware of emerging neurodiversity related issues. People are sharing their narratives of high functioning anxiety in a variety of forums. Despite news text reporting upon this phenomenon, the concept has managed to escape a research spotlight. OBJECTIVE To critically investigate the evidence base of news article reporting of anxiety-related work performance strengths, challenges and support measures. METHODS Thematic analysis was applied to news texts derived from CrossSearch database and internet enquiries and journal articles obtained from Scopus, Medline and Science Direct databases. RESULTS The analysis of eight news texts and 36 journal articles produced evidence-based themes including those of work performance strengths (quality, quantity, creativity) challenges (overreaching, perfectionism, overthinking, communication) and support measures (medical, cognitive, physical, flexibility). CONCLUSION This investigative review reveals that anxiety-related work performance strengths, challenges and support measures as identified within news text reporting of the high functioning anxiety concept have at least some basis in the literature. It might therefore be the case that organizations who invest in supporting employees who identify with high functioning dimensions of their anxiety disorders are the ones who are ultimately rewarded with work performance advantages.
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Affiliation(s)
- Damian Mellifont
- Centre for Disability Research and Policy, The University of Sydney, NSW, Australia. Tel.: +61 0434 956 400; E-mail:
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28
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Carolan S, de Visser RO. Employees' Perspectives on the Facilitators and Barriers to Engaging With Digital Mental Health Interventions in the Workplace: Qualitative Study. JMIR Ment Health 2018; 5:e8. [PMID: 29351900 PMCID: PMC5797290 DOI: 10.2196/mental.9146] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Prevalence rates of work-related stress, depression, and anxiety are high, resulting in reduced productivity and increased absenteeism. There is evidence that these conditions can be successfully treated in the workplace, but take-up of psychological treatments among workers is low. Digital mental health interventions delivered in the workplace may be one way to address this imbalance, but although there is evidence that digital mental health is effective at treating stress, depression, and anxiety in the workplace, uptake of and engagement with these interventions remains a concern. Additionally, there is little research on the appropriateness of the workplace for delivering these interventions or on what the facilitators and barriers to engagement with digital mental health interventions in an occupational setting might be. OBJECTIVE The aim of this research was to get a better understanding of the facilitators and barriers to engaging with digital mental health interventions in the workplace. METHODS Semistructured interviews were held with 18 participants who had access to an occupational digital mental health intervention as part of a randomized controlled trial. The interviews were transcribed, and thematic analysis was used to develop an understanding of the data. RESULTS Digital mental health interventions were described by interviewees as convenient, flexible, and anonymous; these attributes were seen as being both facilitators and barriers to engagement in a workplace setting. Convenience and flexibility could increase the opportunities to engage with digital mental health, but in a workplace setting they could also result in difficulty in prioritizing time and ensuring a temporal and spatial separation between work and therapy. The anonymity of the Internet could encourage use, but that benefit may be lost for people who work in open-plan offices. Other facilitators to engagement included interactive and interesting content and design features such as progress trackers and reminders to log in. The main barrier to engagement was the lack of time. The perfect digital mental health intervention was described as a website that combined a short interactive course that was accessed alongside time-unlimited information and advice that was regularly updated and could be dipped in and out of. Participants also wanted access to e-coaching support. CONCLUSIONS Occupational digital mental health interventions may have an important role in delivering health care support to employees. Although the advantages of digital mental health interventions are clear, they do not always fully translate to interventions delivered in an occupational setting and further work is required to identify ways of minimizing potential barriers to access and engagement. TRIAL REGISTRATION ClinicalTrials.gov: NCT02729987; https://clinicaltrials.gov/ct2/show/NCT02729987?term=NCT02729987& rank=1 (Archived at WebCite at http://www.webcitation.org/6wZJge9rt).
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Affiliation(s)
- Stephany Carolan
- School of Psychology, University of Sussex, Brighton, United Kingdom
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29
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Yeager CM, Benight CC. If we build it, will they come? Issues of engagement with digital health interventions for trauma recovery. Mhealth 2018; 4:37. [PMID: 30363749 PMCID: PMC6182033 DOI: 10.21037/mhealth.2018.08.04] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/17/2018] [Indexed: 12/12/2022] Open
Abstract
Exposure to traumatic events is extremely common with nearly 75% reported to have experienced one or more traumatic events worldwide. A significant number of those exposed will develop posttraumatic stress disorder (PTSD) along with depression, anxiety, and substance use disorders. Globally, trauma-related mental health disorders are the leading cause of global disability burden, and many of these disorders are caused, or worsened, by exposure to wars, natural and human-caused disasters, and other traumatic events. Significant barriers to treatment exist including logistical, geographical, financial, stigma, and other attitudinal challenges. One opportune approach to overcoming these barriers is the provision of mental health interventions via technology that can be readily standardized for wide dissemination of evidence-based care. However, engagement with technology-based interventions is a concern and limited participation and high attrition rates are common. This may be especially true for trauma survivors who often experience symptoms of avoidance and hyperarousal. Engagement is regarded as an essential component of intervention efficacy and has been demonstrated to be associated with more positive clinical outcomes, yet theoretically based research in this area is sparse. This review focuses on the complex issue of engagement with digital health interventions (DHIs). Specifically, we review the conceptualization and measurement of engagement, predictors of engagement, and importantly, the relationship of engagement with intervention effectiveness. Finally, a theoretically based model of engagement is proposed that considers the unique challenges of trauma recovery. This review is not intended to provide a systematic or exhaustive set of recommendations, rather it is intended to highlight the challenges of engagement research including its definition, measurement, and modeling. Future engagement research that includes valid and reliable measures of engagement will enable consistent exploration of engagement predictors that can then inform methods for increasing engagement and, ultimately, intervention effectiveness.
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Affiliation(s)
- Carolyn M. Yeager
- Psychology Department, University of Colorado Colorado Springs, Colorado Springs, CO 80918, USA
- Trauma, Health, & Hazards Center, University of Colorado Colorado Springs, Colorado Springs, CO 80918, USA
| | - Charles C. Benight
- Psychology Department, University of Colorado Colorado Springs, Colorado Springs, CO 80918, USA
- Trauma, Health, & Hazards Center, University of Colorado Colorado Springs, Colorado Springs, CO 80918, USA
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