Internet interventions: Past, present and future

"I am now on 'speaking terms' with my migraine monster" - patient experiences in acceptance-based cognitive behavioral therapy delivered via the internet for migraine: a randomized controlled pilot study using a mixed-method approach

Migraine is a common neurological disorder globally. Migraines, with or without aura, are episodic and recurring with symptom-free periods. Frequent and prolonged attacks can lead to chronic migraine. This pilot randomized controlled trial (RCT) aimed to evaluate feasibility of therapist-guided, acceptance-based internet cognitive behavioral therapy (iCBT) as an adjunct to standard medical care for migraine patients in Swedish primary healthcare settings using a mixed methods approach. Participants (treatment n = 15, control n = 14) underwent qualitative and quantitative assessments to evaluate feasibility, acceptance, and initial treatment effects. Interviews with participants (n = 7) indicate that most participants had struggled with migraines for decades and expressed dissatisfaction with the limited medical care. They found the flexible, digital format particularly helpful, praising its accessibility and structured learning. While they appreciated the comprehensive content, some faced challenges with the psychological language and the program pace. Post-treatment, participants reported emotional and behavioral changes, and better migraine management. Seventy-two percent of the 29 participants completed both baseline and 3-month follow-up measures. On average, participants completed 7.7 modules, with 60% completing all 10 modules. Promising effect size indicated a reduction in migraine days during the three-month follow-up. Both qualitative and quantitative data support the feasibility and acceptability of the intervention in primary care settings.

Safety and Efficacy of Modular Digital Psychotherapy for Social Anxiety: Randomized Controlled Trial

BACKGROUND

Social anxiety disorder is a common mental health condition characterized by an intense fear of social situations that can lead to significant impairment in daily life. Cognitive behavioral therapy (CBT) has been recognized as an effective treatment; however, access to therapists is limited, and the fear of interacting with therapists can delay treatment seeking. Furthermore, not all individuals respond. Tailoring modular treatments to individual cognitive profiles may improve efficacy. We developed a novel digital adaptation of CBT for social anxiety that is both modular and fully digital without a therapist in the loop and implemented it in the smartphone app Alena.

OBJECTIVE

This study aimed to evaluate the safety, acceptability, and efficacy of the new treatment in online participants with symptoms of social anxiety.

METHODS

In total, 2 web-based randomized controlled trials (RCTs) comparing individuals with access to the treatment through the app to a waitlist control group were conducted. Participants were recruited on the web and reported Social Phobia Inventory (SPIN) total scores of ≥30. Primary outcomes were safety and efficacy over 6 weeks in 102 women aged 18 to 35 years (RCT 1) and symptom reduction (SPIN scores) after 8 weeks in 248 men and women aged 18 to 75 years (RCT 2).

RESULTS

In RCT 1, active and control arm adverse event frequency and severity were not distinguishable (intervention: 7/52, 13%; waitlist control: 8/50, 16%; χ21=0.007; P=.93). App acceptability was high, with a median completion rate of 90.91% (IQR 54.55%-100%). Secondary outcomes suggested greater symptom reduction in the active arm (mean SPIN score reduction -9.83, SD 12.80) than in the control arm (mean SPIN score reduction -4.13, SD 11.59; t90=-2.23; false discovery rate P=.04; Cohen d=0.47). RCT 2 replicated these findings. Adverse event frequency was comparable across the 2 groups (intervention: 20/124, 16.1%; waitlist control: 21/124, 16.8%; χ21<0.001; P>.99). Despite a longer treatment program, median completion remained high (84.85%, IQR 51.52%-96.97%). SPIN score reduction was greater in the active arm (mean -12.89, SD 13.87) than in the control arm (mean -7.48, SD 12.24; t227=-3.13; false discovery rate P=.008; Cohen d=0.42).

CONCLUSIONS

The web-only, modular social anxiety CBT program appeared safe, acceptable, and efficacious in 2 independent RCTs on online patient groups with self-reported symptoms of social anxiety.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05858294; https://clinicaltrials.gov/study/NCT05858294 (RCT 1) and ClinicalTrials.gov NCT05987969; https://clinicaltrials.gov/study/NCT05987969 (RCT 2).

Longitudinal interplay between subjective stress, anxiety, depression, and well-being in internet-based stress recovery intervention for nurses

BACKGROUND

Cognitive behavioural therapy (CBT) interventions are effective in reducing subjective stress. Nevertheless, the longitudinal links between mental health indicators are rarely studied in intervention research. Therefore, it is unknown how the intervention effects are sustained.

AIM

The current study investigated mechanisms explaining sustained intervention effects in a sample of medical nurses who receive a CBT-based internet-delivered stress recovery program.

METHOD

A single-group longitudinal study design with three measurement points, pre-test, post-test, and 3-month follow-up, was used in the current study. The sample consisted of nurses and assistant nurses from Lithuania (n=111, age: M (SD) = 41.69 years (10.85)) who had participated in a 6-week CBT internet intervention targeting stress recovery. Data were collected as the randomised control trial, the treatment samples were combined, and the data were analysed using cross-lagged panel analysis with four variables representing the psychological well-being and symptoms of stress, anxiety, and depression.

RESULTS

The results revealed that decreased anxiety and increased psychological well-being at post-test predicted reduced stress levels at the 3-month follow-up. In addition, decreased anxiety at post-test predicted decreased depression at follow-up.

CONCLUSIONS

Decreased anxiety and increased well-being could explain the sustainability of reduced stress following a CBT-based internet intervention for nurses. The implications of this for research and practice are discussed.

Improving Child and Adolescent Mental Health: A Bibliometric Analysis of Related Intervention Studies

In response to the increase in adolescent mental health problems, related intervention research has flourished. This study examined 2258 mental health intervention studies captured by the Web of Science, focusing on their distribution, interdisciplinary collaboration, and emerging trends, using bibliometric analysis. Our findings revealed a rise in studies and enhanced collaboration across disciplines, with studies from the United States, Australia, and the United Kingdom showing high academic output, intellectual impact, and strong scientific partnerships. However, there is a noticeable Western-centrism in the research. Identifying current trends and key areas of focus offers valuable insights for future practices in child and adolescent mental health.

The Paradox of Digital Health: Why Middle-Aged Adults Outperform Young Adults in Health Management Utilization via Technology

Background/Objectives: Globally, life expectancy has been increasing with South Korea focusing on improving health to enhance quality of life. The COVID-19 pandemic further emphasized the need for digital transformation in healthcare, accelerating digital health adoption. This study explores the digital divide between 'Digital Natives (20-39 Y)' and 'Digital Immigrants (40-69 Y)', focusing on digital device usage and confidence. Methods: This study utilized national survey data from the Digital Health Literacy Survey Results and Policy Implications, focusing on differences in digital device use and confidence between young adults (20-39 Y) and middle-aged adults (40-69 Y). The participants comprised 1000 adults aged 20 to 69 in the Republic of Korea. Respondents were queried about their use of digital health tools, such as wearable devices and mobile apps. Confidence in using digital systems and managing health via digital tools was assessed using a five-point Likert scale. Results: The findings indicated that while young adults have lower rates of using digital devices for healthcare, they exhibit higher confidence in using such devices. In contrast, middle-aged adults, despite having lower confidence, report higher usage of digital devices for healthcare purposes. Conclusions: This study explored differences in digital confidence and healthcare usage between age groups and aimed to propose effective health management strategies based on digital accessibility.

Top-funded companies offering digital health interventions for the prevention and treatment of depression: a systematic market analysis

BACKGROUND

Digital innovations can reduce the global burden of depression by facilitating timely and scalable interventions. In recent years, the number of commercial Digital Health Interventions for Depression (DHIDs) has been on the rise. However, there is limited knowledge on their content and underpinning scientific evidence. This study aimed to: (i) identify the top-funded companies offering DHIDs and (ii) provide an overview of their interventions, including scientific evidence, psychotherapeutic approaches and use of novel technologies.

METHODS

A systematic search was conducted using two venture capital databases to identify the top-30 funded companies offering DHIDs. In addition, studies related to the DHIDs' were identified via academic databases and hand-searching. The methodological quality of the publications was evaluated using the Mixed Methods Appraisal Tool.

RESULTS

The top-30 funded companies offering DHIDs received a total funding of 2,592 million USD. Less than half of the companies produced any scientific research associated with their DHIDs, with a total of 83 publications identified. Twenty-five publications were randomised control trials, of which 15 reported moderate-to-large effects in reducing depression symptoms. Regarding novel technologies, few DHIDs incorporated the use of conversational agents or low-burden sensing technologies.

CONCLUSIONS

Funding received by top-funded companies was not related to the amount of scientific evidence provided on their DHIDs. There was a strong variation in the quantity of evidence produced and an overall need for more rigorous effectiveness trials. Few DHIDs used automated approaches such as conversational agents, limiting their scalability.

Focusing with colorectal cancer patients: a pilot study of a brief online group intervention

Introduction

Focusing-Oriented Psychotherapy has had a long history and influence on the field of psychotherapy. By "clearing a space" and "focusing," individuals can enhance their emotional awareness and improve their ability to self-regulate. These tasks are particularly relevant in the context of Psycho-Oncology, although the research on their potential benefits for cancer patients is limited. Furthermore, the application of these tasks in a group or online setting has not been thoroughly explored.

Methods

This study aimed to examine the effectiveness of a two-session online intervention based on Focusing for cancer-diagnosed participants and its impact on their mental health and wellbeing. The study involved three participants with a diagnosis of colorectal cancer who were undergoing palliative treatment. We used both qualitative and quantitative methods. PFC-2 was used to assess participants' accomplishment of the task; FMS was used to assess the change in the focusing attitude, while CORE-OM, and PWBS-RV were used as mental health distress and psychological wellbeing measures; participant feedback was collected through questionnaires and a semi-structured interview.

Results

The results suggest that the tasks led to greater self-awareness, heightened self-reflection, and a sense of relief for the participants.

Discussion

These findings suggest that the group intervention protocol based on online Focusing sessions is potentially useful for broader applications.

Clinical utility of shared book reading on YouTube: An analysis of metadata, evidence-based content, understandability, and actionability

PURPOSE

Digital content may increase parental access to training as well as the diversity of the training programs. YouTube videos may provide a platform from which professionals may adopt content for such programs. This study provides data regarding the clinical utility of YouTube videos about shared book reading (SBR) found on the United States (USA) and India channels.

METHOD

A cross-sectional analysis of videos about SBR was conducted to examine metadata, evidence-based content, understandability, and actionability. Descriptive statistics were used to analyse metadata and content. Health literacy concepts of understandability and actionability were measured, and descriptive statistics are reported.

RESULT

Of 800 videos identified, 10 included information related to storybook selection, dialogic reading, extra-textual strategies, and print-referencing strategies. These met adequate levels of understandability and actionability.

CONCLUSION

Results provide some direction and recommendations for parent-training programs in the USA and India. The study highlights the use of YouTube videos and suggests its utility as a supplement source within parent-training programs.

Supportive eHealth Technologies and Their Effects on Physical Functioning and Quality of Life for People With Lung Cancer: Systematic Review

BACKGROUND

Despite advancements in treatment and early diagnosis, people with lung cancer are not living as long as those with other cancers. The more common symptoms of lung cancer, such as breathlessness, fatigue, and depression, can be alleviated by improving patients' physical functioning. Therefore, good symptom management and improved health-related quality of life (HRQoL) are priorities in this patient group. However, current health care services have limited capacity to provide this support. One way to address this issue of health care resources is to empower patients to self-manage their condition using eHealth technologies.

OBJECTIVE

The purpose of this review was to identify and assess available research on technologies that support persons with lung cancer to improve or maintain their physical functioning, HRQoL, or both.

METHODS

Six databases-PubMed, Web of Science, CINAHL, MEDLINE, SPORTDiscus, and PsycINFO-were searched from January 1, 1990, to April 30, 2023. Studies were suitable for inclusion if the participants included people with lung cancer aged >18 years who had been exposed to a physical activity, exercise, or training intervention that was delivered via an electronic or web-based application with or without a comparator. Furthermore, the study had to report on the impact of the intervention on physical functioning and HRQoL. Studies that focused on telemedicine without a digital intervention were excluded. The Grading of Recommendations Assessment, Development, and Evaluation system was used to assess the quality of the included papers. Due to the heterogeneity of the studies, a narrative synthesis was undertaken.

RESULTS

This review is reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 794 papers were initially identified through our search, of which, after screening, 8 (1%) were confirmed suitable for inclusion in the review. As 2 (25%) of the 8 papers reported on different stages of the same study, we included only 7 studies in our analysis. The studies were undertaken between 2010 and 2018 across multiple countries and aimed to develop a technology and test its feasibility or acceptance. The 7 technologies identified included web-based applications, mobile apps, and gaming consoles. The studies demonstrated impact on walking distance, muscle strength, balance, dyspnea symptoms, and cancer-related fatigue. HRQoL scores also showed improvement.

CONCLUSIONS

The findings indicate that eHealth technologies can positively impact physical functioning and well-being for people with lung cancer, but there are limited studies that demonstrate the impact of these digital interventions over longer periods. None of the studies reported on the implementation or adoption of a mobile health or eHealth intervention in routine clinical practice, highlighting the need for further research in this area.

TRIAL REGISTRATION

PROSPERO CRD42023414094; https://tinyurl.com/39hhbwyx.

Current state and practical recommendations on reproductive mental health: a narrative review

Emotional disorders (EDs) are highly prevalent during the reproductive period, including pregnancy, postpartum, and women undergoing fertility treatments. International guidelines are increasingly suggesting the need to evaluate, prevent, and treat EDs in those women. The main aim of this narrative review is to summarize current practice in the field of EDs management during fertility treatments, pregnancy, and the postpartum and to propose a new technology-based model of care that helps to provide psychological care to all women who are in these periods. Four different databases (Pubmed, Scopus, Science Direct, Web of Science) were consulted. Selected keywords were related with infertility, pregnancy, postpartum, EDs, assessment, prevention, treatment, and technologies. We identified 1603 studies and 43 were included in this review. According to these studies, different face-to-face protocols already exist to manage EDs in women undergoing fertility treatments, pregnant or at the postpartum. We noticed an increased interest in developing technology-based solutions to overcome the limitations of traditional mental healthcare services. However, we also detected some issues in the use of technologies (i.e. increased attention to the postpartum or the lack of transdiagnostic approaches). Our results evidenced that there is still a need to develop modern, well-designed, and conceptually-relevant ICT-based programs to be used in women undergoing fertility treatments, pregnant or at the postpartum.

Internet-Based Cognitive-Behavioral Therapy for Individuals Experiencing Panic Attacks: A Scoping Literature Review

Panic attacks (PAs) are prevalent and highly comorbid with various physical and psychological disorders. Cognitive-behavioral therapy (CBT) is a well-established psychosocial intervention. Internet-delivered CBT (ICBT) presents a promising avenue to overcome barriers and provide evidence-based support to those in need. The current scoping review aimed to systematically map the existing literature and identify knowledge gaps regarding the impact of ICBT on outcome measures for individuals experiencing PAs. The PRISMA guidelines for scoping reviews were used. A total of 3,044 records were retrieved, and 18 studies from 2013 to 2023 were ultimately included in the analysis. ICBT demonstrated effectiveness as a psychosocial intervention for improving panic symptoms and anxiety in individuals with PAs. However, the impact of ICBT on quality of life (QOL) remains inconclusive. All studies included in this review focused on assessing the severity of panic symptoms, with limited emphasis on measuring QOL. This scoping review holds significant implications for research and practice. However, further addressing the research needs identified in this review will enhance our understanding and improve treatment outcomes for PAs. [Journal of Psychosocial Nursing and Mental Health Services, 62(4), 9-15.].

Effects of Digital Health Literacy Program on Sufficient Health Behavior Among Thai Working-Age People With Risk Factors for Noncommunicable Diseases

BACKGROUND

Noncommunicable diseases (NCDs) account for more than 75% of deaths in Thailand, which is higher than the global average of 71%.

OBJECTIVE

The aim of this study was to investigate the effects of the Digital Health Literacy (DHL) and Sufficient Health Behavior (SHB) Program on Thai working-age adults age 20 to 65 years with risk factors for NCDs (i.e., overweight and lacking physical activity), and compare the health literacy (HL) and SHB of participants living in urban and semi-urban areas at posttest.

METHODS

Using the lottery method, this one-group pretest-posttest quasi-experimental design randomly selected 200 participants and assigned them to two equally sized groups. The data were gathered through surveys with an item discrimination power between .20 and .86 and a reliability of 0.94 and were statistically analyzed using t-test and F-test.

KEY RESULTS

The DHL and SHB Program comprises six sessions over a 12-week period, and activities designed to enhance knowledge of NCDs, HL, health communication, and health behavior modification. It was conducted by health care workers from urban and semi-urban public hospitals via Zoom using various digital toolkits such as YouTube, animations, infographics, role-play videos, clips, and e-books. At the posttest, the participants had higher HL (t = 2.67, p = .001) and SHB (t = 3.36, p = .001). There was a difference in SHB scores (F = 4.640, p = .032) between those living in urban and those in semi-urban areas, but no difference in HL scores (F = 1.436, p = .232).

CONCLUSIONS

The DHL and SHB Program improved HL and SHB in Thai working-age adults with risk factors for NCDs in both urban and semi-urban communities. [HLRP: Health Literacy Research and Practice. 2024;8(2):e93-e101.].

Predictors and moderators of outcome of ICBT for loneliness with guidance or automated messages - A secondary analysis of a randomized controlled trial

Internet-based cognitive behavioral therapy (ICBT) is promising in alleviating loneliness in adults. Identifying individuals who benefit from ICBT for loneliness is pivotal to offering this intervention in a more targeted way and improving the intervention for those who do not benefit. This secondary analysis of a randomized controlled trial (RCT) aimed to identify predictors and moderators of outcome of an ICBT with guidance or automated messages for loneliness. In the RCT, 243 participants suffering from loneliness were randomly assigned to an ICBT with guidance (n = 98), automated messages (n = 97), or a waitlist-control condition (n = 48). In total, 180 participants completed the post-assessment (i.e., 10 weeks post-randomization). Outcomes were treatment outcome assessed with the UCLA-9 Loneliness Scale at post-assessment and treatment response, i.e., reliable improvement on the UCLA-9 from pre- to post. The relationship between a wide range of patient characteristics (grouped into socio-demographic, clinical, loneliness-specific, and treatment-related variables) and outcome was analyzed using multiple linear and logistic regressions. Feeling less burdened by loneliness resulted in higher odds of reliable improvement in guided ICBT compared to the waitlist-control condition. No treatment outcome or response moderators were identified for ICBT with automated messages compared to the waitlist-control group. Across active intervention groups, loneliness at baseline, age and fit between the tasks and goals of the intervention and participants' need predicted treatment outcome. Predictors of treatment response for ICBT with guidance and automated messages were not identified, and no variables differentially predicted the effects of ICBT with guidance or automated messages on the outcomes. In conclusion, individuals less burdened by their feelings of loneliness benefited more from guided ICBT. Lower baseline loneliness scores, younger age, and a better match between tasks and goals of the intervention and participants' needs also predicted a more favorable treatment outcome for both ICBT with guidance and automated messages.

Facilitators of, barriers to, and preferences for e-mental health interventions for depression and anxiety in men: Metasynthesis and recommendations

BACKGROUND

Little is known about men's use of online mental health (eMH) interventions and factors that promote their engagement or attrition. We aimed to synthesise the qualitative literature on men's preferences for, attitudes towards, and experiences of using eMH interventions for depression and anxiety, and develop recommendations from the findings.

METHOD

Systematic searches were conducted (Jan 2000-Oct 2020) in six databases; study quality was assessed using Qualsyst with a minimum total of 0.55 required for inclusion. Extracted data were synthesised using meta-aggregation.

RESULTS

Eight studies met inclusion criteria and three synthesised findings were generated. (1) Facilitators of men's eMH use: finding apps and technology motivating and convenient, support and encouragement from important others, and interventions allowing men to take action, gain control over their mental health, and resulting in positive outcomes; (2) Barriers to men's eMH use: lack of free time, predicted or experienced lack of benefit from use, and technical difficulties; (3) What men want in eMH: personalised, tailored, relevant interventions that are bright and easy to use, with information presented in multiple formats, psychoeducation, exercises, self-monitoring, information on further resources, and the option of clinician involvement, without any repetitive questioning, boring tools, or negative feedback.

LIMITATIONS

All included studies were conducted in high income, 'Western' countries; most data related to experiences of using an existing eMH intervention within a trial, rather than in 'real world' settings where eMH acceptability is generally lower and experiences may differ.

CONCLUSIONS

Practice, research, and policy recommendations are presented.

The latest developments with internet-based psychological treatments for depression

INTRODUCTION

Internet-based psychological treatments for depression have been around for more than 20 years. There has been a continuous line of research with new research questions being asked and studies conducted.

AREAS COVERED

In this paper, the author reviews studies with a focus on papers published from 2020 and onwards based on a Medline and Scopus search. Internet-based cognitive behavior therapy (ICBT) programs have been developed and tested for adolescents, older adults, immigrant groups and to handle a societal crisis (e.g. COVID-19). ICBT works in regular clinical settings and long-term effects can be obtained. Studies on different treatment orientations and approaches such as acceptance commitment therapy, unified protocol, and tailored treatments have been conducted. Effects on quality-of-life measures, knowledge acquisition and ecological momentary assessment as a research tool have been reported. Factorial design trials and individual patient data meta-analysis are increasingly used in association with internet intervention research. Finally, prediction studies and recent advances in artificial intelligence are mentioned.

EXPERT OPINION

Internet-delivered treatments are effective, in particular if therapist guidance is provided. More target groups have been covered but there are many remaining challenges including how new tools like artificial intelligence will be used when treating depression.

Predictors of nonresponse to treatment and low adherence to internet-based cognitive behavioral therapy in depressed/anxious women facing the couple's fertility problems: a secondary analysis of a randomized control trial

BACKGROUND

The study aimed to examine the predictors of treatment nonresponse and low adherence to Internet-based cognitive behavioral therapy and face-to-face therapy for treating depression and anxiety in women facing the couple's fertility problems.

METHODS

This is a secondary analysis based on a previous randomized controlled trial including 152 depressed/anxious women facing the couple's fertility problems. The study defines low adherence as receiving less than 4 sessions (out of 8 sessions). Nonresponse to treatment refers to a < 50% reduction in the anxiety and depression total scores.

RESULTS

A high level of anxiety/depression score before psychotherapy increases the risk of nonresponse to both Internet-based and face-to-face psychotherapies by 1.4 to 2 times in women facing the couple's fertility problems after the treatment and in the 6-month follow-up. However, 4 factors, including diagnosis of mixed anxiety and depression, low education level, long marriage duration, and infertility caused by mixed female/male factors, reduced the risk of nonresponse to psychotherapies.

CONCLUSION

Women facing the couple's fertility problems with high depression and anxiety scores are at risk of poor prognosis in response to psychotherapy. Psychologists and healthcare providers of infertility centers should pay more attention to the timely identification and referral of depressed/anxious patients to psychologists.

Therapeutic alliance in two forms of guided self-help for binge eating

The role of therapeutic alliance within psychological treatments for eating disorders (EDs), including those delivered remotely, is well established. However, few studies have investigated alliance in guided self-help, a widely recommended first-line treatment for EDs characterised by regular binge eating. Using data from a randomised controlled trial, the current study examined both facilitator and patient assessments of alliance within e-mail-assisted and face-to-face guided self-help and looked at associations between alliance, ED symptoms and ED-related impairment. One hundred thirteen patients and 11 facilitators completed measures of alliance during and following a course of guided self-help. Whilst ratings were reliable across patients and facilitators, alliance scores were higher both in the patient sample and in the face-to-face condition. Ratings of alliance showed no correlations with ED symptoms at post-treatment, and early alliance was not significantly associated with outcome, which could inform how early symptom change is encouraged in guided self-help.

Usability study of SOSteniamoci: An internet-based intervention platform to support informal caregivers in Italy

Background

Providing informal care can be experienced as stressful and lead to caregiver burden. Internet-based interventions, a specific form of eHealth, have proven to be a good option to support informal caregivers. SOSteniamoci, an internet-based intervention already tested in Lithuania, was translated and adapted for Italian caregivers.

Objective

As many novel eHealth solutions have been rejected by end-users due to usability problems, we aimed to evaluate the usability of the adapted platform, using a computer-based prototype.

Methods

The following methods and metrics were applied: 1. task analysis, using audio and video recordings that included three usability metrics: task completion rate, frequency of errors, and frequency of help requests; 2. the system usability scale (SUS); and 3. a semi-structured interview to collect additional data about the system's design and overall satisfaction.

Results

Ten informal caregivers (60% female; age M = 47.8, SD = 15.21) provided insights and suggestions for increasing the usability of the platform. The platform was considered satisfactory, with a mean score on the SUS of 75 (SD = 13.07) out of 100. The task analysis measurements highlighted difficulties in how to log in to the platform, understanding what the intervention is about, and texting the therapist. The same difficulties were also mentioned during the post-experience interview. Thus, improvements were subsequently made to enhance users' experience when navigating the platform. Finally, the platform overall was found to be intuitive and friendly, and the contents were appreciated.

Conclusion

To maintain participants' engagement and prevent drop-out, it is crucial to test the usability of internet-based interventions. Even though the platform proved to be user-friendly, intuitive and easy to use, several enhancements were implemented based on participants' feedback. Thus, the usability of internet-based interventions should be tested, and end-users must be involved in the development process of such solutions.

The added value of an internet-based intervention for treatment of aggression in forensic psychiatric outpatients-study protocol for a multicentre, mixed-methods randomized controlled trial

Background

Even though internet-based interventions have been used in treatment of forensic psychiatric outpatients for over 10 years, no robust effectiveness studies have been conducted in this complex branch of mental healthcare.

Objectives

To present the protocol of a study that investigates whether the addition of the internet-based intervention "Dealing with Aggression" to treatment as usual (TAU) leads to better treatment outcomes than TAU that is delivered solely in-person.

Methods

This study uses a multicentre mixed-methods randomized controlled trial (RCT) design, with four Dutch forensic outpatient organizations. Patients are included if they receive outpatient treatment for aggression. They will be randomized into an experimental condition, in which the intervention is added to TAU (n = 64), or a control condition, with only TAU (n = 64). Participants are assessed four times: at baseline (T0), halfway during the 10-week intervention (T1), after completing the intervention (T2), and after 3 months (T3). Primary outcome measure is self-reported aggression, other outcome measures are regulatory emotional self-efficacy and treatment readiness, the number of treatment sessions, and dynamic risk factors. Adherence to and engagement with the internet-based intervention will be investigated as predictors for effectiveness. Perceived effect and points of improvement are identified via semistructured interviews with patients and therapists.

Discussion

This will be the first study to investigate the effectiveness of an internet-based intervention in a forensic psychiatric outpatient sample. By means of the mixed-methods design and use of adherence and engagement as predictors, this study will answers questions about if, but also why and for whom this intervention works.

Internet-delivered cognitive behaviour therapy for affective disorders, anxiety disorders and somatic conditions: An updated systematic umbrella review

Background

Internet-delivered cognitive behaviour therapy (ICBT), which can involve guidance from a clinician, continues to be a way to deliver psychological treatments. A previous umbrella review identified moderate-to-large effect sizes favouring ICBT compared to control conditions when treating major depression and anxiety disorders. Given the rapid developments in the field, an updated umbrella review of available meta-analyses can show other conditions and subpopulations for which ICBT is effective. The aim of the study was to provide an expanded overview of the efficacy of ICBT for a broader range of adult psychiatric and somatic conditions.

Methods

We conducted an updated search of the literature since the publication of the previous umbrella review back in 2019 and up until March 2024. Five different search engines were used (Medline (OVID), Scopus, Web of Science, Cochrane library and CINAHL). The search was expanded to include additional psychiatric conditions (e.g., suicidal ideation) and somatic conditions (e.g., tinnitus and chronic pain).

Results

Of the 6509 identified articles, 39 meta-analyses met the inclusion criteria. In these meta-analyses 19 unique outcomes were represented. The most common outcome was symptoms of major depressive disorder, followed by symptoms of anxiety. Effect sizes for the comparisons against control conditions ranged between small (e.g., SMD = 0.10 for stress in employees) to large (e.g., SMD = 1.20 for depressive symptoms among older adults).

Conclusions

ICBT can generally reduce symptoms of a wide range of conditions including both psychiatric and somatic conditions, as well as other mental health problems. This updated review of available meta-analyses also indicated that ICBT has been successful in treating symptoms in different subpopulations such as older adults and students. However, some knowledge gaps remain, including the use of ICBT for psychotic disorders, and the quality of the available meta-analyses' points to a need for more stringent methodological procedures.

Cognitive Behavioral Therapy and Mindfulness-Based Cognitive Therapy for Depressive Disorders: Enhancing Access and Tailoring Interventions in Diverse Settings

Depressive disorders are an enormous societal burden given their high prevalence and impact on all facets of being human (e.g., relationships, emotions, motivation). There is a variety of evidence-based psychological treatments, with cognitive behavioral therapy (CBT) being the gold standard for major depression. Research has shown that mindfulness-based interventions (MBIs) such as mindfulness-based cognitive therapy (MBCT) are an effective relapse prevention and treatment for depression and that MBIs can be integrated in individual therapy. Furthermore, various delivery modes (e.g., digital-delivered therapy) and settings are offered to best meet different needs and improve accessibility: Evidence suggests that therapist-guided digital CBT, blended therapy, and, to some degree, digitalized MBIs may be an efficacious supplement to traditional face-to-face therapy. This chapter provides an overview of the principles and evidence base for CBT and MBCT as well as different delivery modes for depressive disorders in adults. Finally, chances and challenges of integration are discussed as implications for practice, as well as recommendations and ideas for future research.

Hurdles and potentials when implementing internet-delivered Acceptance and commitment therapy for chronic pain: a retrospective appraisal using the Quality implementation framework

OBJECTIVES

Internet-delivered psychological interventions can be regarded as evidence-based practices and have been implemented in psychiatric and somatic care at primary and specialist levels. However, challenges as low adherence and poor routinization, have arisen during attempts to implement internet-delivered interventions in chronic pain settings. Internet-delivered Acceptance and Commitment Therapy (IACT) has been found to be helpful for chronic pain patients and might aid in developing pain rehabilitation services. However, the integration of IACT into standard health care has not yet been described from an implementation science perspective. The aim of this hybrid 1 effectiveness-implementation study was to evaluate the process of implementing IACT in a pain rehabilitation setting, to guide future implementation initiatives.

METHODS

In this retrospective study we described actions taken during an implementation initiative, in which IACT was delivered as part of an interdisciplinary pain rehabilitation program (IPRP) at a specialist level clinic. All documents relevant to the study were reviewed and coded using the Quality Improvement Framework (QIF), focusing on adoption, appropriateness and sustainability.

RESULTS

The QIF-analysis of implementation actions resulted in two categories: facilitators and challenges for implementation. Sustainability may be facilitated by sensitivity to the changing needs of a clinical setting and challenged by unfitting capacity building. Appropriateness might be challenged by an insufficient needs assessment and facilitated by aligning routines for communication with the clinic's existing infrastructure. Adoption may be facilitated by staff key champions and an ability to adapt to occurring hurdles. Possible influential factors, hypotheses and key process challenges are presented in a logic model to guide future initiatives.

CONCLUSIONS

Sustainable implementation may depend on both the continuity of facilitating implementation actions and flexibility to the changing needs and interests of patients, caregivers and organization. We conclude that the use of theories, models and frameworks (TMF) as well as a logic model may ease design, planning and evaluation of an implementation process. Lastly, we suggest that IACT may be appropriate for IPRP when given before or after IPRP, focusing on psychiatric comorbidities.

From research to routine care: A historical review of internet-based cognitive behavioral therapy for adult mental health problems in Sweden

This narrative historical review examines the development of internet-based cognitive behavioral therapy (ICBT) in Sweden, describing its progression within both academic and routine care settings. The review encompasses key publications, significant scientific findings, and contextual factors in real-world settings. Over 25 years ago, Sweden emerged as a pioneering force in internet-delivered treatment research for mental health. Since then, Swedish universities, in collaboration with research partners, have produced substantial research demonstrating the efficacy of ICBT across various psychological problems, including social anxiety disorder, panic disorder, generalized anxiety disorder, and depression. Although research conducted in clinical settings has been less frequent than in academic contexts, it has confirmed the effectiveness of therapist-supported ICBT programs for mild-to-moderate mental health problems in routine care. Early on, ICBT was provided as an option for patients at both the primary care level and in specialized clinics, using treatment programs developed by both public and private providers. The development of a national platform for delivering internet-based treatment and the use of procurement in selecting ICBT programs and providers are factors that have shaped the current routine care landscape. However, gaps persist in understanding how to optimize the integration of digital treatment in routine care, warranting further research and the use of specific implementation frameworks and outcomes. This historical perspective on the research and delivery of ICBT in Sweden over two decades offers insights for the international community into the development and broad dissemination of a specific digital mental health intervention within a national context.

Effectiveness of compassion-based online therapy on suicidal thoughts and pain catastrophizing in female patients with multiple sclerosis in the relapsing-remitting phase

Introduction

According to research, multiple sclerosis is related to suicidal thoughts and pain catastrophizing as psycho-pathological variables, and on the other hand, compassion-based treatment can reduce mental disorders by targeting dimensions such as self-compassion. Also, since this disease is progressive and over time can cause movement restrictions in these people, online psychotherapy can be a better option for these people. So, the purpose of this study was to investigate the effectiveness of online compassion therapy on suicidal thoughts and pain catastrophizing in female patients with multiple sclerosis.

Methods

The current research was applied and quasi-experimental in a pre-test-post-test manner with a control group. The research sample consisted of 30 patients with multiple sclerosis living in Shiraz in 2019, who were randomly divided into two 15-person experimental and control groups. The participants were tested on scales of suicidal thoughts and pain catastrophizing, and the treatment plan based on compassion therapy was presented to the participants of the experimental group in 8 two-hour sessions online. The control group was placed on the waiting list until the completion of the treatment sessions and the post-test implementation, and after the post-test implementation, they received the treatment. Control variables in this study included gender and disease phase. Then, their scores were measured, after completing the treatment, and a three-month follow-up period. Descriptive statistics and covariance test were used to analyze the data.

Results

Patients showed a clear improvement in the severity of symptoms in both variables. So that the scores of suicidal thoughts and pain catastrophizing in the experimental group after receiving the treatment, as well as after a three-month follow-up period, were significantly reduced (p < 0.001).

Conclusion

Confirming the effectiveness of online therapy based on compassion on improving psychological outcomes in these patients, as an effective and online treatment method, is a clear step towards continuing the implementation of psychological interventions and paying attention to the dimension of mental health in this group of people.

Tailored internet-based psychological treatment for psychological problems during the COVID-19 pandemic: A randomized controlled trial

The COVID-19 pandemic influence mental health in both infected and non-infected populations. In this study we examined if individually tailored internet-based cognitive behavioral therapy (ICBT) could be an effective treatment for psychological symptoms related to the pandemic. Following recruitment we included 76 participants who were randomized to either a treatment group (n = 37) or a waitlist control group (n = 39). The treatment group received 8 modules (out of 16 possible) during 8 weeks with weekly therapist support. We collected data on symptoms of depression, experienced quality of life, anxiety, stress, anger, insomnia, PTSD, and alcohol use before, after the treatment and at one year follow-up. Using multiple regression analysis, group condition was found to be a statistically significant predictor for a decrease, favoring the treatment group, in symptoms of depression, insomnia, and anger with small to moderate effect sizes. The improvements remained at one year follow-up. Group condition did not significantly predict changing symptoms regarding experienced quality of life, anxiety, stress, PTSD and alcohol use. Findings indicate that ICBT is an effective intervention for some psychological symptoms associated with the COVID-19 pandemic. There is a need for further studies on mechanisms of change and on tailored ICBT for problems associated with crises like the pandemic.

Effectiveness of online cognitive behavioural therapy on quality of life in adults with depression: A systematic review

WHAT IS KNOWN ON THE SUBJECT

Depression is a leading cause of disability worldwide that negatively impacts quality of life. Talk therapy such as cognitive behavioural therapy is an effective treatment for depression. The Internet is an important tool for mental healthcare delivery. Internet-delivered or online talk therapy interventions are associated with lower costs and improved accessibility. Current reviews do not address the effectiveness of Internet-delivered cognitive behavioural therapy (iCBT) on quality of life (QoL).

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE

Interventions for iCBT have better QoL improvements for individuals with greater depressive symptom severity, females, young adults and individuals with complex comorbid disorders. Support from a healthcare provider for iCBT interventions have better outcomes than self-guided therapy interventions. Tailoring the iCBT intervention to the specialized needs of the population is beneficial.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

There is potential to address treatment gaps for managing the care of individuals with depression. Utilizing iCBT promotes the integration of accessible mental healthcare in clinical settings. Healthcare providers can have a more comprehensive approach to delivering iCBT by considering adaptations relevant to the clinical population being treated.

ABSTRACT

INTRODUCTION: Major depressive disorder (MDD) is a leading cause of disability resulting from social, psychological and biological factors affecting quality of life (QoL). Cognitive behavioural therapy (CBT) is an effective psychotherapy for MDD. Internet-delivered CBT (iCBT) is associated with lower costs and improved accessibility.

AIM

We aimed to examine the effectiveness of iCBT on QoL in adults with depression.

METHOD

PubMed, Embase and PsycINFO were searched between 2010 and 2022. Inclusion criteria were experimental designs, adults ≥18 years old, depression diagnosis or valid self-report measure, iCBT intervention; and QoL outcome. Exclusion criteria were studies without depression analysis and intellectual disabilities or psychosis.

RESULTS

Seventeen articles were included, with a negative correlation between depression severity and QoL. Sex, age and physical comorbidity positively influenced effectiveness. Depressive severity, dysfunctional attitude and negative thinking were predictors and moderators of QoL. Clinician support can impact social interactions and sense of belonging.

DISCUSSION

Internet-delivered cognitive behavioural therapy is effective for improving QoL in adults with MDD. Severe depression, females, younger age and comorbid disorders were associated with greater QoL improvements.

IMPLICATIONS FOR PRACTICE

The findings suggest iCBT could address depression treatment gaps related to improving QoL. Utilizing iCBT potentially improves the care continuum for individuals with complex disorders.

Harnessing Artificial Intelligence: Strategies for Mental Health Nurses in Optimizing Psychiatric Patient Care

This narrative review explores the transformative impact of Artificial Intelligence (AI) on mental health nursing, particularly in enhancing psychiatric patient care. AI technologies present new strategies for early detection, risk assessment, and improving treatment adherence in mental health. They also facilitate remote patient monitoring, bridge geographical gaps, and support clinical decision-making. The evolution of virtual mental health assistants and AI-enhanced therapeutic interventions are also discussed. These technological advancements reshape the nurse-patient interactions while ensuring personalized, efficient, and high-quality care. The review also addresses AI's ethical and responsible use in mental health nursing, emphasizing patient privacy, data security, and the balance between human interaction and AI tools. As AI applications in mental health care continue to evolve, this review encourages continued innovation while advocating for responsible implementation, thereby optimally leveraging the potential of AI in mental health nursing.

Crossover of the dimensions of work-family and family-work conflict in couples: Protocol for a qualitative study

Conflict between work and non-work is a bidirectional and a multidimensional construct that has garnered much attention from researchers and practitioners alike. Previously, studies with a dyadic design demonstrated that interrole conflict can cross over between partners in romantic relationships. The aim of the present study is to explore-from an individual and dyadic perspective-how partners perceive dimensions of interrole conflict (that is: time, strain, behaviour, and possibly others) and whether crossover between partners is dimension-dependent. This protocol outlines a qualitative interview study. Participants (N = 40) will be dual-earner couples that meet two inclusion criteria: both partners need to be professionally active, and the couples need to have lived together for at least a year. Interviews will be conducted separately with each partner. To analyse the data at the individual level we will use reflexive thematic analysis. To analyse the data at the dyadic level we will apply an adapted version of the framework method. We anticipate that findings of this study will have the potential to advance theoretical models depicting crossover processes and, more generally, the interface between work and family lives. Moreover, insights into how couples experience dimension-based interrole conflict will be important for the development of targeted interventions.

Scheduled Support Versus Support on Demand in Internet-Delivered Cognitive Behavioral Therapy for Social Anxiety Disorder: Randomized Controlled Trial

Objectives

Clinician-supported internet-delivered cognitive behavioral therapy (ICBT) can be an effective treatment option when treating social anxiety disorder (SAD). Unguided ICBT is often found to be less effective. One possible solution to reduce the costs of clinician support is to provide support on demand. In this format of guidance, participants have the option to contact their clinician if needed. In a few studies, this mode of support has been compared favorably to scheduled support.

Method

Participants in a previously reported controlled trial on SAD who had been in a waitlist control group were randomly allocated to ICBT with either on-demand guidance or scheduled weekly therapist guidance. A total of 99 participants were included. Data were collected weekly on the primary outcome measure, the Liebowitz Social Anxiety Scale self-report (LSAS-SR), and at pre- and post-treatment for secondary measures. Data were analyzed in accordance with the intention-to-treat principle using mixed-effects models.

Results

Both groups improved significantly during the treatment according to the LSAS-SR ratings. The groups did not differ in their estimated change during the treatment period, with a between-group effect of d = 0.02, 95% CI [-0.37, 0.43]. Both groups experienced similar improvement also on the secondary outcome measures, with small between-group effect sizes on all outcomes.

Conclusions

The findings indicate that support on demand can be an effective way of providing guidance in ICBT for SAD, although more research on this topic is needed. A limitation of the study is that it was conducted in 2009, and the findings were in the file drawer. Subsequent published studies support our initial findings, but more research is needed.

The role of therapist support on the efficacy of an internet-delivered stress recovery intervention for healthcare workers: a randomized control trial

Internet-delivered CBT interventions effectively improve different aspects of mental health, although the therapist's role remains unclear. The aim of this trial was to evaluate the efficacy of a therapist-supported 6-week internet-delivered intervention in improving stress recovery among healthcare workers compared to a group with optional therapist support. A total of 196 participants were recruited and randomly allocated to regular therapists' support or optional therapists' support groups. The primary outcome measure was the Recovery Experiences Questionnaire (REQ), developed to assess four components of stress recovery: psychological detachment, relaxation, mastery, and control. Secondary outcomes measured perceived stress (PSS-10), anxiety (GAD-7), depression (PHQ-9), and psychological well-being (WHO-5). All four stress recovery skills improved significantly after participating in the intervention at a 3-month follow-up, with small to medium effects (0.27-0.65) in both groups. At follow-up, we also found a significant reduction in perceived stress, depression, and anxiety in both groups, as well as an improvement in psychological well-being. The results indicate that ICBT can be effective in improving stress recovery skills among healthcare workers with optional support from the therapist, provided at the participants' request. This RCT suggests that optional therapist support could meet participants' needs and reduce resources needed in routine care.

Who benefits from guided internet-based interventions? A systematic review of predictors and moderators of treatment outcome

To our knowledge, no systematic review has been conducted on predictors or moderators of treatment outcome across diagnoses in guided internet-based interventions (IBIs) for adults. To identify who benefits from this specific format and therein inform future research on improving patient-treatment fit, we aimed to aggregate results of relevant studies. 2100 articles, identified by searching the databases PsycInfo, Ovid Medline, and Pubmed and through snowballing, were screened in April/May 2021 and October 2022. Risk of bias and intra- and interrater reliability were assessed. Variables were grouped by predictor category, then synthesized using vote counting based on direction of effect. N = 60 articles were included in the review. Grouping resulted in 88 predictors/moderators, of which adherence, baseline symptoms, education, age, and gender were most frequently assessed. Better adherence, treatment credibility, and working alliance emerged as conclusive predictors/moderators for better outcome, whereas higher baseline scores predicted more reliable change but higher post-treatment symptoms. Results of all other predictors/moderators were inconclusive or lacked data. Our review highlights that it is currently difficult to predict, across diagnoses, who will benefit from guided IBIs. Further rigorous research is needed to identify predictors and moderators based on a sufficient number of studies. PROSPERO registration: CRD42021242305.

Digital mental health outcome monitoring for a structured text-based youth counselling intervention: Demographic profile and outcome change

BACKGROUND

Digital mental health interventions comprise a potentially effective and accessible form of support for young people, particularly at times when traditional face-to-face service delivery is reduced, as in the COVID-19 pandemic.

AIMS

This study assessed the demographic profile of young people using a digital mental health support service and evaluated outcome change over the course of a structured online counselling intervention (synchronous text-chat sessions with a practitioner).

MATERIALS AND METHODS

The data were collected from 23,260 young people aged between 10 and 25 years engaging with the intervention between April 2019 and June 2021.

RESULTS

Young people accessing these services had high levels of mental health needs, particularly those identifying with non-binary gender identity. Service users were mostly female, with equitable rates of access for young people from racialised communities. Overall outcome change demonstrated small effect sizes according to the YP-CORE (0.19) and CORE-10 (0.38), which increased to a moderate level when young people remained engaged with a dedicated practitioner for at least seven sessions (0.38, 0.58). Regression analysis illustrated the effect of the number of sessions on outcome change, but this can be also influenced by other variables such as age and gender.

DISCUSSION AND CONCLUSION

Further research is required to explore ways to engage with young people using digital web-based services for a longer period and to collect and analyse single-session outcome data.

The Effect of Digital Mindfulness Interventions on Depressive, Anxiety, and Stress Symptoms in Pregnant Women: A Systematic Review and Meta-Analysis

Introduction. Pregnancy is a unique time in a woman's life that can be both exciting and challenging. It is also a period that can be associated with significant stress, anxiety, and depression, which can have negative consequences for both the mother and the baby. Mindfulness interventions are known to be a well-suited treatment and prevention method for psychiatric symptoms in pregnancy, and web-based applications have been explored. We here present an up-to-date systematic review and meta-analysis of randomized-controlled trials to investigate the effect of digital-based mindfulness interventions on depressive, anxiety, and stress symptoms during pregnancy. Methods. The systematic literature search and data extraction was performed by two independent raters. It resulted in 13 eligible studies overall comprising 1373 participants. We conducted random-effects meta-analyses for depressive, anxiety, and stress symptoms after completion of a digital mindfulness intervention (compared to a control group). Results. Digital mindfulness intervention methods were significantly able to reduce depression (g = -0.47, 95% CI [-0.9; -0.09]) and anxiety symptoms (g = -0.41, 95% CI [-0.77; -0.05]), but not stress symptoms. These effects were moderated by the attrition rate (βDepression = 0.025, pDepression < 0.01; βAnxiety = 0.022, pAnxiety < 0.01; βStress = 0.022, pStress < 0.01). Primiparity also had a significant influence on the intervention effect regarding depression symptoms (β = 0.033, p = 0.024). Conclusions. Digital mindfulness interventions are a promising method to reduce mental health symptoms in pregnant women. We identified certain parameters moderating this effect, for example, primiparity and the attrition rate.

[Online Therapy as an Add-on to Psychoanalysis? What Needs for Online Therapy Modules do Psychodynamic Psychotherapists in Private Practice Express for Their Outpatient Work?]

OBJECTIVE

In recent years, psychotherapists have been increasingly confronted with the challenge of meeting treatment needs efficiently with limited time resources and at the same time achieving stable treatment success in the long term. One way to address this is to integrate Internet-based interventions (IBI) into outpatient psychotherapy. While there is a lot of research on IBI based on cognitive-behavioral therapy, little is known about the same for psychodynamic treatment models. Therefore, the question will be answered as to what specific online modules would need to look like that psychodynamic psychotherapists would use in their outpatient practice to support their regular face-to-face therapies.

METHODS

In this study, 20 psychodynamic psychotherapists were asked about their requirements on the content of online modules that could be integrated into outpatient psychotherapy, using semi-structured interviews. The transcribed interviews were analyzed using Mayring's qualitative content analysis.

RESULTS

Results showed that some psychodynamic psychotherapists already use exercises or materials which could be transferred into the online format. In addition, general requirements about online modules emerged, such as an easy handling or a playful character. At the same time, it became clear when and with what kind of patient groups online modules would be integrated into psychodynamic psychotherapy.

DISCUSSION

The interviewed psychodynamic psychotherapists considered it an attractive approach to offer online modules as a supplement to psychotherapy and in a broad spectrum of content. They gave practical advice for the design of possible modules, both on the level of general handling and regarding concrete contents, words, and ideas.

CONCLUSION

The results contributed to the development of online modules for use in routine care, the effectiveness of which will be investigated in a randomized controlled trial in Germany.

Applying dyadic digital psychological interventions for reducing caregiver burden in the illness context: a systematic review and a meta-analysis protocol

INTRODUCTION

Providing informal care to one's romantic partner who is ill may become a highly distressing and demanding task. Based on the innovative dyadic coping model, several support interventions have been developed to alleviate informal caregivers' burden, including both caregivers' and care receivers' needs. Considering the unique challenges characterising the caregiving phenomenon, such as geographical barriers and time restrictions, digital solutions should be considered. However, there is a lack of research examining the effectiveness of dyadic digital solutions. Thus, this review aims to examine the existing literature on the efficacy of dyadic digital psychological interventions designed for caregivers and their care-receivers couples within the illness context.

METHODS AND ANALYSIS

Randomised controlled trials targeting caregivers' burden among dyads of informal caregivers and care receivers will be identified via an electronic search of the following databases: PubMed, Embase, the Cochrane Library, Cinhal, Scopus, PsycINFO, MEDLINE and supplemented by hand searching of previous systematic reviews. The search will be undertaken following the PICO (population, intervention, comparison and outcome) elements. If possible, a meta-analysis will be conducted to examine: (1) the effectiveness of dyadic digital psychological interventions for reducing caregivers' burden (primary outcome) among caregivers who are in a romantic relationship with the care receivers; (2) the effectiveness of dyadic digital psychological interventions on secondary outcomes such as anxiety, depression, stress, quality of life, well-being and self-efficacy among caregivers and care receivers; and (3) moderating effects of clinical and methodological factors on caregivers' burden. Prior to inclusion in the review, retrieved papers will be critically appraised by two independent reviewers. The Cochrane Risk of Bias tool will assess the risk of bias for randomised controlled trials.

ETHICS AND DISSEMINATION

Ethical approval is not required as no primary data will be collected. Findings will be disseminated through peer-reviewed publications, presentations at academic conferences and lay summaries for various stakeholders.

PROSPERO REGISTRATION NUMBER

CRD42022299125.

Exploring Dynamics of Changes in Psychological Skills in the Development of Talented Athletes

In this study we examined changes in a psychological skill set, defined as crucial for the growth of talented athletes, through repeated assessments of the six-factor Psychological Characteristics of Development Excellence Questionnaire (PCDEQ). In a first phase of this study, we built and evaluated a French adaptation of the PCDEQ: the PCDEQ-SV (18 items). After confirmatory factor analysis, Cronbach's alpha revealed that scales for its six factors ranged from very good to just below minimally acceptable as a model fit. The mean inter-item correlations for the scales, built on three items per scale, were optimal, leading us to assume that this short version was reliable. In the second phase, we analyzed the changes in the skill sets of 67 talented Swiss athletes who were given the PCDEQ-SV three times over 1 year. Feedback on the scores was provided to participants in comparison to the test's cutoffs after T1 and T2. The analysis then focused on those who scored below the cutoffs and their resources for skill improvements. We found that the highest number of participants scored below the cutoffs at testing times, T1 and T2 on Factors 2, 6 and 1. Changes in scores were characterized by overall dynamics of improvement. The resources most used to effect those changes were "personal work with no outside help," "discussions with significant others," and "specific work with the coach." The results are discussed in relation to the iGen's resources for self-determination of psychological skills improvement.

Effectiveness of an App-Based Short Intervention to Improve Sleep: Randomized Controlled Trial

BACKGROUND

A growing body of evidence for digital interventions to improve sleep shows promising effects. The interventions investigated so far have been primarily web-based; however, app-based interventions may reach a wider audience and be more suitable for daily use.

OBJECTIVE

This study aims to evaluate the intervention effects, adherence, and acceptance of an unguided app-based intervention for individuals who wish to improve their sleep.

METHODS

In a randomized controlled trial, we evaluated the effects of an app-based short intervention (Refresh) to improve sleep compared with a waitlist condition. Refresh is an 8-week unguided intervention covering the principles of cognitive behavioral therapy for insomnia (CBT-I) and including a sleep diary. The primary outcome was sleep quality (insomnia symptoms) as self-assessed by the Regensburg Insomnia Scale (RIS). The secondary outcomes were depression (9-item Patient Health Questionnaire [PHQ-9] score) and perceived insomnia-related impairment.

RESULTS

We included 371 participants, of which 245 reported poor sleep at baseline. About 1 in 3 participants who were allocated to the intervention group never accessed the intervention. Active participants completed on average 4 out of 8 chapters. Retention rates were 67.4% (n=250) at postassessment and 57.7% (n=214) at the 6-month follow-up. At postintervention, insomnia symptoms in the intervention group had improved more than those in the waitlist group, with a small effect (d=0.26) in the whole sample and a medium effect (d=0.45) in the subgroup with poor sleep. Effects in the intervention group were maintained at follow-up. Perceived insomnia-related impairment also improved from pre- to postassessment. No significant intervention effect on depression was detected. Working alliance and acceptance were moderate to good.

CONCLUSIONS

An app-based, unguided intervention is a feasible and effective option to scale-up CBT-I-based treatment, but intervention uptake and adherence need to be carefully addressed.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN53553517; https://www.isrctn.com/ISRCTN53553517.

Internet-based stress recovery intervention for adolescents: study protocol for a randomized controlled trial

BACKGROUND

Research reveals a high prevalence of stressors in adolescence. Mental health in adolescence is highly related to life-stressors exposure and difficulties in adjusting to stressors. Therefore, interventions for recovery from stress are in high demand. The study aims to evaluate the efficacy of the Internet-based stress recovery intervention for adolescents.

METHODS

A two-arm randomized controlled trial (RCT) on the efficacy of the FOREST-A-an Internet-based stress recovery intervention for adolescents-will be conducted. The FOREST-A is an adapted version of stress recovery intervention initially developed for healthcare workers. FOREST-A is a third-wave cognitive behavioral therapy and mindfulness-based Internet-delivered 4-week psychosocial intervention, which comprises six modules: Introduction, Relaxation, Psychological detachment, Mastery, Control, and Summary. The intervention will be evaluated using the two-arm RCT with intervention and care as usual (CAU) condition at pre-test, post-test, and 3-month follow-up. The measured outcomes will be stress recovery, adjustment disorder, generalized anxiety and depression symptoms, psychological well-being, and perceived positive social support.

DISCUSSION

The study will contribute to the development of Internet interventions-easily and broadly accessible tools-for the enhancement of adolescents' stress recovery skills. Based on the study's findings, further development of the FOREST-A, including upscaling and implementation, is foreseen.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05688254. Registered on January 6, 2023.

Free choice of treatment content, support on demand and supervision in internet-delivered CBT for adults with depression: A randomized factorial design trial

Even if much is known regarding the effects of internet-delivered cognitive behaviour therapy (ICBT) for depression there are several topics that have not been studied. In this factorial design trial with 197 participants we investigated if clients in ICBT could select treatment modules themselves based on a selection of 15 tailored treatment modules developed for use in ICBT for depression. We contrasted this against clinician-tailored module selection. We also investigated if support on demand (initiated by the client) could work as well as scheduled support. Finally, we tested if clients that were mentioned in supervision would improve more than clients not mentioned (with the exception of acute cases). The treatment period lasted for 10 weeks, and we measured effects at post-treatment and two-year follow-up. Measures of depression and secondary outcomes were collected at pre-treatment, post-treatment and two-year follow-up. Overall, within-group effects were large across conditions (e.g., d = 1.73 on the BDI-II). We also found a small but significant difference in favour of self-tailored treatment over clinician-tailored (d = 0.26). Within-group effects for the secondary measures were all moderate to large including a test of knowledge about CBT. The other two contrasts "support on demand" and "supervision" yielded mostly non-significant differences, with the exception of a larger dropout rate in the support on demand condition. There were few negative effects (2.2%). Effects were largely maintained at a two-year follow-up. We conclude that clients can choose treatment modules and that support on demand may work. The role of supervision is not yet clear as advice can be transferred across clients.

Web-Based Psychosocial Interventions for Disaster-Related Distress: What Has Been Trialed in the Past, and What Can We Learn From This?

OBJECTIVES

To summarize reports describing implementation and evaluation of Web-based psychosocial interventions for disaster-related distress with suggestions for future intervention and research, and to determine whether a systematic literature review on the topic is warranted.

METHODS

Systematic searches of Embase, PsycINFO, and MEDLINE were conducted. Duplicate entries were removed. Two rounds of inclusion/exclusion were conducted (abstract and full-text review). Relevant data were systematically charted by 2 reviewers.

RESULTS

The initial search identified 112 reports. Six reports, describing and evaluating 5 interventions, were included in a data analysis. Four of the 5 interventions were asynchronous and self-guided modular programs, with interactive components. The fifth was a short-term, online supportive group intervention. Studies utilized a variety of evaluation methods, and only 1 of 14 outcome measures used across the studies was utilized in more than 1 project.

CONCLUSIONS

Several Web-based psychosocial interventions have been developed to target disaster-related distress, but few programs have been formally evaluated. A systematic review of the topic would not be recommended at this time due to heterogeneity in reported studies. Further research on factors impacting participation, generalizability, and methods of program delivery with consistent outcome measures is needed.

Factors Influencing Community Participation in Internet Interventions Compared With Research Trials: Observational Study in a Nationally Representative Adult Cohort

BACKGROUND

Digital mental health (DMH) programs can be effective in treating and preventing mental health problems. However, community engagement with these programs can be poor. Understanding the barriers and enablers of DMH program use may assist in identifying ways to increase the uptake of these programs, which have the potential to provide broad-scale prevention and treatment in the community.

OBJECTIVE

In this study, we aimed to identify and compare factors that may influence participation in DMH programs in practice and research trials, identify any respondent characteristics that are associated with these factors, and assess the relationship between intentions to use DMH programs and actual uptake.

METHODS

Australian adults aged ≥18 years were recruited from market research panels to participate in the study. The sample was representative of the Australian adult population based on age, gender, and location. Participants completed a cross-sectional web-based survey assessing demographic characteristics, mental health symptom measures, attitudes and use of DMH programs in practice and in research studies, and the factors influencing their use in both settings.

RESULTS

Across both research and practice, trust in the organization delivering the service or trial was the top-ranked factor influencing participation, followed by anonymity or privacy and adequate information. There was little variation in rankings across demographic groups, including intentions to use DMH programs or mental health status. Intentions to use DMH programs were a strong predictor of both current (odds ratio 2.50, 99% CI 1.41-4.43; P<.001) and past (odds ratio 2.98, 99% CI 1.71-5.19; P<.001) use behaviors.

CONCLUSIONS

Efforts to increase the uptake of DMH programs or participation in research trials should focus on clearly communicating the following to users: the legitimacy of the organization delivering the program, security and use of participant data, and effectiveness of DMH programs.

What do we know about alcohol internet interventions aimed at employees?-A scoping review

Background

Internet interventions are a promising avenue for delivering alcohol prevention to employees. The objective of this scoping review was to map all research on alcohol internet interventions aimed at employees regardless of design, to gain an overview of current evidence and identify potential knowledge gaps.

Methods

We conducted a literature search in three data bases (PsycInfo, PubMed, and Web of Science). Eligibility criteria were that (1) the study targeted employees age ≥18 years; (2) the intervention was delivered predominantly online; (3) the study focused specifically or in part on alcohol use; and (4) the study was published in English in a peer-reviewed academic journal. Two reviewers independently screened, reviewed, and extracted data.

Results

Twenty studies were included, of which 10 were randomized controlled trials, five were secondary analyses, three were feasibility trials, one was a cohort study and one described the rationale and development of an intervention. No qualitative studies were found. Randomized trials tended to show effects when interventions were compared to waitlists but not when more intensive interventions were compared to less intensive ones. We identified two design-related aspects where studies differed; (1) whether all applicants were included regardless of alcohol use level and (2) whether the intervention was explicitly framed as alcohol-focused or not. Significant recruitment problems were noted in several studies.

Conclusions

Alcohol internet interventions hold promise in delivering alcohol prevention to employees, but heterogeneity in study design and difficulties in recruitment complicate interpretation of findings.

Systematic review registration

https://osf.io/25x7e/, Open Science Framework.

Predictors of Adolescents' Response to a Web-Based Intervention to Improve Psychosocial Adjustment to Having an Appearance-Affecting Condition (Young Person's Face IT): Prospective Study

BACKGROUND

Adolescents with a condition affecting their appearance that results in a visible difference can be at risk of psychosocial distress and impaired adjustment. Evidence for the effectiveness of existing interventions in improving psychosocial outcomes is limited, and relevant treatment can be difficult to access. Young Person's Face IT (YPF), a self-guided web-based intervention, has demonstrated potential in reducing social anxiety in adolescents with a visible difference. However, more knowledge is needed about the variables that contribute to variations in intervention effects to identify those who may benefit most from YPF.

OBJECTIVE

This study aimed to investigate demographic, psychosocial, and intervention-related variables as predictors of overall intervention effects after adolescents' use of YPF.

METHODS

We used longitudinal data collected as part of a larger, ongoing mixed methods project and randomized controlled trial (ClinicalTrials.gov NCT03165331) investigating the effectiveness of the Norwegian version of YPF. Participants were 71 adolescents (mean age 13.98, SD 1.74 years; range 11-18 years; 43/71, 61% girls) with a wide range of visible differences. The adolescents completed primary (body esteem and social anxiety symptoms) and secondary (perceived stigmatization, life disengagement, and self-rated health satisfaction) outcome measures at baseline and postintervention measurement. The predictor variables were demographic (age and gender), psychosocial (frequency of teasing experiences related to aspects of the body and appearance as well as depressive and anxiety symptoms), and intervention-related (time spent on YPF) variables.

RESULTS

Two-thirds (47/71, 66%) of the adolescents completed all YPF sessions and spent an average of 265 (SD 125) minutes on the intervention. Backward multiple regression analyses with a 2-tailed P-value threshold of .20 revealed that several variables were retained in the final models and predicted postintervention outcome changes. Body esteem was predicted by age (P=.14) and frequency of teasing experiences (P=.09). Social anxiety symptoms were predicted by gender (P=.12), frequency of teasing experiences (P=.03), depressive and anxiety symptoms (P=.08), and time spent on YPF (P=.06). Perceived stigmatization was predicted by age (P=.09), gender (P=.09), frequency of teasing experiences (P=.19), and depressive and anxiety symptoms (P=.06). Life disengagement was predicted by gender (P=.03), depressive and anxiety symptoms (P=.001), and time spent on YPF (P=.14). Self-rated health satisfaction was predicted by age (P=.008). However, the results were limited by relatively low explained postintervention variance, ranging from 1.6% to 24.1%.

CONCLUSIONS

This study suggests that adolescent boys, adolescents who experience higher levels of psychosocial distress related to their visible difference, and adolescents who spend sufficient time on YPF may obtain better overall intervention effects.

Development of a comprehensive flourishing intervention to promote mental health using an e-Delphi technique

BACKGROUND

Although observational studies have already shown promising results of flourishing, a broader concept of health based on positive psychology, there is still a gap in the literature regarding studies that combine different topics of flourishing in a single intervention.

OBJECTIVES

To develop a comprehensive and integrate intervention based on positive psychology gathering different topics of flourishing to improve mental health outcomes in individuals with depressive symptoms.

METHODS

The following steps were performed: (1) a comprehensive literature review; (2) the designing of a 12-session group intervention based on the values, virtues, and topics of flourishing; (3) assessment of the rationale, coherence, and feasibility by a panel of healthcare professionals answering semi-structured questions, and (4) application of an e-Delphi technique including mental health experts to reach a consensus of at least 80% for each item of the protocol.

RESULTS

A total of 25 experts participated in the study, 8 in the panel with semi-structured questions and 17 in the e-Delphi technique. A three-round e-Delphi technique was required to reach a consensus for all items. In the first round, a consensus was reached for 86.2% of the items. The remaining items (13.8%) were either excluded or reformulated. In the second round, a consensus was not obtained on one item, which was reformulated and approved in the third round. Qualitative analyses of the open questions were performed and suggestions for the protocol were considered. The final version of the intervention was composed of 12 weekly group sessions with 90-min each. The topics included in the intervention were physical and mental health, virtues and character strengths, love, gratitude, kindness, volunteering, happiness, social support, family, friends and community, forgiveness, compassion, resilience, spirituality, purpose and meaning of life, imagining the "best possible future," and flourishing.

CONCLUSION

The flourishing intervention was successfully developed using an e-Delphi technique. The intervention is ready to be tested in an experimental study to verify its feasibility and effectiveness.

Smartphone-delivered mental health care interventions for refugees: A systematic review of the literature

According to the United Nations, an estimated 26.6 million people worldwide were refugees in 2021. Experiences before, during, and after flight increase psychological distress and contribute to a high prevalence of mental disorders. The resulting high need for mental health care is generally not reflected in the actual mental health care provision for refugees. A possible strategy to close this gap might be to offer smartphone-delivered mental health care. This systematic review summarizes the current state of research on smartphone-delivered interventions for refugees, answering the following research questions: (1) Which smartphone-delivered interventions are available for refugees? (2) What do we know about their clinical (efficacy) and (3) nonclinical outcomes (e.g., feasibility, appropriateness, acceptance, and barriers)? (4) What are their dropout rates and dropout reasons? (5) To what extent do smartphone-delivered interventions consider data security? Relevant databases were systematically searched for published studies, gray literature, and unpublished information. In total, 456 data points were screened. Twelve interventions were included (nine interventions from 11 peer-reviewed articles and three interventions without published study reports), comprising nine interventions for adult refugees and three for adolescent and young refugees. Study participants were mostly satisfied with the interventions, indicating adequate acceptability. Only one randomized controlled trial (RCT; from two RCTs and two pilot RCTs) found a significant reduction in the primary clinical outcome compared to the control group. Dropout rates ranged from 2.9 to 80%. In the discussion, the heterogeneous findings are integrated into the current state of literature.

The relationship between posttherapeutic Cognitive Behavior Therapy skills usage and follow-up outcomes of internet-delivered Cognitive Behavior Therapy

BACKGROUND

Clients independently applying Cognitive Behavior Therapy (CBT) skills is an important outcome of CBT-based treatments. The relationship between posttherapeutic CBT skills usage and clinical outcomes remains under-researched-especially after internet-delivered CBT (iCBT).

OBJECTIVE

Explore contemporaneous and lagged effects of posttherapeutic CBT skills usage frequency on iCBT follow-up outcomes.

METHOD

Nested within a randomized controlled trial, 241 participants received 8-week supported iCBT for anxiety and/or depression, completing measures of anxiety, depression, functional impairment, and CBT skills usage frequency at 3-, 6-, 9-, and 12-month follow-up. Cross-lagged panel models evaluated primary aims.

RESULTS

While analyses support a contemporaneous relationship between anxiety, depression, functional impairment, and CBT skills usage frequency, no consistent lagged effects were observed.

CONCLUSION

Findings align with qualitative research but the role of CBT skills usage in the maintenance of iCBT effects remains unclear. Innovative research modeling temporal and possibly circular relationships between CBT skill usage and clinical outcomes is needed to inform iCBT optimization.