Integrating storytelling into the theory and practice of contextual behavioral science

Adding online storytelling-based acceptance and commitment therapy to antidepressant treatment for primary care patients: a randomized clinical trial

Depression is most often treated in primary care, where the prevailing treatment is antidepressant medication. Primary care patients with depression are less likely to be exposed to psychosocial interventions, despite evidence suggesting many of these treatments are effective. An example is acceptance and commitment therapy (ACT), a behavioral treatment for depression with a growing evidence base. A self-guided ACT intervention with a peer narrative (i.e. storytelling) format was developed with the intention of creating a treatment option for primary care patients that was more accessible than traditional psychotherapy. Titled LifeStories, the online program features videos of real individuals sharing coping skills for depression based on lived experiences and key ACT principles. A total of 93 primary care patients taking antidepressants were randomized to either continued antidepressant treatment alone or antidepressant treatment plus LifeStories for 4 weeks. There were no differences over time on depression severity and psychological inflexibility. However, LifeStories led to greater improvements in quality of life and increased patients' interest in additional treatment compared to antidepressant medication alone.Clinical trial pre-registration: ClinicalTrials.gov (NCT04757961).

Race-based trauma and post-traumatic growth through identity transformation

Race-based trauma has been linked to multiple adverse health and mental health outcomes, including hypertension, post-traumatic stress, anxiety, and depression. While the possibility of post-traumatic growth (PTG) has been investigated following other types of trauma, relatively less work has been done on PTG following race-based trauma. In this article, we present a theoretical framework integrating three areas of research: race-based trauma, PTG, and racial identity narratives. Based on the work on Black and Asian American identity and integrating theory and research on historical trauma and PTG, this framework posits that the transformation of externally imposed narratives into more authentic, internally generated ones can serve as an important influence that sparks PTG after racial trauma. Based on this framework, strategies and tools that enact the cognitive processes of PTG, including writing and storytelling, are suggested as ways to promote post-trauma growth in response to racial trauma.

Children’s perspective on fears connected to school transition and intended coping strategies

The transition from primary to secondary school comes with major changes in the lives of children. There is a shortage of in-depth analyses of young people’s perspectives concerning their fears and strategies to address these. This qualitative study aims to gain first-hand understanding of children’s fears and the intended coping strategies used during school transition. Data from 52 workshops were analysed, with a total of 896 students (M age = 10.40, SD = .839) in lower Austria. First, in the classroom setting, a vignette story about a child facing fears about school transition from primary to secondary school was developed with pupils in a brainstorming session. This was followed by self-selected small group discussions, where pupils proposed strategies to help cope with these fears. A thematic analysis was carried out. Major thematic clusters distinguished between four types of fears: peer victimisation, being alone, victimisation by authority figures, and academic failure. Three additional thematic clusters described strategies for countering the fears: enacting supportive networks, personal emotion regulation, and controlling behaviour. In addition to these connected clusters, two further themes were identified: strategy outcomes and consequences, i.e., personal experiences with using specific strategies, and the discussion of participants about contradictions and questionable usefulness of identified strategy outcomes. In conclusion, the children in our study reported more social fears as compared to academic fears. Children seem reasonably competent at naming and identifying strategies; however, maladaptive strategies, as well as controversies within the described strategies may indicate a lack of certainty and competence at engaging with these strategies on a practical level.

Acceptability, Engagement, and Exploratory Outcomes of an Emotional Well-being App: Mixed Methods Preliminary Evaluation and Descriptive Analysis

BACKGROUND

There is growing evidence suggesting that the emotional well-being of the public has been negatively affected in the past year. Consequently, demand for well-being support has increased. Although there is substantial empirical support for mental health apps that target diagnosed conditions, there is less research on emotional well-being apps. Among existing well-being apps, few studies have been conducted on apps that are based on lived experience and those that seek to enhance users' understanding of their emotional patterns. Thus, the acceptability of these novel apps requires further evaluation before upscaling.

OBJECTIVE

This evaluation aims to describe the acceptability, engagement, and preliminary outcomes of using an app (Paradym) designed to promote emotional well-being and positive mental health.

METHODS

This is a pre-post, mixed-methods, single-arm evaluation that is aggregated with digital analytics data. We anonymously collected real-world data on the demographics and well-being of the participants as well as the usability and acceptance of the app using validated questionnaires and open-ended questions. Participants tested the app for a minimum of 2 weeks before completing the follow-up measures. Google Analytics was used to record the level of app engagement. Chi-square and 2-tailed t tests were conducted to analyze quantitative data, and a thematic analysis approach was adopted for qualitative data.

RESULTS

A total of 115 participants completed baseline questionnaires, of which 79.1% (91/115) users downloaded the app. The sample was diverse in terms of ethnicity, including 43.4% (50/115) people who self-identified as belonging to minority ethnic groups. Most of the participants were female (78/115, 67.8%) and between the ages of 18 and 25 years (39/115, 33.9%). A total of 34 app users who completed questionnaires at baseline and follow-up provided valuable feedback to inform the future directions of Paradym. Favorable themes emerged describing the app's content, functionality, and underlying principles. Although usability feedback varied across items, a considerable number of participants (22/34, 64%) found that the app was easy to use. Google Analytics revealed that at least 79% (27/34) of people used the app daily. On the basis of preliminary observations, app users experience increased mental well-being. Post hoc analyses indicated that the reduction in depression scores (t₃₃=-2.16) and the increase in the well-being measures (t₃₃=2.87) were statistically significant. No adverse events were reported during the follow-up period.

CONCLUSIONS

The findings of this evaluation are encouraging and document positive preliminary evidence for the Paradym app.