1
|
Bisby MA, Barrett V, Staples LG, Nielssen O, Dear BF, Titov N. Things You Do: A randomized controlled trial of an unguided ultra-brief intervention to reduce symptoms of depression and anxiety. J Anxiety Disord 2024; 105:102882. [PMID: 38850775 DOI: 10.1016/j.janxdis.2024.102882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/05/2024] [Accepted: 05/22/2024] [Indexed: 06/10/2024]
Abstract
The 'Things You Do' encompass five types of actions that are strongly associated with good mental health: Healthy Thinking, Meaningful Activities, Goals and Plans, Healthy Habits, and Social Connections. Ultra-brief interventions which increase how often people perform these actions may decrease depression and anxiety. A two-arm randomized controlled trial (N = 349) compared an unguided ultra-brief intervention based on the 'Things You Do' against a waitlist control. The intervention included one online module, two practice guides, and four weeks of daily text messages. The primary timepoint was 5-weeks post-baseline. The intervention resulted in moderate reductions in depression (d = 0.51) and anxiety (d = 0.55) alongside moderate increases in the frequency of Things You Do actions (d = 0.54), compared to controls. No significant change in number of days out of role or life satisfaction were observed. Treatment completion was high (92 %), most participants reported being satisfied with the treatment (66 %), and improvements were maintained at 3-month follow-up. This study demonstrated that an automated ultra-brief 'Things You Do' intervention resulted in clinically significant reductions in depression and anxiety. Ultra-brief interventions may provide a scalable solution to support individuals who are unlikely to engage in longer forms of psychological treatment.
Collapse
Affiliation(s)
- Madelyne A Bisby
- eCentreClinic, School of Psychological Sciences, Macquarie University, Australia; MindSpot Clinic, MQ Health, Macquarie University, Australia.
| | | | | | - Olav Nielssen
- MindSpot Clinic, MQ Health, Macquarie University, Australia
| | - Blake F Dear
- eCentreClinic, School of Psychological Sciences, Macquarie University, Australia; MindSpot Clinic, MQ Health, Macquarie University, Australia
| | - Nickolai Titov
- eCentreClinic, School of Psychological Sciences, Macquarie University, Australia; MindSpot Clinic, MQ Health, Macquarie University, Australia
| |
Collapse
|
2
|
Thielecke J, Kuper P, Lehr D, Schuurmans L, Harrer M, Ebert DD, Cuijpers P, Behrendt D, Brückner H, Horvath H, Riper H, Buntrock C. Who benefits from indirect prevention and treatment of depression using an online intervention for insomnia? Results from an individual-participant data meta-analysis. Psychol Med 2024:1-14. [PMID: 38469832 DOI: 10.1017/s0033291724000527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND Major depressive disorder (MDD) is highly prevalent and burdensome for individuals and society. While there are psychological interventions able to prevent and treat MDD, uptake remains low. To overcome structural and attitudinal barriers, an indirect approach of using online insomnia interventions seems promising because insomnia is less stigmatized, predicts MDD onset, is often comorbid and can outlast MDD treatment. This individual-participant-data meta-analysis evaluated the potential of the online insomnia intervention GET.ON Recovery as an indirect treatment to reduce depressive symptom severity (DSS) and potential MDD onset across a range of participant characteristics. METHODS Efficacy on depressive symptom outcomes was evaluated using multilevel regression models controlling for baseline severity. To identify potential effect moderators, clinical, sociodemographic, and work-related variables were investigated using univariable moderation and random-forest methodology before developing a multivariable decision tree. RESULTS IPD were obtained from four of seven eligible studies (N = 561); concentrating on workers with high work-stress. DSS was significantly lower in the intervention group both at post-assessment (d = -0.71 [95% CI-0.92 to -0.51]) and at follow-up (d = -0.84 [95% CI -1.11 to -0.57]). In the subsample (n = 121) without potential MDD at baseline, there were no significant group differences in onset of potential MDD. Moderation analyses revealed that effects on DSS differed significantly across baseline severity groups with effect sizes between d = -0.48 and -0.87 (post) and d = - 0.66 to -0.99 (follow-up), while no other sociodemographic, clinical, or work-related characteristics were significant moderators. CONCLUSIONS An online insomnia intervention is a promising approach to effectively reduce DSS in a preventive and treatment setting.
Collapse
Affiliation(s)
- Janika Thielecke
- Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Unit Healthy Living & Work, TNO (The Netherlands Organization for Applied Scientific Research), Leiden, Netherlands
| | - Paula Kuper
- Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Dirk Lehr
- Department of Health Psychology and Applied Biological Psychology, Institute for Sustainability, Education & Psychology, Leuphana University Luneburg, Luneburg, Germany
| | - Lea Schuurmans
- Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
| | - Mathias Harrer
- Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
- GET.ON Institute for Online Health Trainings GmbH, Berlin, Germany
| | - David D Ebert
- Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, Netherlands
- Amsterdam Public Health, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Dörte Behrendt
- Department of Health Psychology and Applied Biological Psychology, Institute for Sustainability, Education & Psychology, Leuphana University Luneburg, Luneburg, Germany
| | - Hanna Brückner
- Department of Health Psychology and Applied Biological Psychology, Institute for Sustainability, Education & Psychology, Leuphana University Luneburg, Luneburg, Germany
| | - Hanne Horvath
- GET.ON Institute for Online Health Trainings GmbH, Berlin, Germany
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, Netherlands
- Amsterdam Public Health, Amsterdam University Medical Centers, Amsterdam, Netherlands
- Department of Psychiatry, VU University Medical Center, Amsterdam, Netherlands
| | - Claudia Buntrock
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke University Magdeburg, Magdeburg, Germany
| |
Collapse
|
3
|
Thielecke J, Kuper P, Ebert D, Cuijpers P, Smit F, Riper H, Lehr D, Buntrock C. Does outcome expectancy predict outcomes in online depression prevention? Secondary analysis of randomised-controlled trials. Health Expect 2024; 27:e13951. [PMID: 39102655 PMCID: PMC10753640 DOI: 10.1111/hex.13951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Evidence shows that online interventions could prevent depression. However, to improve the effectiveness of preventive online interventions in individuals with subthreshold depression, it is worthwhile to study factors influencing intervention outcomes. Outcome expectancy has been shown to predict treatment outcomes in psychotherapy for depression. However, little is known about whether this also applies to depression prevention. The aim of this study was to investigate the role of participants' outcome expectancy in an online depression prevention intervention. METHODS A secondary data analysis was conducted using data from two randomised-controlled trials (N = 304). Multilevel modelling was used to explore the effect of outcome expectancy on depressive symptoms and close-to-symptom-free status postintervention (6-7 weeks) and at follow-up (3-6 months). In a subsample (n = 102), Cox regression was applied to assess the effect on depression onset within 12 months. Explorative analyses included baseline characteristics as possible moderators. Outcome expectancy did not predict posttreatment outcomes or the onset of depression. RESULTS Small effects were observed at follow-up for depressive symptoms (β = -.39, 95% confidence interval [CI]: [-0.75, -0.03], p = .032, padjusted = .130) and close-to-symptom-free status (relative risk = 1.06, 95% CI: [1.01, 1.11], p = .013, padjusted = 0.064), but statistical significance was not maintained when controlling for multiple testing. Moderator analyses indicated that expectancy could be more influential for females and individuals with higher initial symptom severity. CONCLUSION More thoroughly designed, predictive studies targeting outcome expectancy are necessary to assess the full impact of the construct for effective depression prevention. PATIENT OR PUBLIC CONTRIBUTION This secondary analysis did not involve patients, service users, care-givers, people with lived experience or members of the public. However, the findings incorporate the expectations of participants using the preventive online intervention, and these exploratory findings may inform the future involvement of participants in the design of indicated depression prevention interventions for adults. CLINICAL TRIAL REGISTRATION Original studies: DRKS00004709, DRKS00005973; secondary analysis: osf.io/9xj6a.
Collapse
Affiliation(s)
- Janika Thielecke
- Professorship of Psychology and Digital Mental Health Care, Department of Sports and Health SciencesTechnical University of MunichMunichGermany
- Department of Clinical Psychology and Psychotherapy, Institute of PsychologyFriedrich‐Alexander ‐University Erlangen‐NürnbergErlangenGermany
- The Netherlands Organization for Applied Scientific Research (TNO)LeidenThe Netherlands
| | - Paula Kuper
- Professorship of Psychology and Digital Mental Health Care, Department of Sports and Health SciencesTechnical University of MunichMunichGermany
- Institute of Social Medicine and Health Systems Research, Faculty of MedicineOtto‐von‐Guericke University MagdeburgMagdeburgGermany
| | - David Ebert
- Department of Clinical Psychology and Psychotherapy, Institute of PsychologyFriedrich‐Alexander ‐University Erlangen‐NürnbergErlangenGermany
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental PsychologyVU UniversityAmsterdamThe Netherlands
- Amsterdam Public HealthAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Filip Smit
- Department of Clinical, Neuro and Developmental PsychologyVU UniversityAmsterdamThe Netherlands
- Amsterdam Public HealthAmsterdam University Medical CentersAmsterdamThe Netherlands
- Department of Mental Health and PreventionTrimbos Institute, Netherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
- Department of Epidemiology and BiostatisticsUniversity Medical Center AmsterdammsterdamThe Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental PsychologyVU UniversityAmsterdamThe Netherlands
- Amsterdam Public HealthAmsterdam University Medical CentersAmsterdamThe Netherlands
- Department of PsychiatryVU University Medical CenterAmsterdamThe Netherlands
| | - Dirk Lehr
- Department of Health Psychology and Applied Biological PsychologyLeuphana University LuneburgLüneburgGermany
| | - Claudia Buntrock
- Institute of Social Medicine and Health Systems Research, Faculty of MedicineOtto‐von‐Guericke University MagdeburgMagdeburgGermany
| |
Collapse
|
4
|
Kleiman EM, Rizvi SL, Duberstein PR. Initial Validation of an Ecological Momentary Assessment Measure of Self-Efficacy to Manage Negative Emotions. Assessment 2023; 30:2223-2233. [PMID: 36604797 DOI: 10.1177/10731911221146341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Although ecological momentary assessment (EMA) provides an opportunity for the examination of intervention mechanisms in real time, there are few validated tools to assess key treatment mechanisms in EMA studies. Our focus in this study is a potentially critical treatment mechanism, improvement in self-efficacy for managing negative emotions. We examined the psychometric properties of the Patient-Reported Outcomes Measurement Information System (PROMIS) self-efficacy for managing negative emotions scale measured via EMA. Participants (n = 145 college students) in a clinical trial of Dialectical Behavior Therapy skills completed four daily EMAs for 6 weeks (13,153 total responses). Results indicated (a) excellent internal consistency and good factor structure, (b) sufficient variability at both the between- and the within-persons levels, and (c) strong construct and predictive validity. This study supports the validity of an EMA measure of self-efficacy for managing negative emotions that can be used in real time, both in intervention studies and in observational research.
Collapse
Affiliation(s)
- Evan M Kleiman
- Rutgers, The State University of New Jersey, Piscataway, USA
| | - Shireen L Rizvi
- Rutgers, The State University of New Jersey, Piscataway, USA
| | | |
Collapse
|
5
|
Harrer M, Ebert DD, Kuper P, Paganini S, Schlicker S, Terhorst Y, Reuter B, Sander LB, Baumeister H. Predicting heterogeneous treatment effects of an Internet-based depression intervention for patients with chronic back pain: Secondary analysis of two randomized controlled trials. Internet Interv 2023; 33:100634. [PMID: 37635949 PMCID: PMC10457531 DOI: 10.1016/j.invent.2023.100634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/19/2023] [Accepted: 06/06/2023] [Indexed: 08/29/2023] Open
Abstract
Background Depression is highly prevalent among individuals with chronic back pain. Internet-based interventions can be effective in treating and preventing depression in this patient group, but it is unclear who benefits most from this intervention format. Method In an analysis of two randomized trials (N = 504), we explored ways to predict heterogeneous treatment effects of an Internet-based depression intervention for patients with chronic back pain. Univariate treatment-moderator interactions were explored in a first step. Multilevel model-based recursive partitioning was then applied to develop a decision tree model predicting individualized treatment benefits. Results The average effect on depressive symptoms was d = -0.43 (95 % CI: -0.68 to -0.17; 9 weeks; PHQ-9). Using univariate models, only back pain medication intake was detected as an effect moderator, predicting higher effects. More complex interactions were found using recursive partitioning, resulting in a final decision tree with six terminal nodes. The model explained a large amount of variation (bootstrap-bias-corrected R2 = 45 %), with predicted subgroup-conditional effects ranging from di = 0.24 to -1.31. External validation in a pilot trial among patients on sick leave (N = 76; R2 = 33 %) pointed to the transportability of the model. Conclusions The studied intervention is effective in reducing depressive symptoms, but not among all chronic back pain patients. Predictions of the multivariate tree learning model suggest a pattern in which patients with moderate depression and relatively low pain self-efficacy benefit most, while no benefits arise when patients' self-efficacy is already high. If corroborated in further studies, the developed tree algorithm could serve as a practical decision-making tool.
Collapse
Affiliation(s)
- Mathias Harrer
- Psychology & Digital Mental Health Care, Technical University Munich, Munich, Germany
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - David Daniel Ebert
- Psychology & Digital Mental Health Care, Technical University Munich, Munich, Germany
| | - Paula Kuper
- Psychology & Digital Mental Health Care, Technical University Munich, Munich, Germany
- Clinical Psychology, Institute for Psychology, Humboldt University Berlin, Berlin, Germany
| | - Sarah Paganini
- Department of Sport Psychology, Institute of Sports and Sport Science, University of Freiburg, Freiburg, Germany
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Sandra Schlicker
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
| | - Benedikt Reuter
- Clinical Psychology, Institute for Psychology, Humboldt University Berlin, Berlin, Germany
- Department Humanmedizin, Medical School Berlin, Berlin, Germany
| | - Lasse B. Sander
- Medical Psychology and Medical Sociology, Faculty of Medicine, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
| |
Collapse
|
6
|
Lutsch AG, Baumeister H, Paganini S, Sander LB, Terhorst Y, Domhardt M. Mechanisms of change in digital cognitive behavioral therapy for depression in patients with chronic back pain: A mediation analysis of a multicenter randomized clinical trial. Behav Res Ther 2023; 168:104369. [PMID: 37531807 DOI: 10.1016/j.brat.2023.104369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/07/2023] [Accepted: 07/06/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND While there is evolving knowledge on change processes of digital cognitive behavioral therapy (CBT) in the treatment of depression, little is known about how these interventions produce therapeutic change in the comorbid constellation of chronic back pain (CBP). Here, we examined whether the effects of a digital intervention to treat depression in patients with CBP are mediated by three pain-related variables (i.e., pain self-efficacy, pain-related disability, pain intensity). METHODS This study is a secondary analysis of a randomized clinical trial conducted in routine care at 82 orthopedic clinics across Germany. In total, 209 adults with CBP and diagnosed depression (SCID interview) were randomly assigned to the intervention (n = 104) or treatment-as-usual (n = 105). Cross-lagged mediation models were estimated to investigate longitudinal mediation effects of putative mediators with depression symptom severity (PHQ-9) as primary outcome at post-treatment. RESULTS Longitudinal mediation effects were observed for pain self-efficacy (ß = -0.094, 95%-CI [-0.174, -0.014], p = 0.021) and pain-related disability (ß = -0.068, 95%-CI [-0.130, -0.001], p = 0.047). Furthermore, the hypothesized direction of the mediation effects was supported, reversed causation did not occur. Pain intensity did not reveal a mediation effect. CONCLUSIONS The results suggest a relevant role of pain self-efficacy and pain-related disability as change processes in the treatment of depression for patients with CBP in routine care. However, further research is needed to disclose potential reciprocal relationships of mediators, and to extend and specify our knowledge of the mechanisms of change in digital CBT for depression.
Collapse
Affiliation(s)
- Arne G Lutsch
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany
| | - Sarah Paganini
- Department of Sport Psychology, Institute of Sports and Sport Science, University of Freiburg, Germany
| | - Lasse B Sander
- Medical Psychology and Medical Sociology, Medical Faculty, University of Freiburg, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany
| | - Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany.
| |
Collapse
|
7
|
Drüge M, Staeck R, Haller E, Seiler C, Rohner V, Watzke B. Innovative moments in low-intensity, telephone-based cognitive-behavioral therapy for depression. Front Psychol 2023; 14:1165899. [PMID: 37564304 PMCID: PMC10409642 DOI: 10.3389/fpsyg.2023.1165899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/05/2023] [Indexed: 08/12/2023] Open
Abstract
Background Innovative moments (IMs), defined as moments in psychotherapy when patients' problematic patterns change toward more elaborated and adaptive patterns, have been shown to be associated with a clinical change in patients with depression. Thus, far IMs have been studied in face-to-face settings but not in telephone-based cognitive-behavioral therapy (t-CBT). This study investigates whether IMs occur in t-CBT and examines the association between IMs and symptom improvement, and reconceptualization and symptom improvement. Methods The therapy transcripts of n = 10 patients with mild to moderate depression (range: 7-11 sessions, in total 94 sessions) undergoing t-CBT were qualitatively and quantitatively analyzed. Symptom severity (Patient Health Questionnaire-9) and IMs (levels and proportions) were assessed for each therapy session. Hierarchical linear models were used to test the prediction models. Results The rating of IMs was shown to be feasible and reliable using the Innovative Moments Coding System (IMCS) (84.04% agreement in words coded), which is indicative of the applicability of the concept of IMs in t-CBT. Only reconceptualization IMs were shown to have a predictive value for treatment success (R2 = 0.05, p = 0.01). Discussion The results should be interpreted with caution due to the exploratory nature of this study. Due to the telephone setting, it was necessary to adapt the IMCS. Nonetheless, the extent of IMs identified in the low-intensity t-CBT investigated was comparable to IMs in face-to-face therapy. Further studies are needed to clarify the association between IMs and treatment success as a change process, especially for low-intensity treatments.
Collapse
Affiliation(s)
- Marie Drüge
- Department of Psychology, Clinical Psychology with Focus on Psychotherapy Research, University of Zurich, Zurich, Switzerland
| | - Robert Staeck
- Faculty of Medicine, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Elisa Haller
- Faculty of Psychology, Clinical Psychology and Intervention Science, University of Basel, Basel, Switzerland
| | - Cara Seiler
- Department of Psychology, Clinical Psychology with Focus on Psychotherapy Research, University of Zurich, Zurich, Switzerland
| | - Valentin Rohner
- Department of Psychology, Clinical Psychology with Focus on Psychotherapy Research, University of Zurich, Zurich, Switzerland
| | - Birgit Watzke
- Department of Psychology, Clinical Psychology with Focus on Psychotherapy Research, University of Zurich, Zurich, Switzerland
| |
Collapse
|
8
|
Küchler AM, Kählke F, Bantleon L, Terhorst Y, Ebert DD, Baumeister H. Moderators and mediators of change of an internet-based mindfulness intervention for college students: secondary analysis from a randomized controlled trial. Front Digit Health 2023; 5:1179216. [PMID: 37441226 PMCID: PMC10333756 DOI: 10.3389/fdgth.2023.1179216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/07/2023] [Indexed: 07/15/2023] Open
Abstract
Background Existing evidence suggests internet- and mobile-based interventions (IMIs) improve depressive symptoms in college students effectively. However, there is far less knowledge about the potential mechanisms of change of mindfulness-based IMIs, which could contribute to optimizing target groups and interventions. Hence, within this secondary analysis of data from a randomized controlled trial (RCT), potential moderators and mediators of the effectiveness of the IMI StudiCare Mindfulness were investigated. Methods Moderation and mediation analyses were based on secondary data from a RCT that examined the effectiveness of the 7-module IMI StudiCare Mindfulness in a sample of college students (intervention group: n = 217; waitlist control group: n = 127). Assessments were collected before (t0; baseline), 4 weeks after (t1; during intervention), and 8 weeks after (t2; post-intervention) randomization. Longitudinal mediation analyses using structural equation modeling were employed, with depressive symptom severity as the dependent variable. For moderation analyses, bilinear interaction models were calculated with depressive symptom severity and mindfulness at t2 as dependent variables. All data-analyses were performed on an intention-to-treat basis. Results Mediation analyses showed a significant, full mediation of the intervention effect on depressive symptom severity through mindfulness (indirect effect, a*b = 0.153, p < 0.01). Only the number of semesters (interaction: β = 0.24, p = 0.035) was found to moderate the intervention's effectiveness on depressive symptom severity at t2, and only baseline mindfulness (interaction: β = -0.20, p = 0.047) and baseline self-efficacy (interaction: β = -0.27, p = 0.012) were found to be significant moderators of the intervention effect on mindfulness at t2. Conclusion Our results suggest a mediating role of mindfulness. Moderation analyses demonstrated that the intervention improved depressive symptom severity and mindfulness independent of most examined baseline characteristics. Future confirmatory trials will need to support these findings. Clinical Trial Registration The trial was registered a priori at the WHO International Clinical Trials Registry Platform via the German Clinical Studies Trial Register (TRN: DRKS00014774; registration date: 18 May 2018).
Collapse
Affiliation(s)
- Ann-Marie Küchler
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Fanny Kählke
- Department for Sport and Health Sciences, Professorship for Psychology & Digital Mental Health Care, Technical University of Munich, Munich, Germany
| | - Leandra Bantleon
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - David Daniel Ebert
- Department for Sport and Health Sciences, Professorship for Psychology & Digital Mental Health Care, Technical University of Munich, Munich, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| |
Collapse
|
9
|
Kaplan DM, Hughes CD, Schatten HT, Mehl MR, Armey MF, Nugent NR. Emotional change in its "natural habitat": Measuring everyday emotion regulation with passive and active ambulatory assessment methods. JOURNAL OF PSYCHOTHERAPY INTEGRATION 2023; 33:123-140. [PMID: 37588252 PMCID: PMC10427127 DOI: 10.1037/int0000291] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Ambulatory assessment methods have made it possible to study psychological phenomena in real-time, with translational potential for psychotherapy process research. This article uses case example data to demonstrate applications of ambulatory assessment to measuring emotion regulation, a process with relevance across diagnoses and treatment modalities that may be particularly important to measure in situ. Two methods are reviewed: Ecological Momentary Assessment (EMA), which enables self-reported momentary assessments as people go about their days, and the Electronically Activated Recorder (EAR), an unobtrusive naturalistic observation methodology that collects short audio recordings from participants' moment-to-moment environments, capturing an acoustic diary of their social interactions, daily behaviors, and natural daily language use. Using case example data from research applying EMA and EAR methods in the context of adolescent self-injurious thoughts and behaviors, we illustrate how EMA can be used to measure emotion regulation over time and across contexts, and how EAR can assess the behaviors and social-environmental factors that interact with emotion regulation in clinically important ways. We suggest applications of this measurement approach for investigations of clients' emotional change over the course of psychotherapy, as well as potential clinical applications of these methods.
Collapse
Affiliation(s)
- Deanna M Kaplan
- Department of Family and Preventive Medicine, Emory University School of Medicine
| | - Christopher D Hughes
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
| | - Heather T Schatten
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
- Psychosocial Research Program, Butler Hospital
| | | | - Michael F Armey
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
| | - Nicole R Nugent
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
| |
Collapse
|
10
|
Küchler AM, Schultchen D, Dretzler T, Moshagen M, Ebert DD, Baumeister H. A Three-Armed Randomized Controlled Trial to Evaluate the Effectiveness, Acceptance, and Negative Effects of StudiCare Mindfulness, an Internet- and Mobile-Based Intervention for College Students with No and "On Demand" Guidance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3208. [PMID: 36833903 PMCID: PMC9965996 DOI: 10.3390/ijerph20043208] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
The college years can be accompanied by mental distress. Internet- and mobile-based interventions (IMIs) have the potential to improve mental health but adherence is problematic. Psychological guidance might promote adherence but is resource intensive. In this three-armed randomized controlled trial, "guidance on demand" (GoD) and unguided (UG) adherence-promoting versions of the seven-module IMI StudiCare Mindfulness were compared with a waitlist control group and each other. The GoD participants could ask for guidance as needed. A total of 387 students with moderate/low mindfulness were recruited. Follow-up assessments took place after 1 (t1), 2 (t2), and 6 (t3) months. Post-intervention (t2), both versions significantly improved the primary outcome of mindfulness (d = 0.91-1.06, 95% CI 0.66-1.32) and most other mental health outcomes (d = 0.25-0.69, 95% CI 0.00-0.94) compared with WL, with effects generally persisting after 6 months. Exploratory comparisons between UG and GoD were mostly non-significant. Adherence was low but significantly higher in GoD (39%) vs. UG (28%) at the 6-month follow-up. Across versions, 15% of participants experienced negative effects, which were mostly mild. Both versions effectively promoted mental health in college students. Overall, GoD was not associated with substantial gains in effectiveness or adherence compared with UG. Future studies should investigate persuasive design to improve adherence.
Collapse
Affiliation(s)
- Ann-Marie Küchler
- Department of Clinical Psychology and Psychotherapy, Ulm University, 89081 Ulm, Germany
| | - Dana Schultchen
- Department of Clinical and Health Psychology, Ulm University, 89081 Ulm, Germany
| | - Tim Dretzler
- Department of Clinical Psychology and Psychotherapy, Ulm University, 89081 Ulm, Germany
| | - Morten Moshagen
- Department of Quantitative Methods in Psychology, Ulm University, 89081 Ulm, Germany
| | - David D. Ebert
- Department for Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, 89081 Ulm, Germany
| |
Collapse
|
11
|
Kathan A, Harrer M, Küster L, Triantafyllopoulos A, He X, Milling M, Gerczuk M, Yan T, Rajamani ST, Heber E, Grossmann I, Ebert DD, Schuller BW. Personalised depression forecasting using mobile sensor data and ecological momentary assessment. Front Digit Health 2022; 4:964582. [PMID: 36465087 PMCID: PMC9715619 DOI: 10.3389/fdgth.2022.964582] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/24/2022] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION Digital health interventions are an effective way to treat depression, but it is still largely unclear how patients' individual symptoms evolve dynamically during such treatments. Data-driven forecasts of depressive symptoms would allow to greatly improve the personalisation of treatments. In current forecasting approaches, models are often trained on an entire population, resulting in a general model that works overall, but does not translate well to each individual in clinically heterogeneous, real-world populations. Model fairness across patient subgroups is also frequently overlooked. Personalised models tailored to the individual patient may therefore be promising. METHODS We investigate different personalisation strategies using transfer learning, subgroup models, as well as subject-dependent standardisation on a newly-collected, longitudinal dataset of depression patients undergoing treatment with a digital intervention ( N = 65 patients recruited). Both passive mobile sensor data as well as ecological momentary assessments were available for modelling. We evaluated the models' ability to predict symptoms of depression (Patient Health Questionnaire-2; PHQ-2) at the end of each day, and to forecast symptoms of the next day. RESULTS In our experiments, we achieve a best mean-absolute-error (MAE) of 0.801 (25% improvement) for predicting PHQ-2 values at the end of the day with subject-dependent standardisation compared to a non-personalised baseline ( MAE = 1.062 ). For one day ahead-forecasting, we can improve the baseline of 1.539 by 12 % to a MAE of 1.349 using a transfer learning approach with shared common layers. In addition, personalisation leads to fairer models at group-level. DISCUSSION Our results suggest that personalisation using subject-dependent standardisation and transfer learning can improve predictions and forecasts, respectively, of depressive symptoms in participants of a digital depression intervention. We discuss technical and clinical limitations of this approach, avenues for future investigations, and how personalised machine learning architectures may be implemented to improve existing digital interventions for depression.
Collapse
Affiliation(s)
- Alexander Kathan
- EIHW – Chair of Embedded Intelligence for Health Care and Wellbeing, University of Augsburg, Augsburg, Germany
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Technical University of Munich, Munich, Germany
- Clinical Psychology & Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
- GET.ON Institut für Online Gesundheitstrainings GmbH/HelloBetter, Hamburg, Germany
| | - Ludwig Küster
- GET.ON Institut für Online Gesundheitstrainings GmbH/HelloBetter, Hamburg, Germany
| | - Andreas Triantafyllopoulos
- EIHW – Chair of Embedded Intelligence for Health Care and Wellbeing, University of Augsburg, Augsburg, Germany
| | - Xiangheng He
- EIHW – Chair of Embedded Intelligence for Health Care and Wellbeing, University of Augsburg, Augsburg, Germany
- GLAM – Group on Language, Audio, & Music, Imperial College London, London, UK
| | - Manuel Milling
- EIHW – Chair of Embedded Intelligence for Health Care and Wellbeing, University of Augsburg, Augsburg, Germany
| | - Maurice Gerczuk
- EIHW – Chair of Embedded Intelligence for Health Care and Wellbeing, University of Augsburg, Augsburg, Germany
| | - Tianhao Yan
- EIHW – Chair of Embedded Intelligence for Health Care and Wellbeing, University of Augsburg, Augsburg, Germany
| | | | - Elena Heber
- GET.ON Institut für Online Gesundheitstrainings GmbH/HelloBetter, Hamburg, Germany
| | - Inga Grossmann
- GET.ON Institut für Online Gesundheitstrainings GmbH/HelloBetter, Hamburg, Germany
| | - David D. Ebert
- Psychology & Digital Mental Health Care, Technical University of Munich, Munich, Germany
- GET.ON Institut für Online Gesundheitstrainings GmbH/HelloBetter, Hamburg, Germany
| | - Björn W. Schuller
- EIHW – Chair of Embedded Intelligence for Health Care and Wellbeing, University of Augsburg, Augsburg, Germany
- GLAM – Group on Language, Audio, & Music, Imperial College London, London, UK
| |
Collapse
|
12
|
Zarski AC, Velten J, Knauer J, Berking M, Ebert DD. Internet- and mobile-based psychological interventions for sexual dysfunctions: a systematic review and meta-analysis. NPJ Digit Med 2022; 5:139. [PMID: 36085306 PMCID: PMC9463146 DOI: 10.1038/s41746-022-00670-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/02/2022] [Indexed: 11/18/2022] Open
Abstract
Sexual dysfunctions are highly prevalent and undertreated. Internet- and mobile-based psychological interventions (IMIs) could be a promising addition to close this treatment gap, given their accessibility, anonymity, and scalability. This systematic review and meta-analysis investigated the efficacy of IMIs for sexual dysfunctions. A comprehensive literature search was conducted in August 2021 on randomized controlled trials investigating the effects of IMIs on sexual functioning and satisfaction compared to a control condition. Twelve RCTs with 14 comparisons were reviewed with six IMIs targeting female and six IMIs targeting male sexual dysfunctions and n = 952 participants were evaluated in the meta-analysis. IMIs were significantly more effective than control conditions (k = 11 waitlist control group, k = 3 online discussion board) at post-treatment for female sexual functioning (g = 0.59, CI: 0.28–0.90, I2 = 0%) and satisfaction (g = 0.90, CI: 0.02–1.79, I2 = 82%), and male sexual functioning (g = 0.18, CI: 0.02–0.34, I2 = 0%). No significant effect was found for male sexual satisfaction (g = 0.69, CI: −0.13–1.51, I2 = 88%) with substantial heterogeneity in studies. Most studies showed high dropout, with ten studies indicating some concern of risk of bias, and two studies showing high risk of bias. The results suggest that IMIs can be an effective treatment for sexual dysfunctions, although additional high-quality research is needed. Given the limited availability of specialized treatment for sexual dysfunctions and individual preferences for discrete treatment options, IMIs seem to be a valuable addition to routine care, empowering individuals to promote their sexual health on a guided self-help basis.
Collapse
Affiliation(s)
- Anna-Carlotta Zarski
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany. .,Professorship Psychology and Digital Mental Health Care, Department of Sport and Health Sciences, Technical University Munich, Munich, Germany.
| | - Julia Velten
- Mental Health Research and Treatment Center, Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Johannes Knauer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - David Daniel Ebert
- Professorship Psychology and Digital Mental Health Care, Department of Sport and Health Sciences, Technical University Munich, Munich, Germany
| |
Collapse
|
13
|
Balci S, Spanhel K, Sander LB, Baumeister H. Culturally adapting internet- and mobile-based health promotion interventions might not be worth the effort: a systematic review and meta-analysis. NPJ Digit Med 2022; 5:34. [PMID: 35322172 PMCID: PMC8943001 DOI: 10.1038/s41746-022-00569-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/21/2022] [Indexed: 11/17/2022] Open
Abstract
Health promotion interventions offer great potential in advocating a healthy lifestyle and the prevention of diseases. Some barriers to communicating health promotion to people of certain cultural groups might be overcome via the internet- and mobile-based interventions (IMI). This systematic review and meta-analysis aims to explore the effectiveness of culturally adapted IMI for health promotion interventions among culturally diverse populations. We systematically searched on Cochrane Central Register of Controlled Trials (CENTRAL), EbscoHost/MEDLINE, Ovid/Embase, EbscoHost/PsychINFO, and Web of Science databases in October 2020. Out of 9438 records, 13 randomized controlled trials (RCT) investigating culturally adapted health promotion IMI addressing healthy eating, physical activity, alcohol consumption, sexual health behavior, and smoking cessation included. From the included studies 10,747 participants were eligible. Culturally adapted IMI proved to be non-superior over active control conditions in short- (g = 0.10, [95% CI -0.19 to 0.40]) and long-term (g = 0.20, [95% CI -0.11 to 0.51]) in promoting health behavior. However, culturally adapted IMI for physical activity (k = 3, N = 296) compared to active controls yielded a beneficial effect in long-term (g = 0.48, [95%CI 0.25 to 0.71]). Adapting health promotion IMI to the cultural context of different cultural populations seems not yet to be recommendable given the substantial adaption efforts necessary and the mostly non-significant findings. However, these findings need to be seen as preliminary given the limited number of included trials with varying methodological rigor and the partly substantial between-trial heterogeneity pointing in the direction of potentially useful culturally adapted IMI which now need to be disentangled from the less promising approaches.PROSPERO registration number: 42020152939.
Collapse
Affiliation(s)
- Sumeyye Balci
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, D-89081, Ulm, Germany.
| | - Kerstin Spanhel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, D-79085, Freiburg, Germany
| | - Lasse Bosse Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, D-79085, Freiburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, D-89081, Ulm, Germany
| |
Collapse
|
14
|
Spanhel K, Hovestadt E, Lehr D, Spiegelhalder K, Baumeister H, Bengel J, Sander LB. Engaging Refugees With a Culturally Adapted Digital Intervention to Improve Sleep: A Randomized Controlled Pilot Trial. Front Psychiatry 2022; 13:832196. [PMID: 35280163 PMCID: PMC8905517 DOI: 10.3389/fpsyt.2022.832196] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/31/2022] [Indexed: 01/09/2023] Open
Abstract
Refugees are exposed to multiple stressors affecting their mental health. Given various barriers to mental healthcare in the arrival countries, innovative healthcare solutions are needed. One such solution could be to offer low-threshold treatments, for example by culturally adapting treatments, providing them in a scalable format, and addressing transdiagnostic symptoms. This pilot trial examined the feasibility, acceptance, and preliminary effectiveness of a culturally adapted digital sleep intervention for refugees. Sixty-six refugees participated, with 68.2% of them seeking psychological help for the first time. Only three participants did not show clinically significant insomnia severity, 93.9% reported past traumatic experiences. Participants were randomly assigned to the intervention group (IG) or the waitlist control group (CG). Insomnia severity, measured by the Insomnia Severity Index, and secondary outcomes (sleep quality, fear of sleep, fatigue, depression, wellbeing, mental health literacy) were assessed at baseline, 1 and 3 months after randomization. The self-help intervention included four modules on sleep hygiene, rumination, and information on mental health conditions associated with sleep disturbances. 66.7% of the IG completed all modules. Satisfaction with the intervention and its perceived cultural appropriateness were high. Linear multilevel analyses revealed a small, non-significant intervention effect on insomnia severity of Hedge's g = 0.28 at 3-months follow-up, comparing the IG to the CG [F 2, 60 = 0.88, p = 0.421]. This non-confirmatory pilot trial suggests that low-threshold, viable access to mental healthcare can be offered to multiple burdened refugees by culturally adapting an intervention, providing it in a scalable format, and addressing a transdiagnostic symptom.
Collapse
Affiliation(s)
- Kerstin Spanhel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Eva Hovestadt
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Dirk Lehr
- Department of Health Psychology, Institute of Psychology, Leuphana University Lueneburg, Lueneburg, Germany
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Juergen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Lasse B Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| |
Collapse
|
15
|
Domhardt M, Grund S, Mayer A, Büscher R, Ebert DD, Sander LB, Karyotaki E, Cuijpers P, Baumeister H. Unveiling mechanisms of change in digital interventions for depression: Study protocol for a systematic review and individual participant data meta-analysis. Front Psychiatry 2022; 13:899115. [PMID: 36262633 PMCID: PMC9574035 DOI: 10.3389/fpsyt.2022.899115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The efficacy and effectiveness of digital interventions for depression are both well-established. However, precise effect size estimates for mediators transmitting the effects of digital interventions are not available; and integrative insights on the specific mechanisms of change in internet- and mobile-based interventions (IMIs)-as related to key features like delivery type, accompanying support and theoretical foundation-are largely pending. OBJECTIVE We will conduct a systematic review and individual participant data meta-analysis (IPD-MA) evaluating the mediators associated with therapeutic change in various IMIs for depression in adults. METHODS We will use three electronic databases (i.e., Embase, Medline/PubMed, PsycINFO) as well as an already established database of IPD to identify relevant published and unpublished studies. We will include (1) randomized controlled trials that examine (2) mediators of (3) guided and unguided (4) IMIs with (5) various theoretical orientations for (6) adults with (7) clinically relevant symptoms of depression (8) compared to an active or passive control condition (9) with depression symptom severity as primary outcome. Study selection, data extraction, as well as quality and risk of bias (RoB) assessment will be done independently by two reviewers. Corresponding authors of eligible primary studies will be invited to share their IPD for this meta-analytic study. In a 1-stage IPD-MA, mediation analyses (e.g., on potential mediators like self-efficacy, emotion regulation or problem solving) will be performed using a multilevel structural equation modeling approach within a random-effects framework. Indirect effects will be estimated, with multiple imputation for missing data; the overall model fit will be evaluated and statistical heterogeneity will be assessed. Furthermore, we will investigate if indirect effects are moderated by different variables on participant- (e.g., age, sex/gender, symptom severity), study- (e.g., quality, studies evaluating the temporal ordering of changes in mediators and outcomes), and intervention-level (e.g., theoretical foundation, delivery type, guidance). DISCUSSION This systematic review and IPD-MA will generate comprehensive information on the differential strength of mediators and associated therapeutic processes in digital interventions for depression. The findings might contribute to the empirically-informed advancement of psychotherapeutic interventions, leading to more effective interventions and improved treatment outcomes in digital mental health. Besides, with our novel approach to mediation analyses with IPD-MA, we might also add to a methodological progression of evidence-synthesis in psychotherapy process research. STUDY REGISTRATION WITH OPEN SCIENCE FRAMEWORK OSF https://osf.io/md7pq/.
Collapse
Affiliation(s)
- Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Simon Grund
- Department of Quantitative Psychology, University of Hamburg, Hamburg, Germany
| | - Axel Mayer
- Department of Psychological Methods and Evaluation, Bielefeld University, Bielefeld, Germany
| | - Rebekka Büscher
- Department of Rehabilitation Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany.,Medical Psychology and Medical Sociology, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - David D Ebert
- Department of Psychology and Digital Mental Health Care, Technical University Munich, Munich, Germany
| | - Lasse B Sander
- Department of Rehabilitation Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany.,Medical Psychology and Medical Sociology, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| |
Collapse
|
16
|
Domhardt M, Engler S, Nowak H, Lutsch A, Baumel A, Baumeister H. Mechanisms of Change in Digital Health Interventions for Mental Disorders in Youth: Systematic Review. J Med Internet Res 2021; 23:e29742. [PMID: 34842543 PMCID: PMC8665396 DOI: 10.2196/29742] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/14/2021] [Accepted: 07/27/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Digital health interventions (DHIs) are efficacious for several mental disorders in youth; however, integrated, evidence-based knowledge about the mechanisms of change in these interventions is lacking. OBJECTIVE This systematic review aims to comprehensively evaluate studies on mediators and mechanisms of change in different DHIs for common mental disorders in children and adolescents. METHODS A systematic literature search of the electronic databases Cochrane Central Register of Controlled Trials, Embase, MEDLINE, and PsycINFO was conducted, complemented by backward and forward searches. Two independent reviewers selected studies for inclusion, extracted the data, and rated the methodological quality of eligible studies (ie, risk of bias and 8 quality criteria for process research). RESULTS A total of 25 studies that have evaluated 39 potential mediators were included in this review. Cognitive mediators were the largest group of examined intervening variables, followed by a broad range of emotional and affective, interpersonal, parenting behavior, and other mediators. The mediator categories with the highest percentages of significant intervening variables were the groups of affective mediators (4/4, 100%) and combined cognitive mediators (13/19, 68%). Although more than three-quarters of the eligible studies met 5 or more quality criteria, causal conclusions have been widely precluded. CONCLUSIONS The findings of this review might guide the empirically informed advancement of DHIs, contributing to improved intervention outcomes, and the discussion of methodological recommendations for process research might facilitate mediation studies with more pertinent designs, allowing for conclusions with higher causal certainty in the future.
Collapse
Affiliation(s)
- Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Sophie Engler
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Hannah Nowak
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Arne Lutsch
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Amit Baumel
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| |
Collapse
|
17
|
Domhardt M, Nowak H, Engler S, Baumel A, Grund S, Mayer A, Terhorst Y, Baumeister H. Therapeutic processes in digital interventions for anxiety: A systematic review and meta-analytic structural equation modeling of randomized controlled trials. Clin Psychol Rev 2021; 90:102084. [PMID: 34610493 DOI: 10.1016/j.cpr.2021.102084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/13/2021] [Accepted: 09/08/2021] [Indexed: 01/14/2023]
Abstract
While the efficacy of Internet- and mobile-based interventions (IMIs) for treating anxiety disorders is well established, there is no comprehensive overview about the underlying therapeutic processes so far. Thus, this systematic review and meta-analysis evaluated research on mediators and mechanisms of change in IMIs for adult anxiety disorders (PROSPERO: CRD42020185545). A systematic literature search was performed in five databases (i.e., CENTRAL, Embase, MEDLINE, PsycINFO and ClinicalTrials.gov). Two reviewers independently screened studies for inclusion, assessed the risk of bias and adherence to quality criteria for process research. Overall, 26 studies (N = 6042) investigating 64 mediators were included. Samples consisted predominantly of participants with clinically relevant symptoms of generalized anxiety disorder and severe health anxiety, as well as of participants with non-clinically relevant anxiety symptoms. The largest group of examined mediators (45%) were cognitive variables, evincing also the second highest proportion of significance (19/29); followed in numbers by skills (examined: 22%; significant: 10/14) and a wide range of other (19%; 7/12), emotional/affective (11%; 2/7) and behavioral mediators (3%; 1/2). Meta-analytical synthesis of mediators, limited by a small number of eligible studies, was conducted by deploying a two-stage structural equation modeling approach, resulting in a significant indirect effect for negative thinking (k = 3 studies) and non-significant indirect effects for combined cognitive variables, both in clinical (k = 5) and non-clinical samples (k = 3). The findings of this review might further the understanding on presumed change mechanisms in IMIs for anxiety, informing intervention development and the concurrent optimization of outcomes. Furthermore, by reviewing eligible mediation studies, we discuss methodological implications and recommendations for future process research, striving for causally robust findings. Future studies should investigate a broader range of variables as potential mediators, as well as to develop and apply original (digital) process and engagement measures to gather qualitative and high-resolution data on therapeutic processes.
Collapse
Affiliation(s)
- Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany.
| | - Hannah Nowak
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany
| | - Sophie Engler
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany
| | - Amit Baumel
- Department of Community Mental Health, University of Haifa, Israel
| | - Simon Grund
- IPN - Leibniz Institute for Science and Mathematics Education, Kiel, Germany
| | - Axel Mayer
- Department of Psychological Methods and Evaluation, Bielefeld University, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany; Department of Psychological Research Methods, Ulm University, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany
| |
Collapse
|
18
|
Baumeister H, Ebert DD, Snoek F. Special issue on digital health interventions in chronic medical conditions: Editorial. Internet Interv 2021; 28:100457. [PMID: 35646604 PMCID: PMC9136333 DOI: 10.1016/j.invent.2021.100457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Chronic medical conditions are increasingly common and associated with a high burden for persons affected by them. Digital health interventions might be a viable way to support persons with a chronic illness in their coping and self-management. The present special issue's editorial on digital health interventions in chronic medical conditions summarizes core findings and discusses next steps needed to further the field while avoiding to reinvent the wheel, thereby elaborating on four topics extracted from the special issue's articles: 1) Needs assessment and digital intervention development, 2) Efficacy and (cost-)effectiveness, 3) Dissemination and implementation research: reach and engagement as well as 4) next generation of digital interventions.
Collapse
Affiliation(s)
- Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Germany,Correspondence: Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Straße 16, D-89081 Ulm, Germany.
| | - David D. Ebert
- Psychology and Digital Mental Health Care, Department of Sport and Health Sciences, Technical University of Munich, Germany
| | - Frank Snoek
- Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| |
Collapse
|
19
|
Domhardt M, Messner EM, Eder AS, Engler S, Sander LB, Baumeister H, Terhorst Y. Mobile-based interventions for common mental disorders in youth: a systematic evaluation of pediatric health apps. Child Adolesc Psychiatry Ment Health 2021; 15:49. [PMID: 34517896 PMCID: PMC8438844 DOI: 10.1186/s13034-021-00401-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/27/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The access to empirically-supported treatments for common mental disorders in children and adolescents is often limited. Mental health apps might extend service supplies, as they are deemed to be cost-efficient, scalable and appealing for youth. However, little is known about the quality of available apps. Therefore, we aimed to systematically evaluate current mobile-based interventions for pediatric anxiety, depression and posttraumatic stress disorder (PTSD). METHODS Systematic searches were conducted in Google Play Store and Apple App Store to identify relevant apps. To be eligible for inclusion, apps needed to be: (1) designed to target either anxiety, depression or PTSD in youth (0-18 years); (2) developed for children, adolescents or caregivers; (3) provided in English or German; (4) operative after download. The quality of eligible apps was assessed with two standardized rating systems (i.e., Mobile App Rating Scale (MARS) and ENLIGHT) independently by two reviewers. RESULTS Overall, the searches revealed 3806 apps, with 15 mental health apps (0.39%) fulfilling our inclusion criteria. The mean overall scores suggested a moderate app quality (MARS: M = 3.59, SD = 0.50; ENLIGHT: M = 3.22, SD = 0.73). Moreover, only one app was evaluated in an RCT. The correlation of both rating scales was high (r = .936; p < .001), whereas no significant correlations were found between rating scales and user ratings (p > .05). CONCLUSIONS Our results point to a rather poor overall app quality, and indicate an absence of scientific-driven development and lack of methodologically sound evaluation of apps. Thus, future high-quality research is required, both in terms of theoretically informed intervention development and assessment of mental health apps in RCTs. Furthermore, institutionalized best-practices that provide central information on different aspects of apps (e.g., effectiveness, safety, and data security) for patients, caregivers, stakeholders and mental health professionals are urgently needed.
Collapse
Affiliation(s)
- Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081, Ulm, Germany
| | - Eva-Maria Messner
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081, Ulm, Germany
| | - Anna-Sophia Eder
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081, Ulm, Germany
| | - Sophie Engler
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081, Ulm, Germany
| | - Lasse B Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs-University Freiburg, Engelberger Str. 41, 79106, Freiburg im Breisgau, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081, Ulm, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081, Ulm, Germany.
- Department of Research Methods, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89069, Ulm, Germany.
| |
Collapse
|
20
|
Domhardt M, Baumeister H. Wirkfaktoren und Veränderungsmechanismen digitaler psychotherapeutischer Interventionen. PSYCHOTHERAPEUT 2021. [DOI: 10.1007/s00278-021-00525-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
21
|
Schuster R, Kaiser T, Terhorst Y, Messner EM, Strohmeier LM, Laireiter AR. Sample size, sample size planning, and the impact of study context: systematic review and recommendations by the example of psychological depression treatment. Psychol Med 2021; 51:902-908. [PMID: 33879275 PMCID: PMC8161431 DOI: 10.1017/s003329172100129x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 01/27/2021] [Accepted: 03/23/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Sample size planning (SSP) is vital for efficient studies that yield reliable outcomes. Hence, guidelines, emphasize the importance of SSP. The present study investigates the practice of SSP in current trials for depression. METHODS Seventy-eight randomized controlled trials published between 2013 and 2017 were examined. Impact of study design (e.g. number of randomized conditions) and study context (e.g. funding) on sample size was analyzed using multiple regression. RESULTS Overall, sample size during pre-registration, during SSP, and in published articles was highly correlated (r's ≥ 0.887). Simultaneously, only 7-18% of explained variance related to study design (p = 0.055-0.155). This proportion increased to 30-42% by adding study context (p = 0.002-0.005). The median sample size was N = 106, with higher numbers for internet interventions (N = 181; p = 0.021) compared to face-to-face therapy. In total, 59% of studies included SSP, with 28% providing basic determinants and 8-10% providing information for comprehensible SSP. Expected effect sizes exhibited a sharp peak at d = 0.5. Depending on the definition, 10.2-20.4% implemented intense assessment to improve statistical power. CONCLUSIONS Findings suggest that investigators achieve their determined sample size and pre-registration rates are increasing. During study planning, however, study context appears more important than study design. Study context, therefore, needs to be emphasized in the present discussion, as it can help understand the relatively stable trial numbers of the past decades. Acknowledging this situation, indications exist that digital psychiatry (e.g. Internet interventions or intense assessment) can help to mitigate the challenge of underpowered studies. The article includes a short guide for efficient study planning.
Collapse
Affiliation(s)
- Raphael Schuster
- Department of Psychology, University of Salzburg, Austria
- Center for Clinical Psychology, Psychotherapy and Health Psychology, University of Salzburg, Austria
| | - Tim Kaiser
- Department of Psychology, University of Greifswald, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, University of Ulm, Germany
- Department of Research Methods, University of Ulm, Germany
| | - Eva Maria Messner
- Department of Clinical Psychology and Psychotherapy, University of Ulm, Germany
| | | | - Anton-Rupert Laireiter
- Department of Psychology, University of Salzburg, Austria
- Center for Clinical Psychology, Psychotherapy and Health Psychology, University of Salzburg, Austria
- Faculty of Psychology, University of Vienna, Austria
| |
Collapse
|
22
|
Domhardt M, Schröder A, Geirhos A, Steubl L, Baumeister H. Efficacy of digital health interventions in youth with chronic medical conditions: A meta-analysis. Internet Interv 2021; 24:100373. [PMID: 33732626 PMCID: PMC7941178 DOI: 10.1016/j.invent.2021.100373] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/18/2021] [Accepted: 02/17/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Digital health interventions might extend service provisions for youth with chronic medical conditions (CC) and comorbid mental health symptoms. We aimed to comprehensively evaluate the efficacy of Internet- and mobile-based interventions (IMIs) for different psychological and disease-related outcomes in children and adolescents with CC. METHOD Studies were identified by systematic searches in CENTRAL, Embase, MEDLINE/PubMed and PsycINFO, complemented by searches in reference lists of eligible studies and other reviews. We included studies, when they were randomized controlled trials (RCTs) comparing the efficacy of an IMI to control conditions in improving psychological and disease-related outcomes in youth (mean age ≤ 18 years) with CC. Study selection, data extraction and risk of bias assessment were conducted independently by two reviewers. Meta-analyses were performed within a random-effects model, and Hedges' g (with 95% confidence intervals) was calculated as effect size measure. Primary outcomes were comorbid mental health symptoms (i.e., depression, anxiety and stress), as well as quality of life and self-efficacy. RESULTS A total of 19 randomized controlled trials (2410 patients) were included in this meta-analysis. IMIs were associated with improvements in self-efficacy (g = 0.38; 95% CI, 0.15 to 0.61; I 2 = 0) and combined disease-related outcomes (g = -0.13; 95% CI, -0.25 to -0.01; I 2 = 21). Meta-analyses on other outcomes were non-significant, and some pre-planned analyses were not feasible because of a shortage of studies. CONCLUSION The available evidence on IMIs for improving mental and health-related outcomes in youth with CC is limited. Our findings point to a rather small benefit and limited efficacy. Future research is needed, to comprehensively assess the potential of IMIs to extend collaborative care, and to identify factors contributing to improved user-centered interventions with better treatment outcomes.
Collapse
Affiliation(s)
- Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Germany
| | - Annalena Schröder
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Germany
| | - Agnes Geirhos
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Germany
| | - Lena Steubl
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Germany
| |
Collapse
|
23
|
Steubl L, Sachser C, Baumeister H, Domhardt M. Mechanisms of change in Internet- and mobile-based interventions for PTSD: a systematic review and meta-analysis. Eur J Psychotraumatol 2021; 12:1879551. [PMID: 34025920 PMCID: PMC8128120 DOI: 10.1080/20008198.2021.1879551] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: While Internet- and mobile-based interventions (IMIs) are potential options to increase the access to evidence-based therapies for post-traumatic stress disorder (PTSD), comprehensive knowledge on their working mechanisms is still scarce. Objective: We aimed to evaluate studies investigating the efficacy and mechanisms of change in IMIs for adults with PTSD. Method: In this systematic review and meta-analysis (PROSPERO CRD42019130314), five databases were consulted to identify relevant studies, complemented by forward (i.e. citation search) and backward (i.e. review of reference lists from included studies) searches. Randomized controlled trials (RCTs) investigating the efficacy of IMIs compared to active controls, as well as component and mediation studies were included. Two independent reviewers extracted the data and assessed the risk of bias and requirements for process research. Random-effects meta-analyses on PTSD symptom severity as primary outcome were conducted and further information was synthesized qualitatively. Results: In total, 33 RCTs were included (N = 5421). The meta-analysis comparing IMIs to non-bonafide active controls yielded a significant standardized mean difference (SMD) of -0.36 (95%CI -0.53 to -0.19) favouring IMIs. Although meta-analytic pooling was not possible for the component and mediation studies, evidence suggests no differential effects regarding PTSD symptom reduction between different levels of support and personalization and between different types of exposure. Moreover, mediation studies revealed significant intervening variable effects for self-efficacy beliefs, perceived physical impairment, social acknowledgement, and trauma disclosure. Conclusions: Results indicate that IMIs for PTSD are superior to active controls. Furthermore, findings may contribute to the development of new interventions by outlining important directions for future research (e.g. regarding requirements for process research) and highlighting potential mechanisms of change (i.e. self-efficacy, perceived physical impairment, social acknowledgement, and trauma disclosure).
Collapse
Affiliation(s)
- Lena Steubl
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Cedric Sachser
- Clinic for Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| |
Collapse
|