Abstract
BackgroundOnline psychotherapy is clinically effective yet why, how, and for whom the effects are greatest remain largely unknown. In the present study, we examined whether mental health self-efficacy (MHSE), a construct derived from Bandura’s Social Learning Theory (SLT), influenced symptom and functional outcomes of a new mobile phone and web-based psychotherapy intervention for people with mild-to-moderate depression, anxiety and stress.MethodsSTUDY I: Data from 49 people with symptoms of depression, anxiety and/or stress in the mild-to-moderate range were used to examine the reliability and construct validity of a new measure of MHSE, the Mental Health Self-efficacy Scale (MHSES). STUDY II: We conducted a secondary analysis of data from a recently completed randomised controlled trial (N = 720) to evaluate whether MHSE effected post-intervention outcomes, as measured by the Depression, Anxiety and Stress Scales (DASS) and Work and Social Adjustment Scale (WSAS), for people with symptoms in the mild-to-moderate range.ResultsSTUDY I: The data established that the MHSES comprised a unitary factor, with acceptable internal reliability (Cronbach’s alpha = .89) and construct validity. STUDY II: The intervention group showed significantly greater improvement in MHSE at post-intervention relative to the control conditions (p’s < = .000). MHSE mediated the effects of the intervention on anxiety and stress symptoms. Furthermore, people with low pre-treatment MHSE reported the greatest post-intervention gains in depression, anxiety and overall distress. No effects were found for MHSE on work and social functioning.ConclusionMental health self-efficacy influences symptom outcomes of a self-guided mobile phone and web-based psychotherapeutic intervention and may itself be a worthwhile target to increase the effectiveness and efficiency of online treatment programs.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12610000625077.
Highlights
Online psychotherapy is clinically effective yet why, how, and for whom the effects are greatest remain largely unknown
We report on outcomes of two studies: the development and psychometric evaluation of the Mental Health Self-efficacy Scale (MHSES) (Study I), and secondary analysis of data from a recently completed Randomised controlled trials (RCTs) to examine the effects of mental health self-efficacy (MHSE) on symptom and functional outcomes of a fully-automated mobile phone and web intervention (Study II)
Study I An initial factor analysis (FA) of the six MHSES items yielded a single factor solution accounting for 67% of the cumulative variance
Summary
Online psychotherapy is clinically effective yet why, how, and for whom the effects are greatest remain largely unknown. We examined whether mental health self-efficacy (MHSE), a construct derived from Bandura’s Social Learning Theory (SLT), influenced symptom and functional outcomes of a new mobile phone and web-based psychotherapy intervention for people with mild-to-moderate depression, anxiety and stress. Online self-management of depression and anxiety has evolved as a popular, clinically effective and costefficient public health solution to reducing the personal and societal burden associated with unmet treatment need [1,2]. Whereas effect sizes in studies of online interventions compare well with face-to-face treatments [6], the psychological mechanisms that explain these findings are largely unknown. A potential framework for understanding the effects of online interventions for mental health problems is provided by Bandura’s Social Learning Theory (SLT; [9]), a theory that specifies multiple interacting determinants of behaviour and behaviour change. Findings show that higher levels of pre-treatment self-efficacy and increased self-efficacy over the course of treatment are important predictors of therapeutic success, and suggest that precise targeting of self-efficacy antecedent processes and information cues may assist in honing treatment efficiency and efficacy [9]
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