Digital Mental Health Interventions Research Articles

Digital Mental Health for Schizophrenia and Other Severe Mental Illnesses: An International Consensus on Current Challenges and Potential Solutions.

Digital approaches may be helpful in augmenting care to address unmet mental health needs, particularly for schizophrenia and severe mental illness (SMI). An international multidisciplinary group was convened to reach a consensus on the challenges and potential solutions regarding collecting data, delivering treatment, and the ethical challenges in digital mental health approaches for schizophrenia and SMI. The consensus development panel method was used, with an in-person meeting of 2 groups: the expert group and the panel. Membership was multidisciplinary including those with lived experience, with equal participation at all stages and coproduction of the consensus outputs and summary. Relevant literature was shared in advance of the meeting, and a systematic search of the recent literature on digital mental health interventions for schizophrenia and psychosis was completed to ensure that the panel was informed before the meeting with the expert group. Four broad areas of challenge and proposed solutions were identified: (1) user involvement for real coproduction; (2) new approaches to methodology in digital mental health, including agreed standards, data sharing, measuring harms, prevention strategies, and mechanistic research; (3) regulation and funding issues; and (4) implementation in real-world settings (including multidisciplinary collaboration, training, augmenting existing service provision, and social and population-focused approaches). Examples are provided with more detail on human-centered research design, lived experience perspectives, and biomedical ethics in digital mental health approaches for SMI. The group agreed by consensus on a number of recommendations: (1) a new and improved approach to digital mental health research (with agreed reporting standards, data sharing, and shared protocols), (2) equal emphasis on social and population research as well as biological and psychological approaches, (3) meaningful collaborations across varied disciplines that have previously not worked closely together, (4) increased focus on the business model and product with planning and new funding structures across the whole development pathway, (5) increased focus and reporting on ethical issues and potential harms, and (6) organizational changes to allow for true communication and coproduction with those with lived experience of SMI. This study approach, combining an international expert meeting with patient and public involvement and engagement throughout the process, consensus methodology, discussion, and publication, is a helpful way to identify directions for future research and clinical implementation in rapidly evolving areas and can be combined with measurements of real-world clinical impact over time. Similar initiatives will be helpful in other areas of digital mental health and similarly fast-evolving fields to focus research and organizational change and effect improved real-world clinical implementation.

Evidence-Based Therapist-Supported Digital Mental Health Intervention for Patients Experiencing Medical Multimorbidity: A Retrospective Cohort Intent-to-Treat Study.

Multimorbidity or the co-occurrence of multiple health conditions is increasing globally and is associated with significant psychological complications. It is unclear whether digital mental health (DMH) interventions for patients experiencing multimorbidity are effective, particularly given that this patient population faces more treatment resistance. The goal of the current study was to examine the impact of smartphone-delivered DMH interventions for patients presenting with elevated internalizing symptoms that have reported multiple lifetime medical conditions. This preregistered (see https://osf.io/vh2et/) retrospective cohort intent-to-treat study with 2,819 patients enrolled in a therapist-supported DMH intervention examined the associations between medical multimorbidity (MMB) and mental health outcomes. Results indicated that more MMB was significantly associated with greater presenting mental health symptom severity. MMB did not have a deleterious influence on depressive symptom trajectories across treatment, although having one medical condition was associated with a steeper decrease in anxiety symptoms compared to patients with no medical conditions. Finally, MMB was not associated with time to dropout, but was associated with higher dropout and was differentially associated with fewer beneficial treatment outcomes, although this is likely attributable to higher presenting symptom severity, rather than lesser symptom reductions during treatment. Overall, the MHP was associated with large effect size decreases in depressive and anxiety symptoms regardless of the number of MMB. Future DMH treatments and research might investigate tailored barrier reduction and extended treatment lengths for patients experiencing MMB to allow for greater treatment dose to reduce symptoms below clinical outcome thresholds.

Scoping Review: Digital Mental Health Interventions for Children and Adolescents Affected by War.

Over 200 million children and adolescents live in countries affected by violent conflict, are likely to have complex mental health needs, and struggle to access traditional mental health services. Digital mental health interventions have the potential to overcome some of the barriers in accessing mental health support. We performed a scoping review to map existing digital mental health interventions relevant for children and adolescents affected by war, examine the strength of the evidence base, and inform the development of future interventions. Based on a pre-registered strategy, we systematically searched MEDLINE, Embase, Global Health, APA PsychInfo, and Google Scholar from the creation of each database to 30th September 2022, identifying k=6,843 studies. Our systematic search was complemented by extensive consultation with experts from the GROW Network. The systematic search identified 6 relevant studies: one evaluating digital mental health interventions for children and adolescents affected by war and five for those affected by disasters. Experts identified 35 interventions of possible relevance. The interventions spanned from universal prevention to specialist-guided treatment. Most interventions directly targeted young people and parents/carers and were self-guided. A quarter of the interventions were tested through randomized controlled trials. Because most interventions were not culturally or linguistically adapted to relevant contexts, their implementation potential was unclear. There is very limited evidence for the use of digital mental health interventions for children and adolescents affected by war at present. The review provides a framework to inform the development of new interventions.

Experiences using an online therapist-guided psychotherapy platform (OPTT) in correctional workers with depression, anxiety, and PTSD.

Correctional workers (CWs) are frequently exposed to potentially traumatic events in the workplace, leading to an increased prevalence of mental health concerns. Online psychotherapy can address many of the barriers CWs face when seeking adequate mental health care. Despite their benefits, CWs' experience using digital mental health interventions is relatively unknown. This information could be valuable in developing enhanced care delivery to improve recruitment, retention, satisfaction, and treatment outcomes. This study investigated the experiences of a sample of CWs enrolled in a clinical trial evaluating the efficacy of the Online Psychotherapy Tool (OPTT) in this population. Participants were surveyed and interviewed to capture their opinions and feedback on the program. Survey analysis was conducted through Qualtrics statistical analysis software. The interview transcripts and open-ended survey questions were analyzed using thematic analysis methods in NVivo. Participants (n=14) were cis-gender, predominantly white, with an average age of 38 years. While most respondents preferred in-person therapy, they also reported the benefits of the online psychotherapy program. Specifically, they expressed positive perceptions of the platform, the quality and interaction of their care provider, and the homework assignments and skills learned. Lack of motivation to complete weekly homework assignments was a frequently cited challenge. Unhelpful aspects of the therapy noted issues with the online format and frustration with certain program elements. Participants expressed a positive outlook on the program, the platform, and treatment outcomes. A preference for in-person therapy was still indicated, demonstrating the need to focus on engagement in digital mental health interventions. In addition, the findings of this study shed light on the factors that can influence help-seeking in this population, including stigma in the work environment, demanding work schedules, workplace perceptions, and previous experiences accessing mental health services.

Outcomes of Best-Practice Guided Digital Mental Health Interventions for Youth and Young Adults with Emerging Symptoms: Part II. A Systematic Review of User Experience Outcomes.

Although many young people demonstrate resilience and strength, research and clinical evidence highlight an upward trend in mental health concerns among those aged 12 to 25years. Youth-specific digital mental health interventions (DMHIs) aim to address this trend by providing timely access to mental health support for young people (12-25years). However, there is a considerable gap in understanding young people user experiences with digital interventions. This review, co-designed with Australia's leading mental health organization Beyond Blue, utilizes a systematic methodology to synthesize evidence on user experience in youth-oriented digital mental health interventions that are fully or partially guided. Five relevant online databases were searched for articles published from 2018 to 2023, yielding 22,482 articles for screening and 22 studies were included in the present analysis. User experience outcomes relating to satisfaction and engagement were assessed for each included intervention, with experience indicators relating to usefulness, usability, value, credibility, and desirability being examined. Elements associated with positive/negative outcomes were extracted. Elements shown to positively influence user experience included peer engagement, modern app-based delivery, asynchronous support, and personalized content. In contrast, users disliked static content, homework/log-keeping, the requirement for multiple devices, and social media integration. Asynchronous interventions showed high satisfaction but faced engagement issues, with combined asynchronous/synchronous interventions reporting better completion rates. DMHIs offer a promising platform for youth mental health support and has the potential to dramatically increase the reach of interventions through the adoption of technological and user experience best practices. While young people respond positively to many aspects of intervention modernization, such as interactive, app-based design, other concepts, such as social media integration, they need to be adopted by the field more cautiously to ensure trust and engagement.Trial Registration CRD42023405812.

Exploring behaviour-intention gaps to explain low retention in a community-based video-conferencing intervention for depression: lessons for researchers using technology as interventions

Purpose This paper aims to reflect on the outcomes of a community-based video-conferencing intervention for depression, predating the COVID-19 pandemic. The study investigates the potential implications of its findings for enhancing adherence to digital mental health interventions. The primary objective is to present considerations for researchers aimed at minimising the intention-behaviour gap frequently encountered in digital mental health interventions. Design/methodology/approach A randomised control feasibility trial design was used to implement a telehealth model adapted from an established face-to-face community-based intervention for individuals clinically diagnosed with depression. In total, 60 participants were initially recruited in association with a local mental health charity offering traditional talking-based therapies with only eight opting to continue through all phases of the project. Modifications aligning with technological advancements were introduced. Findings However, the study faced challenges, with low uptake observed after an initial surge in recruitment interest. The behaviour-intention gap highlighted technology as a barrier to service accessibility, exacerbated by participant age. Furthermore, the clinical diagnosis of depression, characterised by low mood and reduced interest in activities, emerged as a potential influencing factor. Research limitations/implications The limitations of the research include its pre-pandemic execution, during a nascent stage of technological mental health interventions when participants were less familiar with online developments. Practical implications Despite these limitations, this study's reflections offer valuable insights for researchers aiming to design and implement telehealth services. Addressing the intention-behaviour gap necessitates a nuanced understanding of participant demographics, diagnosis and technological familiarity. Social implications The study's relevance extends to post-pandemic society, urging researchers to reassess assumptions about technology availability to ensure engagement. This paper contributes to the mental health research landscape by raising awareness of critical considerations in the design and implementation of digital mental health interventions. Originality/value Reflections from a pre-pandemic intervention in line with the developments of a post-pandemic society will allow for research to consider that because the technology is available does not necessarily result in engagement.

Predictors of adherence to a publicly available self-guided digital mental health intervention

ABSTRACT Low adherence to self-guided digital mental health interventions (DMHIs) have raised concerns about their real-world effectiveness. Naturalistic data from self-guided DMHIs are often not available, hindering our ability to assess adherence among real-world users. This study aimed to analyze 3 years of user data from the public launch of an empirically supported 12-session self-guided DMHI, to assess overall program adherence rates and explore predictors of adherence. Data from 984 registered users were analyzed. Results showed that only 14.8% of users completed all 12 modules and 68.6% completed less than half of the modules. Users who were younger, had milder depression, had never seen a mental health provider, and who rejected signing-up for weekly program emails completed significantly more modules. Results add to concerns about the generalizability of controlled research on DMHIs due to lower adherence outside of research trials. This study highlights the potential of user data in identifying key factors that may be related to adherence. By examining adherence patterns among different sub-sets of users, we can pinpoint and focus on individuals who may adhere and benefit more from self-guided programs. Findings could also have implications for guiding intervention personalization for individuals who struggle to complete DMHIs.

Digitization and its Discontents: The Promise and Limitations of Digital Mental Health Interventions

AbstractThere is a mental health crisis in the United States that shows no signs of abating. Prevalence rates of mental disorders among both adults and children are rising and there are simply not enough mental health professionals to meet the growing demand. To address this problem, digital programs are being designed to diagnose and treat mental health conditions either adjunctively to a human clinician or as stand-alone treatments. Such developments hold great promise in ameliorating the mental health professional supply shortage. However, certain limitations of digital programs may prevent many users from desiring a digital psychotherapist. This paper surveys both the promise, and limitations, of digital psychotherapies.

Expanding our understanding of digital mental health interventions for Indigenous youth: An updated systematic review.

Past research has examined available literature on electronic mental health interventions for Indigenous youth with mental health concerns. However, as there have recently been increases in both the number of studies examining electronic mental health interventions and the need for such interventions (i.e. during periods of pandemic isolation), the present systematic review aims to provide an updated summary of the available peer-reviewed and grey literature on electronic mental health interventions applicable to Indigenous youth. The purpose of this review is to better understand the processes used for electronic mental health intervention development. Among the 48 studies discussed, smoking cessation and suicide were the most commonly targeted mental health concerns in interventions. Text message and smartphone application (app) interventions were the most frequently used delivery methods. Qualitative, quantitative, and/or mixed outcomes were presented in several studies, while other studies outlined intervention development processes or study protocols, indicating high activity in future electronic mental health intervention research. Among the findings, common facilitators included the use of community-based participatory research approaches, representation of culture, and various methods of motivating participant engagement. Meanwhile, common barriers included the lack of necessary resources and limits on the amount of support that online interventions can provide. Considerations regarding the standards and criteria for the development of future electronic mental health interventions for Indigenous youth are offered and future research directions are discussed.

Digital mental health interventions as stand-alone vs. augmented treatment as usual

BackgroundSmartphone-based digital mental health interventions (DMHI) have been described as a purported solution to meet growing healthcare demands and lack of providers, but studies often don’t account for whether patients are concurrently in another treatment modality.MethodsThis preregistered quasi-experimental intent-to-treat study with 354 patients enrolled in a therapist-supported DMHI examined the treatment effectiveness of the Meru Health Program (MHP) as a stand-alone treatment as compared to the MHP in combination with any other form of treatment, including (1) in-person therapy, (2) psychotropic medication use, and (3) in-person therapy and psychotropic medication use.ResultsPatients with higher baseline depressive and anxiety symptoms were more likely to self-select into multiple forms of treatment, an effect driven by patients in the MHP as adjunctive treatment to in-person therapy and psychotropic medication. Patients in combined treatments had significantly higher depressive and anxiety symptoms across treatment, but all treatment groups had similar decreasing depressive and anxiety symptom trajectories. Exploratory analyses revealed differential treatment outcomes across treatment combinations. Patients in the MHP in combination with another treatment had higher rates of major depressive episodes, psychiatric hospitalization, and attempted death by suicide at baseline.ConclusionsPatients with higher depressive and anxiety symptoms tend to self-select into using DMHI in addition to more traditional types of treatment, rather than as a stand-alone intervention, and have more severe clinical characteristics. The use the MHP alone was associated with improvement at a similar rate to those with higher baseline symptoms who are in traditional treatments and use MHP adjunctively.

State of the Science: Using Digital Mental Health Interventions to Extend the Impact of Psychological Services

In recent years, digital mental health interventions (DMHIs) have emerged as a paradigm shift in care delivery that could expand the scale, efficiency, and effectiveness of psychological services. However, DMHI impact is constrained by issues related to limited reach, poor adoption, implementation barriers, and poor long-term maintenance. Organized by the Reach, Effectiveness, Adoption, Implementation, and Maintenance(RE-AIM) framework, this paper surveys the current state of DMHIs, highlighting research and practice gaps as well as potential strategies to move the field forward. Similarly, we discuss the role that emerging technologies and changes in the profession will play in shaping DMHIs in years to come. Finally, concrete and actionable steps to advance equity in the DMHI field are provided, with an emphasis on strategies to increase the representativeness of marginalized populations in DMHI research, the inclusion of these groups in the design and testing of DMHIs, and how to improve the contextual and cultural fit of DMHIs.

Using Adaptive Bandit Experiments to Increase and Investigate Engagement in Mental Health.

Digital mental health (DMH) interventions, such as text-message-based lessons and activities, offer immense potential for accessible mental health support. While these interventions can be effective, real-world experimental testing can further enhance their design and impact. Adaptive experimentation, utilizing algorithms like Thompson Sampling for (contextual) multi-armed bandit (MAB) problems, can lead to continuous improvement and personalization. However, it remains unclear when these algorithms can simultaneously increase user experience rewards and facilitate appropriate data collection for social-behavioral scientists to analyze with sufficient statistical confidence. Although a growing body of research addresses the practical and statistical aspects of MAB and other adaptive algorithms, further exploration is needed to assess their impact across diverse real-world contexts. This paper presents a software system developed over two years that allows text-messaging intervention components to be adapted using bandit and other algorithms while collecting data for side-by-side comparison with traditional uniform random non-adaptive experiments. We evaluate the system by deploying a text-message-based DMH intervention to 1100 users, recruited through a large mental health non-profit organization, and share the path forward for deploying this system at scale. This system not only enables applications in mental health but could also serve as a model testbed for adaptive experimentation algorithms in other domains.

Outcomes of Best-Practice Guided Digital Mental Health Interventions for Youth and Young Adults with Emerging Symptoms: Part I. A Systematic Review of Socioemotional Outcomes and Recommendations.

Youth-specific digital mental health interventions (DMHI) represent an emerging field of study, and aim to increase access, improve socioemotional outcomes, and, where required, support triage to targeted interventions. However, prior reviews have reported inconsistent findings on the clinical effectiveness of such interventions in young adults (12-25years). Further, shortfalls remain for the impact of guided interventions based on the mode of delivery and the type of human support personnel (e.g., professional or peer) guiding the intervention. In response, this systematic review, co-designed with Australia's leading mental health organization, aims to assess the effectiveness of guided digital programs in improving youth socioemotional outcomes. Included studies involve young people experiencing mental ill-health, receiving brief (i.e., 1-12 sessions), digitally delivered (at least partially) psychological interventions that were guided or partially guided, tested in a type of experimental study, with a socioemotional outcome. Specific socioemotional outcomes examined were depression, anxiety, stress, wellbeing, mindfulness, and quality of life. A systematic search of the contemporary published and grey literature identified 22,482 records with 32 relevant records published between 2018 and 2023. A narrative synthesis guided integration of findings. Results demonstrated strong evidence for the effectiveness of guided interventions on socioemotional outcomes (i.e., depression, anxiety, stress) yet these effects were short-lived. When factoring in the use of different control groups (i.e., active vs. inactive), inconsistent effects were observed for the socioemotional outcomes of depression, anxiety, and stress. The mode of delivery (i.e., asynchronous, synchronous, combined) and the type of human support personnel did not appear to impact socioemotional outcomes. Results indicate efficacious brief digital interventions for depression and anxiety include refresher/follow-up content, goal setting content, and relapse prevention content. In contrast, poor efficacy is associated with interventions that include homework tasks, self-monitoring, and log-keeping content.PROSPERO, ID CRD42023405812.

Unlocking the Digital Toolbox — A Mixed Methods Survey of New Zealand Mental Health Clinicians’ Knowledge, Use and Attitudes Towards Digital Mental Health Interventions

AbstractTo assess New Zealand mental health clinicians and trainees’ knowledge, usage patterns, and attitudes towards digital mental health tools and their potential role in clinical practice. Participants recruited through professional organisations and training programs completed an online survey (August 2021 to February 2022). Eligible participants included Registered Health Professionals working in mental health or those enrolled in relevant training programs. The survey explored their knowledge, use of digital interventions, and perspectives on incorporating digital tools into clinical practice. Quantitative responses were summarised for the entire sample, and free-text responses regarding perceived benefits and concerns were coded to establish their relative importance. One hundred forty-four people started the survey and a total of 118 participants (77% female, 68% NZ European) completed it. Key findings indicated that 81% of the respondents had used digital tools, 65% rated their knowledge as moderate or higher, and 86% expressed interest in utilising digital tools. The primary advantages included ease of access and empowerment for clients, while concerns centred around the digital divide and the threat that digital tools may be used to replace traditional services. Clinicians demand more support and training including access to locally accredited tools. Blended (digital interwoven with in-person) support was highly favoured too. New Zealand mental health clinicians generally hold favourable views towards digital tools, with a significant proportion already trying them in their clinical practice. Clinicians are wary of digital approaches exacerbating existing inequities and want free of charge, secure, user-friendly, and evidence-based tools.

Real-time heart rate variability biofeedback amplitude during a large-scale digital mental health intervention differed by age, gender, and mental and physical health.

Heart rate variability biofeedback (HRVB) is an efficacious treatment for depression and anxiety. However, translation to digital mental health interventions (DMHI) requires computing and providing real-time HRVB metrics in a personalized and user-friendly fashion. To address these gaps, this study validates a real-time HRVB feedback algorithm and characterizes the association of the main algorithmic summary metric-HRVB amplitude-with demographic, psychological, and health factors. We analyzed HRVB data from 5158 participants in a therapist-supported DMHI incorporating slow-paced breathing to treat depression or anxiety symptoms. A real-time feedback metric of HRVB amplitude and a gold-standard research metric of low-frequency (LF) power were computed for each session and then averaged within-participants over 2 weeks. We provide HRVB amplitude values, stratified by age and gender, and we characterize the multivariate associations of HRVB amplitude with demographic, psychological, and health factors. Real-time HRVB amplitude correlated strongly (r = .93, p < .001) with the LF power around the respiratory frequency (~0.1 Hz). Age was associated with a significant decline in HRVB (β = -0.46, p < .001), which was steeper among men than women, adjusting for demographic, psychological, and health factors. Resting high- and low-frequency power, body mass index, hypertension, Asian race, depression symptoms, and trauma history were significantly associated with HRVB amplitude in multivariate analyses (p's < .01). Real-time HRVB amplitude correlates highly with a research gold-standard spectral metric, enabling automated biofeedback delivery as a potential treatment component of DMHIs. Moreover, we identify demographic, psychological, and health factors relevant to building an equitable, accurate, and personalized biofeedback user experience.

Timing matters in (mis)identifying moderators and mediators of digital interventions for eating disorders: Commentary on McClure et al. (2023).

This commentary addresses the challenges in identifying consistent moderators and mediators of psychological treatments for eating disorders (EDs), as highlighted by McClure et al. (International Journal of Eating Disorders, 2023) in their systematic review. Specifically, we discuss the often-overlooked importance of temporal context (when an intervention is delivered), alongside sociodemographic and symptom type (for whom an intervention is delivered), in understanding and optimizing treatment engagement and effectiveness. We outline how individuals' fluctuating levels of motivation and receptivity across different "pivotal moments" in the help-seeking process-including initial outreach and self-screening, ongoing care engagement, and post-discharge-can dynamically impact interventions' relevance and impacts. We also overview how Just-In-Time Adaptive Interventions in digital mental health interventions can be harnessed to simultaneously consider "when" and "for whom" ED interventions can exert the greatest benefits. We conclude with several recommendations for conducting ED intervention and implementation research that integrate timing into support delivery and study design, enabling a deeper understanding of not just how and for whom, but when, ED interventions can be most effective.

Views of German mental health professionals on the use of digital mental health interventions for eating disorders: a qualitative interview study

IntroductionDigital mental health interventions (DMHIs) are getting increasingly important for mental health care. In the case of eating disorders (EDs), DMHIs are still in early stages. Few studies so far investigated the views of mental health professionals for EDs on the integration of DMHIs in routine care.ObjectiveTo gain insights into the experiences, perspectives, and expectations of mental health professionals for EDs regarding DMHIs and to identify requirements for the future integration of DMHIs into routine care.MethodsSemi-structured qualitative telephone interviews with 24 German mental health professionals treating patients with EDs were conducted. A content analysis following a deductive-inductive approach asked for experiences, advantages and chances, disadvantages and boundaries, desired functions and properties, target groups, and general conditions and requirements for DMHIs for patients with EDs.ResultsOnly few professionals reported experiences with DMHIs besides video-based psychotherapy during the pandemic. From the therapists’ point of view, DMHIs have the potential to deliver low-threshold access for patients with EDs. Useful functionalities were seen in digital meal records, skills training, and psychoeducation. However, a stable therapeutic alliance was reported as an important prerequisite for the successful integration into care. Therapists expressed concerns in case of severe anorexia nervosa or suicidality. The participants felt to be informed inadequately on recent developments and on the evidence base of DMHIs.ConclusionsMental health professionals for EDs show positive attitudes towards DMHIs, however many barriers to the integration in routine care were observed. The highest potential was seen for the use of DMHIs in addition to outpatient care and in aftercare. Specific requirements for DMHIs are related to different areas of the healthcare spectrum and for the different symptom profiles in anorexia nervosa, bulimia nervosa and binge eating disorder. Targeted DMHIs are needed and appropriate especially for concepts of blended care.

Development of a digital intervention for psychedelic preparation (DIPP)

Psychedelic substances induce profound alterations in consciousness. Careful preparation is therefore essential to limit adverse reactions, enhance therapeutic benefits, and maintain user safety. This paper describes the development of a self-directed, digital intervention for psychedelic preparation. Drawing on elements from the UK Medical Research Council (MRC) framework for developing complex interventions, the design was informed by a four-factor model of psychedelic preparedness, using a person-centred approach. Our mixed-methods investigation consisted of two studies. The first involved interviews with 19 participants who had previously attended a ‘high-dose’ psilocybin retreat, systematically exploring their preparation behaviours and perspectives on the proposed intervention. The second study engaged 28 attendees of an ongoing psilocybin retreat in co-design workshops, refining the intervention protocol using insights from the initial interviews. The outcome is a co-produced 21-day digital course (Digital Intervention for Psychedelic Preparation (DIPP)), that is organised into four modules: Knowledge–Expectation, Psychophysical–Readiness, Safety–Planning, and Intention–Preparation. Fundamental components of the course include daily meditation practice, supplementary exercises tied to the weekly modules, and mood tracking. DIPP provides a comprehensive and scalable solution to enhance psychedelic preparedness, aligning with the broader shift towards digital mental health interventions.

Research Trends in the Study of Acceptability of Digital Mental Health-Related Interventions: A Bibliometric and Network Visualisation Analysis

The acceptability of digital health interventions is a multifaceted concept that is central to user engagement. It is influenced by cultural and social norms and it is, also, a key consideration for intervention development and evaluation. For this reason, it is important to have a clear overview of how research in digital interventions’ acceptability has evolved, what type of measures or assessments have been most frequently utilised, and what may be the implications for the knowledge area and future research directions. The purpose of this bibliometric and network visualization analysis was to explore the main research patterns in the study of the acceptability of digital mental health interventions and highlight the key characteristics of knowledge production on this topic. The Web of Science was searched for relevant primary studies, with 990 documents selected for inclusion in this bibliometric analysis. Publications’ metrics, text and author keyword analysis, and bibliographical coupling of the documents provided insights into how technological developments, specific research interests, research priorities, and contexts have shaped research in the field. The main differentiation in acceptability approaches emanated from the studies’ research designs, the stage of intervention development and evaluation, and the extent to which there was a focus on user attitudes, experience, and engagement. These differentiations further indicate the importance of having clarity as to what concepts or elements of acceptability a study addresses as well as approaches that have the potential to address the complexities of acceptability.

Between Rhetoric and Reality: Real-world Barriers to Uptake and Early Engagement in Digital Mental Health Interventions

Digital mental health interventions (DMHIs) have potential to provide effective and accessible care to entire populations, but low client uptake and engagement are significant problems. Few prior studies explore the lived experiences of non-engagers, because reaching this population is inherently difficult. We present an observational inquiry into the barriers to sign-up and early use of a DMHI, along with reasons for initial interest in the DMHI. We collected 205 online questionnaire responses and 20 interviews from self-referring participants across four healthcare ecosystems in the UK and US. Questionnaire results revealed that uncertainty about DMHI usefulness and usability were the main barriers to uptake, whereas forgetting about it, not finding time for it and not finding it useful were the main barriers to early engagement. Participants reported multiple reasons for considering the DMHI, reflecting the contextual, subjective nature of mental health. Our thematic analysis generated themes around (1) the need for human connection, (2) the impact of self-stigma on help-seeking, (3) the lack of knowledge around DMHIs and psychological therapy, (4) the desire for personally relevant care, and (5) the fluctuating, perennial nature of mental health. We discuss implications for DMHI design, implementation and future research, as well as transdisciplinary opportunities.