Self-guided Intervention Research Articles

Mental Health Effects of COVID-19 Among Health Care Providers: A Case Study of Kalulushi General Hospital in Kalulushi District, Zambia

Coronavirus disease 2019 is an infectious disease which was first identified in Wuhan a City in the Peoples Republic of China in December 2019. The aim of this study was to establish the mental health effects of COVID 19 on the frontline health care providers at Kalulushi General Hospital in Kalulushi district of Zambia. A descriptive cross-sectional study was employed to assess the mental health effects of COVID 19 on the frontline health care providers at Kalulushi General Hospital in Zambia. The study used simple random sampling technique to select 122 respondents to participate in the study. Data was collected from study participants using structured questionnaire. The collected data was analyzed using SPSS version 25 and MS excel and was presented using tables, bar charts and pie charts. Multivariate logistic regression analysis was used to examine the relationships between socio-demographic characteristics and mental health effects of COVID-19 parameters. The ethical approval was gotten from Lusaka Apex Medical University Biomedical Research Ethics Committee, Kalulushi General Hospital and Kalulushi District Health Office respectively. The study revealed that, most of the respondents (31%) were afraid of contracting COVID-19, while 27% of study participants claimed that COVID 19 was a propaganda and that no one knew when it would end. The study also found that, a small proportion of study participants reported a decline in work morale (17%), likely associated with witnessing numerous deaths (19%) and the added stress of inadequate personal protective equipment (PPE) experienced by 15%. The study further demonstrated that 58% of the respondents accepted that working in a COVID-19 environment affected their mental health while 42% of the respondents did not accept that working in the COVID-19 environment did affect mental health of frontline healthcare providers. The study further revealed that, most of the respondents were using handwashing or sanitizers, facemasks and protective clothing (27%) to cope with COVID-19 pandemic. The study also showed that, a few respondents were practicing social distancing (22%), and having healthy diet (19%) in order to cope with COVID-19. Marital status and religion were found to have significant association with copying strategies of frontline healthcare providers against COVID-19 pandemic at Kalulushi General Hospital in Kalulushi District of Zambia (P < 0.05). WHO, CDC, and Zambian Ministry of Health should prioritize implementing Critical Incident Stress Management protocols, develop culturally sensitive mobile applications to offer self-guided interventions, and promote healthy coping mechanisms among frontline healthcare providers.

“I'm not afraid to be alone with the baby now”: Parents' experiences of an online self-guided cognitive intervention for unwanted intrusive thoughts about harming their child

Half of parents to infants and toddlers experience unwanted intrusive thoughts (UITs) about intentionally harming their child. For some, this can lead to impaired parental self-efficacy, elevated parental stress, and symptoms of depression. Many do not disclose their thoughts due to shame. Our research group has developed a self-guided online cognitive intervention for parents with distressing UITs of intentional child-related harm. A previous randomized pilot trial (N = 43) showed that the intervention was more effective than waitlist in reducing distress related to UITs. It also improved parental self-efficacy. This study is an qualitative investigation of the participants’ experiences with the intervention. We conducted semi-structured interviews with 8 participants. A thematic analysis revealed two overarching themes: (1) Changed perception of the unwanted intrusive thoughts and (2) Different paths to recovery. The parents reported that the intervention taught skills to approach their UITs in a more flexible way, which had positive effects on well-being and parenting. The flexibility and anonymity of the online format was highlighted as positive. Some would have liked additional therapist support and better adaptations to a smartphone format. The findings provide additional qualitative data how an online self-guided intervention can help parents who struggle with UITs.

Impact of an Online Discussion Forum on Self-Guided Internet-Delivered Cognitive Behavioral Therapy for Public Safety Personnel: Randomized Trial.

Internet-delivered cognitive behavioral therapy (ICBT) is an effective and accessible treatment for various mental health concerns. ICBT has shown promising treatment outcomes among public safety personnel (PSP), who experience high rates of mental health problems and face barriers to accessing other mental health services. Client engagement and clinical outcomes are better in ICBT with therapist guidance, but ICBT is easier to implement on a large scale when it is self-guided. Therefore, it is important to identify strategies to improve outcomes and engagement in self-guided ICBT and other self-guided digital mental health interventions. One such strategy is the use of online discussion forums to provide ICBT clients with opportunities for mutual social support. Self-guided interventions accompanied by online discussion forums have shown excellent treatment outcomes, but there is a need for research experimentally testing the impact of online discussion forums in ICBT. We aimed to evaluate a transdiagnostic, self-guided ICBT intervention tailored specifically for PSP (which had not previously been assessed), assess the impact of adding a therapist-moderated online discussion forum on outcomes, and analyze participants' feedback to inform future research and implementation efforts. In this randomized trial, we randomly assigned participating PSP (N=107) to access an 8-week transdiagnostic, self-guided ICBT course with or without a built-in online discussion forum. Enrollment and participation were entirely web-based. We assessed changes in depression, anxiety, and posttraumatic stress as well as several secondary outcome measures (eg, treatment engagement and satisfaction) using questionnaires at the pre-enrollment, 8-week postenrollment, and 20-week postenrollment time points. Mixed methods analyses included multilevel modeling and qualitative content analysis. Participants engaged minimally with the forum, creating 9 posts. There were no differences in treatment outcomes between participants who were randomly assigned to access the forum (56/107, 52.3%) and those who were not (51/107, 47.7%). Across conditions, participants who reported clinically significant symptoms during enrollment showed large and statistically significant reductions in symptoms (P<.05 and d>0.97 in all cases). Participants also showed good treatment engagement and satisfaction, with 43% (46/107) of participants fully completing the intervention during the course of the study and 96% (79/82) indicating that the intervention was worth their time. Previous research has shown excellent clinical outcomes for self-guided ICBT accompanied by discussion forums and good engagement with those forums. Although clinical outcomes in our study were excellent across conditions, engagement with the forum was poor, in contrast to previous research. We discuss several possible interpretations of this finding (eg, related to the population under study or the design of the forum). Our findings highlight a need for more research evaluating the impact of online discussion forums and other strategies for improving outcomes and engagement in self-guided ICBT and other digital mental health interventions. ClinicalTrials.gov NCT05145582; https://clinicaltrials.gov/study/NCT05145582.

Associations Between Weight Discrimination, Eating-Disorder-Related Psychiatric Impairment, and Eating-Disorder Treatment Interest Across the Weight Spectrum.

Only approximately 20% of college students with an eating disorder (ED) seek treatment. One barrier to seeking treatment is weight discrimination. Past research demonstrates that experiencing weight discrimination is associated with increased ED risk and decreased in-person treatment engagement. Weight discrimination may be a particularly relevant treatment barrier for students who have a higher body weight given their higher likelihood of experiencing weight discrimination. College students with a probable ED diagnosis (N = 372; Mage = 23.94; 73.12% women, 18.55% men, 6.18% another gender; 11.29% Asian, 4.57% Black, 12.63% Hispanic, 83.60% White, 4.84% Native American, and 0.54% another race) completed an online self-report survey that included the Clinical Impairment Assessment (CIA), Experience of Weight Discrimination (EWD) Scale, and a 0-100 scale to indicate interest in participating in virtual guided self-help ED treatment. Linear regression showed significant positive relationships between weight discrimination and ED-related psychiatric impairment and treatment interest. Elevations in CIA scores corroborate past literature that suggested that weight discrimination was positively related to ED psychopathology. Contrary to past research, college students who experienced weight discrimination had greater treatment interest. Students who experience weight discrimination may view virtual self-guided treatment as less weight-stigmatizing due to the "do-it-yourself" approach and no in-person interactions. Findings highlight the potential impacts of weight discrimination on acceptability of ED-related care. Future research is needed to identify ways to reduce weight discrimination and promote weight-inclusive practices in the medical system.

Is There a Place for Cognitive Restructuring in Brief, Self-Guided Interventions? Randomized Controlled Trial of a Single-Session, Digital Program for Adolescents

ABSTRACT Objective Self-guided digital mental health interventions (DMHIs) teaching empirically supported skills (e.g. behavioral activation) have demonstrated efficacy for improving youth mental health, but we lack evidence for the complex skill of cognitive restructuring (CR). Method We conducted the first-ever RCT testing a CR DMHI (“Project Think”) against an active control (supportive therapy; “Project Share”) in collaboration with public schools. Pre-registered outcomes were DMHI acceptability and helpfulness post-intervention, as well as internalizing symptoms and CR skills use from baseline to seven-month follow-up, in the full sample and the subsample with elevated symptoms. Results Participants (N = 597; MAge = 11.99; 48% female; 68% White) rated both programs highly on acceptability and helpfulness. Both conditions were associated with significant internalizing symptom reductions across time in both samples, with no significant condition differences. CR skills use declined significantly across time for Project Share youths but held steady across time for Project Think youths in both samples; this pattern produced a significant condition difference favoring Project Think within the elevated sample at seven-month follow-up. Conclusion Internalizing symptoms declined comparably for Think and Share participants. Consequently, future research should examine whether encouraging youths to share their feelings produces symptom improvements, and whether a single-session, self-guided CR DMHI produces beneficial effects relative to more inert control conditions. Further, the decline in CR skills use for Project Share youths versus sustained CR use by Project Think youths raises questions about the natural time course of youths’ CR use and the impact of these DMHIs on that course. ClinicalTrials.gov Registration: NCT04806321.

Motivational Variables as Moderating Effects of a Web-Based Mental Health Program for University Students: Secondary Analysis of a Randomized Controlled Trial.

Self-guided web-based interventions have the potential of addressing help-seeking barriers and symptoms common among university students, such as depression and anxiety. Unfortunately, self-guided interventions are also associated with less adherence, implicating motivation as a potential moderator for adherence and improvement for such interventions. Previous studies examining motivation as a moderator or predictor of improvement on web-based interventions have defined and measured motivation variably, producing conflicting results. This secondary analysis of data from a randomized controlled trial aimed to examine constructs of motivation as moderators of improvement for a self-guided 8-week web-based intervention in university students (N=1607). Tested moderators included internal motivation, external motivation, and confidence in treatment derived from the Treatment Motivation Questionnaire. The primary outcome was an improvement in depression and anxiety measured by the Depression Anxiety Stress Scale-21. Piecewise linear mixed effects models showed that internal motivation significantly moderated symptom change for the intervention group (t1504=-2.94; P=.003) at average and high (+1 SD) motivation levels (t1507=-2.28; P=.02 and t1507=-4.05; P<.001, respectively). Significant results remained even after controlling for baseline severity. The results showed that confidence in treatment did not significantly moderate symptom change for the intervention group (t1504=1.44; P=.15). In this sample, only internal motivation was positively correlated with service initiation, intervention adherence, and intervention satisfaction. The combination of a web-based intervention and high or moderate internal motivation resulted in greater improvement in the total Depression Anxiety Stress Scale-21 score. These findings highlight the importance of conceptually differentiating motivation-related constructs when examining moderators of improvement. The results suggest that the combination of a web-based intervention and high or moderate internal motivation results in greater improvement. These findings highlight the importance of conceptually differentiating motivation-related constructs when examining moderators of improvement. To better understand the moderating role of internal motivation, future research is encouraged to replicate these findings in diverse samples as well as to examine related constructs such as baseline severity and adherence. Understanding these characteristics informs treatment strategies to maximize adherence and improvement when developing web-based interventions as well as allows services to be targeted to individuals likely to benefit from such interventions. ClinicalTrials.gov NCT04361045; https://clinicaltrials.gov/study/NCT04361045.

Pilot educational intervention for the care of adolescents with autism spectrum disorder during puberty

ABSTRACT Puberty is a particularly vulnerable time for individuals with autism spectrum disorder (ASD) during which baseline challenges are exacerbated, functioning often deteriorates, and additional barriers emerge. Specific concerns include increased vulnerability, decreased safety, and increased mood and behavioral disturbances. Youth with ASD need guidance and explicit instruction/skill development on topics such as hygiene/self-care, appropriate sexual activity, and menstruation management. Lack of provider preparation, knowledge, and confidence, along with stigma about the needs and capabilities of individuals with ASD, are major barriers to care. Initiatives to expand the preparation of health care personnel, including nurse practitioners, to provide quality care to individuals with ASD are essential. This article describes the results of a pilot project using a brief, self-guided educational intervention for developing and practicing family nurse practitioners. Before and after viewing the educational module, participants completed author-created surveys assessing their self-perceived knowledge, attitudes, and intent to change practice. Expert analysis of survey items provided face validity. Comparison of mean presurvey and postsurvey responses showed significant increases in self-perceived knowledge, attitudes, and intent to implement practice changes. Lack of confidence was endorsed as the most common remaining barrier to change. Findings indicate that the brief module improved participants' self-reported knowledge, attitudes, and intent to implement practice recommendations. Such interventions can be easily incorporated into nursing education and professional development and are appropriate for dissemination to including nurse practitioners working within and outside primary care settings, as well as to related service providers.

Feasibility, acceptability, and efficacy of a positive emotion regulation intervention to promote resilience for healthcare workers during the COVID-19 pandemic: A randomized controlled trial.

Burnout poses a substantial, ongoing threat to healthcare worker (HCW) wellbeing and to the delivery of safe, quality healthcare. While systemic and organization-level changes in healthcare are critically important, HCWs also need individual-level skills to promote resilience. The objective of this trial is to test feasibility, acceptability, and efficacy of PARK, an online self-guided positive affect regulation intervention, in a sample of healthcare workers during the COVID-19 pandemic. In the context of the unprecedented rise in burnout during the COVID-19 pandemic, we conducted a randomized waitlist-controlled trial of the Positive Affect Regulation sKills (PARK) program-a five-week, online, self-guided coping skills intervention nested within an ongoing cohort of HCWs. N = 554 healthcare workers were randomly assigned to receive the intervention immediately or to receive the intervention after approximately 12 weeks. Outcomes included change in burnout, emotional wellbeing (positive affect, meaning and purpose, depression, anxiety) and sleep over approximately 12 weeks. Analyses included mixed-effects linear regression models comparing change over time in outcomes between intervention and control conditions. One third (n = 554) of the participants in the cohort of HCWs consented to participate and enrolled in PARK in April 2022. Compared to those who did not enroll, participants in the trial reported higher burnout, poorer emotional wellbeing, and poorer sleep at baseline (April, 2022; all ps < .05). Intent-to-treat analyses showed that participants randomly assigned to the intervention immediately (PARK-Now) improved significantly on anxiety (within-group change on PROMIS T-score = -0.63; p = .003) whereas those in the waitlist (PARK-Later) did not (within group T-score change 0.04, p = 0.90). The between-group difference in change, however, was not statistically significant (B = -0.67 p = 0.10). None of the other wellbeing outcomes changed significantly in the intervention group compared to the waitlist. Additional as-treated analyses indicated that those participants who completed all 5 of the weekly online lessons (N = 52; 9.4%) improved significantly more on the primary outcome of positive affect compared to those who enrolled in PARK but completed zero lessons (n = 237; 42.8%; B = 2.85; p = .0001). Online self-guided coping skills interventions like PARK can be effective in targeted samples and future work will focus on adaptations to increase engagement and tailor PARK for HCWs who could most benefit.

Predictors of outcome in self-guided internet-delivered cognitive-behavior therapy for obsessive-compulsive disorder: A preliminary investigation.

Internet-delivered cognitive-behavioral therapy (ICBT) is an effective treatment for obsessive-compulsive disorder (OCD). ICBT can be delivered in a self-guided or clinician-guided format. While a literature is emerging on the predictors of response to clinician-guided ICBT, there is a lack of research examining the predictors of response to self-guided ICBT. The aim of the present study was to examine predictors of outcome in a large sample of participants with OCD who commenced a self-guided ICBT intervention. One hundred and fifty-seven participants (Mage = 34.82; SD = 10.49; 78% female) were included in the study. Regression analyses were conducted to determine clinical and demographic predictors of (1) posttreatment symptom severity and (2) a clinically meaningful treatment response for both the intention-to-treat (ITT) and completer samples. The regression models significantly predicted posttreatment outcome for both the ITT (F(8, 148) = 15.844, p < .001) and completer sample (F(8, 101) = 5.929, p < .001), explaining 46% and 34% of the variance respectively. Higher baseline OCD severity, younger age, experiencing higher contamination or symmetry symptoms, and a history of past treatment were all found to be significantly associated with higher posttreatment severity in the ITT sample. In the completer sample only higher baseline OCD severity and severity of harm-related obsessions and checking compulsions was significantly associated with higher posttreatment severity. When predicting treatment response the regression models for both the ITT and completer sample were nonsignificant.

An initial test of a new self-guided internet-based intervention for social anxiety: iExposure

ABSTRACT Social anxiety is a prevalent mental health concern that impacts approximately 12% of the US population. There is a need for targeted mechanism-focused interventions for social anxiety that are also highly scalable. Using a recently developed naturalistic paradigm with simulated teleconferencing interactions as the central treatment element, we developed a new self-guided internet-based intervention for social anxiety called iExposure. This randomized clinical trial aimed at testing two mechanism-driven exposure augmentation strategies for social anxiety. Participants (N = 53) were randomized to four sessions of either (a) standard iExposure (n = 18), (b) iExposure +Attention Control (n = 22), or (c) iExposure + Attention Guidance (n = 13) and administered over two weeks. At follow-up across conditions, there were large reductions in communication anxiety d = -1.51 and moderate reductions in social anxiety d = -0.60. The attention control condition led to larger reductions in social anxiety compared to standard iExposure d = -0.81 and attention guidance did not enhance iExposure for general symptoms of social anxiety, d = -0.27. These findings provide preliminary support for the utility of iExposure. Further research is needed with a larger sample to understand its efficacy with regard to the role of attention augmentation strategies.

The effectiveness of self-guided interventions in adults with depressive symptoms: a systematic review and meta-analysis

Despite promising scalability and accessibility, evidence on the efficacy of self-guided interventions for adult depression is inconclusive. This study investigated their effectiveness and acceptability, considering diverse delivery formats and support levels. We systematically searched PubMed, PsycINFO, Embase, and Cochrane Library until 1st January 2024. Included were randomised controlled trials comparing self-guided interventions with a control condition for adult depression. Two independent researchers extracted data. Effect sizes were pooled using random-effects models, with post-intervention depressive severity compared with control conditions as the primary outcome. Study validity was evaluated using Cochrane Risk of Bias 2.0. This study was pre-registered with OSF (https://osf.io/rd43v). We identified 92 studies (111 interventions vs. control comparisons) with 16,706 participants (mean age: 18.78-74.41 years). Compared to controls, self-guided interventions were moderately effective at post-assessment (g=0.53, 95% CI: 0.45-0.61; I2=79.17%) and six to twelve months post-randomisation follow-up (g=0.32, 95% CI: 0.16-0.48; I2=79.19%). Trials with initial human screening (g=0.59) and interventions delivered in computer programs (g=1.04) had the significantly largest effect sizes. No differences in treatment effects were observed across support levels, therapy types, commercial availability, or the presence of online discussion forums. Self-guided interventions were less acceptable than control conditions (RR=0.92, p<0.001). Most studies showed a moderate to high risk of bias (n=80). Existing trials on self-guided interventions are at high risk of bias, potentially overestimating treatment effects. Despite lower acceptability compared to controls, self-guided interventions are moderately effective in treating adult depression, regardless of support levels and online discussion features. None.

A Self-Guided Internet-Based Intervention for the Reduction of Gambling Symptoms

Most individuals with problem gambling or gambling disorder remain untreated due to barriers to treatment. Limited research exists on alternative treatments. To investigate the efficacy of a self-guided internet-based intervention for individuals with gambling problems and to identify potential outcome moderators. This single-center randomized clinical trial was conducted from July 13, 2021, to December 31, 2022, at the University Medical Center Hamburg-Eppendorf. Participants were recruited across Germany for 2 assessments (before intervention [t0] and 6 weeks after intervention [t1]). Eligible participants were individuals aged 18 to 75 years with gambling problems, internet access, German proficiency, and willingness to participate in 2 online assessments. The self-guided internet-based intervention was based on cognitive behavioral therapy, metacognitive training, acceptance and commitment therapy, and motivational interviewing. The primary outcome was change in gambling-related thoughts and behavior as measured with the pathological gambling adaption of the Yale-Brown Obsessive-Compulsive Scale. Secondary outcomes were change in depressive symptoms, gambling severity, gambling-specific dysfunctional thoughts, attitudes toward online interventions, treatment expectations, and patient satisfaction. A total of 243 participants (154 [63.4%] male; mean [SD] age, 34.73 [10.33] years) were randomized to an intervention group (n = 119) that gained access to a self-guided internet-based intervention during 6 weeks or a wait-listed control group (n = 124). Completion at t1 was high (191 [78.6%]). Results showed a significantly greater reduction in gambling-related thoughts and behavior (mean difference, -3.35; 95% CI, -4.79 to -1.91; P < .001; Cohen d = 0.59), depressive symptoms (mean difference, -1.05; 95% CI, -1.87 to -0.22; P = .01; Cohen d = 0.33), and gambling severity (mean difference, -1.46; 95% CI, -2.37 to -0.54; P = .002; Cohen d = 0.40) but not in gambling-specific dysfunctional thoughts (mean difference, -1.62; 95% CI, -3.40 to 0.15; P = .07; Cohen d = 0.23) favoring the intervention group. Individuals in the intervention group who had a positive treatment expectation and more severe gambling-specific dysfunctional thoughts and gambling symptoms benefited more on the primary outcome relative to the control group. In this randomized clinical trial, the effectiveness of a self-guided internet-based intervention for individuals with self-reported problematic gambling behavior was demonstrated when measured 6 weeks after start of the intervention. The study's findings are particularly relevant given the increasing need for accessible and scalable solutions to address problematic gambling. bfarm.de Identifier: DRKS00024840.

Evaluating the effectiveness of a mobile app-based self-guided psychological interventions to reduce relapse in substance use disorder: protocol for a randomized controlled trial.

Substance Use Disorder (SUD) persists as a significant public health challenge worldwide, with an estimated prevalence of approximately 10-15% across the global populace. This condition is characterized by a notably high risk of lapses and relapses, even subsequent to treatment interventions. Mobile health interventions, owing to their widespread accessibility, emerge as a promising approach to diminish the risk of relapse post-treatment and to broaden the scope of care, especially in regions with a scarcity of trained medical professionals. This study is designed to assess the effectiveness of mobile interventions in mitigating cravings and preventing lapses among individuals diagnosed with SUD. Employing a two-armed, randomized controlled trial framework, the study will evaluate a self-administered psychological intervention delivered through a mobile application, Nałogometr 2.0. Over a period of three months, participants will engage with intervention modules that primarily incorporate mindfulness techniques and Cognitive Behavioral Therapy (CBT) principles. Ecological Momentary Assessment (EMA) will be utilized to gather longitudinal data on a range of variables that are indicative of craving intensity and the risk of lapse. In addition to this, a monthly-administered battery of questionnaires will be employed to gauge the severity of substance dependence, as well as to measure levels of anxiety, depression, and overall life satisfaction. Results will be submitted for publication in peer-reviewed journals. https://clinicaltrials.gov/, identifier [NCT05730504].

Economic evaluation of Be a Mom, a web-based intervention to prevent postpartum depression in high-risk women alongside a randomized controlled trial

BackgroundPostpartum depression (PPD) poses significant challenges, affecting both mothers and children, with substantial societal and economic implications. Internet-based cognitive behavioral therapy interventions (iCBT) offer promise in addressing PPD, but their economic impact remains unexplored. This study aimed to evaluate the cost-utility of Be a Mom, a self-guided iCBT intervention, compared with a waiting-list control among postpartum women at high risk of PPD. MethodsThis economic evaluation was conducted alongside a 14-month randomized controlled trial adopting a societal perspective. Participants were randomized to Be a Mom (n = 542) or a waitlisted control group (n = 511). Self-report data on healthcare utilization, productivity losses, and quality-adjusted life years (QALYs) were collected at baseline, post-intervention, and 4 and 12 months post-intervention. Incremental cost-effectiveness ratios (ICERs) were calculated, and cost-effectiveness acceptability curves were generated using nonparametric bootstrapping. Sensitivity analyses were conducted to assess result robustness. ResultsOver 14 months, Be a Mom generated a QALY gain of 0.0184 (0.0022, 0.0346), and cost savings of EUR 34.06 (−176.16, 108.04) compared to the control group. At a willingness to pay of EUR 20,000, Be a Mom had a 97.6 % probability of cost-effectiveness. LimitationsResults have limitations due to self-selected sample, potential recall bias in self-reporting, missing data, limited follow-up, and the use of a waiting-list control group. ConclusionsThis study addresses a critical gap by providing evidence on the cost-utility of an iCBT intervention tailored for PPD prevention. Further research is essential to identify scalable and cost-effective interventions for reducing the burden of PPD.

Developing Social Enhancements for a Web-Based, Positive Emotion Intervention for Alzheimer Disease Caregivers: Qualitative Focus Group and Interview Study.

Alzheimer disease is a degenerative neurological condition that requires long-term care. The cost of these responsibilities is often borne by informal caregivers, who experience an elevated risk of negative physical and psychological outcomes. Previously, we designed a positive emotion regulation intervention that was shown to improve well-being among dementia caregivers when delivered through one-on-one videoconferencing lessons with a trained facilitator. However, the format required significant resources in terms of logistics and facilitator time. To broaden the reach of the intervention, we aimed to develop the Social Augmentation of Self-Guided Electronic Delivery of the Life Enhancing Activities for Family Caregivers (SAGE LEAF) program, an iteration of the intervention in a self-guided, web-based format with enhanced opportunities for social connection. The aim of this study was to gather feedback to inform the design of social features for the SAGE LEAF intervention. In the absence of a facilitator, our goal with the self-guided SAGE LEAF intervention was to integrate various social features (eg, discussion board, automated support, and profiles) to maximize engagement among participants. Qualitative data were collected from 26 individuals through (1) interviews with participants who completed a previous version of the intervention via videoconferencing with a facilitator, (2) focus groups with dementia caregivers who had not previously experienced the intervention, and (3) focus groups with Alzheimer disease clinical care providers. We conducted a qualitative thematic analysis to identify which social features would be the most helpful and how they could be implemented in a way that would be best received by caregivers. Interview and focus group feedback indicated that participants generally liked the potential features suggested, including the discussion boards, multimedia content, and informational support. They had valuable suggestions for optimal implementation. For example, participants liked the idea of a buddy system where they would be matched up with another caregiver for the duration of the study. However, they expressed concern about differing expectations among caregivers and the possibility of matched caregivers not getting along. Participants also expressed interest in giving caregivers access to a podcast on the skills, which would allow them to review additional content when they wished. Taken together, the discussions with caregivers and providers offered unique insights into the types of social features that may be integrated into the SAGE LEAF intervention, as well as implementation suggestions to improve the acceptability of the features among caregivers. These insights will allow us to design social features for the intervention that are optimally engaging and helpful for caregivers.

Exploring the Benefits and Acceptance of Blended Positive Psychotherapy as an Adjunctive Treatment for Clients with Residual Depressive Symptoms: A Mixed-Method Study

A proof-of-concept study was conducted to explore the acceptability and potential benefits of a blended positive psychotherapy intervention for clients with residual depressive symptoms. A single-arm pilot study was conducted in 2022 and 2023 with 24 Dutch adults experiencing residual depressive symptoms after treatment. Clients who had recently received an evidence-based treatment for depressive disorder were approached to participate in this study through opportunity sampling. The intervention consisted of nine sessions with a therapist and a six-week self-guided digital positive psychology intervention. Acceptability was examined using semi-structured interviews (n = 15). Participants filled out questionnaires pre- (n = 21), mid- (n = 14) and post-intervention (n = 8). Potential benefits were assessed in terms of changes in mental well-being (MHC-SF), depression (PHQ-9) and personal recovery (QPR). Quantitative data and qualitative data were analysed using linear mixed-effects models and framework analysis, respectively. The analyses were primarily based on Sekhon’s theoretical framework of acceptability. Linear mixed-effects analyses showed changes over time in most mental health indicators, including mental well-being (Hedge’s g = 1.58), depression (g = 1.43) and personal recovery (g = 1.96). Most of the interviewed participants considered blended positive psychotherapy a valuable adjunctive treatment; it connected well with their wish to become more positive in their daily life without ignoring difficult experiences. For some participants, shifting towards a positive treatment approach was difficult, resulting in early dropout. This study’s findings suggest that blended positive psychotherapy is acceptable to most people with residual depressive symptoms after treatment. Its impact is yet to be established in larger samples of studies involving more robust designs.

Internet-delivered therapy for alcohol misuse: engagement, satisfaction, and outcomes when patients select their preference for therapist- or self-guided treatment

BackgroundAlcohol misuse is common and causes substantial harm. Internet-delivered cognitive behaviour therapy (ICBT) is effective in reducing alcohol misuse; however, the literature investigating how treatment outcomes are impacted by patients’ preferences for therapist- versus self-guided ICBT for alcohol misuse is sparse.MethodsIn this preference trial, 74 eligible patients (who reported ≥ 14 drinks in the previous week and obtained scores suggesting hazardous or harmful drinking) chose between enrolling in either therapist- or self-guided ICBT for alcohol misuse. We investigated whether those who chose therapist- versus self-guided ICBT differed in their (a) drinking outcomes—as measured by Timeline Follow-Back (TLFB) and heavy drinking days (HDD) at post-treatment and 3-month follow-up—and (b) post-treatment ICBT engagement and satisfaction.ResultsThe majority (81.1%) of eligible patients chose therapist-guided ICBT. These patients reported higher psychotropic medication use, drinking difficulties, and anxiety symptoms. For both the therapist- and self-guided patients, a modified intention-to-treat analysis revealed large within-group treatment effects for TLFB (β = − 2.64, SE 0.66; p < 0.001) and HDD (β = − 0.34, SE 0.07; p < 0.001), with large pre-to-post-treatment Cohen’s effect sizes of d = 0.97 (95% CI [0.49, 1.45]) for TLFB and d = 1.19 (95% CI [0.69, 1.68]) for HDD. The interaction comparing the effects of therapist- to self-guided ICBT over time was not significant for TLFB (p = 0.34) or HDD (p = 0.06). With treatment, for both therapist- and self-guided patients, there was a significant improvement in drinking difficulties, cravings, and confidence with controlling cravings, as well as in anxiety, depression, and functional impairment. Further, the majority (75.7%) of patients completed five or more lessons, as well as reported overall satisfaction with the treatment (88.9%) and increased confidence in managing their symptoms (86.7%); these outcomes also did not differ between therapist- and self-guided patients.ConclusionsThe current study shows that ICBT for alcohol misuse is associated with reduced drinking and comorbid mental health difficulties over time, irrespective of whether patients chose to complete the course on their own or with therapist guidance.Trial registration number: NCT04611854 (https://clinicaltrials.gov/ct2/show/NCT04611854).

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.

Nudges and Prompts Increase Engagement in Self-Guided Digital Health Treatment for Depression and Anxiety: Results From a 3-Arm Randomized Controlled Trial.

Accessible and effective approaches to mental health treatment are important because of common barriers such as cost, stigma, and provider shortage. The effectiveness of self-guided treatment is well established, and its use has intensified because of the COVID-19 pandemic. Engagement remains important as dose-response relationships have been observed. Platforms such as Facebook (Meta Platform, Inc), LinkedIn (Microsoft Corp), and X Corp (formerly known as Twitter, Inc) use principles of behavioral economics to increase engagement. We hypothesized that similar concepts would increase engagement in self-guided digital health. This 3-arm randomized controlled trial aimed to test whether members of 2 digital self-health courses for anxiety and depression would engage with behavioral nudges and prompts. Our primary hypothesis was that members would click on 2 features: tips and a to-do checklist. Our secondary hypothesis was that members would prefer to engage with directive tips in arm 2 versus social proof and present bias tips in arm 3. Our tertiary hypothesis was that rotating tips and a to-do checklist would increase completion rates. The results of this study will form a baseline for future artificial intelligence-directed research. Overall, 13,224 new members registered between November 2021 and May 2022 for Evolution Health's self-guided treatment courses for anxiety and depression. The control arm featured a member home page without nudges or prompts. Arm 2 featured a home page with a tip-of-the-day section. Arm 3 featured a home page with a tip-of-the-day section and a to-do checklist. The research protocol for this study was published in JMIR Research Protocols on August 15, 2022. Arm 3 had significantly younger members (F2,4564=40.97; P<.001) and significantly more female members (χ24=92.2; P<.001) than the other 2 arms. Control arm members (1788/13,224, 13.52%) completed an average of 1.5 course components. Arm 2 members (865/13,224, 6.54%) clicked on 5% of tips and completed an average of 1.8 course components. Arm 3 members (1914/13,224, 14.47%) clicked on 5% of tips, completed 2.7 of 8 to-do checklist items, and completed an average of 2.11 course components. Completion rates in arm 2 were greater than those in arm 1 (z score=3.37; P<.001), and completion rates in arm 3 were greater than those in arm 1 (z score=12.23; P<.001). Engagement in all 8 components in arm 3 was higher than that in arm 2 (z score=1.31; P<.001). Members engaged with behavioral nudges and prompts. The results of this study may be important because efficacy is related to increased engagement. Due to its novel approach, the outcomes of this study should be interpreted with caution and used as a guideline for future research in this nascent field. RR2-10.2196/37231.

A randomized clinical trial for a self-guided sleep intervention following moderate-severe traumatic brain injury: Study protocol

BackgroundIndividuals with a history of moderate-severe traumatic brain injury (TBI) experience a significantly higher prevalence of insomnia compared to the general population. While individuals living with TBI have been shown to benefit from traditional insomnia interventions (e.g., face-to-face [F2F]), such as Cognitive Behavioral Therapy for Insomnia (CBTI), many barriers exist that limit access to F2F evidence-based treatments. Although computerized CBT-I (CCBT-I) is efficacious in terms of reducing insomnia symptoms, individuals with moderate-severe TBI may require support to engage in such treatment. Here we describe the rationale, design, and methods of a randomized controlled trial (RCT) assessing the efficacy of a guided CCBT-I program for reducing insomnia symptoms for participants with a history of moderate-severe TBI. MethodsThis is an RCT of a guided CCBT-I intervention for individuals with a history of moderate-severe TBI and insomnia. The primary outcome is self-reported insomnia severity, pre- to post-intervention. Exploratory outcomes include changes in sleep misperception following CCBT-I and describing the nature of guidance needed by the Study Clinician during the intervention. ConclusionThis study represents an innovative approach to facilitating broader engagement with an evidence-based online treatment for insomnia among those with a history of moderate-severe TBI. Findings will provide evidence for the level and nature of support needed to implement guided CCBT-I. Should findings be positive, this study would provide support for a strategy by which to deliver guided CCBT-I to individuals with a history of moderate-severe TBI.