Self-guided Intervention Research Articles

Digital psychological self-care for problematic alcohol use: feasibility of a new clinical concept.

Digital interventions based on cognitive-behavioural therapy and relapse prevention can increase treatment access for people with problematic alcohol use, but for these interventions to be cost-effective, clinician workload needs to remain low while ensuring patient adherence and effects. Digital psychological self-care is the provision of a self-guided digital intervention within a structured care process. To investigate the feasibility and preliminary effects of digital psychological self-care for reducing alcohol consumption. Thirty-six adults with problematic alcohol use received digital psychological self-care during 8 weeks, including telephone assessments as well as filling out self-rated questionnaires, before, directly after and 3 months after the intervention. Intervention adherence, usefulness, credibility and use of clinician time were assessed, along with preliminary effects on alcohol consumption. The study was prospectively registered as a clinical trial (NCT05037630). Most participants used the intervention daily or several times a week. The digital intervention was regarded as credible and useful, and there were no reported adverse effects. Around 1 h of clinician time per participant was spent on telephone assessments. At the 3-month follow-up, preliminary within-group effects on alcohol consumption were moderate (standardised drinks per week, Hedge's g = 0.70, 95% CI = 0.19-1.21; heavy drinking days, Hedge's g = 0.60, 95% CI = 0.09-1.11), reflecting a decrease from 23 to 13 drinks per week on average. Digital psychological self-care for reducing alcohol consumption appears both feasible and preliminarily effective and should be further optimised and studied in larger trials.

A brief online single session intervention increases undergraduate confidence speaking out in an active learning physiology course

Increasingly, college physiology courses are transitioning from traditional lecture to active learning because students learn more and fail less when they engage in their learning through activities and discussions in class. Fear of negative evaluation (FNE), defined as a student’s sense of dread associated with being unfavorably evaluated while participating in a social situation, discourages undergraduates from participating in small group discussions, whole class discussions, and conversing one-on-one with instructors. FNE disproportionately impacts women, persons excluded because of their ethnicity or race (PEERs), LGBTQ+ individuals, and those coming from low socioeconomic backgrounds. To equip undergraduates with skills to cope with fear of negative evaluation and bolster their confidence, clinical psychologists and biology education researchers developed Project Engage, a digital, self-guided single-session intervention for college students. It teaches students strategies for coping with and reducing fear of negative evaluation by providing biologically-informed psychoeducation, utilizing interactive elements for engagement, and generating a personalized action plan. In a study of 300 upper-level physiology students, participants randomized to complete Project Engage reported greater increases in overall confidence in engaging in small group discussions (p < 0.01), whole class discussions (p < 0.001) and one-on-one interactions with instructors (p<0.05), from baseline to immediate post-intervention, compared to participants in an active control condition. This work provides a foundation for a freely-available, easily accessible intervention to bolster student confidence contributing in class, with the hope of creating more equitable active learning physiology courses. NSF grant #2141681 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Cognitive-behavioral and dietary weight loss intervention in adult kidney transplant recipients with overweight and obesity: Results of a pilot RCT study (Adi-KTx).

The obesity epidemic and its health consequences have not spared the population of kidney transplant (KTx) candidates and recipients. In addition, KTx recipients are susceptible to weight gain after transplantation. Overweight and obesity after KTx are strongly associated with adverse outcomes. Therefore, we designed a randomized controlled, mono-center study to specifically test the effectiveness of a primarily cognitive-behavioral approach supplemented by nutritional counseling for weight reduction following KTx as the intervention group (IG) in comparison to a brief self-guided intervention as control group (CG). The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00017226). Fifty-six KTx patients with a BMI from 27 to 40 kg/m2 were included in this study and randomized to the IG or CG. Main outcome was the number of participants achieving a 5% weight loss during the treatment phase. Additionally, participants were assessed 6 and 12 months after the end of the 6-month treatment phase. Participants significantly lost weight without group differences. 32.0% (n = 8) of the patients in the IG and 16.7% (n = 4) of the patients in the CG achieved a weight loss of 5% or more. Weight loss was largely maintained during follow-up. Retention and acceptance rate in the IG was high, with 25 (out of 28) patients completing all 12 sessions and one patient completing 11 sessions. Short-term, cognitive-behaviorally oriented weight loss treatment seems to be feasible and acceptable for patients after KTx who suffer from overweight or obesity. This clinical trial was ongoing at the onset of the COVID-19 pandemic which might have influenced study conduct and results. Clinical Trial Registration: https://clinicaltrials.gov/ DRKS-ID: DRKS00017226.

Abstract 720: Implementation and evaluation of a mental health app with comedy content for women living with advanced cancer

Abstract Introduction: Metastatic cancer patients report elevated stress levels and unique stressors compared to other adults. This study tested the feasibility and efficacy of a mental health app with comedy content delivered to women living with advanced cancer (WLAC). Methods: The mental health platform Neolth was used as a self-guided intervention for WLAC, ages 18+ years. WLAC were recruited by The Comedy Cures Foundation through a press release, social media posts, an email newsletter, and a video call for participants on the foundation’s website. No compensation was provided to participants. After using the Neolth platform, which included watching comedy content for eight weeks, researchers evaluated engagement, and stress levels using The Perceived Stress Scale -10 (PSS-10), self-efficacy using The New General Self-Efficacy Scale (GSES), and anxiety and depression using The Hospital Anxiety and Depression Scale (HADS-A and HADS-D). Results: 54 WLAC (M = 52.2 years, R = 31-74) from 10 countries and 24 states participated by completing the baseline questionnaire. 20.5% identified as BIPOC and 33.0% had previous experience with a mental health app. 57.4% (N=31) completed the study surveys at Week 4 and Week 8. At Week 8, HADS-D scores decreased 18.1%, PSS-10 scores decreased 15.1%, HADS-A scores decreased by 9.7%, and GSES scores increased 7.6%. Participants spent an average of 116 minutes per week on Neolth with an average of 3.15 logins per week. 43.6% of time spent was completing self-guided relaxation practices and 17.2% watching Comedy Cures Foundation videos from cancer survivor Saranne Rothberg. The 30-day retention on Neolth was 100%, with 60-day retention 83%. Conclusion: This study demonstrated the ability of a mental health app with comedy content to engage and support the mental health of WLAC, presenting a cost-effective intervention. Further examination with a larger sample size is needed to conduct multivariate analyses for enhanced understanding of the role of mobile apps and comedy content in reducing stress, anxiety, and depression for WLAC. Citation Format: Saranne Rothberg, Katherine B. Grill, Claire Wheeler. Implementation and evaluation of a mental health app with comedy content for women living with advanced cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 720.

Randomized controlled trials assessing efficacy of brief web-based stress management interventions for college students during the COVID pandemic.

The purpose of this study was to evaluate the efficacy of brief, self-guided web-based interventions for decreasing distress among U.S. college students during the pandemic. Three randomized controlled trials were conducted during the spring (Study 1), summer (Study 2), and fall (Study 3) 2020 terms, and were combined into one sample to increase power (N = 775). We evaluated a web-based intervention that focused on increasing present control that had been shown to be effective in several studies prior to the pandemic (e.g., Nguyen-Feng et al., 2017). This intervention was compared to an active comparison condition (psychoeducation about and reminders to engage in Centers for Disease Control and Prevention (CDC)-recommended stress management techniques) in Study 1, to a waitlist comparison in Study 2, and to both comparison conditions in Study 3. Participants were undergraduate psychology students at two campuses of a midwestern state university system. Outcomes-perceived stress (primary); depression, anxiety, and stress symptoms (secondary); and boredom (tertiary)-were assessed at pretest and posttest (and 3-week follow-up in Study 3). Differences across conditions were significant for perceived stress, stress symptoms, and boredom (but not depression or anxiety). Contrary to hypotheses, the Present Control and CDC stress management interventions were equally effective. Both were more effective than no intervention (between-group ds = -0.27 and -0.42). Both interventions were more effective for students with higher baseline stress levels. Completion and adherence rates were high for both conditions. Results suggest that very brief, self-guided stress management interventions can be effective in reducing stress among college students. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Protocol for a bandit-based response adaptive trial to evaluate the effectiveness of brief self-guided digital interventions for reducing psychological distress in university students: the Vibe Up study

IntroductionMeta-analytical evidence confirms a range of interventions, including mindfulness, physical activity and sleep hygiene, can reduce psychological distress in university students. However, it is unclear which intervention is most effective....

Intake of added sugar, fruits, vegetables, and legumes of Portuguese preschool children: Baseline data from SmartFeeding4Kids randomized controlled trial participants.

The SmartFeeding4Kids (SF4K) program is an online self-guided intervention for parents with the propose of changing parental feeding practices and children's dietary intake, focusing on the intake of added sugars, fruit, vegetables, and legumes. This paper aims to describe children's dietary pattern at baseline through a 24-h food recall, the SmartKidsDiet24. Overall, 89 participants recorded at least one meal of the 3-day food recall. Mean age was 36.22 ± 6.05 years and 53.09 ± 15.42 months old for parents and children, respectively. Of these, 22 participants were considered to have 2 days of near complete 24-h food recalls. Children's dietary intake are reported for these 22 participants based on parents reports and, thus, represent estimations only, as it remains unknown whether children consumed other non-reported foods. Fruit was the group with the highest daily intake among children (mean 1.77 ± 1.10 portions/day), followed by added sugar foods (mean 1.48 ± 0.89 portions/day), vegetables [median 1.27 (1.64) portions/day] and legumes [median 0.12 (0.39) portions/day]. Fruit intake was positively correlated with vegetable intake (p = 0.008). Regarding Dietary Reference Values accomplishment, 13.6% of children exceeded the daily safe and adequate intake of sodium, 77.3% did not meet potassium and fiber recommendations, and 31.8% did not meet vitamin C recommendations. All children did not meet calcium, vitamin B12 and vitamin D intake recommendations. Our findings further justify the need for dietary interventions in this field, to improve young children's diets. ClinicalTrials.gov, identifier NCT04591496.

The efficacy of self-guided internet and mobile-based interventions for preventing anxiety and depression – A systematic review and meta-analysis

BackgroundAnxiety and depression are highly prevalent mental disorders which are associated with a considerable personal and economic burden. As treatment alone has a minimal impact on prevalence, there is now a growing focus on interventions which may help prevent anxiety and depression. Internet and mobile based interventions have been identified as a useful avenue for the delivery of preventative programmes due to their scalability and accessibility. The efficacy of interventions that do not require additional support from a trained professional (self-guided) in this capacity is yet to be explored. MethodA systematic search was conducted on the Cochrane Library, PubMed, PsycARTICLES, PsycINFO, OVID, MEDline, PsycEXTRA and SCOPUS databases. Studies were selected according to defined inclusion and exclusion criteria. The primary outcome was evaluating the effect of self-guided internet and mobile based interventions on incidence of anxiety and depression. The secondary outcome was effect on symptom severity. ResultsAfter identifying and removing duplicates, 3211 studies were screened, 32 of which were eligible for inclusion in the final analysis. Nine studies also reported incidence data (depression = 7, anxiety = 2). The overall Risk Ratios for incidence of anxiety and depression were 0.86 (95% CI [0.28, 2.66], p = .79) and 0.67 (95% CI [0.48, 0.93], p = .02) respectively. Analysis for 27 studies reporting severity of depressive symptoms revealed a significant posttreatment standardised mean difference of −0.27 (95% CI [ −0.37, −0.17], p < .001) for self-guided intervention groups relative to controls. A similar result was observed for 29 studies reporting severity of anxiety symptoms with a standardised mean difference of −0.21 (95% CI [-0.31, −0.10], p < .001). ConclusionsSelf-guided internet and mobile based interventions appear to be effective at preventing incidence of depression, though further examination of the data suggests that generalisability of this finding may be limited. While self-guided interventions also appear effective in reducing symptoms of anxiety and depression, their ability to prevent incidence of anxiety is less clear. A heavy reliance on symptom measures in the data analysed suggests future research could benefit from prioritising the use of standardised diagnostic measuring tools to assess incidence. Future systematic reviews should aim to include more data from grey literature and reduce the impact of study heterogeneity.

A self-guided internet-delivered intervention for adults with ADHD: Results from a randomized controlled trial

BackgroundAttention-deficit/hyperactivity disorder (ADHD) in adulthood, with an estimated prevalence of 2–3 %, is associated with several challenges in daily life functioning. Still, the availability of evidence-based psychological interventions for adults with ADHD is limited. Interventions delivered over the Internet on smartphones or personal computers may help to increase the availability of and access to effective psychological interventions. ObjectiveThis study reports on the efficacy of a self-guided psychological Internet-delivered intervention on severity levels of ADHD symptomatology and quality of life in adults with ADHD. MethodsAdults with a self-reported ADHD diagnosis (N = 120) were included in a randomized controlled trial with two arms: 1) self-guided Internet-delivered intervention for managing symptoms and impairments related to ADHD (n = 61); 2) online psychoeducation module (control group, n = 59). The primary clinical outcome was severity levels of ADHD as measured with the Adult ADHD Self-Report Scale. Secondary outcomes were quality of life as measured with the Adult ADHD Quality of Life scale and stress as measured with the Perceived Stress Scale. Measures were obtained at three time points: before (baseline), immediately after (8 weeks) and 3 months after the intervention. The secondary objective of the study was to explore user satisfaction with and adherence to the intervention. ResultsLinear Mixed Model analysis revealed moderate to large between group effect-size improvements on self-report measures of ADHD symptomatology (d = 0.70) and quality of life (d = 0.53). Importantly, effects were maintained at 3-month follow-up (d = 0.76 and d = 0.52). In terms of adherence, 29 % completed all modules, while 59 % completed at least five modules (out of 7). Treatment satisfaction was adequate, with n = 34 (79 %) indicating that they were very satisfied or satisfied with the intervention, and n = 37 (88 %) indicating that they would recommend the intervention to a friend. DiscussionThe study demonstrated the efficacy of a self-guided Internet-delivered intervention by showing reliable and statistically significant improvements in self-reported ADHD symptomatology and quality of life. The intervention may be suitable for better managing ADHD symptoms in primary care and as a low intensity intervention population wide. Trial registrationClinicalTrials.gov, Identifier NCT04726813, January 27, 2021.

Preservice teachers’ science learning and self-efficacy to teach with robotics-based activities: Investigating a scaffolded and a self-guided approach

IntroductionRobotics is viewed as a viable pedagogical strategy for STEM learning because it is characterized by many practices common to the STEM disciplines such as engineering design. With many national curricular calling for STEM integration in K-12 formal educational settings, there is a need for empirical evidence about the effectiveness of different pedagogical approaches to teach with robotics-based activities to promote curriculum learning outcomes and teaching practice. This exploratory study investigated the effectiveness of a scaffolded robotics intervention and a self-guided robotics intervention on pre-service teacher knowledge (PST) of science concepts related to gears and on PST self-efficacy to teach with the robotics-based activities.MethodsA quasi-experimental, pre-post intervention study was implemented with two non-equivalent groups of elementary preservice teachers (PSTs) in a Bachelor of Education program. PSTs in the self-guided group (n = 11) worked with robotics kits in the library at their own pace. PSTs in the scaffolded intervention group (n = 16) were guided through the activity by the author with instructional scaffolds. IBM SPSS Statistics 27 was used to analyze the data.ResultsThe relationship between intervention type and gains in science knowledge was not statistically significant for the self-guided group but was statistically significant for the scaffolded group suggesting that scaffolding supported PST’s learning of the science concepts. With respect to PST self-efficacy to teach with the robotics-based activity, both intervention types revealed statistically significant gains from pre to post tests, however effect sizes indicated that the scaffolded intervention resulted in greater gains in PST self-efficacy to teach with the robotics-based activities.DiscussionThe results provide exploratory evidence that the scaffolded robotics approach, modelled for and experienced by the pre-service teachers in this study, was effective for their learning of science curricular concepts related to gears and for developing their self-efficacy for teaching the robotics-based activities. It should be noted that findings may not be generalizable due to the small sample sizes, especially of the self-guided group. Nevertheless, the findings do provide insights for teacher educators incorporating robotics-based activities into curricular courses such as science methods as it provides specific examples of scaffolds that were effective for science learning and for developing PST self-efficacy. The study also contributes to the literature on instructional strategies that promote robotics adoption in K-12 schools to support development of STEM knowledge and skills.

Mediating Role of Treatment Perceptions in the Relationship Between Individual Characteristics and Engagement With a Digital Psychological Intervention for Pediatric Chronic Pain: Secondary Data Analysis.

Engagement predicts benefits from self-managed treatments. However, engagement is an important concern in digital interventions, with over 50% of patients being nonadherent to interventions in chronic conditions such as chronic pain. Little is known about the individual characteristics that contribute to engagement with a digital self-management treatment. This study tested the mediating role of treatment perceptions (difficulty and helpfulness) in the association between individual baseline characteristics (treatment expectancies and readiness to change) and treatment engagement (online and offline) with a digital psychological intervention for adolescents with chronic pain. A secondary data analysis of a single-arm trial of Web-based Management of Adolescent Pain, a self-guided internet intervention developed for the management of chronic pain in adolescents, was conducted. Survey data were collected at baseline (T1), midtreatment (ie, 4 weeks after the treatment started; T2), and post treatment (T3). Online engagement was assessed using back-end information on the number of days adolescents accessed the treatment website, while the offline engagement was assessed with the reported frequency of use of skills (ie, pain management strategies) learned at the end of the treatment. Four parallel multiple mediator linear regression models, using ordinary least square regression incorporating the variables were tested. In total, 85 adolescents with chronic pain (12-17 years old, 77% female) participated. Several mediation models were significant in predicting online engagement. A significant indirect effect was found for the path expectancies-helpfulness-online engagement (effect 0.125; SE 0.098; 95% CI 0.013-0.389) and for the path precontemplation-helpfulness-online engagement (effect -1.027; SE 0.650; 95% CI -2.518 to -0.054). Fourteen percent of the variance of online engagement was explained by the model including expectancies as a predictor (F3=3.521; P<.05), whereas 15% was explained by the model where readiness to change was the predictor (F3=3.934; P<.05). Offline engagement was partially explained in the model including readiness to change as the predictor but with marginal significance (F3=2.719; R2=0.111; P=.05). Treatment perception, specifically, perceived helpfulness, was a mediator of the pathway between both treatment expectancies and readiness to change and online engagement with a digital psychological intervention for chronic pain. Assessing these variables at baseline and midtreatment may help to determine the risk of nonadherence. Further work is needed to confirm these mediation pathways in larger samples. ClinicalTrials.gov NCT04043962; https://clinicaltrials.gov/ct2/show/NCT04043962.

A randomised, controlled, feasibility trial of an online, self-guided breathlessness supportive intervention (SELF-BREATHE) for individuals with chronic breathlessness due to advanced disease.

SELF-BREATHE is a complex, transdiagnostic, supportive, digital breathlessness intervention co-developed with patients. SELF-BREATHE seeks to build capacity and resilience within health services by improving the lives of people with chronic breathlessness using nonpharmacological, self-management approaches. This study aimed to determine whether SELF-BREATHE is feasible to deliver and acceptable to patients living with chronic breathlessness. A parallel, two-arm, single-blind, single-centre, randomised controlled, mixed-methods feasibility trial with participants allocated to 1) intervention group (SELF-BREATHE) or 2) control group (usual National Health Service (NHS) care). The setting was a large multisite NHS foundation trust in south-east London, UK. The participants were patients living with chronic breathlessness due to advanced malignant or nonmalignant disease(s). Participants were randomly allocated (1:1) to an online, self-guided, breathlessness supportive intervention (SELF-BREATHE) and usual care or usual care alone, over 6 weeks. The a priori progression criteria were ≥30% of eligible patients given an information sheet consented to participate; ≥60% of participants logged on and accessed SELF-BREATHE within 2 weeks; and ≥70% of patients reported the methodology and intervention as acceptable. Between January 2021 and January 2022, 52 (47%) out of 110 eligible patients consented and were randomised. Of those randomised to SELF-BREATHE, 19 (73%) out of 26 logged on and used SELF-BREATHE for a mean±sd (range) 9±8 (1-33) times over 6 weeks. 36 (70%) of the 52 randomised participants completed and returned the end-of-study postal questionnaires. SELF-BREATHE users reported it to be acceptable. Post-intervention qualitative interviews demonstrated that SELF-BREATHE was acceptable and valued by users, improving breathlessness during daily life and at points of breathlessness crisis. These data support the feasibility of moving to a fully powered, randomised controlled efficacy trial with minor modifications to minimise missing data (i.e. multiple methods of data collection: face-to-face, telephone, video assessment and by post).

A Digital Single-Session Intervention Platform for Youth Mental Health: Cultural Adaptation, Evaluation, and Dissemination

Despite the proliferation of evidence-based digital mental health programs for young people, their low uptake and inconsistent implementation preclude them from benefiting youths at scale. Identifying effective implementation strategies for evidence-based supports is especially critical in regions where treatment access is lowest owing to mental health provider shortages. The goal of this academic-community partnership, funded by the City of San Antonio Metropolitan Health District, was to culturally adapt, disseminate, and gauge the acceptability and utility of an evidence-based digital mental health platform-Project Youth Empowerment and Support (YES)-among English- and Spanish-speaking youths living in south Texas. Project YES is an open-access, anonymous platform containing 3 evidence-based, self-guided interventions for youth mental health. Project YES was culturally adapted via focus groups and co-design sessions with San Antonio youths with lived experience of depression and anxiety; translated into Spanish; and disseminated throughout San Antonio, Texas, via community and school partnerships. During the project period (April 2021 to December 2021), 1801 San Antonio youths began and 894 (49.64%) of them completed a 30-minute, single-session intervention within Project YES (aged 11-17 years; n=718, 39.87% male; n=961, 53.36% female; and n=3, 0.17% intersex; n=1477, 82.01% Hispanic; n=77, 4.28% non-Hispanic White; n=113, 6.27% Black; n=28, 1.55% Asian; and n=93, 5.16% other). This completion rate (49.64%) surpassed those previously observed for Project YES (eg, 34% when disseminated via social media). San Antonio youths rated Project YES as highly acceptable across all metrics, both in English and Spanish. In addition, the youths who completed Project YES-ENGLISH reported significant improvements in hopelessness (Cohen d=0.33; P<001), self-hate (Cohen d=0.27; P<001), and perceived agency (Cohen d=0.25; P<001) from before to after the intervention, and the youths who completed Project YES-SPANISH reported significant improvements in self-hate (Cohen d=0.37; P=.049) from before to after the intervention. The results indicate that Project YES-an open-access, free, and anonymous web-based single-session intervention platform-is an acceptable, accessible, and applicable mental health support for English- and Spanish-speaking San Antonio youths.

Brief self-guided digital intervention versus a comprehensive therapist-guided online cognitive behavioural therapy for atopic dermatitis: a trial protocol for a randomised non-inferiority trial

IntroductionOur aim is to investigate whether a shortened digital self-care intervention is non-inferior to, and cost-effective compared with, a comprehensive and therapist-guided cognitive behavioural therapy treatment for atopic dermatitis (AD).Methods...

Perceptions of a self-guided web-based exercise programme for shoulder pain after spinal cord injury: A qualitative study

Study designQualitative study.ObjectivesThe benefits of exercise to reduce shoulder pain in people with spinal cord injury (SCI) are well documented. Digital health interventions offer a potential solution to overcome barriers to access rehabilitation support for exercise. The aim of this project was to gain people’s perspectives to inform the development of a self-guided web-based exercise intervention. Shoulder Pain Intervention delivered over the interNet (SPIN) is a self-guided web-based intervention to prescribe, monitor, and progress evidence-based exercises for people living with SCI and shoulder pain.SettingCommunity in Auckland, New Zealand.MethodsThe Person-Based Approach was used as the framework. Using an Interpretive Descriptive methodology, data were collected in individual and focus group interviews, exploring participants’ perceptions of this intervention idea. Data were analysed using conventional content analysis.ResultsSixteen participants took part and asked Is it right for me?. This had three main sub-themes. Should I use it?, whether I believe it will work for me right now; Can I use it?, whether I can operate the intervention competently and confidently and Will I use it?, whether it will be responsive to my unique needs, and keep me coming back.ConclusionsParticipants expressed their expectations and tipping points when considering using an intervention like this. These findings will inform and guide design and development of an acceptable technology-based intervention to increase the likelihood of engagement with a self-guided web-based exercise programme. The model developed from these themes could be used to inform future self-guided intervention development.

Predictors of Adolescents' Response to a Web-Based Intervention to Improve Psychosocial Adjustment to Having an Appearance-Affecting Condition (Young Person's Face IT): Prospective Study.

Adolescents with a condition affecting their appearance that results in a visible difference can be at risk of psychosocial distress and impaired adjustment. Evidence for the effectiveness of existing interventions in improving psychosocial outcomes is limited, and relevant treatment can be difficult to access. Young Person's Face IT (YPF), a self-guided web-based intervention, has demonstrated potential in reducing social anxiety in adolescents with a visible difference. However, more knowledge is needed about the variables that contribute to variations in intervention effects to identify those who may benefit most from YPF. This study aimed to investigate demographic, psychosocial, and intervention-related variables as predictors of overall intervention effects after adolescents' use of YPF. We used longitudinal data collected as part of a larger, ongoing mixed methods project and randomized controlled trial (ClinicalTrials.gov NCT03165331) investigating the effectiveness of the Norwegian version of YPF. Participants were 71 adolescents (mean age 13.98, SD 1.74 years; range 11-18 years; 43/71, 61% girls) with a wide range of visible differences. The adolescents completed primary (body esteem and social anxiety symptoms) and secondary (perceived stigmatization, life disengagement, and self-rated health satisfaction) outcome measures at baseline and postintervention measurement. The predictor variables were demographic (age and gender), psychosocial (frequency of teasing experiences related to aspects of the body and appearance as well as depressive and anxiety symptoms), and intervention-related (time spent on YPF) variables. Two-thirds (47/71, 66%) of the adolescents completed all YPF sessions and spent an average of 265 (SD 125) minutes on the intervention. Backward multiple regression analyses with a 2-tailed P-value threshold of .20 revealed that several variables were retained in the final models and predicted postintervention outcome changes. Body esteem was predicted by age (P=.14) and frequency of teasing experiences (P=.09). Social anxiety symptoms were predicted by gender (P=.12), frequency of teasing experiences (P=.03), depressive and anxiety symptoms (P=.08), and time spent on YPF (P=.06). Perceived stigmatization was predicted by age (P=.09), gender (P=.09), frequency of teasing experiences (P=.19), and depressive and anxiety symptoms (P=.06). Life disengagement was predicted by gender (P=.03), depressive and anxiety symptoms (P=.001), and time spent on YPF (P=.14). Self-rated health satisfaction was predicted by age (P=.008). However, the results were limited by relatively low explained postintervention variance, ranging from 1.6% to 24.1%. This study suggests that adolescent boys, adolescents who experience higher levels of psychosocial distress related to their visible difference, and adolescents who spend sufficient time on YPF may obtain better overall intervention effects.

Process model of emotion regulation-based digital intervention for emotional problems.

To address the lack of mental health practitioners in developing countries, the current study explored the feasibility of a newly developed self-guided digital intervention program TEA (training for emotional adaptation) in alleviating depressive and anxiety symptoms, as one of a few studies which adapted from theoretical models with effective intervention techniques. The first part of this study involved 11 professional mental health practitioners giving feedback on the feasibility of the TEA; while the second part involved a mixed-method single-arm study with 32 participants recruited online, who went through the seven intervention sessions within 14 days. The questionnaires were collected before, after, 14 days after, and 30 days after intervention. Additionally, 10 participants were invited to semi-structured interviews regarding their suggestions. Practitioners thought that the TEA showed high professionalism (8.91/10) and is suitable for treating emotional symptoms (8.09/10). The generalized estimating equation model showed that the TEA significantly reduced participants' depressive and anxiety symptoms, while the effects of the intervention remained 30 days post intervention (Cohen's d > 1). Thematic analysis revealed three main themes about future improvement, including content improvement, interaction improvement, and bug-fixing. To address the current needs for digital mental health intervention programs to account for the insufficient availability of mental health services in China, the current study provides preliminary evidence of the effectiveness of TEA, with the potential to address the urgent need for remote mental health services. The study was registered at the Chinese Clinical Trial Register (ChiCTR), with number [ChiCTR2200065944].

Preliminary Outcomes from a Single-Session, Asynchronous Online, Stress and Anxiety Management Workshop for College Students.

Self-guided asynchronous online interventions may provide college students access to evidence-based care, while mitigating barriers like limited hours of service. Thus, we examined the preliminary effectiveness of a 45-minute self-guided, asynchronous online, Dialectical Behavior Therapy (DBT)-informed stress and anxiety management workshop. Participants: College undergraduates (N = 131) were randomized to either workshop (n = 65) or waitlist control (n = 66) conditions. Participants in the workshop condition completed baseline measures of depression, stress, and anxiety, before completing the workshop. Participants in the waitlist control condition only completed the baseline measures. All participants were reassessed at one-week follow-up. Controlling for baseline measures, students in the workshop condition experienced significantly less stress and greater self-efficacy to regulate stress and anxiety at follow-up, compared to waitlist controls. A 45- minute self-guided, asynchronous online, DBT Skills-informed stress and anxiety management workshop may reduce stress and self-efficacy to regulate stress and anxiety.

The Effects of a Complex Interactive Multimodal Intervention on Personalized Stress Management Among Health Care Workers in China: Nonrandomized Controlled Study.

Health care workers (HCWs) frequently face multiple stressors at work, particularly those working night shifts. HCWs who have experienced distress may find it difficult to adopt stress management approaches, even if they are aware of the effects of stress and coping processes. Therefore, an individualized intervention may be required to assist distressed HCWs in bridging the "knowledge-practice" gap in stress management and effectively alleviating stress symptoms. The main objective of this research was to compare the effects of a complex interactive multimodal intervention (CIMI) to self-guided stress management interventions on stress symptoms of distressed HCWs, as measured by physiological (heart rate variability), psychological (perceived stress, mental distress, and subjective happiness), and sleep disorder (fatigue and sleepiness) indicators. We conducted a nonrandomized, controlled study in 2 Chinese general hospitals. The participants in this study were 245 HCWs who fulfilled at least 1 of the 3 dimensions on the Depression, Anxiety, and Stress Scale. All eligible individuals were required to complete a questionnaire and wear a 24-hour Holter device to determine the physiological signs of stress as indexed by heart rate variability at both baseline and after the intervention. The CIMI group received a 12-week online intervention with 4 components-mobile stress management instruction, a web-based WeChat social network, personalized feedback, and a nurse coach, whereas the control group simply received a self-guided intervention. After a 12-week intervention, the Perceived Stress Scale (PSS) scores reduced significantly in the CIMI group (mean difference [MD] -5.31, 95% CI -6.26 to -4.37; P<.001) compared to the baseline levels. The changes in PSS scores before and after the intervention exhibited a significant difference between the CIMI and control groups (d=-0.64; MD -4.03, 95% CI -5.91 to -2.14; P<.001), and the effect was medium. In terms of physiological measures, both the control group (MD -9.56, 95% CI -16.9 to -2.2; P=.01) and the CIMI group (MD -8.45, 95% CI -12.68 to -4.22; P<.001) demonstrated a significant decrease in the standard deviation of normal-to-normal intervals (SDNN) within the normal clinical range; however, there were no significant differences between the 2 groups (d=0.03; MD 1.11, 95% CI -7.38 to 9.59; P=.80). The CIMI was an effective intervention for improving sleep disorders, as well as parts of the psychological stress measures in distressed HCWs. The findings provide objective evidence for developing a mobile stress management intervention that is adaptable and accessible to distressed HCWs, but its long-term effects should be investigated in future research. ClinicalTrials.gov NCT05239065; https://clinicaltrials.gov/ct2/show/NCT05239065.

CAREGIVER DEPRESSION AND PROGRESS TOWARD VALUES: AN AUTOREGRESSIVE CROSS-LAGGED PANEL MODEL

Abstract Acceptance and Commitment Therapy (ACT) is an established in-person therapy but can be provided self-guided online. Recently, online ACT has been adapted to support dementia family caregivers. A primary goal of ACT is to connect individuals with their self-identified values, with the assumption that increased progress towards values will lead to improved well-being. While there are established negative associations between depression and progress towards values, the lagged influence of progress toward values at one time point on another time point within intervention is less understood. Our sample was 51 dementia caregivers who completed an online self-guided ACT intervention. Participants were 80.3% female, 53% spouse, with a mean age of 65.98 (SD =11.66). We created an auto-regressive cross-lagged panel model to examine longitudinal associations between progress towards values and depressive symptoms at three time points. Controlling for time 1 (pre-intervention) depressive symptoms, progress towards values at time 1 significantly predicted depression at time 2 (β = -.427, p &amp;lt; 0.01) and progress towards values at time 2 (β = .716, p &amp;lt; 0.001). Depression at time 2 significantly predicted progress towards values at time 3 (β = -.515, p &amp;lt; 0.001) and depressive symptoms at time 3 (β = .580, p &amp;lt; 0.001). The R^2 range from .30-.43. Our analyses suggest that participants’ initial progress toward values strongly negatively predicted their subsequent depressive symptoms, which then predicted later progress towards values. These findings demonstrate the potential reciprocal relationship between progress towards values and depressive symptoms within ACT intervention.