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There is growing interest in smartphone apps as a means of increasing the reach of interventions for poor sleep. To date, most evaluations of sleep interventions delivered via mental health apps (MHapps) have focused on formal treatment programs designed for clinical populations and specific disorders, such as cognitive behavioural therapy (CBT) for insomnia. Yet, there has been a dramatic increase in the demand, availability, and media coverage of standalone, audio-based tools designed for ad-hoc use by the general public before and during sleeping hours. Despite the popularity of such tools (including amongst individuals with disrupted sleep), there is a lack of empirical evidence regarding their efficacy. The current study will aim to assess the feasibility of conducting a future definitive RCT to evaluate the efficacy of two categories of standalone, audio-based sleep exercises (referred to collectively as ‘Sleep Tools’ here) featured on Unmind -- a digital mental health platform for working adults. The two categories will include 1) Nightwaves (NW; ambient music and nature sounds), and 2) Sleep Tales (ST; narrated stories), both of which are designed to facilitate improved sleep. The study will recruit working adults who meet predefined criteria for poor sleep, and will be a multi-arm, parallel-group, external pilot RCT with assessments at pre- (t0) and post-intervention (t1). Participants will be randomised to one of two Sleep Tools interventions featured on the Unmind platform (NW or ST), or to a wait-list (WL) control group, for a period of 4 weeks. The primary aim of this study is to assess the feasibility of the research methods and interventions, in preparation for a definitive RCT. A secondary aim is to assess the preliminary efficacy of each intervention arm via self-reported outcome measures of sleep disturbance, sleep-related impairment, workplace productivity, core symptoms of depression and anxiety, and overall mental wellbeing, captured at t0 and t1. The study will incorporate a secondary trial designed to report on acceptability and usability of the Unmind Sleep Tools under more pragmatic, naturalistic study conditions.

There is growing interest in online and smartphone-based applications (‘apps’) as an alternative delivery medium for mental health and well-being interventions. However, few commercial mental health apps (MHapps) are supported by empirical evidence, and there is a lack of evidence regarding the impact of MHapps when delivered to employee groups or in workplace settings. This pilot study aims to evaluate the feasibility, acceptability, and preliminary efficacy of three brief interventions featured on Unmind -- a digital mental health platform for the workplace that incorporates evidence-based practices such as cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT). The three interventions being evaluated (referred to as "Series") are designed to address stress, anxiety, and resilience, respectively. The study will recruit UK-based, community-dwelling, working adult participants, and employ a parallel, multi-arm, external pilot randomised controlled trial (RCT) design, with a 1-month follow-up. Participants will be randomly allocated to one of the three intervention arms or to a no-intervention control group with a 1:1:1:1 allocation ratio. The primary aim of the study is to evaluate the feasibility and acceptability of each intervention arm. A secondary aim is to establish the preliminary efficacy of each intervention arm with respect to self-report measures of stress, anxiety, depression, resilience, and overall mental health/wellbeing, including establishing between-group effect sizes (for each Unmind Series versus a no-intervention control) and 95% confidence intervals (CIs). The findings from this study will inform whether a definitive RCT to evaluate the efficacy of the Unmind platform is warranted, and will provide estimates of the parameters required for its design and implementation.

ObjectivesThe objective of this study was to assess whether the Meru Health Program (MHP), a novel, self-guided, structured smartphone-based intervention with asynchronous therapist support, is associated with improvements in occupational impairment and daily functioning in working adults with symptoms of depression and anxiety. MethodsIn this observational, pre-post study, occupational and functional impairment (assessed via the Workplace Performance and Activity Impairment [WPAI] questionnaire) was measured pre- and post-intervention in a real-world sample of employed patients (n = 64) receiving treatment via the MHP for symptoms of mild to moderate depression and/or anxiety (Patient Health Questionnaire-9 item scale [PHQ-9] > 4 and/or Generalized Anxiety Disorder-7 item scale [GAD-7] > 4). ResultsThe MHP was associated with improvements in presenteeism (mean decrease = 12.1, 95% CI = [4.17 – 20.0], p = 0.003; d = 0.56), overall work impairment (mean decrease = 13.4, 95% CI = [5.62 – 21.2], p < 0.001; d = 0.54), and impairment in daily functioning (mean decrease = 14.8, 95% CI = [9.09 – 20.4], p < 0.001; d = 0.60), as well as smaller (non-significant) improvements in absenteeism (mean decrease = 4.32, 95% CI = [-1.00 to 9.64], p = 0.11; d = 0.25). A conservative estimate of annual productivity cost savings associated with the MHP is $6271 per employee, corresponding to a 30% relative improvement in overall work productivity. ConclusionsRemote, smartphone-based interventions such as the MHP may help employees suffering with mild-to-moderate mental health issues function and perform better at work, resulting in cost savings for employers.

Human decisions can be habitual or goal-directed, also known as model-free (MF) or model-based (MB) control. Previous work suggests that the balance between the two decision systems is impaired in psychiatric disorders such as compulsion and addiction, via overreliance on MF control. However, little is known whether the balance can be altered through task training. Here, 20 healthy participants performed a well-established two-step task that differentiates MB from MF control, across five training sessions. We used computational modelling and functional near-infrared spectroscopy to assess changes in decision-making and brain hemodynamic over time. Mixed-effects modelling revealed overall no substantial changes in MF and MB behavior across training. Although our behavioral and brain findings show task-induced changes in learning rates, these parameters have no direct relation to either MF or MB control or the balance between the two systems, and thus do not support the assumption of training effects on MF or MB strategies. Our findings indicate that training on the two-step paradigm in its current form does not support a shift in the balance between MF and MB control. We discuss these results with respect to implications for restoring the balance between MF and MB control in psychiatric conditions., PLoS Computational Biology, 15 (11), ISSN:1553-734X, ISSN:1553-7358