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Technological interventions are increasingly popular methods of targeting and preventing loneliness in older adults. Research has identified various factors that influence the willingness and propensity of older adults to integrate technology into their social lives and the ways in which this may enhance their social connectedness. Given prevalence rates and negative outcomes associated with loneliness for this population, further research is warranted to clarify the mechanisms through which technological interventions may decrease loneliness. This study aimed to better understand the perspectives of older adults on the role of technology in their social relationships in later life. Four focus groups were conducted with 27 older adults, aged 65–80 years. Transcripts were analysed using thematic analysis, and results were validated via written participant feedback. Participants reported technology as one of many tools used to maintain their social relationships. Their choice to use technology for social interaction was influenced by their estimation of effort required, likely quality of the interaction, and the privacy and security provided. These factors were the same as those that influenced decisions to use other methods (e.g. face-to-face meetings). Based on the results, we recommend that loneliness interventions should be technology-agnostic and multifaceted, providing a wide range of tools that recognise the technological competencies of older adults and supporting different interaction types to meet the preferences of the individual.

Loneliness, a negative emotion stemming from the perception of unmet social needs, is a major public health concern. Current interventions often target social domains but produce small effects and are not as effective as established emotion regulation (ER)-based interventions for general psychological distress (i.e., depression/anxiety). Given that loneliness and distress are types of negative affect, we aimed to compare them within an ER framework by examining the amount of variance ER strategies accounted for in loneliness versus distress, and comparing the ER strategy profiles characterising them. Participants (N = 582, Mage = 22.31, 77.66% female) completed self-report measures of loneliness, distress, and use of 12 cognitive (e.g., cognitive reappraisal) or behavioural (e.g., expressive suppression) ER strategies. Regression analyses revealed that ER explained comparable variance in these constructs. Latent profile analysis identified seven profiles differing in ER patterns, with no distinct loneliness or distress profile identified. Rather, similar patterns of ER characterised these two constructs, involving the greater use of generally maladaptive strategies and the lesser use of generally adaptive strategies. However, loneliness was additionally characterised by less use of strategies involving social connection/expression. Overall, our study supports the utility of ER for understanding loneliness. Established ER-based frameworks/interventions for distress may have transdiagnostic utility in targeting loneliness.

Loneliness impedes recovery from mental illness. Despite increased interest in loneliness in psychosis, qualitative methods are underused in clinical research on this topic.We used qualitative interviews to explore loneliness among persons with schizophrenia spectrum disorders (SSDs). We examined which aspects of living with psychosis were associated with the experience of loneliness, including symptomatology, social relationships, and disruptions in school/work.Sixteen participants diagnosed with SSDs engaged in semi-structured, qualitative interviews about loneliness. Participants commented on current activities and social relationships, including their perceptions of the quantity, quality and types of relationships. Important demographic and clinical information was acquired through communication with participants and/or through medical record review. Thematic analysis was used to examine interview content.Our analyses revealed four key topic areas and several sub-themes related to loneliness across participants, including aspects of the physical environment (e.g. financial limitations), social context (e.g. lacking a romantic partner), and psychological functioning (e.g. psychotic/symptoms) that impact lonely feelings. Participants commented on coping strategies to manage loneliness and provided suggestions for possible interventions.Persons diagnosed with SSDs report significant and impactful feelings of loneliness. This study highlights the need for novel and effective treatments targeting loneliness in this population.

Background Loneliness and social isolation are recognised as social problems and denote a significant health burden. The aim of this study was to conduct a systematic literature review to explore the health state utility values (HSUVs) associated with loneliness and/or social isolation. Method Peer-reviewed journals published in English language that reported both HSUVs along with loneliness and/or social isolation scores were identified through five databases. No restrictions were made relating to the population, study design or utility estimation method used. Results In total, 19 papers were included; 12 included a measure of loneliness, four studies included a measure of social isolation and three studies considered both loneliness and social isolation. All studies focused on individuals with pre-existing health conditions—where the EQ-5D-3L instrument was most frequently used to assess HSUVs. HSUVs ranged from 0.5 to 0.95 in those who reported not being lonely, 0.42 to 0.97 in those who experienced some level of loneliness, 0.3 to 0.87 in those who were socially isolated and 0.63 to 0.94 in those who were not socially isolated. Conclusion There was significant variation in HSUVs complicated by the presence of co-morbidities, population heterogeneity, variations in methods used to derive utility scores and differences in the measurement of loneliness and/or social isolation. Nevertheless, the lower HSUVs observed should be considered to significantly impact quality of life, though we also note the need for further research to explore the unique impact of loneliness and social isolation on HSUVs that can be used in the future economic evaluations.

Background Young people are vulnerable to experiencing problematic levels of loneliness which can lead to poor mental health outcomes. Loneliness is a malleable treatment target and preliminary evidence has shown that it can be addressed with digital platforms. Peer Tree is a strength-based digital smartphone application aimed at reducing loneliness. The study aim is to reduce loneliness and assess the acceptability, usability, and feasibility of Peer Tree in young people enrolled at university. Methods This will be a pilot randomised controlled trial (RCT) comparing a strength-based digital smartphone application (Peer Tree) with a control condition. Forty-two young people enrolled at university will be recruited for this pilot RCT. Participants with suicidal ideation or behaviours, acute psychiatric symptoms in the past month, or a current diagnosis of a mood or social anxiety disorder will be excluded. Allocation will be made on a 1:1 ratio and will occur after the initial baseline assessment. Assessments are completed at baseline, at post-intervention, and at follow-up. Participants in the control condition complete the same three assessment sessions. The primary outcome of the study will be loneliness. Depression, social anxiety, quality of life, acceptability, usability, feasibility, and safety of Peer Tree will also be measured as secondary outcomes. Discussion This trial will report the findings of implementing Peer Tree, a smartphone application aimed at reducing loneliness in university students. Findings from this trial will highlight the initial efficacy, acceptability, and feasibility of using digital positive psychology interventions to reduce subthreshold mental health concerns. Findings from this trial will also describe the safety of Peer Tree as a digital tool. Results will contribute evidence for positive psychology interventions to address mental ill-health. Trial registration Australian New Zealand Clinical Trial Registry ACTRN12619000350123. Registered on 6 March 2020

Loneliness is an important health issue facing older people due to its association with poor quality of life and poor health outcomes. This paper aimed to clarify key issues around loneliness among older adults and draw attention to innovative programs and the translation of emerging research into practice. Loneliness is a mismatch between a person's actual and desired social connections, experienced as negative emotions. Older adults are vulnerable to loneliness because of changes associated with ageing. As such, identifying as older is often seen as a burden, negatively impacting self-esteem, sense of purpose and relevance, culminating in loneliness. Interventions combatting loneliness can target individuals, relationships, communities or societies. We advocate for an intersectoral approach to support healthy ageing and reduce loneliness. This will require further research to evaluate new approaches with loneliness as the primary outcome, and additional funding to translate evidence into an integrated multi-level approach to addressing loneliness.

Objective: The aim of the current study was to investigate cardiovascular responses to a brief social exclusion stressor, the Cyberball task, and to determine whether individual differences in depression, anxiety, and perceived social isolation moderate physiological stress responses. Methods: Sixty-four participants engaged in the Cyberball task while heart rate, blood pressure, and respiratory rate were continuously measured. Results: Systolic (M = 121.61, SD = 13.34) and diastolic (M = 77.34, SD = 7.56) blood pressure increased significantly during the exclusion condition compared with the rest condition (M = 117.81, SD = 12.71, M = 75.63, SD = 7.39, respectively). Significant correlations were also found between social anxiety (r = −0.25) and depression (r = −0.25) scores with systolic blood pressure from the exclusion condition. Further, participants who reported high depression scores had attenuated cardiovascular responses to social exclusion. Conclusions: Overall, cardiovascular activity were elevated after a brief social stressor, but those with clinically relevant cut off scores on the CES-D had attenuated cardiovascular responses These findings support the growing body of literature surrounding cardiovascular stress reactivity to stress induced from social exclusion.

Loneliness is a growing public health concern that is associated with poor mental health (e.g., social anxiety, depression) and increased physical health problems (e.g., cardiovascular disease, sleep disturbances). Socially vulnerable groups such as the elderly, migrants, and asylum seekers are more susceptible to the effects of loneliness. We examined loneliness severity in lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual orientation and gender identity diverse (LGBTQIA+) communities. The relationships between loneliness, mental health, social support, belongingness, and quality of life in a sample of LGBTQIA+ (n = 238) and non-LGBTQIA+ (n = 270) adults aged 18-73 years (N = 508) were examined. Overall, LGBTQIA+ adults experienced higher levels of loneliness, depression, and social anxiety than the non-LGBTQIA+ comparison group. LGBTQIA+ adults also reported lower perceived social support and were at higher risk of social isolation than the non-LGBTQIA+ group. Thus, LGBTQIA+ adults may be at greater risk of loneliness and social isolation than has previously been recognized. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

COVID-19 pandemic and its associated social and physical distancing restrictions may have had a severe impact on health. In the present study, we investigate the changes in physical, social and mental health, as well as the health literacy of Australians subsequent to the onset of COVID-19 pandemic, and examine the influence of loneliness on these health-related factors. Using a retrospective cross-sectional study design, 607 Australian adults completed a self-report online survey which assessed their health-related factors before and after onset of the COVID-19 pandemic (data collected between June 2020 to November 2020). Australians reported statistically significant increase in a number of (poorer) health-related factors (e.g., weight gain, sleeping difficulties, poor somatic health, higher loneliness, more issues navigating the healthcare system) post onset of COVID-19 pandemic. Further, after adjusting for covariates, higher loneliness during pandemic predicted poorer health-related outcomes (e.g., more somatic health complaints, poorer quality of diet, poorer social support for health). The COVID-19 pandemic and its associated social and physical distancing restrictions may have contributed towards poorer health-related factors among Australian adults. Further, increased loneliness during the pandemic may have further worsened physical health and health literacy outcomes among Australians.

Purpose: Loneliness and social isolation, experienced more long-term, has been shown to increase mortality and lead to poorer health outcomes in specific cohorts. However, it is unclear what the prevalence of chronic loneliness and social isolation is, and which demographic groups are most at risk of reporting more chronic forms. Methods: A psychometrically validated classification system was used to identify people who met criteria for episodic and chronic loneliness and social isolation using the Household Income and Labour Dynamics in Australia (HILDA) survey waves 14-18. Results: The cumulative prevalence over five years of loneliness (overall 34%; 21% episodic, 13% chronic) far exceeded that of social isolation (overall 17%; 13% episodic, 4% chronic). There was consistency in the demographic characteristics (from age, sex, household type, income) of those who experienced loneliness and social isolation. However, people with a long-term health condition had an elevated risk of episodic loneliness (AOR = 1.24, 95%CI = 1.11-1.39) and a markedly higher risk of chronic loneliness (AOR = 2.01, 95% CI = 1.76-2.29), compared with those without a long-term health condition. Conclusions: Loneliness, both episodic and chronic subtypes, is more prevalent than social isolation, yet remains neglected and poorly targeted within current practice and policy.

Background First-episode psychosis typically has its onset during adolescence. Prolonged deficits in social functioning are common in FEP and yet often variance in functioning remains unexplained. Developmental psychology frameworks may be useful for understanding these deficits. Eudaimonic well-being (EWB), or positive self-development, is a developmental psychology construct that has been shown to predict mental health outcomes across multiple populations but has not been systematically reviewed in FEP. Aim Our aim was to systematically review the evidence for: the predictors of EWB, the effectiveness of EWB interventions and to examine the quality of this research in FEP. Methods Selected studies measured either composite or components of EWB. A systematic search produced 2876 abstracts and 122 articles were identified for full screening which produced 17 final papers with 2459 participants. Results Studies comprised six RCTs, eight prospective follow-up studies and three case-controlled studies. Self-esteem and self-efficacy were the most commonly measured components. A meta-analysis of RCTs revealed no statistically significant effect of interventions on self-esteem. The extant research indicates that character strengths may be associated with higher EWB. Self-esteem may be lower in FEP compared with age matched controls but not different from ultra-high risk patients. Self-esteem appears to be associated with poorer insight and improved therapeutic alliance. Significant problems with both external and internal validity of reviewed studies were apparent. Conclusions The hypotheses that lowered EWB is a risk factor for both onset of FEP and for poorer functional outcomes warrant further investigation. There is currently no evidence for effective interventions for EWB in FEP.

Loneliness is increasingly recognised as the next critical public health issue. A plausible reason for this concern may be related to emerging societal trends affecting the way we relate, communicate, and function in our social environment. In 2006, a prominent review of the clinical significance of loneliness was published. However, there has not been a comprehensive update on known and emerging risk factors and correlates of loneliness since then. Furthermore, there is no conceptual model that has been developed to better account for the complexity of loneliness and to inform the development of evidence-based solutions as we challenge the issues of the twenty-first century. We reviewed the current literature to identify either known or emerging risk factors and correlates of loneliness since 2006. This includes new or known evidence on: (1) demography; (2) health, including physical health; mental health; cognitive health; brain, biology, and genetics; and (3) socio-environmental factors including digital communication and the workplace. We synthesized the literature according to a new proposed conceptual model of loneliness which showed the interplay between known and emerging correlates and risk factors from demography, health, to socio-environmental factors. In the conceptual model of loneliness, we illustrated how solutions can be delivered and tailored to an individual based on their life circumstances and preferences. We concluded by making specific recommendations in advancing our scientific understanding of loneliness. Our knowledge can only be deepened if we increase scientific rigour via accounting for confounding variables and using longitudinal, multi-disciplinary, and multiple methodologies in research. We also call for the rigorous evaluation of programs targeting loneliness.

Prior research focusing on social anxiety and impairment in friendships has explored the role of specific behaviors within friendships, such as receiving favors from a friend, in its relation to social anxiety symptoms and friendship quality. In a prior study, we examined three types of reactions to favors (negative reactions to favors, positive reactions to favors, and expectation of tit-for-tat behavior) and explored how these reactions relate to social anxiety, which resulted in the creation of the Favor Scale, a measure of an individual’s response to friendly giving. In the current study, we explore the psychometric properties of the Favor Scale in a sample of individuals with generalized social anxiety disorder (GSAD) and a sample of healthy controls (NOSAD). Results largely replicated the three-factor structure of the Favor Scale (with the removal of a single item in the GSAD group) and findings suggested both tit-for-tat behavior and negative reactions to favors are elevated in GSAD individuals compared to NOSAD individuals.

Background Voice-hearing experiences can be distressing and impairing, and existing psychological treatments show modest effectiveness. Ecological momentary assessment and intervention (EMA/I) are two promising approaches which may be used as digital tools to support and enhance existing psychological therapies. The aim of this study was to investigate the potential clinical utility of smartphone-based EMA/I in a blended, coping focused therapy for voice-hearing experiences. Method: This pilot RCT focused on feasibility, acceptability and preliminary estimations of efficacy. Thirty-four participants with persisting and distressing voices were randomised to receive the four-session intervention along-side treatment-as-usual (TAU) or TAU-only. Results: Findings supported the feasibility and acceptability of the approach, with good engagement and satisfaction rates, and clinical outcomes showed the intervention holds promise for improving coping, overall severity of voices and to some degree their negative impact. Conclusion: This is the first examination of the use of EMA/I in a blended therapy for psychotic experiences, with findings suggesting these technologies show promise as clinical tools.

Background Community interventions are often promoted as a way of reducing loneliness and social isolation in our neighbourhoods. However, those community interventions are rarely examined within rigorous study designs. One strategy that holds the potential to reduce loneliness and can promote health and wellbeing is doing acts of kindness. The current study involves evaluating the impact of kindness acts on loneliness in community-dwelling individuals using an online social networking platform. Methods This study is made up of three randomised controlled trials conducted in three countries. Each randomised controlled trial has two arms (intervention vs waitlist control) and is designed to compare the effectiveness of the KIND challenge, which involves doing at least one act of kindness per week within a four-week period. This study will recruit users of an online community, be randomised online, and will be conducted using online assessments. We will first explore the effects of the intervention on the primary outcome of loneliness, followed by secondary outcomes, social isolation, neighbour relationship quality and contact, mental health symptoms, stress, quality of life, and positive affect. Further, we will assess the feasibility, acceptability, and safety of the KIND Challenge. Discussion This study, designed to evaluate the impact of kindness on the community, will be the first large scale randomised control trial conducted across three countries, Australia, UK, and USA. It will examine the potential of community-led interventions to reduce loneliness, improve social isolation, and promote neighbourhood cohesion, health, and wellbeing, which is especially crucial during the COVID-19 public health crisis. Trial registration Clinical Trials Registry. NCT04398472. Registered 21st May 2020.

Background Loneliness and social isolation are increasingly recognised as global public health threats, meaning that reliable and valid measures are needed to monitor these conditions at a population level. We aimed to determine if robust and practical scales could be derived for conditions such as loneliness and social isolation using items from a national survey. Methods We conducted psychometric analyses of ten items in two waves of the Household, Income and Labour Dynamics in Australia Survey, which included over 15,000 participants. We used the Hull method, exploratory structural equation modelling, and multidimensional item response theory analysis in a calibration sample to determine the number of factors and items within each factor. We cross-validated the factor structure using confirmatory factor analysis in a validation sample. We assessed construct validity by comparing the resulting sub-scales with measures for psychological distress and mental well-being. Results Calibration and cross-validation consistently revealed a three-factor model, with sub-scales reflecting constructs of loneliness and social isolation. Sub-scales showed high reliability and measurement invariance across waves, gender, and age. Construct validity was supported by significant correlations between the sub-scales and measures of psychological distress and mental health. Individuals who met threshold criteria for loneliness and social isolation had consistently greater odds of being psychologically distressed and having poor mental health than those who did not. Conclusions These derived scales provide robust and practical measures of loneliness and social isolation for population-based research.

Age differences in the prevalence of loneliness have been a key focus among researchers, practitioners, and policy makers. However, the degree to which those reflect genuine differences in the experience of loneliness or the way individuals understand and respond to loneliness measures is yet to be examined. The current study explored the age measurement invariance of the 20-item Revised University of California Los Angeles, Loneliness Scale (UCLA-LSR) and its shorter forms in a U.K. sample of adults aged 18 to 99 years ( M = 50.6, SD = 19.7). The fit of different structures/versions was explored through multigroup confirmatory factor analysis (CFA; N = 4,375) and local structural equation modeling ( N = 19,521). Results indicated a poor and/or inconsistent structure for the 20-item UCLA-LSR and many of its shorter forms. Of the structures considered, 12 showed acceptable model fit and received age measurement invariance testing through multigroup CFA and alignment; 10 of these achieved full, partial, or approximate measurement invariance. Our findings suggest that the age measurement invariance of loneliness measures should not be assumed, and crucially, this must be explored before accurate and meaningful age comparisons can be made. Implications for measurement research, and clinical and community practice, are discussed.

Social anxiety disorder (SAD) is characterised as an excessive fear of negative judgment from others and is considered one of the most disabling of the mental ill health conditions. Research findings indicate that it is also a significant issue for individuals diagnosed with a psychotic disorder, with prevalence rates of social anxiety ranging from 8% to 36%. This study was conducted to address the variance of the reported prevalence rates of comorbid SAD amongst individuals with a psychotic disorder diagnosis. Via a systematic review, we collated all available literature on the prevalence of SAD in individuals with a psychotic disorder, and evaluated the prevalence results via meta-analysis. We also synthesised all psychosocial outcomes attributed to SAD comorbidity and conducted a narrative review of the relevant findings. Across 25 studies providing data from 1980 to May 2018 and spanning 13 countries (N = 92,522), we found a pooled prevalence rate of 21% (16%-26%). In outpatient samples, (17 studies), the prevalence was 25% (19%-31%), statistically significantly higher (z = 5.12, p .001) than that of the inpatient studies six studies, which was 9% (7%-12%). We also found that SAD comorbidity is associated with increased depression, poorer social function, poorer subjective quality of life, greater negative self-evaluation, and greater insight. The results from this systematic review and meta-analysis suggest that SAD is prevalent amongst individuals with a psychotic disorder. More consistent screening for SAD and the development of theoretically driven and empirically supported tailored treatments are recommended.

Purpose Loneliness is a challenge for individuals with psychosis; however, interventions rarely target loneliness in this group. Method We developed a pilot positive psychology group intervention designed to reduce loneliness in psychosis and examined its feasibility and acceptability. Results Sixteen participants attended 5.38 (SD = 0.70) out of six sessions, with a dropout rate of 10%. Participants were significantly less lonely at post-treatment (p

Background: Social restrictions and government-mandated lockdowns implemented worldwide to curb the SARS-CoV-2 virus disrupt our social interactions, behaviours, and routines. While many studies have examined how the pandemic has influenced feelings of loneliness and poor mental health, such as depression and anxiety, few have focused on social anxiety symptomatology. Methods: We collected data on loneliness, social anxiety, depression, and social restrictions severity across three timepoints in the first six months of the pandemic, in 2665 participants across 121 countries. We later restricted our analyses to Australia, United States, and United Kingdom (n = 1562) to code from reliable sources of objective social restriction data. Longitudinal data were analysed using a multivariate latent growth curve model. Findings: Loneliness reduced, depression remained unchanged, and social anxiety symptoms increased as social restrictions severity eased in the first six months of the SARS-CoV-2 pandemic. Consistent with previous research, specific demographic factors (e.g., younger age, unemployment, lower wealth, and living alone) all influenced loneliness, depression, and social anxiety at the onset of the pandemic. No demographic factors influenced changes in levels over time for loneliness or depression, but being younger and being unemployed influenced change in levels over time for social anxiety. Loneliness, social anxiety, and depressive symptoms were highly related, but the course of social anxiety symptoms differed from loneliness and depression- those higher in social anxiety at baseline also increased in social anxiety quicker over time. Interpretation: Social anxiety remains an overlooked mental health symptom in SARS-CoV-2 pandemic research. Frontline practitioners may see increased social anxiety and avoidance even as social restrictions ease. Service delivery providers should focus on vulnerable groups, including those aged 18 to 25 years, unemployed, and with lower wealth, during this public health crisis. Funding: None to declare. Declaration of Interest: None to declare. Ethical Approval: Ethics approval was granted by Swinburne University Human Research Ethics Committee.

Objective The objective of the Entourage project was to develop an innovative digital mental health intervention addressing key barriers experienced by young people in accessing evidence‐based therapy for social anxiety. In particular, Entourage takes a specific focus on reaching young men, given their lower rates of service engagement. Method This article discusses the theoretical underpinnings, therapeutic mechanisms, persuasive technology elements, and development process of a novel approach incorporating graphic medicine, clinical and peer support, and social networking. Results Based on an integrated cognitive model of social anxiety disorder and consistent with the principles of cognitive behavioural therapy (CBT), a novel digital intervention for social anxiety was developed (Entourage). Using the moderated online social therapy (MOST) model, Entourage provides young people with a digital strengths‐based platform to overcome social anxiety symptoms. Designed in close partnership with young people with a lived experience of mental ill‐health, and overseen by a steering group of young men, Entourage applies graphic medicine through bespoke therapy comics to help users understand and overcome symptoms. Program e‐mentors (expert clinicians and trained peer workers) work in tandem to maintain engagement, support participant skill acquisition, and promote opportunities for social connectedness. Behavioural experiments and in‐vivo exposure activities facilitate restructuring of maladaptive social anxiety‐focussed cognitions. Conclusions Entourage represents an innovative approach to managing social anxiety in young people. Intervention elements seek to ensure longer‐term engagement of users, in particular young men, who have unmet service needs. Results of a single‐group clinical trial of Entourage are forthcoming. KEY POINTS (1) Young people experiencing problematic levels of social anxiety also face a range of barriers in accessing traditional face‐to‐face therapy, particularly as the nature of the disorder involves avoidance of interpersonal interaction. (2) Digital interventions applying CBT for social anxiety have shown promise, however new approaches are needed that provide therapeutic content alongside opportunities for behavioural application of therapy. (3) Entourage represents an innovative application of an integrated cognitive model of social anxiety. Combined with strengths based approaches to accessible online treatment for young people, it involves graphic medicine, clinical and peer support, and social networking.

[Extract] National surveys provide critical snapshots of the prevalence of mental health problems and the needs of individuals and communities adversely affected by them. The second Australian national survey of psychosis, conducted in 2010 with sites across five Australian States covering 10% of Australians in the 18–64-year-old age group, is an important case in point (Morgan et al., 2012). In addition to attaining updated prevalence data, the second survey extended upon its predecessor (Jablensky et al., 2000) by capturing an enriched picture of the lives of people diagnosed with psychosis thereby providing new emphases for achieving better outcomes. The in-depth interviews, covering clinical presentation, living circumstances, and social participation, continue to provide a source of new insights.

BACKGROUND University students are vulnerable to poor mental health, psychological distress, and loneliness relative to nonuniversity student peers. However, the rate of seeking mental health treatment among university students is low. Web-based psychological interventions may provide an opportunity for supporting vulnerable university students who are unlikely to otherwise seek support. OBJECTIVE The aim of this study is to examine the feasibility, acceptability, safety, and efficacy of an existing web-based transdiagnostic cognitive behavioral therapy (CBT) mental health program for use among Australian university students. METHODS This is a pilot randomized controlled trial comparing a self-directed web-based CBT mental health program with a waitlist control. The self-directed modules will be augmented with optional webchat or telephone coaching with a therapist. The recruitment target is 70 university students who do not present with a clinical mental health disorder. Allocation will be made in a 1:1 ratio and will occur after the initial baseline assessment. Assessments will be completed at baseline, upon completion of a 4-week waitlist (waitlist group only), upon completion of the program, and at 3 months after completion of the program. RESULTS The trial was funded in June 2018, and the protocol was approved by the Swinburne University Human Research Ethics Committee in September 2018. Recruitment commenced in October 2018, with the first participant allocated in November 2018. A total of 70 participants were recruited to the trial. The trial recruitment ceased in June 2019, and data collection was finalized in December 2019. We expect the final data analysis to be completed by November 2020 and results to be published early in 2021. The primary outcomes are feasibility, acceptability, safety, and symptoms of depression, anxiety, and stress. The secondary outcomes are psychological wellbeing, quality of life, loneliness, self-reported physical health status, emotion regulation, and cognitive and mindfulness processes. CONCLUSIONS The acceptability, feasibility, safety, and efficacy of a web-based mental health program in university students will be evaluated. Web-based mental health programs offer the opportunity to engage university students who may be reluctant to seek support through traditional face-to-face mental health services, and the transdiagnostic approach of the program has the potential to address the breadth of mental health concerns of university students. CLINICALTRIAL Australian New Zealand Clinical Trial Registry ACTRN12618001604291; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001604291 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/21307

Objective The primary objective was to determine the acceptability, feasibility and safety of a novel digital intervention (Entourage) for young people with prominent social anxiety symptoms, with a particular focus on the engagement of young men. The secondary aim was to explore whether the intervention was associated with clinically significant improvements to clinical and social variables known to co-occur with social anxiety. Method A multidisciplinary team comprising of mental health clinicians, researchers, young adult fiction writers, a comic artist and young people with a lived experience of social anxiety developed the Entourage platform in collaboration. Entourage combines evidence-based therapeutic techniques for social anxiety with an engaging, social-media-based interface that allows users to build social connections, while also receiving expert clinical moderation and support from peer workers. Acceptability, feasibility and safety outcomes of Entourage were tested in a 12-week pilot study with 89 young people (48.3% male; age M = 19.8 years, SD = 3.3 years). Eligible participants were recruited via liaison with four headspace early-intervention centres in north-western Melbourne. Results 56.8% of the sample reported social anxiety symptoms in the severe or very severe range at baseline. Results demonstrated the Entourage intervention was feasible, safe, and potentially acceptable, with 98.6% of participants reporting they would recommend Entourage to another young person experiencing social anxiety. Usage results were also comparable across male and non-male participants. Results showed that young people reliably and significantly improved on clinical and social variables. In particular, young males showed a clinically significant improvement on social anxiety symptoms (d = 0.79, p, Highlights • Entourage is a novel digital intervention for social anxiety. • Clinical and peer moderators help to boost engagement with the intervention. • Entourage was trialled with 89 young people experiencing social anxiety. • Entourage was acceptable, feasible and safe, with clinical and social benefit.