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The majority of individuals is exposed to at least one traumatic event in life. Children and adolescents are more likely to be exposed to repeated or multiple traumatic events, and youth who have endured chronic and widespread trauma are especially vulnerable to subsequent symptoms like posttraumatic stress symptoms (PTSS). Furthermore, youth exposed to trauma frequently do not seek professional help, and there is a lack of evidence-based treatment options. Considering youth’s barriers towards face-to-face psychotherapy, and concurrent high affinity with digital devices, internet- and mobile-based psychological interventions (IMIs) have the potential to increase youth‘s access to evidence-based treatments for PTSS. While IMIs have been shown to provide an effective and acceptable treatment option for adults exposed to trauma and with PTSS, research on IMIs for youth is still scarce. Therefore, the aim of this review is to evaluate the efficacy of internet- and mobile based psychological interventions for youth exposed to traumatic events.

For sexual dysfunction, the research and implementation of Internet- and Mobile-based Psychological Interventions (IMIs) is still in its infancy compared to other mental disorders such as anxiety disorders and depression. IMIs are particularly suitable as a treatment modality for sexual dysfunctions, as sexual difficulties are often associated with strong feelings of shame and rarely addressed in routine care. Despite progressive sexual education and social openness in many European countries, sexual dysfunctions are still a taboo subject in many societies around the globe and are associated with stigmatization, which has a negative effect on the utilization of available treatments. The characteristics of IMIs such as anonymity and low-threshold access can be helpful to lower treatment barriers. Not seeing the therapist face to face can make it easier to address sensitive issues such as sexual problems. To provide evidence-based treatment independent of time and place can help to address the underuse and availability of treatments for sexual dysfunction. Furthermore, the core treatment elements for sexual dysfunction are designed in such a way that they can usually be carried out by patients in the privacy of their own homes. The fact that therapy elements have already been designed for self-directed use and include highly structured behavioral exercises is another advantage of IMIs. The last systematic review of internet-based interventions on sexual dysfunctions was done by van Lankveld (2016) and focused solely on women. Due to new studies, a broader scope, as well as stricter guidelines on risk of bias, we see the need for an update.

Psychological treatments for female sexual dysfunctions have proven to be effective. However, not all women benefit from treatment to the same extent with regard to treatment outcomes and some women even show symptom deterioration. Therefore, it is important to find out for whom interventions are effective, how differential effects can be explained and how treatment outcomes can be optimized. To improve the efficacy of treatment for female sexual dysfunction, identifying effect modifiers (predictors and moderators) that influence treatment outcomes seems to be crucial. The heterogeneous results regarding predictors and moderators of different treatment studies so far warrant a systematic summary. The goal of this study is to provide a review of the current state of research on variables that are accountable for differential effects of psychological treatment targeting sexual dysfunctions.

Depression is a highly prevalent mental disorder and is associated with substantial impairment and reduced quality of life for affected individuals. Internet- and mobile-based interventions (IMIs) have shown to be a promising, cost-effective, and for therapists and patients acceptable way to treat this disorder. Their efficacy is well documented, so that IMIs have proven to be as effective as face-to-face therapy. However, not all patients treated with IMIs benefit to the same extent. Not only because of findings that indicate that some patients do not respond to IMIs or even deteriorate, it is an important research issue to find out for whom IMIs are effective and for whom not, and to investigate how differential effects can be explained and how treatment outcome can be optimized. These questions are particularly relevant in the context of efforts to establish a personalized mental health care by matching patients to those therapies that are most promising for them. To address these issues, moderators of treatment outcome must be identified. The goal of this paper is to provide a review of the current state of research on variables that are accountable for differential effects of IMIs targeting depression and that may be used to assign patients with differential characteristics to appropriate treatments in the future.

Introduction: Although evidence-based treatments for posttraumatic stress disorder (PTSD) in adolescents and young adults exist, affected youth do not have sufficient access to these treatments due to structural and attitudinal barriers. Internet- and mobile-based interventions (IMIs) can help fill this healthcare gap, but such programmes have not yet been sufficiently evaluated in youth with PTSD. Aim: This study aims to investigate the feasibility of an IMI for youth with PTSD in a one-arm, non-randomised, prospective proof-of-concept feasibility study. Methods: We aim to recruit 32 youth between 15 and 21 years old with clinically relevant posttraumatic stress symptoms (CATS ≥ 21), who will receive access to the IMI. The IMI consists of nine sessions involving psychoeducation, emotion regulation and coping skills, written-based imaginal exposure, cognitive restructuring and relapse prevention. Participants will be guided by an eCoach, who provides weekly semi-standardised written feedback on completed sessions and adherence reminders. We will use a formal feasibility framework to assess different dimensions of feasibility: (1) recruitment capability and resulting sample characteristics, (2) data collection procedures and outcome measures, (3) acceptability of the IMI and study procedures, (4) resources and ability to manage and implement the study and IMI and (5) participants’ responses to the IMI in terms of symptom severity and satisfaction. Additionally, potential negative effects related to the intervention will be assessed. Assessments take place pre-, mid- and post-intervention and at follow-up, including semi-structured clinical telephone interviews for PTSD diagnostics at pre- and post-intervention assessment. Qualitative interviews will be conducted to investigate the youth perspectives on the IMI. Discussion: This study aims to determine the feasibility of a guided IMI for youth with PTSD to adapt the IMI as closely as possible to youth needs and to inform the design, procedure and safety management of a large-scale efficacy RCT. Trial registration:German Clinical Trials Register identifier: DRKS00023341. Evidence-based care for adolescents after trauma is not widely available.• This study evaluates the feasibility of a guided trauma-focused Internet intervention as a time- and location-independent low-threshold treatment option for adolescents and young adults with posttraumatic stress disorder. Evidence-based care for adolescents after trauma is not widely available.• This study evaluates the feasibility of a guided trauma-focused Internet intervention as a time- and location-independent low-threshold treatment option for adolescents and young adults with posttraumatic stress disorder.

Background Emerging evidence indicates the effectiveness of internet-based mobile-supported stress management interventions (iSMIs) in highly stressed employees. It is yet unclear, however, whether iSMIs are also effective without a preselection process in a universal prevention approach, which more closely resembles routine occupational health care. Moreover, evidence for whom iSMIs might be suitable and for whom not is scarce. Objective The aim of this study was to evaluate the iSMI GET.ON Stress in a universal prevention approach without baseline inclusion criteria and to examine the moderators of the intervention effects. Methods A total of 396 employees were randomly assigned to the intervention group or the 6-month waiting list control group. The iSMI consisted of 7 sessions and 1 booster session and offered no therapeutic guidance. Self-report data were assessed at baseline, 7 weeks, and at 6 months following randomization. The primary outcome was perceived stress. Several a priori defined moderators were explored as potential effect modifiers. Results Participants in the intervention group reported significantly lower perceived stress at posttreatment (d=0.71, 95% CI 0.51-0.91) and at 6-month follow-up (d=0.61, 95% CI 0.41-0.81) compared to those in the waiting list control group. Significant differences with medium-to-large effect sizes were found for all mental health and most work-related outcomes. Resilience (at 7 weeks, P=.04; at 6 months, P=.01), agreeableness (at 7 weeks, P=.01), psychological strain (at 6 months, P=.04), and self-regulation (at 6 months, P=.04) moderated the intervention effects. Conclusions This study indicates that iSMIs can be effective in a broad range of employees with no need for preselection to achieve substantial effects. The subgroups that might not profit had extreme values on the respective measures and represented only a very small proportion of the investigated sample, thereby indicating the broad applicability of GET.ON Stress. Trial Registration German Clinical Trials Register DRKS00005699; https://www.drks.de/DRKS00005699

Introduction: Internet- and mobile-based interventions (IMIs) and their integration into routine psychotherapy (i.e., blended therapy) can offer a means of complementing psychotherapy in a flexible and resource optimized way. Objective: The present study will evaluate the non-inferiority, cost-effectiveness, and safety of two versions of integrated blended psychotherapy for depression and anxiety compared to standard cognitive behavioral therapy (CBT). Methods: A three-armed multicenter cluster-randomized controlled non-inferiority trial will be conducted comparing two implementations of blended psychotherapy (PSYCHOnlineTHERAPYfix/flex) compared to CBT. Seventy-five outpatient psychotherapists with a CBT-license will be randomized in a 1:1:1 ratio. Each of them is asked to include 12 patients on average with depressive or anxiety disorders resulting in a total sample size of N = 900. All patients receive up to a maximum of 16 psychotherapy sessions, either as routine CBT or alternating with Online self-help sessions (fix: 8/8; flex: 0–16). Assessments will be conducted at patient study inclusion (pre-treatment) and 6, 12, 18, and 24 weeks and 12 months post-inclusion. The primary outcome is depression and anxiety severity at 18 weeks post-inclusion (post-treatment) using the Patient Health Questionnaire Anxiety and Depression Scale. Secondary outcomes are depression and anxiety remission, treatment response, health-related quality of life, patient satisfaction, working alliance, psychotherapy adherence, and patient safety. Additionally, several potential moderators and mediators including patient characteristics and attitudes toward the interventions will be examined, complemented by ecological day-to-day digital behavior variables via passive smartphone sensing as part of an integrated smart-sensing sub-study. Data-analysis will be performed on an intention-to-treat basis with additional per-protocol analyses. In addition, cost-effectiveness and cost-utility analyses will be conducted from a societal and a public health care perspective. Additionally, qualitative interviews on acceptance, feasibility, and optimization potential will be conducted and analyzed. Discussion: PSYCHOnlineTHERAPY will provide evidence on blended psychotherapy in one of the largest ever conducted psychotherapy trials. If shown to be non-inferior and cost-effective, PSYCHOnlineTHERAPY has the potential to innovate psychotherapy in the near future by extending the ways of conducting psychotherapy. The rigorous health care services approach will facilitate a timely implementation of blended psychotherapy into standard care. Trial Registration: The trial is registered in the German Clinical Trials Register (DRKS00023973; date of registration: December 28th 2020)., publishedVersion

Background: Despite a large body of evidence demonstrating the effectiveness of psychotherapy for posttraumatic stress for children and adolescents, the adoption of empirically supported treatments (ESTs) in routine care is low. Objective: This implementation study aims to evaluate the dissemination of Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) for children and adolescents with posttraumatic stress symptoms (PTSS) after child abuse and neglect (CAN) with a focus on supervision. Method: In a cluster-randomized controlled trial, the study will evaluate the implementation of TF-CBT focussing on the training of therapists including the provision of supervision. The effectiveness of specialized trauma-focused supervision will be compared to supervision as usual with respect to the successful implementation of TF-CBT for youths with PTSS administered by psychotherapists with different levels of professional experience. The primary outcome is whether the patient receives a treatment with sufficient adherence to the TF-CBT manual. The unit of randomization will be the therapists. The main outcome will be analysed using multilevel logistic regressions. Secondary outcomes will concern further patient-related (reduction of PTSS and depressive symptoms) and therapist-related (professional quality of life) variables. Additional exploratory analyses are planned. Discussion: Since the trial is designed as an implementation study, it permits naturalistic referrals to the participating therapists by patients, caregivers, child and youth welfare agencies and paediatricians. The strict primary outcome will help evaluating the role of model-based supervision in the implementation process. The explorative outcomes will evaluate whether implementation success translates into better patient outcomes. We expect that the dissemination measures will lead to a successful implementation of TF-CBT and promote sustainable structures in routine care that will remain in place after study completion and offer access to ESTs for future children and youths with a history of CAN.

Context: Internet Use Disorder (IUD), characterized as the inability to control one's internet use, is emerging as an increasing societal concern as it is associated with reduced quality of life and mental health comorbidities. Evidence-based treatment options are, however, scarce due to the novelty of the diagnosis. Internet- and mobile-based interventions may be an effective means to deliver psychological treatment to individuals with IUD as they address individuals affected in their online setting. The aim of the study is to evaluate the efficacy of a newly developed, guided internet- and mobile-based intervention for IUD. Methods: In a two-armed randomized controlled trial (N = 130), individuals showing problematic internet use patterns (Internet Addiction Test ≥ 49) will be randomly allocated to the internet- and mobile-based intervention or a waiting control group. Assessments will take place at baseline, 7 weeks, 6- and 12 months after randomization. The primary outcome is internet addiction symptom severity (IAT) at 7 weeks. Secondary outcomes include quality of life, depressive symptoms, anxiety, and other psychosocial variables associated with IUD. Intervention: The intervention consists of seven sessions: Goal setting and motivational interviewing, impulse control, problem solving, cognitive restructuring, self-worth, relapse prevention, and a booster session. Participants are supported by an eCoach who provides individual feedback after completion of each session. Participants can choose between several elective sessions based on individual need. Conclusions: This is the first study to evaluate an internet- and mobile-based intervention for IUD, which could be a promising first step to reduce individuals' disease burden. Trial Registration: DRKS00015314. The study is currently ongoing. First participants were enrolled in the study on September 14th 2018. Recruitment will continue approximately through March 2020.