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Purpose: The Love Together, Parent Together (L2P2) program is a brief, online couple's intervention designed to prevent relationship deterioration by targeting maladaptive psychological processes. Methods: The current study used a parallel-group randomized controlled trial of L2P2 to examine its feasibility, acceptability, and preliminary effectiveness. One-hundred forty couples with young children (< 6 years old) were randomly assigned to L2P2 or a control group. In three writing sessions over nine weeks, all couples completed fact-based summaries about recent conflicts; the L2P2 group also responded to three writing prompts eliciting conflict reappraisal. Participants completed baseline, post-intervention, and 1- and 3-month follow-up assessments. Results: Goals related to feasibility and acceptability were met. In addition, the control group, but not the L2P2 group, showed deteriorating relationship quality from baseline to post-intervention. Conclusions: L2P2 shows promise as a brief intervention to attenuate declines in relationship quality in couples. Clinicaltrials.gov Registration: NCT05261022. [ABSTRACT FROM AUTHOR]

Abstract Background Cognitive therapy for social anxiety disorder (CT-SAD) has extensive empirical support and is recommended in several national guidelines. However, ensuring access to evidence-based psychological therapies such as CT-SAD remains a global challenge. An internet-delivered version of this treatment protocol (iCT-SAD) has recently been developed in the UK as a way to overcome this challenge, demonstrating comparable outcomes to face-to-face CT-SAD whilst requiring less therapist time per client. Initial findings also suggest its cross-cultural transferability, but the previous studies in other cultural settings used the English language programme and only included English-fluent participants as a second language. It is not yet known what outcomes can be achieved once the programme has been translated and adapted for a different cultural context. Therefore, this trial aims to evaluate the clinical efficacy of Japanese iCT-SAD when combined with treatment as usual (TAU) in clients with SAD. Methods This two-arm, parallel-group, superiority randomised controlled trial will recruit 60 Japanese participants with SAD, randomly assigning them to either Japanese iCT-SAD + TAU or TAU alone at a ratio of 1:1. The primary outcome measure is the self-report Liebowitz Social Anxiety Scale, and secondary.outcomes include other measures of social anxiety symptoms and processes, general mood and functioning, and response to treatment. We will also assess treatment acceptability and gather participant feedback. Assessments will take place at baseline (week 0), mid-treatment (week 8), and post-treatment (week 15), with a further 3-month follow-up (week 27) for the iCT-SAD + TAU arm. The primary analyses will be conducted on an intent-to-treat basis, comparing the primary and secondary outcome measures between groups using linear mixed-effect models, along with additional mediation analysis. Discussion Investigating the efficacy of translated and culturally adapted iCT-SAD in different cultural contexts is an important step in evaluating the global reach of internet interventions. This trial will provide valuable insights into the effects of iCT-SAD combined with usual care, and how this treatment could be delivered in routine clinical settings in Japan. Trial registration International Standard Randomized Controlled Trials (ISRCTN), ISRCTN82859645, registered on January 19, 2024. UMIN Clinical Trials Registry (UMIN-CTR), UMIN000052702, registered on November 6, 2023.

Background: Chronic pain often clusters in families, where parents and their offspring both experience chronic pain conditions. Young children of parents with irritable bowel syndrome (IBS) represent an at-risk group for the development of abdominal pain, disability, and excess health care visits in later childhood. Parental solicitous responses to children's expressions of discomfort and maternal modeling of their own illness behavior contribute to a greater focus on somatic sensations, leading to illness behaviors in children. This randomized controlled trial will test the effectiveness of an early preventive web-based psychosocial intervention (REACH)[TM] vs. an educational web-based safety comparison condition delivered to parents with IBS to alter parental responses and lead to improved child health and decreased health care costs. Methods: Parents with IBS who have children ages 4–7 years are recruited via community-based approaches (e.g., social media advertisements, school electronic distribution, research networks) and health care providers. The target sample is 460 parents randomized to REACH, a web-based social learning and cognitive behavior therapy (SLCBT) intervention or an educational web-based safety comparison condition (EC). Participants will be assessed at baseline, 6-week (immediate post-intervention), 6-month, 12-month, and 18-month follow-up periods (months post-completion of intervention). The primary outcome is change in parental solicitous/protective behaviors. Secondary outcomes include parent risk and protective factors, child health and symptom outcomes, and health care utilization and cost savings. Discussion: This study adapts a validated, parent-delivered intervention to treat chronic pain in children to a web-based application designed to prevent the development of chronic pain in very young, high-risk children. If successful, this strategy can both prevent adverse sequelae of this condition from developing as well as be widely accessible. Furthermore, the availability of a prevention model for parent training could result in significant short- and long-term health benefits across a broad spectrum of conditions. Trial registration: ClinicalTrials.gov NCT05730491. Registered on February 15, 2023. [ABSTRACT FROM AUTHOR]

Background: Cognitive therapy for social anxiety disorder (CT-SAD) has extensive empirical support and is recommended in several national guidelines. However, ensuring access to evidence-based psychological therapies such as CT-SAD remains a global challenge. An internet-delivered version of this treatment protocol (iCT-SAD) has recently been developed in the UK as a way to overcome this challenge, demonstrating comparable outcomes to face-to-face CT-SAD whilst requiring less therapist time per client. Initial findings also suggest its cross-cultural transferability, but the previous studies in other cultural settings used the English language programme and only included English-fluent participants as a second language. It is not yet known what outcomes can be achieved once the programme has been translated and adapted for a different cultural context. Therefore, this trial aims to evaluate the clinical efficacy of Japanese iCT-SAD when combined with treatment as usual (TAU) in clients with SAD. Methods: This two-arm, parallel-group, superiority randomised controlled trial will recruit 60 Japanese participants with SAD, randomly assigning them to either Japanese iCT-SAD + TAU or TAU alone at a ratio of 1:1. The primary outcome measure is the self-report Liebowitz Social Anxiety Scale, and secondary.outcomes include other measures of social anxiety symptoms and processes, general mood and functioning, and response to treatment. We will also assess treatment acceptability and gather participant feedback. Assessments will take place at baseline (week 0), mid-treatment (week 8), and post-treatment (week 15), with a further 3-month follow-up (week 27) for the iCT-SAD + TAU arm. The primary analyses will be conducted on an intent-to-treat basis, comparing the primary and secondary outcome measures between groups using linear mixed-effect models, along with additional mediation analysis. Discussion: Investigating the efficacy of translated and culturally adapted iCT-SAD in different cultural contexts is an important step in evaluating the global reach of internet interventions. This trial will provide valuable insights into the effects of iCT-SAD combined with usual care, and how this treatment could be delivered in routine clinical settings in Japan. Trial registration: International Standard Randomized Controlled Trials (ISRCTN), ISRCTN82859645, registered on January 19, 2024. UMIN Clinical Trials Registry (UMIN-CTR), UMIN000052702, registered on November 6, 2023. [ABSTRACT FROM AUTHOR]

Little is known about the effectiveness of online preventive interventions for paternal perinatal depression (PPD). This systematic review (SR) and meta-analysis (MA) of randomized controlled trials (RCTs) evaluated the effectiveness of online psychological interventions to prevent PPD in fathers and non-birthing partners. The PRISMA 2020 guidelines were followed. The search was conducted in eight electronic databases and other sources from inception to 12 May 2023. The pooled standardized mean difference (SMD) was computed using random-effect models. Seven RCTs were included in the SR and 6 were included in the MA, representing 1.042 fathers from five different countries. No trials focused on non-birthing partners were found. The pooled SMD was −0.258 [95 % confidence interval − 0.513 to −0.004; p

Abstract Background Studying at university is a stressful time for many, which might result in the development of mental health problems. In the first wave of Covid-19, university students in Turkey reported suffering from an elevated level of stress compared to their peers in other countries. Mindfulness-based interventions could provide the means of successfully decreasing the stress level of university students. Moreover, offering interventions via the Internet could be a scalable option to prevent and treat mental health problems, while offering time/place flexibility, anonymity, and cost-effectiveness. Method In a randomized controlled trial of parallel design, the feasibility of a culturally adapted internet- and mobile-based intervention (IMI) (StudiCareM-TR) to promote mindfulness among Turkish-speaking university students was tested. Participants (N = 58) of a public university in Istanbul were randomized into an intervention (IG) vs. waitlist control group (WL). Measurements took place at baseline (t0) and 10 weeks post-randomization (t1). Intervention adherence, acceptance, and potential negative effects were feasibility outcomes. Levels of mindfulness, perceived stress, depression, anxiety, and wellbeing were analyzed in linear regression models to assess the potential efficacy of StudiCareM-TR. All analyses were conducted with the intention-to-treat sample, adjusting for baseline values. Results Based on participants’ feedback, StudiCareM-TR was perceived as acceptable, resulted in few negative effects (n = 7), and yielded improvements in mindfulness (β = 0.70) and presenteeism (β = − 0.61) compared to WL. Secondary outcomes of depression, anxiety, stress, and wellbeing did not show significant improvements. Assessment dropout was 31% (IG: 50%: WL: 89%), and intervention dropout was 45%. Conclusions StudiCareM-TR is feasible and acceptable to use among university students in Turkey and has the potential to improve their mindfulness levels. The intervention should be further developed with a focus on engagement-facilitating features in order to reduce intervention dropouts. Trial registration ID DRKS00024557.

Abstract Background There is extensive research indicating that transdiagnostic interventions are effective for adults and children with anxiety and depressive disorders; however, limited research has been conducted on the efficacy of such programs targeting parents of children with anxiety and depressive symptoms delivered via the Internet. This study aims to investigate the preliminary efficacy of a transdiagnostic Internet-delivered intervention for Romanian parents of children with elevated anxiety and depressive symptoms. Methods We conducted a single-blinded pilot randomized controlled trial. Forty-two parents of children with anxiety and depressive symptoms (M age = 39.79, 78.6% women) from Romania were randomly assigned to one of the two groups, to ParentKIT, an Internet-delivered intervention based on Rational Emotive and Behavioral Therapy (n = 21), or to a delayed treatment condition (waitlist group) (n = 21). ParentKIT consisted of a brief transdiagnostic intervention delivered through nine modules with therapist guidance. Results A significant Group by Time effect was found for child emotional problems as reported by parents (Cohen’s d = − 0.85) and for parental self-efficacy (Cohen’s d = 0.71). Conclusion A transdiagnostic Internet-delivered intervention addressed to parents of children with elevated anxiety and depressive symptoms is a promising approach. Future research should include blind assessments as well as multiple outcome assessors and investigate the long-term efficacy of the intervention. Trial registration NCT05341297.

Background: Low self-esteem is an important factor associated with body dysmorphic concerns. In treatment, self-esteem cannot always be adequately addressed. Internet-based interventions offer a low-threshold and cost-efficient possibility for treating body dysmorphic disorder (BDD). Aims: For this reason, we conducted two studies to explore the effectiveness of an internet-based intervention targeting improving self-esteem in adults with BDD symptoms. Method: The first study investigated the differential effects of a 1-week self-esteem training compared with a 1-week attention-focus training. Two hundred twenty adults with elevated body dysmorphic symptoms were randomly assigned to one of the two trainings. Our second study (n = 58 adults with body dysmorphic symptoms) evaluated an extended 2-week stand-alone self-esteem training. Results: In the first study, self-esteem in different domains (appearance, performance and social), self-focused attention, and BDD symptom severity improved in both groups. Other-focused attention only increased in the attention training group. Participants' overall adherence was high. In the second study we observed significant improvements in self-esteem, BDD symptom severity, and other secondary outcomes, with additional improvements in most outcomes in the second week. Adherence was again high. Conclusions: Together, these findings show that a brief internet-based intervention may be a highly accepted and effective way of improving self-esteem in people suffering from BDD symptoms. [ABSTRACT FROM AUTHOR]

This study aimed to create a tool to assess eHealth interventions for dementia by adapting an existing implementation readiness (ImpRess) checklist that assessed manualised interventions. In Part 1, online semi-structured interviews with individual stakeholders (N = 9) with expertise in eHealth and dementia were conducted (response rate 83%). The Nonadoption, Abandonment, and challenges to the Scale-Up, Spread, and Sustainability of Health and care technologies (NASSS) framework was applied, both to guide the construction of the interview guide, as well as to use its subdomains as codes in the deductive qualitative thematic analysis. Respondents were industry professionals (n = 3), researchers (n = 3), policy officers (n = 2), and a clinician (n = 1). In Part 2, the items of the original ImpRess checklist were supplemented by items that covered determinants discussed in the interviews, that were not included in the original checklist. The main findings from the interviews included: Participants' preference for a non-dementia-specific, more general approach to the checklist; the importance of searching for shared values with implementers; and the need for more systematic monitoring of implementation. The EmpRess checklist applies an inclusive design approach. The checklist will help evaluate the implementation determinants of eHealth interventions for dementia and provide up-to-date information on what is, and is not, working in eHealth for dementia care. [ABSTRACT FROM AUTHOR]

Background: Studying at university is a stressful time for many, which might result in the development of mental health problems. In the first wave of Covid-19, university students in Turkey reported suffering from an elevated level of stress compared to their peers in other countries. Mindfulness-based interventions could provide the means of successfully decreasing the stress level of university students. Moreover, offering interventions via the Internet could be a scalable option to prevent and treat mental health problems, while offering time/place flexibility, anonymity, and cost-effectiveness. Method: In a randomized controlled trial of parallel design, the feasibility of a culturally adapted internet- and mobile-based intervention (IMI) (StudiCareM-TR) to promote mindfulness among Turkish-speaking university students was tested. Participants (N = 58) of a public university in Istanbul were randomized into an intervention (IG) vs. waitlist control group (WL). Measurements took place at baseline (t0) and 10 weeks post-randomization (t1). Intervention adherence, acceptance, and potential negative effects were feasibility outcomes. Levels of mindfulness, perceived stress, depression, anxiety, and wellbeing were analyzed in linear regression models to assess the potential efficacy of StudiCareM-TR. All analyses were conducted with the intention-to-treat sample, adjusting for baseline values. Results: Based on participants' feedback, StudiCareM-TR was perceived as acceptable, resulted in few negative effects (n = 7), and yielded improvements in mindfulness (β = 0.70) and presenteeism (β = − 0.61) compared to WL. Secondary outcomes of depression, anxiety, stress, and wellbeing did not show significant improvements. Assessment dropout was 31% (IG: 50%: WL: 89%), and intervention dropout was 45%. Conclusions: StudiCareM-TR is feasible and acceptable to use among university students in Turkey and has the potential to improve their mindfulness levels. The intervention should be further developed with a focus on engagement-facilitating features in order to reduce intervention dropouts. Trial registration ID: DRKS00024557. [ABSTRACT FROM AUTHOR]

Background: There is extensive research indicating that transdiagnostic interventions are effective for adults and children with anxiety and depressive disorders; however, limited research has been conducted on the efficacy of such programs targeting parents of children with anxiety and depressive symptoms delivered via the Internet. This study aims to investigate the preliminary efficacy of a transdiagnostic Internet-delivered intervention for Romanian parents of children with elevated anxiety and depressive symptoms. Methods: We conducted a single-blinded pilot randomized controlled trial. Forty-two parents of children with anxiety and depressive symptoms (Mage = 39.79, 78.6% women) from Romania were randomly assigned to one of the two groups, to ParentKIT, an Internet-delivered intervention based on Rational Emotive and Behavioral Therapy (n = 21), or to a delayed treatment condition (waitlist group) (n = 21). ParentKIT consisted of a brief transdiagnostic intervention delivered through nine modules with therapist guidance. Results: A significant Group by Time effect was found for child emotional problems as reported by parents (Cohen's d = − 0.85) and for parental self-efficacy (Cohen's d = 0.71). Conclusion: A transdiagnostic Internet-delivered intervention addressed to parents of children with elevated anxiety and depressive symptoms is a promising approach. Future research should include blind assessments as well as multiple outcome assessors and investigate the long-term efficacy of the intervention. Trial registration: NCT05341297. [ABSTRACT FROM AUTHOR]

Adherence to internet-based cognitive-behavioral therapy (iCBT) is often low, possibly reducing its potential. The current study set out to test whether adherence and effects of unguided iCBT for obsessive-compulsive disorder (OCD) could be improved by varying the degree of autonomy in which modules are completed (free choice vs. fixed order). We randomized 151 individuals with OCD to either an unguided iCBT with a fixed (iCBTfixed) or a free-choice (iCBTfree+) order of the modules. We assessed participants at baseline (t0), eight weeks (t1), and 16 weeks (t2). Primary outcomes were adherence (utilization time, modules completed) and change in OCD severity (Y-BOCS). Secondary outcomes included depression, self-esteem, and treatment satisfaction. We calculated intent-to-treat (ITT) and complete case (CC) analyses. Analyses showed that both iCBT programs significantly reduced OCD severity. While groups did not differ on the ITT analyses, for the CC analyses, a greater improvement was found in the iCBTfixed in comparison to the iCBTfree+ group regarding OCD severity and quality of life, with medium effect sizes from t0 to t1 (η p 2 = 0.067–0.077). Time of utilization and number of modules completed did not differ between groups. No placebo control group, short follow-up period, self-report assessment. iCBT is effective in improving OCD. Despite similar adherence in the fixed versus the free-choice module order, the study offers tentative evidence that a fixed order of content is associated with better effects. More research on the effects of adherence on outcome is necessary. • Both unguided iCBT programs in the study reduced OCD symptom severity. • Utilization time and modules completed were not related to outcome. • Tentative evidence that a fixed order of content is associated with better effects [ABSTRACT FROM AUTHOR]

ObjectiveTo describe demographic and clinical characteristics of Spanish- and English-speaking visitors to a "Healthy Mood" website.MethodsAn online study intended to prevent depression by teaching users mood management skills recruited participants globally using primarily Google Ads. Those who consented responded to the Patient Health Questionnaire (PHQ-9) and the MDE Screener (Muñoz, 1998) upon entry into the study.Results1423 participants consented, 437 English speakers and 986 Spanish speakers. Of the 1271 participants with sufficient depression symptom data, 65% screened positive for a current major depressive episode, 30% were at high risk for onset of a major depressive episode, and 5% were in the low-risk category.ConclusionWebsites intended to be preventive appear to attract primarily individuals who are currently experiencing enough symptoms to screen positive for a major depressive episode. Only 30% of participants were appropriate for a depression prevention intervention. Therefore, such sites must be ready to encourage those with current depression to obtain professional help as well as ensure that the online self-help interventions are appropriate for participants who could benefit from both preventive and treatment interventions.

• Our modernized depression intervention used internet and telephonic psychotherapy. • Intervention participants exhibited meaningful improvements in depressive symptoms. • Successful depression treatment did not reduce cardiovascular risk biomarkers. • Depression treatment is not sufficient to lower cardiovascular risk in depression. • Integrated care should harness technology to maximize access/minimize resources. Although depression is a risk and prognostic factor for cardiovascular disease (CVD), clinical trials treating depression in patients with CVD have not demonstrated cardiovascular benefits. We proposed a novel explanation for the null results for CVD-related outcomes: the late timing of depression treatment in the natural history of CVD. Our objective was to determine whether successful depression treatment before, versus after, clinical CVD onset reduces CVD risk in depression. We conducted a single-center, parallel-group, assessor-blinded randomized controlled trial. Primary care patients with depression and elevated CVD risk from a safety net healthcare system (N = 216, M age = 59 years, 78% female, 50% Black, 46% with income <$10,000/year) were randomized to 12 months of the eIMPACT intervention (modernized collaborative care involving internet cognitive-behavioral therapy [CBT], telephonic CBT, and/or select antidepressants) or usual primary care for depression (primary care providers supported by embedded behavioral health clinicians and psychiatrists). Outcomes were depressive symptoms and CVD risk biomarkers at 12 months. Intervention participants, versus usual care participants, exhibited moderate-to-large (Hedges' g = -0.65, p < 0.01) improvements in depressive symptoms. Clinical response data yielded similar results – 43% of intervention participants, versus 17% of usual care participants, had a ≥ 50% reduction in depressive symptoms (OR = 3.73, 95% CI : 1.93–7.21, p < 0.01). However, no treatment group differences were observed for the CVD risk biomarkers – i.e., brachial flow-mediated dilation, high-frequency heart rate variability, interleukin-6, high-sensitivity C-reactive protein, β-thromboglobulin, and platelet factor 4 (Hedges' gs = -0.23 to 0.02, p s ≥ 0.09). Our modernized collaborative care intervention – which harnessed technology to maximize access and minimize resources – produced clinically meaningful improvements in depressive symptoms. However, successful depression treatment did not lower CVD risk biomarkers. Our findings indicate that depression treatment alone may not be sufficient to reduce the excess CVD risk of people with depression and that alternative approaches are needed. In addition, our effective intervention highlights the utility of eHealth interventions and centralized, remote treatment delivery in safety net clinical settings and could inform contemporary integrated care approaches. Trial Registration: ClinicalTrials.gov Identifier: NCT02458690. [ABSTRACT FROM AUTHOR]

Many interventions designed to increase self-compassion are either (1) intense, group-based, and face-to-face delivered programs, such as Mindful Self-Compassion, or (2) less intense, self-administered interventions, such as self-compassionate writing or following guided meditations. This study explores if self-compassion can be increased in a novel intervention that is both intense and accessible using online group-based interactive video teleconferencing. One-hundred-fifty-five healthy participants (130 women, 25 men) were randomized to a wait-list control group or to an intervention group that participated in two online workshops (via Zoom) and completed a self-compassionate writing exercise. Participants filled out the Self-Compassion Scale (SCS) before, directly after, and 1-week after the intervention. We assessed overall self-compassion, in addition to its six constituent subfactors: self-kindness, self-judgment, common humanity, isolation, mindfulness, and over-identification. We analyzed all results using an intent-to-treat approach. In addition, participants' impressions and feasibility of the intervention were assessed. Using linear mixed models, we found that the intervention increased total self-compassion as indicated by a significant interaction of Time and Treatment, F (2, 203.38) = 5.47, p =.005, with a small-to-medium effect, f = 0.22. Contrasts indicated significant differences between the intervention and the control group at the 1-week follow-up, but not directly after the intervention. We found similar effects for self-kindness, common humanity, and isolation. Qualitative answers indicated that participants liked the intervention and were pleased with the opportunity to interact with other participants. Self-compassion can be trained using interactive video teleconferencing interventions. The study highlights the potential benefits of group-based interventions as they allow for more interactions among participants, which in turn could reduce feelings of isolation. Finally, interactive video teleconferencing interventions have large unexplored potential for improving various resources that improve mental health or other facets of well-being other than self-compassion and this article gives recommendations for how to structure such interventions. • Self-compassion interventions often employ either intensive, in-person group-based methods or self-administered formats • Self-compassion can be effectively enhanced using group-based live video teleconferencing • Group-based delivery can strengthen a sense of common humanity and reduce feelings of isolation [ABSTRACT FROM AUTHOR]

Video feedback is a technique used in cognitive therapy for social anxiety disorder (CT-SAD) to update patients' negative self-perceptions of how they appear to others. Clients are supported to watch video of themselves engaging in social interactions. While typically undertaken in session with a therapist, this study aimed to investigate the effectiveness of remotely delivered video feedback embedded within an Internet-based cognitive therapy program (iCT-SAD). We examined patients' self-perceptions and social anxiety symptoms before and after video feedback in two randomised controlled trials. Study 1 compared 49 iCT-SAD participants with 47 from face-to-face CT-SAD. Study 2 was a replication using data from 38 iCT-SAD participants from Hong Kong. In Study 1, ratings of self-perceptions and social anxiety showed significant reductions following video feedback, in both treatment formats. 92 % of participants in iCT-SAD, and 96 % in CT-SAD thought they looked less anxious compared to their predictions after viewing the videos. The change in self-perception ratings was larger in CT-SAD compared to iCT-SAD, but there was no evidence that the impact of video feedback on social anxiety symptoms around a week later differed between the two treatments. Study 2 replicated the iCT-SAD findings of Study 1. The level of therapist support in iCT-SAD videofeedback varied with clinical need and was not measured. The findings indicate that video feedback can be delivered effectively online, and that its impact on social anxiety is not significantly different from in-person treatment delivery. • Video feedback led to significant changes in self-perceptions and social anxiety. • The impact on social anxiety did not significantly differ between therapy formats. • 92 % and 96 % of participants in iCT-SAD and CT-SAD felt that they looked less anxious than predicted. [ABSTRACT FROM AUTHOR]

Objectives: Trauma‐focussed psychological interventions are the treatments of choice for post‐traumatic stress disorder (PTSD). As many clinical services receive high demand for PTSD interventions, strategies to improve treatment efficiency are needed. Some people seek help in the early phase post‐trauma, including as soon as the first few months. It is unclear whether all components of trauma‐focussed CBT are needed in this initial stage. Providing brief intervention in this early phase without work on trauma memories may be feasible and effective. This service evaluation study describes a case series of five participants experiencing PTSD following recent traumas. Methods: Participants completed a shortened 6‐week form of Internet‐delivered Cognitive Therapy for PTSD (iCT‐PTSD), which used fewer treatment modules and focussed primarily on psychoeducation about PTSD, and two key treatment components, 'reclaiming your life' and trigger discrimination. Unlike the full course of iCT‐PTSD, this format did not include working directly with trauma memories. Results: The intervention was associated with large reductions in symptoms of PTSD, depression and anxiety at the 6‐week timepoint, which were maintained at 3‐month follow‐up. Scores on the composite PTSD measure showed an average reduction of 91% between baseline and end of follow‐up. One client required an extension to the weekly phase of treatment and received further treatment modules. All were discharged after follow‐up and did not require further treatment. Conclusions: The findings provide preliminary evidence that this briefer format of iCT‐PTSD was of benefit for those seeking support following recent traumas. Further examination in a larger controlled study is required. [ABSTRACT FROM AUTHOR]

Interventions intended to reduce the consumption of dietary sugars among those population groups demonstrating disproportionately greater and more frequent consumption of sugar-sweetened beverages and foods (SSBF) would benefit from intervention strategies that are tailored to population-specific barriers and facilitators. The objective of this study was to develop and evaluate the acceptability of photo-enhanced and theory-based health promotion messages that target the reduction in SSBF among adult residents of public housing developments, a population known for their high rates of chronic disease. Using the message development tool as a framework, we developed a series of 15 SSBF reduction messages, using an iterative process with community member input. We then evaluated the acceptability of the messages and compared three delivery mechanisms: print, text, and social media. We recruited participants who were residents of urban public housing developments, and who spoke either English or Spanish. A majority of participants identified as being of Hispanic ethnicity (73%). The message acceptability scoring did not appear to differ according to the assigned delivery mechanism, despite some imbalances in participants' characteristics across delivery mechanisms. The messages that targeted motivation were least likely to be accepted. In conclusion, our findings suggest that engaging members of the community at all phases of the development process was a feasible method to develop SSBF reduction messages with a high perceived acceptability. [ABSTRACT FROM AUTHOR]

Abstract Background Migraine is a major pediatric health problem impacting 10–12% of youth. About 1 in 3 youth with migraine are diagnosed with insomnia. Sleep and migraine share a cyclical relationship, and data indicate that insomnia symptoms increase migraine severity. CBT for insomnia (CBT-I) has demonstrated efficacy for improving insomnia in adults with migraine and other pain conditions; however, effects in youth have not been evaluated. Moreover, in adults, there is some indication that CBT-I may lead to changes in pain after there are sustained improvements in sleep, but this has never been empirically tested. Cognitive-behavioral therapy for pain management (CBT-Pain) is an established treatment approach for youth with migraine, leading to reductions in headache frequency and disability. In the proposed study, we will address these gaps in knowledge by using an innovative two-phase trial design to (1) test the efficacy of Internet-delivered CBT-I intervention for youth with migraine and comorbid insomnia compared to Internet-delivered sleep education for modifying sleep and (2) investigate how changes in sleep may modify the response to Internet-delivered CBT-Pain intervention. Methods We will study a cohort of 180 adolescents, ages 11–17 years, with migraine (with or without aura, chronic migraine) and comorbid insomnia. In phase 1, youth will be randomly assigned to receive Internet-delivered CBT-I intervention or Internet sleep education control. In phase 2, all youth will receive Internet-delivered CBT-Pain intervention. Assessments will occur at baseline, immediately after phase 1 intervention, immediately after phase 2 intervention, and 6 months post-intervention. We will use a comprehensive multidimensional assessment of sleep and headache including self-report questionnaires, ambulatory actigraphy monitoring, and 14-day daily diaries. Discussion Given the high prevalence of insomnia in adolescents with migraine, an extension of CBT-I intervention to this population will address an important gap in clinical practice and in conceptual understanding of the relationship between sleep and migraine. By testing a separate CBT-I intervention, we will be able to apply this treatment in the future to other pediatric populations (e.g., cancer, arthritis) who commonly experience comorbid insomnia. Trial registration ClinicalTrials.gov NCT04936321. Registered on June 23, 2021.

BACKGROUND: Internet-based cognitive behavioral therapy has shown effectiveness in managing chronic tinnitus. Internet-based cognitive behavioral therapy is currently available in only a few languages (English, Swedish, Spanish, and German). The current study aimed to adapt, evaluate, and compare the readability and acceptability of the Turkish internet-based cognitive behavioral therapy materials compared to previous versions. METHODS: Internet-based cognitive behavioral therapy materials were adapted from the preexisting American English to the Turkish population in a 4-step process: (1) cultural adaptations, (2) acceptability adaptation of materials to the Turkish-speaking population, and (3) literacy-level adjustments. Experts (n = 11) and patients (n = 11) rated the intervention materials and the ePlatform for acceptability, including usability, content, presentation, and suitability (4). RESULTS: Literacy-level adjustments generated acceptable and readability levels of the Turkish version of the internet-based cognitive behavioral therapy program. The average readability score was 76.15 ± 0.35. The Turkish internet-based cognitive behavioral therapy (Mdn: 7.00) was statistically lower compared to the Swedish (Mdn: 9.00) but higher when compared to the American English and Spanish (Mdn: 5.00) versions. There were no statistical differences between the British English and Turkish versions in readability scores. Acceptability in the internet-based cognitive behavioral therapy platform was rated favorably. CONCLUSION: The Turkish internet-based cognitive behavioral therapy was found to be user-friendly and easy to understand, with navigations that are straightforward, have clear information, and are supported by audiologists. The readability score of the Turkish internet-based cognitive behavioral therapy is within recommended limits to ensure comprehensibility. We suggest that an online cognitive behavioral therapy program is adaptable for other languages for countries with a limited number of clinicians focused on cognitive behavioral therapy and tinnitus. [ABSTRACT FROM AUTHOR]

Objective: Public Speaking Anxiety is highly prevalent among adolescents. However, few interventions have been developed specifically for this group. This four-armed randomized trial addressed the following research questions regarding interventions for adolescents with public speaking anxiety (PSA): 1) is Virtual Reality exposure therapy (VRET) more efficacious than online psychoeducation or waitlist, and 2) is VRET followed by online exposure therapy more efficacious than VRET alone or online psychoeducation followed by online exposure therapy?Methods: Adolescents, aged 13–16 with PSA were randomized to four groups: 1) VRET + no additional intervention (n = 20); 2) VRET + online exposure program (n = 20); 3) online psychoeducation program + exposure program (n = 40); or 4) waitlist (n = 20). Self-rated PSA symptoms served as primary outcome measure, with secondary outcomes covering other social anxiety symptoms.Results: Linear mixed models revealed that there was a significant difference in the decrease in PSA symptoms among adolescents receiving VRET compared with waiting list (p = 0.015), but no significant difference to the online psychoeducation program (p = 0.056). However, online psychoeducation program yielded smaller within-group effect sizes compared to VRET, d = 0.33 vs. d = 0.83 respectively. VRET + online exposure program had a significant decrease in PSA symptoms (p = 0.013), but no significant difference from VRET + no additional intervention or online psychoeducation + online exposure program. Symptom reduction remained stable at 3-month follow-up.Conclusion: The study shows the potential of delivering both gamified VRET as well as online psychoeducation and exposure programs as self-guided interventions for adolescents with PSA.Clinical trial registration:clinicaltrials.gov, identifier: NCT04396392

University years are marked by multiple stressors. Consequently, university students often report anxiety symptoms or disorders, but most remain untreated. Internet-delivered cognitive behavioral therapy (ICBT) has been proposed as an alternative to address known help-seeking barriers, which were aggravated during the COVID-19 pandemic. This meta-analysis aims to evaluate the efficacy of ICBT for university students with anxiety. A systematic search on three databases, EBSCOhost, PubMed, and Web of Science, and a manual search were performed. Fifteen studies were identified, including a total of 1619 participants. Seven studies evaluated ICBT treatment for both anxiety and depression, three for social anxiety, two for generalized anxiety, while the remaining (k = 3) only targeted anxiety, test anxiety, and comorbidity between anxiety and insomnia. Analyses were performed based on a random-effects model using the metafor package in R. The results indicated that ICBT had a significant and positive effect on university students with anxiety compared to controls at post-test (g = −0.48; 95 % CI: −0.63, −0.27; p

Background: Migraine is a major pediatric health problem impacting 10–12% of youth. About 1 in 3 youth with migraine are diagnosed with insomnia. Sleep and migraine share a cyclical relationship, and data indicate that insomnia symptoms increase migraine severity. CBT for insomnia (CBT-I) has demonstrated efficacy for improving insomnia in adults with migraine and other pain conditions; however, effects in youth have not been evaluated. Moreover, in adults, there is some indication that CBT-I may lead to changes in pain after there are sustained improvements in sleep, but this has never been empirically tested. Cognitive-behavioral therapy for pain management (CBT-Pain) is an established treatment approach for youth with migraine, leading to reductions in headache frequency and disability. In the proposed study, we will address these gaps in knowledge by using an innovative two-phase trial design to (1) test the efficacy of Internet-delivered CBT-I intervention for youth with migraine and comorbid insomnia compared to Internet-delivered sleep education for modifying sleep and (2) investigate how changes in sleep may modify the response to Internet-delivered CBT-Pain intervention. Methods: We will study a cohort of 180 adolescents, ages 11–17 years, with migraine (with or without aura, chronic migraine) and comorbid insomnia. In phase 1, youth will be randomly assigned to receive Internet-delivered CBT-I intervention or Internet sleep education control. In phase 2, all youth will receive Internet-delivered CBT-Pain intervention. Assessments will occur at baseline, immediately after phase 1 intervention, immediately after phase 2 intervention, and 6 months post-intervention. We will use a comprehensive multidimensional assessment of sleep and headache including self-report questionnaires, ambulatory actigraphy monitoring, and 14-day daily diaries. Discussion: Given the high prevalence of insomnia in adolescents with migraine, an extension of CBT-I intervention to this population will address an important gap in clinical practice and in conceptual understanding of the relationship between sleep and migraine. By testing a separate CBT-I intervention, we will be able to apply this treatment in the future to other pediatric populations (e.g., cancer, arthritis) who commonly experience comorbid insomnia. Trial registration: ClinicalTrials.gov NCT04936321. Registered on June 23, 2021. [ABSTRACT FROM AUTHOR]

Introduction: Internet interventions for alcohol problems are effective, but not all participants are helped. Further, the importance of adherence has often been neglected in research on internet interventions for alcohol problems. Prediction analysis can help in prospectively assessing participants' probability of success, and ideally, this information could be used to tailor internet interventions to individual needs. Methods: Data were obtained from a randomized controlled trial on internet interventions for alcohol use disorders. Twenty-nine candidate predictors were run in univariate logistic regressions with two dichotomous dependent outcomes: adherence (defined as completing at least 60% of the treatment modules) and low-risk drinking (defined as drinking within national public health guidelines) at two time points – immediately post-treatment and at the 6-month follow-up. Significant predictors were entered hierarchically into domain-specific logistic regressions. In the final models, predictors still showing significant effects were run in multiple logistic regressions. Results: One predictor significantly predicted adherence: treatment credibility (as in how logical the treatment is and how successful one perceives the treatment to be) assessed during the third week of the intervention. Four predictors significantly predicted low-risk drinking at the post-treatment follow-up: pre-treatment abstinence (i.e., not drinking during the 7 days before treatment started), being of the male gender, and two personality factors – a low degree of antagonism and a high degree of alexithymia. At the 6-month follow-up, pre-treatment abstinence was the only significant predictor. Conclusion: Adherence was not predictive of low-risk drinking. Personality variables may have predictive value and should be studied further. Those who abstain from alcohol during the week before treatment starts have a higher likelihood of achieving low-risk drinking than people who initially continue drinking. [ABSTRACT FROM AUTHOR]

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Internet interventions face significant challenges in recruitment and attrition rates are typically high and problematic. Finding innovative yet scientifically valid avenues for attaining and retaining participants is therefore of considerable importance. The main goal of this study was to compare recruitment process and participants characteristics between two similar randomized control trials of mood management interventions. One of the trials (Bunge et al., 2016) was conducted with participants recruited from Amazon's Mechanical Turk (AMT), and the other trial recruited via Unpaid Internet Resources (UIR).MethodsThe AMT sample (Bunge et al., 2016) consisted of 765 adults, and the UIR sample (recruited specifically for this study) consisted of 329 adult US residents. Participants' levels of depression, anxiety, confidence, motivation, and perceived usefulness of the intervention were assessed. The AMT sample was financially compensated whereas the UIR was not.ResultsAMT yielded higher recruitment rates per month (p

Evidence-based psychological interventions are growing in number but are not within reach of many individuals who could benefit from them. The recent revolution in digital technologies now makes it possible to reach people around the globe with digital interventions in the form of web sites, mobile applications, wearable devices, and so on. Although a plethora of digital interventions are available online few are evidence-based and individuals have little guidance to decide among the multitude of options. We propose the development of "digital apothecaries," that is, online repositories of evidence-based digital interventions. As portals to effective interventions, digital apothecaries would be useful to individuals who could access evidence-based interventions directly, to health care providers, who could identify specific digital tools to suggest to or use with their patients, and to researchers, who could study a range of tools with large samples, enabling comparative tests and evaluation of moderators of effects. We present a taxonomy of types of in-person and digital interventions ranging from traditional therapy without the use of digital tools to totally automated self-help interventions. This taxonomy highlights the potential of blending digital tools into health care systems to expand their reach. Digital apothecaries would provide access to evidence-based digital interventions (both free and paid versions), provide data on effectiveness (including effectiveness for diverse populations), and encourage the development and testing of more such tools. Other issues discussed include: criteria for inclusion of interventions into digital apothecaries; how digital tools could enhance health care for diverse populations; and cautionary notes regarding potential negative unintended consequences of the adoption of digital interventions into the health care system. In particular, we warn about the potential misuse of evidence-based digital interventions to justify reducing access to live providers. Digital apothecaries bring with them the promise of reducing health disparities by reaching large numbers of individuals across the world who need health interventions but are not currently receiving them. The health care field is encouraged to mindfully develop this promise, while being alert not to cause inadvertent harm.

Background: Internet-delivered interventions offer a feasible way to facilitate access to mental healthcare and considerable evidence supports their effectiveness for the treatment of different mental disorders. However, potential users' attitudes toward these interventions are crucial for their successful implementation. A better understanding of factors related to treatment acceptance and adherence is required to exploit the full potential of internet interventions. Hence, the aim of the present work was to analyze the acceptability of a therapist-guided internet-delivered CBT intervention for adjustment disorder and its impact on treatment outcomes. Methods: The acceptability was estimated from the acceptance to participate in the randomized controlled trial addressed to explore the effectiveness of the internet intervention in question. Other indicators of acceptability were treatment adherence, expectations, satisfaction, and opinion reported by 34 participants from the trial. Results: Willingness to try an internet intervention was observed and 76.5% of participants completed all seven treatment modules. Less positive initial expectations did not reduce treatment effectiveness, yet they might have led to treatment abandonment. Overall, participants were satisfied with the internet intervention and perceived it as a useful, comfortable and attractive way of receiving psychological assistance. Treatment modules aimed at promoting identification with the treatment goals, relapse prevention, and change in the meaning of the stressor were found to be related to posttraumatic growth and increase in positive affect and quality of life. Participants also expressed that the intervention required considerable motivation. In this regard, therapeutic support was perceived as an important adherence facilitator. Conclusion: The findings from this work support the suitability of internet interventions for the treatment of adjustment disorder. However, further research is required in order to develop guidelines for the design of more attractive and engaging internet interventions. [ABSTRACT FROM AUTHOR]

Aims: Digital mental health services may increase the accessibility and affordability of mental health treatments. However, client dropout a low use is often reported. The purpose of the current study was to investigate the structural validity of the e‐Therapy Attitudes and Process (eTAP) questionnaire, as a theoretically based (theory of planned behavior) tool for understanding ongoing client engagement intentions with digital mental health treatments. The possible role of eHealth literacy in predicting behavioral intentions to use digital mental health treatments was also examined. Methods: Participants were 244 Australian‐based adults aged between 18 and 56 years, who were currently using a digital mental health tool. Data were collected via online survey. Results: Confirmatory Factor Analysis was conducted, with good model fit obtained following two theoretically supported modifications. Moderated hierarchical regression supported the utility of the theory of planned behavior in predicting behavioral intentions, with attitudes emerging as a strong and consistent individual predictor. No support was found for the moderating role or individual significance of eHealth literacy. Conclusions: These findings support the clinical and research use of the eTAP as a theory‐based measure to understand client engagement in digital mental health interventions. The study also highlights the need for interventions to target attitudes to improve clients' ongoing engagement in digital mental health. [ABSTRACT FROM AUTHOR]

Background: Internet-delivered cognitive behavioral therapy (ICBT) is an effective and convenient means of offering cognitive behavioral therapy to the general population. To increase access to ICBT among Canadian public safety personnel (PSP)-a group that experiences elevated rates of mental health concerns and barriers to mental health care-a clinical research unit called PSPNET has tailored ICBT to PSP, primarily through offering case stories and PSP-specific examples within an ICBT program. PSPNET's first and most frequently used ICBT program, called the PSP Wellbeing Course, has been found to reduce symptoms of mental disorders (eg, anxiety, depression, and posttraumatic stress) among PSP. Little research, however, has investigated clients' perceptions of the case stories in this course., Objective: This study was designed to expand the literature on the use and evaluation of case stories in ICBT among PSP. Specifically, this study investigated (1) PSP's perceptions of the case stories using the theoretical model provided by Shaffer and Zikmund-Fisher and (2) PSP feedback on the case stories in the PSP Wellbeing Course., Methods: This study included 41 clients who completed the PSP Wellbeing Course. Of these, 27 clients completed a bespoke questionnaire called the Stories Questionnaire, 10 of whom also participated in a semistructured interview., Results: Findings show that perceptions of the case stories in the PSP Wellbeing Course were largely positive and that the case stories were generally successful in achieving the 5 purposes of case stories (ie, informing, comforting, modeling, engaging, and persuading) proposed by Shaffer and Zikmund-Fisher. Client feedback also identified 3 tangible areas for story improvement: characters, content, and delivery. Each area highlights the need for and potential benefits of story development. Not all PSP engaged with the case stories, though, so results must be interpreted with caution., Conclusions: Overall, this study adds to the growing body of research supporting the use of case stories in internet-delivered interventions among PSP., Trial Registration: ClinicalTrials.gov NCT04127032; https://www.clinicaltrials.gov/ct2/show/NCT04127032., (©Jill AB Price, Julia Gregory, Hugh C McCall, Caeleigh A Landry, Janine D Beahm, Heather D Hadjistavropoulos. Originally published in JMIR Formative Research (https://formative.jmir.org), 25.10.2024.)

Background: Despite accessibility and clinical benefits, open access trials of self-guided digital health interventions (DHIs) for young people have been plagued by high drop-out rates, with some DHIs recording completion rates of less than 3%., Objective: The aim of this study was to explore how young people motivate themselves to complete an unpleasant task and to explore perceived motivators and demotivators for engaging with a DHI., Methods: In this qualitative research study, 30 children and adolescents aged between 7 and 17 years were recruited to participate in 7 focus groups conducted over a 3-month period. Focus group activities and discussions explored sources of motivation to complete tasks and engage in a hypothetical 6-week DHI for anxiety., Results: Children (aged 7-11 years) reported greater reliance on external motivators such as following parent instruction to complete unpleasant tasks, while adolescents (aged 12-17 years) reported greater internal motivation such as self-discipline. Program factors, such as engaging content, were the most commonly mentioned motivators for engaging with a DHI across both age groups. After that, internal sources of motivation were most commonly mentioned, such as perceived future benefits. External factors were the most commonly mentioned demotivators across all ages, with time commitment being the most frequently mentioned., Conclusions: The study's findings have implications for enhancing adherence in future DHIs targeted to children and adolescents. Recommendations include the need for supportive parental involvement for children, while adolescents would likely benefit from mechanisms that promote autonomy, establish a supportive environment, and align with personal interests and values. Belief that a DHI will provide short-term benefits is important to both children and adolescents, as well as having confidence that future benefits will be realized., (© Christopher Cahill, Jennifer Connolly, Shelley Appleton, Melanie Jade White. Originally published in JMIR Pediatrics and Parenting (https://pediatrics.jmir.org).)

Background: Depression is an independent risk factor for cardiovascular disease (CVD), but it is unknown if successful depression treatment reduces CVD risk., Methods: Using eIMPACT trial data, we examined the effect of modernized collaborative care for depression on indicators of CVD risk. A total of 216 primary care patients with depression and elevated CVD risk were randomized to 12 months of the eIMPACT intervention (internet cognitive-behavioral therapy [CBT], telephonic CBT, and select antidepressant medications) or usual primary care. CVD-relevant health behaviors (self-reported CVD prevention medication adherence, sedentary behavior, and sleep quality) and traditional CVD risk factors (blood pressure and lipid fractions) were assessed over 12 months. Incident CVD events were tracked over four years using a statewide health information exchange., Results: The intervention group exhibited greater improvement in depressive symptoms ( p < 0.01) and sleep quality ( p < 0.01) than the usual care group, but there was no intervention effect on systolic blood pressure ( p = 0.36), low-density lipoprotein cholesterol ( p = 0.38), high-density lipoprotein cholesterol ( p = 0.79), triglycerides ( p = 0.76), CVD prevention medication adherence ( p = 0.64), or sedentary behavior ( p = 0.57). There was an intervention effect on diastolic blood pressure that favored the usual care group ( p = 0.02). The likelihood of an incident CVD event did not differ between the intervention (13/107, 12.1%) and usual care (9/109, 8.3%) groups ( p = 0.39)., Conclusions: Successful depression treatment alone is not sufficient to lower the heightened CVD risk of people with depression. Alternative approaches are needed., Trial Registration: ClinicalTrials.gov Identifier: NCT02458690.

Background: Internet-delivered interventions offer a feasible way to facilitate access to mental healthcare and considerable evidence supports their effectiveness for the treatment of different mental disorders. However, potential users’ attitudes toward these interventions are crucial for their successful implementation. A better understanding of factors related to treatment acceptance and adherence is required to exploit the full potential of internet interventions. Hence, the aim of the present work was to analyze the acceptability of a therapist-guided internet-delivered CBT intervention for adjustment disorder and its impact on treatment outcomes.Methods: The acceptability was estimated from the acceptance to participate in the randomized controlled trial addressed to explore the effectiveness of the internet intervention in question. Other indicators of acceptability were treatment adherence, expectations, satisfaction, and opinion reported by 34 participants from the trial.Results: Willingness to try an internet intervention was observed and 76.5% of participants completed all seven treatment modules. Less positive initial expectations did not reduce treatment effectiveness, yet they might have led to treatment abandonment. Overall, participants were satisfied with the internet intervention and perceived it as a useful, comfortable and attractive way of receiving psychological assistance. Treatment modules aimed at promoting identification with the treatment goals, relapse prevention, and change in the meaning of the stressor were found to be related to posttraumatic growth and increase in positive affect and quality of life. Participants also expressed that the intervention required considerable motivation. In this regard, therapeutic support was perceived as an important adherence facilitator.Conclusion: The findings from this work support the suitability of internet interventions for the treatment of adjustment disorder. However, further research is required in order to develop guidelines for the design of more attractive and engaging internet interventions.

Perfectionism has a strong association with eating disorders, anxiety and depression. Unguided internet cognitive behaviour therapy for perfectionism has demonstrated efficacy in female adolescents without elevated eating disorder symptoms. No research to date has examined unguided internet cognitive behaviour therapy for perfectionism for adolescents with elevated eating disorder symptoms as an indicated prevention for eating disorders and co-occurring symptoms of anxiety and depression. The protocol outlines the plan for a randomised controlled trial of a co-designed, unguided internet cognitive behaviour therapy for perfectionism with female adolescents with elevated symptoms of eating disorders. The intervention will be a 4-week programme compared to a waitlist control. Outcomes on eating disorder symptoms, anxiety and depression will be measured pre and post intervention and follow-up. Trial registration: This trial was registered on 23 September 2020 with the Australian New Zealand Clinical Trials Registry (ACTRN12620000951954P).

Interventions intended to reduce the consumption of dietary sugars among those population groups demonstrating disproportionately greater and more frequent consumption of sugar-sweetened beverages and foods (SSBF) would benefit from intervention strategies that are tailored to population-specific barriers and facilitators. The objective of this study was to develop and evaluate the acceptability of photo-enhanced and theory-based health promotion messages that target the reduction in SSBF among adult residents of public housing developments, a population known for their high rates of chronic disease. Using the message development tool as a framework, we developed a series of 15 SSBF reduction messages, using an iterative process with community member input. We then evaluated the acceptability of the messages and compared three delivery mechanisms: print, text, and social media. We recruited participants who were residents of urban public housing developments, and who spoke either English or Spanish. A majority of participants identified as being of Hispanic ethnicity (73%). The message acceptability scoring did not appear to differ according to the assigned delivery mechanism, despite some imbalances in participants’ characteristics across delivery mechanisms. The messages that targeted motivation were least likely to be accepted. In conclusion, our findings suggest that engaging members of the community at all phases of the development process was a feasible method to develop SSBF reduction messages with a high perceived acceptability.

BackgroundAutomated Internet intervention studies have generally had large dropout rates for follow-up assessments. Live phone follow-ups have been often used to increase follow-up completion rates.ObjectiveTo compare, via a randomized study, whether receiving phone calls improves follow-up rates beyond email reminders and financial incentives in a depression prevention study.MethodA sample of 95 participants (63 English-speakers and 32 Spanish-speakers) was recruited online to participate in a "Healthy Mood" study. Consented participants were randomized to either a Call or a No Call condition. All participants were sent up to three email reminders in one week at 1, 3, and 6 months after consent, and all participants received monetary incentives to complete the surveys. Those in the Call condition received up to ten follow-up phone calls if they did not complete the surveys in response to email reminders.ResultsThe follow-up rates for Call vs. No Call conditions at 1, 3, and 6 months, respectively, were as follows: English speakers, 58.6% vs. 52.9%, 62.1% vs. 52.9%, and 68.9% vs. 47.1%; Spanish speakers, 50.0% vs. 35.7%, 33.3% vs. 21.4%, and 33.3% vs. 7.1%. The number of participants who completed follow-up assessments only after being called at 1-, 3- and 6 months was 2 (14.3%), 0 (0%), and 3 (25.0%) for English speakers, and 2 (18.9%), 0 (0%), and 1 (7.7%) for Spanish speakers. The number of phone calls made to achieve one completed follow-up was 58.8 in the English sample and 57.7 and Spanish-speaking sample.ConclusionsAdding phone call contacts to email reminders and monetary incentives did increase follow-up rates. However, the rate of response to follow-up was low and the number of phone calls required to achieve one completed follow-up raises concerns about the utility of adding phone calls. We also discuss difficulties with using financial incentives and their implications.

Despite the availability of evidence-based postpartum depression (PPD) prevention and treatment interventions, perinatal persons continue to suffer. eHealth and mHealth tools to address mental health issues have grown exponentially, especially given the ubiquity of technology and the increased demand for telemental health resources. The Mothers and Babies Online Course (eMB), an 8-lesson prevention of PPD intervention, was digitally adapted to expand the reach of evidence-based interventions to perinatal persons with limited access to maternal mental health resources. This report describes the characteristics, behaviors, and feedback provided by users of the updated eMB website. Two hundred eight predominantly English-speaking U.S. residents enrolled in the eMB. Thirty-seven percent were either pregnant (n = 38) or postpartum (n = 39) women interested in learning skills to manage changes in their mood during and after pregnancy; 63% were health providers (n = 131) interested in learning how to support their patient communities. Seventy-six percent (n = 159) viewed at least one of the eight eMB lessons, with 50.9% exclusively viewing Lesson 1. Few (4.4%) viewed all eight lessons. The lessons were rated favorably on usefulness and understanding. Perinatal women engaged with interactive content at higher rates than health providers. Examining user behaviors and feedback is an essential developmental step before empirically testing the efficacy of digital tools. Future iterations of the eMB will incorporate these preliminary findings to provide perinatal persons with accessible web-based interventions that will hopefully reduce the incidence and negative consequences of postpartum depression.

Background: Despite the potential of digital mental health to provide cost-effective mental health care, its adoption in clinical settings is limited, and little is known about the perspectives and practices of mental health professionals regarding its implementation or the factors influencing these perspectives and practices. Objective: This study aims to characterize in depth the perspectives and practices of mental health professionals regarding the implementation of digital mental health and explore the factors affecting such perspectives and practices. Methods: A qualitative study using in-depth semistructured interviews with Portuguese mental health professionals (N=13)--psychologists and psychiatrists--was conducted. The transcribed interviews were thematically analyzed. Results: Mental health professionals deemed important or engaged in the following practices during the implementation of digital mental health: indication evaluation, therapeutic contract negotiation, digital psychological assessment, technology setup and management, and intervention delivery and follow-up. Low-threshold accessibility and professionals' perceived duty to provide support to their clients facilitated the implementation of digital mental health. Conversely, the lack of structured intervention frameworks; the unavailability of usable, validated, and affordable technology; and the absence of structured training programs inhibited digital mental health implementation by mental health professionals. Conclusions: The publication of practice frameworks, development of evidence-based technology, and delivery of structured training seem key to expediting implementation and encouraging the sustained adoption of digital mental health by mental health professionals. [ABSTRACT FROM AUTHOR]

Objectives: Difficulties with sexual desire impact up to a third of women and most do not seek or receive appropriate care for these complaints, in part due to stigma, embarrassment, and limited availability of treatment. In-person mindfulness-based interventions have lasting benefits to sexual desire and sex-related distress in controlled clinical trials but are difficult to access. Online cognitive-behavioral interventions for sexual concerns have shown promising findings, but online mindfulness interventions have received little testing. The current study assessed the feasibility of an online program (called eSense-Mindfulness) adapted from an effective face-to-face intervention for women with Sexual Interest/Arousal Disorder. Methods: Thirty cisgender women (M age = 35.3) with Sexual Interest/Arousal Disorder consented and completed at least one of the eight modules of eSense-Mindfulness while providing weekly feedback regarding their experience. Feasibility was assessed via attrition rates and participant self-report regarding challenges of using the program. Limited efficacy testing was based on effect sizes for changes in sexual response and sex-related distress. Results: Participants (n = 25 who completed all testing) reported high levels of usability and ease of understanding content and reported the mindfulness exercises as well as the information on partner communication to be the most relevant. Limited efficacy testing showed large effect sizes for reductions in sex-related distress, and improvements in sexual desire, arousal, and satisfaction whereas there were smaller effect sizes for improvements in lubrication, orgasm, and vaginal pain. Conclusions: The findings suggest that efficacious face-to-face mindfulness interventions for sexual dysfunction in women show excellent evidence of feasibility when delivered online without personalized guidance. [ABSTRACT FROM AUTHOR]

Background: Research is needed to determine the extent to which internet-delivered psychological therapies are effective when delivered in countries and cultures outside of where they were developed. Objective: This waitlist-controlled study evaluated the efficacy of a UK-developed, therapist-guided internet Cognitive Therapy programme for Social Anxiety Disorder (iCT-SAD) when delivered in Hong Kong by local therapists. Methods: Patients were randomized to iCT-SAD (n = 22) or a waitlist control group (n = 22). Assessments took place at weeks 0, 8, and 15 (posttreatment/postwait), with a further 3-month follow-up assessment for the iCT-SAD group. The primary outcome measure was the Liebowitz Social Anxiety Scale (self-report), and posttreatment/postwait diagnostic assessments were completed by independent assessors blind to condition. Trial Registration: ISRCTN11357117. Results: Compared with the waitlist group, iCT-SAD significantly reduced social anxiety symptoms (adjusted difference at posttreatment 55.36, 95%CI 44.32 to 66.39, p

Digital CBT refers to the use of digital tools, platforms or devices to deliver or enhance cognitive behavioural therapy assessment, formulation, treatment, training and supervision. The 'Advances in Digital CBT' special issue aimed to document examples of innovative digital CBT practice in this rapidly developing field. In this paper, we have briefly summarised and synthesised the advances demonstrated in this group of articles. These include developments in our understanding of mental health apps, the use of digital tools as an adjunct to therapy, the effectiveness of remotely delivered CBT in routine clinical practice, our understanding of user experiences and involvement, and in digital CBT research methods. We consider the extent of current knowledge in these areas and identify where gaps in evidence lie and how the field could be taken forward to address these. Lastly, we reflect on the broader digital CBT picture and offer our suggestions of six key directions for future research: using robust study designs to evaluate and optimise digital tools; translating and culturally adapting digital tools and practices; understanding and addressing digital exclusion; exploring, reporting and addressing possible negative effects; improving user involvement in design and evaluation; and addressing the implementation gap for digital tools. We suggest that further advances in these areas would be of particular benefit to the digital CBT field. Key learning aims: (1) To gain an overview of the articles in the special issue and an understanding of the advances in digital CBT they represent. (2) To understand how the advances suggested by the present studies could be taken forward and extended. (3) To consider key future directions for further advances in digital CBT. [ABSTRACT FROM AUTHOR]

Online peer support platforms have been shown to provide a supportive space that can enhance social connectedness and personal empowerment. Some studies have analysed forum messages, showing that users describe a range of advantages, and some disadvantages to their use. However, the direct examination of users' experiences of such platforms is rare and may be particularly informative for enhancing their helpfulness. This study aimed to understand users' experiences of the Support, Hope and Recovery Online Network (SHaRON), an online cognitive behavioural therapy-based peer support platform for adults with mild to moderate anxiety or depression. Platform users (n = 88) completed a survey on their use of different platform features, feelings about using the platform, and overall experience. Responses were analysed descriptively and using thematic analysis. Results indicated that most features were generally well used, with the exception of private messaging. Many participants described feeling well supported and finding the information and resources helpful; the majority of recent users (81%) rated it as helpful overall. However, some participants described feeling uncomfortable about posting messages, and others did not find the platform helpful and gave suggestions for improvements. Around half had not used the platform in the past 3 months, for different reasons including feeling better or forgetting about it. Some described that simply knowing it was there was helpful, even without regular use. The findings highlight what is arguably a broader range of user experiences than observed in previous studies, which may have important implications for the enhancement of SHaRON and other platforms. Key learning aims: (1) To understand what an online peer support platform is and how this can be used to support users' mental health. (2) To learn how users described their experience of the SHaRON platform. (3) To understand the benefits that online peer support may provide. (4) To consider what users found helpful and unhelpful, and how this might inform the further development of these platforms. [ABSTRACT FROM AUTHOR]

Background: The Social Brain Toolkit, conceived and developed in partnership with stakeholders, is a novel suite of web-based communication interventions for people with brain injury and their communication partners. To support effective implementation, the developers of the Social Brain Toolkit have collaborated with people with brain injury, communication partners, clinicians, and individuals with digital health implementation experience to coproduce new implementation knowledge. In recognition of the equal value of experiential and academic knowledge, both types of knowledge are included in this study protocol, with input from stakeholder coauthors. Objective: This study aims to collaborate with stakeholders to prioritize theoretically based implementation targets for the Social Brain Toolkit, understand the nature of these priorities, and develop targeted implementation strategies to address these priorities, in order to support the Social Brain Toolkit's implementation. Methods: Theoretically underpinned by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of digital health implementation, a maximum variation sample (N=35) of stakeholders coproduced knowledge of the implementation of the Social Brain Toolkit. People with brain injury (n=10), communication partners (n=11), and clinicians (n=5) participated in an initial web-based prioritization survey based on the NASSS framework. Survey completion was facilitated by plain English explanations and accessible captioned videos developed through 3 rounds of piloting. A speech-language pathologist also assisted stakeholders with brain injury to participate in the survey via video teleconference. Participants subsequently elaborated on their identified priorities via 7 web-based focus groups, in which researchers and stakeholders exchanged stakeholder perspectives and research evidence from a concurrent systematic review. Stakeholders were supported to engage in focus groups through the use of visual supports and plain English explanations. Additionally, individuals with experience in digital health implementation (n=9) responded to the prioritization survey questions via individual interview. The results will be deductively analyzed in relation to the NASSS framework in a coauthorship process with people with brain injury, communication partners, and clinicians. Results: Ethical approval was received from the University of Technology Sydney Health and Medical Research Ethics Committee (ETH20-5466) on December 15, 2020. Data were collected from April 13 to November 18, 2021. Data analysis is currently underway, with results expected for publication in mid-2022. Conclusions: In this study, researchers supported individuals with living experience of acquired brain injury, of communicating with or clinically supporting someone post injury, and of digital health implementation, to directly access and leverage the latest implementation research evidence and theory. With this support, stakeholders were able to prioritize implementation research targets, develop targeted implementation solutions, and coauthor and publish new implementation findings. The results will be used to optimize the implementation of 3 real-world, evidence-based interventions and thus improve the outcomes of people with brain injury and their communication partners. [ABSTRACT FROM AUTHOR]

Background: Digital mental health (DMH) provides effective methods of overcoming issues of time constraints, accessibility, and availability of mental health care. They can provide a valuable means to deliver mental health care in the present pandemic. However, adoption of these methods has been slow. Mental health professional (MHP) concerns at the organizational and policy level that influence this slow adoption need to be examined. Materials and Methods: A narrative review was conducted to identify the barriers. Searches using the databases Scopus, Embase, and PubMed were conducted to identify research focused on barriers reported by MHPs to use DMH. Results: The search resulted in 356 unique citations, and 21 papers met the inclusion and exclusion criteria. Forward and backward sampling resulted in identifying an additional 19 relevant papers. Discussion: Unmet needs for information, training, and infrastructure, challenges to the workflow and excessive workloads, and ambiguous policies serve as barriers to DMH use. This article recommends strategies for researchers, organizations, DMH designers, and governmental institutions to ensure efficient utilization of DMH. Conclusions: Concerted efforts at individual, organizational, and governmental levels are essential to ensure efficient utilization of DMH. [ABSTRACT FROM AUTHOR]