Background: Post-traumatic stress disorder (PTSD) can be a severe psychiatric condition, and access to timely evidence-based treatment is often limited. Prolonged exposure is recommended as first line treatment in clinical guidelines. There is limited research on how digital formats of prolonged exposure used to increase treatment availability impact user experience. Therefore, we wanted to investigate patients' experiences of prolonged exposure in a therapist-guided internet-delivered format (HOPE; Huddinge Online Prolonged Exposure), as part of an uncontrolled feasibility study.Method: Semi-structured interviews were conducted with a total of 14 participants upon their completion of HOPE.Results: Thematic analysis revealed that participants found HOPE to be helpful and effective, especially valuing the flexibility in the digital treatment format. However, a subset of participants reported that HOPE did not meet their needs entirely, indicating room for improvement and tailoring of treatment to individual preferences and needs.Conclusion: This study represents the first exploration of internet-delivered prolonged exposure therapy within a Swedish psychiatric setting, comprising participants characterized by moderate to severe PTSD and self-rated complex PTSD. The results could help guide the development of more accessible and acceptable treatments for PTSD, ultimately improving treatment quality.

As e-health offerings rapidly expand, they are transforming and challenging traditional mental health care systems globally, presenting both promising opportunities and significant risks. This article critically examines the potential and pitfalls of integrating digital technologies into mental health care, particularly in the realms of diagnosis, prevention, and treatment. It explores current advancements and evidence-based practices, and provides a vision for how future technologies can evolve responsibly to meet mental health needs. The article concludes with the TEQUILA framework, addressing essential elements and challenges for fostering a beneficial and ethical future. A responsible future for digital mental health requires building Trust by ensuring data privacy, security, and transparency in AI-driven decisions, along with Evidence-based and robust regulatory oversight to maintain Quality. Usability, design, usability tailored to diverse needs, and ethical alignment with users' Interests will all be essential, while Liability and Accreditation standards will safeguard accountability in this evolving landscape.

The increasing prevalence of pediatric atopic diseases in China poses substantial risks to children's physical health, mental well-being, and quality of life. Cognitive behavioral interventions for caregivers are effective in managing pediatric atopic diseases. Existing interventions are typically siloed and lack integration across the comorbidities of the atopic march. The protection motivation theory (PMT) could provide an integrated cognitive behavioral intervention framework for addressing shared pathophysiological mechanisms and unifying management strategies across atopic diseases, while online interventions offer advantages in accessibility, cost-effectiveness, and scalability, particularly for caregiver-mediated pediatric care.

This study aimed to develop and evaluate a PMT-based cognitive behavioral online (PMT-CBO) intervention for caregivers of children with atopic diseases, assessing its effects on caregivers' protective motivation, behavioral intentions, preventive practices, and children's atopic disease outcomes.

A quasi-experimental design was conducted in 3 health care institutions in Hangzhou, China, where 2 health care institutions were assigned to the PMT-CBO group (127/243, 52.3%) and 1 health care institution was assigned to the control group (116/243, 47.7%). Caregivers in the PMT-CBO group received a 4-week structured course comprising 16 online modules delivered via a WeChat mini-program, whereas controls received routine care with verbal education. Primary outcomes included caregivers' PMT dimensions (threat appraisal and coping appraisal), behavioral intentions, and preventive behaviors, and secondary outcomes involved children's symptom severity and medication adherence. The primary outcome scales or questionnaires were designed by the research team, while the secondary outcome scales were derived from established studies. All scales demonstrated good reliability and validity. Intention-to-treat analysis was used.

Compared to the control group, the PMT-CBO group demonstrated significant improvements in overall PMT scores (Z=-6.289; P<.001) and most subdimensions (response efficacy, self-efficacy, threat severity, and response cost, with P<.05), except susceptibility (Z=-1.321; P=.19) and reward appraisals (Z=-0.989; P=.32). In the intervention group, caregivers exhibited stronger intentions and partial behavioral optimization (eg, environmental allergen control, with Z=-3.025; P=.002) and children showed improved medication adherence (Z=-4.457; P<.001) and alleviated eczema (Z=-3.112; P=.002) and allergic rhinitis symptoms (Z=-3.277; P<.001), although no significant differences emerged in asthma control (Z=-.830; P=.41) or food allergy-related caregiver burden (Z=-1.693; P=.09).

The PMT-CBO intervention enhanced caregivers' motivation and intentions and children's medication adherence and eczema and rhinitis outcomes, with a 91.3% (116/127) completion rate via WeChat's scalable platform. Limited improvements in asthma control and food allergy management implied the future need for additional condition-specific plug-ins, beyond the core PMT-CBO modules. Moreover, merging this PMT-CBO intervention with implementation techniques or ecological frameworks could help address intention-behavior gaps and external barriers, thereby promoting equitable and precision-based allergy care.

Borderline Personality Disorder (BPD) is a severe mental health condition that requires intensive psychotherapeutic treatment. Dialectical Behavior Therapy (DBT) is a specialized treatment approach for BPD with broad empirical evidence. However, as with other disorder-specific treatments, the effect sizes of the standard DBT approach are only modest and access to treatment is limited. To enhance the efficacy of DBT, we developed an adaptation called Trauma-Focused DBT (TF-DBT), which is based on the principles, treatment modes, and functions of DBT. The goal was to (i) condense and accelerate the core therapeutic processes of DBT and (ii) expand therapeutic strategies for addressing BPD symptoms beyond Stage I of DBT (i.e., focusing on behavioral dyscontrol). TF-DBT adopts an accelerated experiential approach that is phase-based in its delivery. It emphasizes the processing of maladaptive emotions related to a wide range of developmental relational trauma (i.e., experiences of traumatic invalidation, emotional abuse, bullying, sexual abuse, or neglect in childhood or adolescence).

The primary aim of this study is to investigate the efficacy of this novel DBT adaptation (TF-DBT) compared to standard DBT (S-DBT) as developed by M. Linehan. We hypothesize that TF-DBT is superior to S-DBT on all BPD symptom measures. A second aim of the study is to investigate the efficacy of the delivery format of both treatments (i.e., online vs. face-to-face), with the hypothesis that online therapy is non-inferior to face-to-face treatment.

This study will enroll N = 260 individuals diagnosed with BPD according to DSM-5. Participants will be randomly assigned to 12 months of outpatient TF-DBT or S-DBT in an online or face-to-face format.

The expected results might help to improve psychotherapy efficacy for BPD. Additionally, they will improve our understanding of the efficacy of online-delivered DBT treatments which might contribute to facilitating access to treatment.

German Clinical Trials Register: registration number DRKS00031808, date of registration 04 July 2023. WHO Universal Trial Number: U1111-1273-3381.

The expansion of e-mental health services offers diverse treatment options. As the variety of available interventions grows, helping individuals navigate these options effectively becomes essential.

This study evaluates the effects of a decision aid for users when choosing between guided internet-based psychological interventions and in-person psychotherapy.

A web-based, randomized controlled trial was conducted with 148 Chinese-speaking adult participants from Hong Kong with Patient Health Questionnaire-9 (PHQ-9) scores ≥10 (indicating clinical depression). Participants were recruited by electronic direct mail, social media, university mass mail, and online advertising then randomly assigned to either the decision aid intervention group or the attention control group. The study's assessments were conducted online through self-administered questionnaires before and after the intervention, while the intervention was delivered via Zoom. The decision aid group underwent a brief interactive, self-directed, web-based decision aid. The decision aid included psychoeducation on depression and treatments, a comparison between internet-based interventions and face-to-face therapy, and personalized reports for value clarification. The attention control involved an unguided web search on mental health information. Primary outcome measures included decision conflict (measured using the SURE tool and Decision Conflict Scale), while secondary outcomes included stage of decision-making, satisfaction with decision, perceived benefits and risks, and likelihood of service utilization.

Time-by-intervention interactions in ANOVA were found, which indicated that the reduction in decisional conflict was more significant in the decision aid group than in the control group, as measured using the brief SURE tool (F1,145=6.47, P=.01; partial η2 = 0.043; 95% CI 0.002-0.122) and decision conflict scale (F1,136=9.56, P=.002; 95% CI 0.0086-0.16). Specifically, interaction effects were observed for 3 of the 5 decision conflict subscales: The decision aid group reported feeling more "informed," experiencing greater "support," and being better able to make "effective decisions." Participants in the decision aid group also reported more advanced stages of decision-making; however, a significant difference between groups was not found for satisfaction with the decision. Although there was no significant change in perceived benefit, participants in the decision aid group had significantly greater reductions in their perceived risks associated with a guided internet-based psychological intervention. In addition, participants who used the decision aid were 2.26 times more likely to prefer (odds ratio [OR] 2.26, 95% CI 1.11-4.60; P=.02) and 2.53 times more likely to use (OR 2.53, 95% CI 1.13-4.92; P=.006) a guided internet-based psychological intervention than participants who searched for mental health information on the web by themselves.

This study demonstrates the extent of the utility and value of a decision aid for assisting individuals with depressive symptoms make informed choices related to e-mental health. Decision aids may facilitate the uptake of digital mental health services. Future research should explore the behavioral and long-term impact and generalizability of decision aids in applied settings.

Chinese Clinical Trial Register ChiCTR2300077323; https://tinyurl.com/2n34ea69; ClinicalTrials.gov NCT05477420; https://clinicaltrials.gov/study/NCT05477420.

Anxiety disorders, marked by excessive fear and worry, are particularly prevalent in autism, affecting up to 45 % of individuals with the condition. Since the 1960s, advances in neuroscience, psychology, and psychopharmacology have enhanced understanding and treatment of anxiety disorders in general population. Standardized diagnostic criteria development facilitated accurate classification of anxiety disorders. Neurobiological research identified key brain regions forming the basis of the amygdala-centred fear circuit model. Pharmacological advancements introduced selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) as safer, first-line treatments. However, these medications show limited efficacy and significant side effects in autistic individuals, highlighting the need for alternative treatments. Cognitive-behavioural therapy (CBT) has gained empirical support, helping to reduce avoidance behaviours, but modifications are often needed for autistic individuals. Emerging therapies, including Mindfulness-Based Stress Reduction for Autism Spectrum Disorder (MASSI) and virtual reality-based interventions, are being explored for individuals with more treatment-resistant anxiety. Ongoing clinical trials are assessing medications used for other psychiatric disorders to determine their efficacy in anxiety treatment for autism. Recent genetic and neuroimaging research has revealed altered brain connectivity and genetic susceptibility in anxiety, promoting the development of personalized treatments. Despite these advances, challenges remain in optimizing interventions and addressing treatment resistance, necessitating continued research and innovation.

Although individuals facing Body Dysmorphic Disorder (BDD) endure considerable levels of distress, they often do not engage in empirically effective cognitive-behavioral therapy. Identified barriers to seeking treatment include logistical challenges, shame and stigmatization, and pessimistic expectations of mental health interventions associated with a lack of insight into having a psychological issue. This study investigates the relevance of these perceived treatment barriers for face-to-face therapy and for online interventions as a potentially accessible alternative or entry to traditional psychotherapy. Through an online survey involving 321 participants (comprising 239 with elevated BDD symptoms and 82 with self-reported probable BDD), we utilize the Barriers to Treatment Questionnaire to assess different perceived barriers. A comparative analysis is conducted to contrast the perceived relevance of barriers to psychotherapy with those reported for online interventions. As a result, perceived barriers to psychotherapy are most prominent in feelings of shame and fear of stigmatization, followed by logistical challenges and negative treatment expectations, and again followed by format-related concerns. Overall perceived barriers to online interventions are lower, though concerns related to the intervention format, such as data security concerns, become more pronounced. Notably, shame and stigmatization remain central factors in both contexts. When offering psychological help to individuals with BDD, the aspects of shame and negative attitudes toward seeking psychological help should be primarily addressed. Considering all their advantages, online interventions should continue to be utilized for BDD, to improve the treatment situation, but it should be noted that this treatment format is not without challenges.

Internet-based cognitive behavioral therapy (ICBT) is a relatively new therapy with unknown effectiveness in patients with cancer. In addition, therapist-guided and self-guided ICBT patient-specific outcomes for cancer patients remain to be explored.

To explore the effects of ICBT on psychological outcomes, physical outcomes, and daily life outcomes in patients with cancer.

Electronic databases such as PubMed, Web of Science, Cochrane Library, EMBASE, APA PsycINFO, ProQuest, and ClinicalTrials.gov were searched for relevant studies published from their inception to October 2022. Five GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) considerations were used to assess the quality of relevant evidence. Data analysis was performed via RevMan 5.4 (The Cochrane Collaboration, London, United Kingdom) and Stata 15.0 (StataCorp, College Station, Texas).

Three thousand two hundred forty-nine participants from 20 studies were included in the meta-analysis. Statistically significant effects of ICBT were found on psychological distress, quality of life (QOL), anxiety, and depression, after the intervention. A separate analysis of follow-up data showed that ICBT had a sustainable effect on psychological distress, anxiety, and depression. Subgroup analyses showed that therapist-guided ICBT was more effective for psychological distress and QOL.

Internet-based cognitive behavioral therapy can improve symptom management for patients with cancer.

Internet-based cognitive behavioral therapy effectively improves psychological distress, anxiety, and depression in patients with cancer after intervention and at follow-up. Internet-based cognitive behavioral therapy improved QOL for cancer patients postintervention but not during follow-up. Internet-based cognitive behavioral therapy did not relieve fatigue or fear of recurrence in cancer patients. Therapist-guided ICBT is recommended for its superior outcomes in alleviating psychological distress and improving overall QOL in adults with cancer when compared with self-guided ICBT.

Patients with subthreshold depression (sD) carry a significant risk of developing major depressive disorder. However, few studies focus on the influence of Internet-based Cognitive Behavioral Therapy (ICBT) on brain network, particularly among Chinese undergraduates. This study aims to conduct resting-state functional MRI (rs-fMRI) to explore the effects of ICBT on neurofunctional network.

This short-term longitudinal study enrolled 30 sD patients and 24 healthy matched participants. We gathered the clinical measurements outcomes from sD patients. Baseline and post-intervention MRI scans were performed for the sD patients, additionally, a matched healthy controls group underwent baseline MRI scans, functional network matrix was established from the temporal rs-MRI series. Nodal efficiency (Enod) was quantified by calculating the area under the curve (AUC) of network metrics.

The patients with sD exhibited reduced clinical measurement scores after ICBT intervention. Moreover, after ICBT intervention, functional network analysis revealed an increased Enod in the orbital part of the left inferior frontal gyrus, and decreased Enod in the left paracentral lobule and right precentral gyrus.

This study showed alterations in brain network in patients with sD after ICBT intervention. These findings shed light on the neurofunctional mechanisms underlying the effects of ICBT in sD patients.

Social anxiety disorder is a common mental health condition characterized by an intense fear of social situations that can lead to significant impairment in daily life. Cognitive behavioral therapy (CBT) has been recognized as an effective treatment; however, access to therapists is limited, and the fear of interacting with therapists can delay treatment seeking. Furthermore, not all individuals respond. Tailoring modular treatments to individual cognitive profiles may improve efficacy. We developed a novel digital adaptation of CBT for social anxiety that is both modular and fully digital without a therapist in the loop and implemented it in the smartphone app Alena.

This study aimed to evaluate the safety, acceptability, and efficacy of the new treatment in online participants with symptoms of social anxiety.

In total, 2 web-based randomized controlled trials (RCTs) comparing individuals with access to the treatment through the app to a waitlist control group were conducted. Participants were recruited on the web and reported Social Phobia Inventory (SPIN) total scores of ≥30. Primary outcomes were safety and efficacy over 6 weeks in 102 women aged 18 to 35 years (RCT 1) and symptom reduction (SPIN scores) after 8 weeks in 248 men and women aged 18 to 75 years (RCT 2).

In RCT 1, active and control arm adverse event frequency and severity were not distinguishable (intervention: 7/52, 13%; waitlist control: 8/50, 16%; χ21=0.007; P=.93). App acceptability was high, with a median completion rate of 90.91% (IQR 54.55%-100%). Secondary outcomes suggested greater symptom reduction in the active arm (mean SPIN score reduction -9.83, SD 12.80) than in the control arm (mean SPIN score reduction -4.13, SD 11.59; t90=-2.23; false discovery rate P=.04; Cohen d=0.47). RCT 2 replicated these findings. Adverse event frequency was comparable across the 2 groups (intervention: 20/124, 16.1%; waitlist control: 21/124, 16.8%; χ21<0.001; P>.99). Despite a longer treatment program, median completion remained high (84.85%, IQR 51.52%-96.97%). SPIN score reduction was greater in the active arm (mean -12.89, SD 13.87) than in the control arm (mean -7.48, SD 12.24; t227=-3.13; false discovery rate P=.008; Cohen d=0.42).

The web-only, modular social anxiety CBT program appeared safe, acceptable, and efficacious in 2 independent RCTs on online patient groups with self-reported symptoms of social anxiety.

ClinicalTrials.gov NCT05858294; https://clinicaltrials.gov/study/NCT05858294 (RCT 1) and ClinicalTrials.gov NCT05987969; https://clinicaltrials.gov/study/NCT05987969 (RCT 2).

Chronic pain affects 1.9 billion people worldwide and wait times for interprofessional pain management programs can be extensive. The existing wait times provide an opportunity to introduce internet-based interventions that enhance self-management ability.

The purpose of this study was to examine the feasibility, acceptability, engagement, and meaningfulness of an online program designed to enhance the readiness for change and self-management.

Participants (N = 61) waiting for interprofessional chronic pain care at two centers were assigned to engage in either a series of eight self-directed web-based modules or engage in the modules with the addition of four one-on-one sessions delivered by coaches trained in motivational interviewing techniques.

We collected participant demographics, feasibility and engagement metrics, and pre and post intervention questionnaires. A subset of participants from each group participated in an interview (n = 22).

The use of online modules was found to be feasible and acceptable for participants and engagement varied depending on individual preference and between modules. Participants noted that the content and approach were relevant and meaningful, influencing changes in thinking and behaviour around pain self-management. Exploratory analyses were performed and supported improvement in self-efficacy and chronic pain acceptance outcomes in both groups. Coaching did not augment improvements in any of our outcomes.

The use of a self-directed web-based chronic pain and motivational empowerment program appears to be a promising option to support people waiting for specialist care and may influence readiness for interprofessional care.

Juvenile idiopathic arthritis (JIA) is a chronic rheumatic condition requiring long-term, multidisciplinary treatment, which consumes significant health care resources and family energy. This study aims to analyze the effectiveness of digital interventions on patient outcomes in individuals with JIA.

This meta-analysis aimed to evaluate the impact of digital interventions on alleviating symptoms and improving overall well-being in children and adolescents with JIA.

A systematic search of 5 databases identified randomized controlled trials assessing the impact of digital interventions on physiological and psychological outcomes in adolescents and children (average age ≤19 y). Outcomes included pain, physical activity, health-related quality of life, self-efficacy, and disease-related issues. A total of 2 reviewers independently screened papers and extracted data on intervention functionalities and outcomes, assessing the risk of bias. A meta-analysis using a random-effects model synthesized the results.

The review included 11 studies involving 885 patients with JIA. Digital interventions included educational (eg, self-management training), therapeutic (eg, pain management), and behavioral (eg, promoting physical activity) approaches. These were delivered through websites, telephone consultations, video conferences, apps, and interactive games, with durations ranging from 8 to 24 weeks and no clear link observed between intervention length and outcomes. Compared with conventional control groups, digital interventions were significantly effective in alleviating pain (standardized mean difference [SMD] -0.19, 95% CI -0.35 to -0.04) and enhancing physical activity levels (SMD 0.37, 95% CI 0.06-0.69). Marginal improvements in health-related quality of life, self-efficacy, and disease-related issues were observed, but these did not reach statistical significance (SMD -0.04, 95% CI -0.19 to 0.11; SMD 0.05, 95% CI -0.11 to 0.20; and SMD 0.09, 95% CI -0.11 to 0.29, respectively). The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach rated the quality of evidence for pain, health-related quality of life, self-efficacy, and disease-related issues as moderate, while the evidence quality for physical activity was assessed as low.

Digital interventions can alleviate pain and enhance physical activity in patients with JIA. However, given the limited sample size and high risk of bias in some studies, further high-quality research is needed to improve the treatment and management of JIA.

Depression and anxiety are prevalent among older adults. However, most older adults have poor access to age-specific mental health services. While Information technology-based Cognitive Behavioral Therapy (ICBT) has shown promise as an accessible alternative to face-to-face interventions, its effectiveness specifically within the older adults warrants further investigation.

To evaluate the effectiveness of ICBT on depression and anxiety symptoms among older adults.

Research articles retrieved from PubMed, EMBASE, the Cochrane Library, Web of Science, PsycINFO, and MEDLINE from inception to April 10, 2024, were reviewed. The search was designed to identify Randomized Controlled Trials (RCTs) that examined the efficacy of ICBT in reducing self-reported depression or anxiety symptoms in older adults. The quality of included studies was assessed using the Cochrane risk-of-bias tool for randomized trials, version 2.0. Posttreatment means and standard deviations (SDs) were compared between intervention and control groups, and pooled effect sizes (Hedges' g) were calculated.

A total of 11 RCTs were eligible for inclusion in this review. Compared to control groups, ICBT yielded small to medium post-treatment pooled effect sizes regarding depressive symptoms (Hedges' g = -0.65, 95 % CI -0.95 to -0.35; P < 0.001) and anxiety symptoms (Hedges' g = -0.47, 95 % CI -0.74 to -0.19; P < 0.001). Subgroup analyses showed that: (1) interventions lasting ≥8 weeks (Hedges' g = -0.88, 95 % CI -1.37 to -0.39; P < 0.001) were more effective than <8 weeks for depressive symptoms; however, <8 weeks (Hedges' g = -0.52, 95 % CI -0.93 to -0.10; P = 0.014) was more effective for anxiety symptoms; (2) ICBT delivered through slideshows was more effective than through other digital platforms for both depressive (Hedges' g = -1.36, 95 % CI -2.40 to -0.31; P = 0.011) and anxiety symptoms (Hedges' g = -1.00, 95 % CI -1.30 to -0.70; P < 0.001); and (3) non-tailored ICBT was more effective than tailored versions for both depressive (Hedges' g = -1.06, 95 % CI -2.03 to -0.09; P = 0.032) and anxiety symptoms (Hedges' g = -0.70, 95 % CI -1.14 to -0.27; P = 0.001).

This meta-analysis reinforces the effectiveness of ICBT in relieving depression and anxiety symptoms among older adults. Future research should identify the most effective components of ICBT to optimize their development.

•French and English iCBT programs were assessed in routine care in eastern Canada.•Moderate to large improvements on all treatment outcomes were obtained.•Adherence was lower and attrition higher than in previous studies.•Satisfaction was high among study completers.•Therapist-guided iCBT may help to increase access to treatment for some patients.

Internet-based Cognitive Behavioral Therapy (ICBT) has shown promise in addressing the treatment gap for eating disorders (EDs), with evidence indicating moderate to large effect sizes. However, some individuals experience no improvement or deterioration in their condition, highlighting the need to understand both successful and unsuccessful outcomes.

This study aimed to explore patients' experiences undergoing Internet-based guided self-help treatment based on Enhanced Cognitive Behavior Therapy (ICBT-E) for bulimia nervosa (BN) and binge eating disorder (BED), focusing on both those who benefited from the treatment and those who did not.

Sixteen participants with a diagnosis of full or subthreshold BN or BED, including eight non-responders and eight responders, participated in a semi-structured telephone interview. Data were analyzed using qualitative content analysis.

Responders strongly identified with the content, facilitating treatment implementation, while non-responders found the content less relevant to their symptoms. The treatment was overall perceived as time-consuming, but non-responders found it overwhelming and struggled with motivation and self-discipline. Non-responders preferred synchronous communication, while responders valued the flexibility of asynchronous contact. Overall, participants acknowledged the importance of ICBT-E, though non-responders felt it was not tailored to their specific needs.

The study highlighted considerations for designing and implementing ICBT-E, including tailoring content to diverse patient symptoms, managing time demands, and considering motivation and self-discipline when assigning this treatment. While ICBT-E shows promise for the widespread dissemination of treatment for EDs, ongoing evaluation of progress during treatment and timely referral to alternative interventions for non-responders are crucial for optimizing outcomes.

Youth mental health services are characterised by high demand and modest clinical outcomes. While digital mental health interventions (DMHIs) have been shown to be clinically effective, the relationship between DMHI use and outcome is unclear. The current study sought to identify the factors affecting the relationship between DMHI use and depression and anxiety symptom improvement in sub-groups of young people.

An observational cohort design included young people aged 12-25 years engaging with a DMHI (MOST) from October 2020 to October 2023. The primary outcome was improvement at 12 weeks on the Patient Health Questionnaire-4 (PHQ4). DMHIs were combinations of self-paced digital cognitive-behavioural therapy content, social network interactions, and professional support. A machine learning clustering algorithm was used to identify distinct user clusters based on baseline characteristics and multiple logistic regression models examined the relationship between DMHI usage and improvement.

Two distinct user clusters emerged, differing by symptom severity, age, service setting, and concurrent external treatment. 46.7% of "Severe" users and 39.8% of "Mild-Moderate" users significantly improved. Greater use of therapy content and professional support interactions were associated with improvement for the Mild-Moderate group only (OR = 1.16, 95% CI: 1.04-1.30, p = 0.008).

While a greater proportion of users in the Severe group significantly improved, increased MOST use was associated with symptom improvement only for the Mild-Moderate group. These findings highlight the complexity of the relationship between DMHI use and outcome. Other unmeasured mediating or moderating factors such concurrent 'offline' treatment may help explain the results. Further research is required to better understand the relationship between DMHI use and clinical outcomes.

Youth mental health (YMH) services have been established internationally to provide timely, age-appropriate, mental health treatment and improve long-term outcomes. However, YMH services face challenges including long waiting times, limited continuity of care, and time-bound support. To bridge this gap, MOST was developed as a scalable, blended, multi-modal digital platform integrating real-time and asynchronous clinician-delivered counselling; interactive psychotherapeutic content; vocational support; peer support, and a youth-focused online community. The implementation of MOST within Australian YMH services has been publicly funded.

The primary aim of this study was to evaluate the real-world engagement, outcomes, and experience of MOST during the first 32 months of implementation.

Young people from participating YMH services were referred into MOST. Engagement metrics were derived from platform usage. Symptom and satisfaction measures were collected at baseline, 6, and 12 (primary endpoint) weeks. Effect sizes were calculated for the primary outcomes of depression and anxiety and secondary outcomes of psychological distress and wellbeing.

Five thousand seven hundred and two young people from 262 clinics signed up and used MOST at least once. Young people had an average of 19 login sessions totalling 129 min over the first 12 weeks of use, with 71.7% using MOST for at least 14 days, 40.1% for 12 weeks, and 18.8% for 24 weeks. There was a statistically significant, moderate improvement in depression and anxiety at 12 weeks as measured by the PHQ4 across all users irrespective of treatment stage (d = 0.41, 95% CI 0.35-0.46). Satisfaction levels were high, with 93% recommending MOST to a friend. One thousand one hundred and eighteen young people provided written feedback, of which 68% was positive and 31% suggested improvement.

MOST is a highly promising blended digital intervention with potential to address the limitations and enhance the impact of YMH services.

To map out the current artificial intelligence (AI)-informed psychosocial interventions research landscape, with a focus on main themes, trends, and prospective future directions.

A bibliometric analysis extracted articles that had been published between 2007 and 2024 from the Web of Science database. Software used to process results were Bibliometrix and VOSviewer.

A total of 207 articles published by 86 different sources were obtained. A publication of high recurrence source was the Journal of Medical Internet Research. The United States showed high research activity in link strength, volume of articles, and citation frequency. Key themes identified were machine learning, mental health, cognitive-behavioral therapy, and personalization. Emerging trends since 2020 show growing interest in ChatGPT and AI-driven therapy.

Bibliometric analysis suggests increased application of AI in psychosocial interventions in mental health. Integrating AI with existing therapies and the development of novel digital tools indicate a future for mental health care that is personalized and innovative. The advent of advanced language models, such as ChatGPT, has opened new horizons in AI-supported mental health care. This preliminary analysis provides a foundational understanding of the current landscape while identifying key areas for further research. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Unguided internet-based cognitive behavioral therapy (ICBT) has been proven effective for major depressive disorder (MDD). However, few studies have examined its cost-effectiveness in low-resource countries and under nonspecialist routine care.

This study aimed to evaluate the short- and long-term cost utility of unguided ICBT compared to a waitlist control for persons with MDD from the perspectives of society and the health care system.

This analysis was implemented alongside an 8-week 2-arm randomized controlled trial with a 12-month follow-up period conducted in Shenzhen, China. Outcomes including cost and health utility were collected at the pretreatment and posttreatment time points and 3, 6, and 12 months after the intervention. Direct medical costs and indirect costs were prospectively collected using the hospital information system and the Sheehan Disability Scale. Health outcomes were measured using the Chinese version of the Short-Form Six-Dimension health index. The primary outcome was incremental cost utility ratio (ICUR) expressed as the difference in costs between 2 therapies by the difference in quality-adjusted life years (QALYs). The seemingly unrelated regression model and the bootstrap method were performed to estimate adjusted ICURs. Cost-effectiveness planes and cost-effectiveness acceptability curves were used to demonstrate uncertainty. A series of scenario analyses were conducted to verify the robustness of base-case results.

In total, 244 participants with MDD were randomly allocated to the ICBT (n=122, 50%) or waitlist control (n=122, 50%) groups. At the pretreatment time point, no statistically significant difference was observed in direct medical cost (P=.41), indirect cost (P=.10), or health utility (P=.11) between the 2 groups. In the base-case analysis, the ICBT group reported higher direct medical costs and better quality of life but lower total costs at the posttreatment time point. The adjusted ICURs at the posttreatment time point were CN ¥-194,720.38 (US $-26,551.50; 95% CI CN ¥-198,766.78 to CN ¥-190,673.98 [US $-27,103.20 to US $-25,999.70]) and CN ¥49,700.33 (US $6776.99; 95% CI CN ¥46,626.34-CN ¥52,774.31 [US $6357.83-$7196.15]) per QALY from the societal and health care system perspectives, respectively, with a probability of unguided ICBT being cost-effective of 75.93% and 54.4%, respectively, if the willingness to pay was set at 1 time the per-capita gross domestic product. In the scenario analyses, the probabilities increased to 76.85% and 77.61%, respectively, indicating the potential of ICBT to be cost-effective over the long term.

Unguided ICBT is a cost-effective treatment for MDD. This intervention not only helps patients with MDD improve clinically but also generates societal savings. These findings provide health economic evidence for a potential scalable MDD treatment method in low- and middle-income countries.

Chinese Clinical Trial Registry (ChiCTR) ChiCTR2100046425; https://tinyurl.com/bdcrj4zv.

Digital health interventions (DHIs) offer scalable solutions for improving mental health care access in underserved settings. This study is part of a multi-phased project aimed at adapting a depression prevention DHI for Jordanian adolescents. It evaluated the feasibility, cultural acceptability, and effectiveness of the translated and culturally adapted DHI, named Al-Khaizuran, with comparisons to school-based group CBT.

A two-arm, single-blind randomized controlled trial with a mixed-methods design was conducted among 109 Jordanian adolescents aged 15-17 years experiencing mild to moderate depression. Participants were randomly assigned to either Al-Khaizuran DHI (n=55) or school-based group CBT (n=54). The adaptation of Al-Khaizuran DHI components was guided by the Ecological Validity Framework, while the procedural adaptation followed Barrera and Castro's Heuristic Framework, incorporating iterative refinement based on user feedback and contextual considerations.

Al-Khaizuran DHI was found to be a culturally relevant and acceptable intervention for Jordanian adolescent. Over half of the participants reported that the intervention was effective, empowering, and easy to use, with 51% expressing satisfaction and willingness to recommend it. However, challenges such as limited access to personal devices, privacy concerns, and participants' reliance on shared family resources emerged as significant barriers to consistent engagement. Participants showed a preference for individualized, blended interventions, with a significant reduction in support for group CBT. No significant difference was found in depression scores between the two groups. However, the Al-Khaizuran DHI group demonstrated higher post-intervention resilience scores (p=0.026). Beliefs about the effectiveness of the intervention significantly predicted behavioral intention (p=0.022), while perceived difficulty was a barrier to adherence (p=0.015).

Al-Khaizuran DHI exemplifies the potential of culturally adapted digital interventions in bridging mental health care gaps in resource-limited settings. However, its effectiveness is contingent upon addressing barriers to access, enhancing program interactivity, and integrating hybrid support systems that combine digital tools with in-person guidance. Future implementations should consider strategies to actively engage parents to foster a supportive environment that promotes the well-being of adolescents.

https://doi.org/10.1186/ISRCTN14751844, identifier ISRCTN14751844.

Internet-delivered transdiagnostic psychological interventions are promising approaches for the treatment of anxiety and depression. This study aimed to review and synthesize evidence related to the effectiveness of Internet-based transdiagnostic interventions for reducing anxiety and depression, and to compare the effects of universal versus tailored interventions.

A Systematic review search was conducted on the PubMed, EMBASE, Cochrane Library, Web of Science, PsychINFO, Medline, and CINAHL databases as of 28 March 2024. Two researchers made their choices based on consensus. This study performed a random-effects meta-analysis comparing patients receiving Internet-based transdiagnostic therapy with a control group, and examined the effects on depression, anxiety, and quality of life. This meta-analysis compared the effect of Internet-delivered universal and tailored transdiagnostic on anxiety and depression.

42 trials were identified with a total of 4982 participants. Compared with the control group, the Internet-delivered transdiagnostic intervention reduced anxiety and depression symptoms (g = -0.617, 95 % CI: -0.699 to -0.535), anxiety (g = -0.580, 95 % CI: -0.690 to -0.470), depression (g = -0.650, 95 % CI: -0.770 to -0.530). The Internet-delivered universal transdiagnostic treatment was more effective than tailored transdiagnostic in improving anxiety and depression. Internet-delivered transdiagnostic interventions also had a positive impact on quality of life (g = 0.310; 95 % CI: 0.130 to 0.490).

This meta-analysis demonstrates that Internet-based transdiagnostic interventions are effective for treating anxiety and depression, and can also improve quality of life. The universal Internet-delivered transdiagnostic intervention is better than the tailored intervention. Future studies should investigate the mechanisms of change and develop outcome measures for these interventions.

Scientific implementation findings relevant to the implementation of internet-delivered cognitive behavioral therapy (iCBT) for depression and anxiety in adults remain sparse and scattered across different sources of published information. Identifying evidence-based factors that influence the implementation of iCBT is key to successfully using iCBT in real-world clinical settings.

This systematic review evaluated the following: (1) aspects that research articles postulate as important for the implementation of iCBT and (2) aspects relevant to the day-to-day running of iCBT services. A mixed methods systematic review using a convergent synthesis design was conducted to bring together evidence across this sparse literature consisting of divergent scientific article types to investigate the implementation of iCBT for depression and anxiety in adults.

We searched the PsycINFO, PsycArticles, MEDLINE, CINAHL Complete, and Embase databases for any published peer-reviewed scientific articles that report on the implementation of iCBT for depression or anxiety disorders in adults. A total of 40 articles spanning the case study, commentary, meta-analysis, mixed methods study, pilot randomized controlled trial, randomized controlled trial, qualitative study, quantitative study, review, and systematic review article types were identified as eligible for this mixed methods review. Data were analyzed qualitatively using the descriptive-interpretive approach.

The first domain highlighted the impact of therapist and patient attitudes when implementing iCBT, the superiority of guided iCBT over unguided iCBT, its noninferiority to equivalent face-to-face treatments, and its utility outside of the original target of mild-to-moderate depression and anxiety. In total, 3 subdomains were identified under the second domain: (1) the management of iCBT in the workplace, detailing the importance of managing the iCBT service, related staff, and their motivations for using it; (2) the practice of iCBT in the workplace, describing the therapeutic aspects of iCBT provision, such as the provision of support, the background of supporters, and screening procedures; and (3) contextual considerations, detailing the impact of governmental legislation on therapy conducted over the internet, the lack of an iCBT workforce as a limiting factor, and the cost estimates associated with iCBT provision.

Broadly, the findings describe several aspects that should be taken into account when researchers or practitioners implement iCBT as part of their work. However, the findings should be interpreted with caution, as the articles reviewed spanned many article types, and few of the included studies were directly focused on evaluating the implementation of iCBT. While findings provide insight into important factors to consider during iCBT implementation, these findings and their limitations highlight the need for more implementation-specific research in this area.

Parents of children treated for cancer may experience psychological difficulties including depression, anxiety, and posttraumatic stress. Digital interventions, such as internet-administered cognitive behavioral therapy, offer an accessible and flexible means to support parents. However, engagement with and adherence to digital interventions remain a significant challenge, potentially limiting efficacy. Understanding factors influencing user engagement and adherence is crucial for enhancing the acceptability, feasibility, and efficacy of these interventions. We developed an internet-administered, guided, low-intensity cognitive behavioral therapy (LICBT)-based self-help intervention for parents of children treated for cancer, (EJDeR [internetbaserad självhjälp för föräldrar till barn som avslutat en behandling mot cancer or internet-based self-help for parents of children who have completed cancer treatment]). EJDeR included 2 LICBT techniques-behavioral activation and worry management. Subsequently, we conducted the ENGAGE feasibility trial and EJDeR was found to be acceptable and feasible. However, intervention adherence rates were marginally under progression criteria.

This study aimed to (1) describe user engagement with the EJDeR intervention and examine whether (2) sociodemographic characteristics differed between adherers and nonadherers, (3) depression and anxiety scores differed between adherers and nonadherers at baseline, (4) user engagement differed between adherers and nonadherers, and (5) user engagement differed between fathers and mothers.

We performed a secondary analysis of ENGAGE data, including 71 participants. User engagement data were collected through log-data tracking, for example, communication with e-therapists, homework submissions, log-ins, minutes working with EJDeR, and modules completed. Chi-square tests examined differences between adherers and nonadherers and fathers and mothers concerning categorical data. Independent-samples t tests examined differences regarding continuous variables.

Module completion rates were higher among those who worked with behavioral activation as their first LICBT module versus worry management. Of the 20 nonadherers who opened the first LICBT module allocated, 30% (n=6) opened behavioral activation and 70% (n=14) opened worry management. No significant differences in sociodemographic characteristics were found. Nonadherers who opened behavioral activation as the first LICBT module allocated had a significantly higher level of depression symptoms at baseline than adherers. No other differences in depression and anxiety scores between adherers and nonadherers were found. Minutes working with EJDeR, number of log-ins, days using EJDeR, number of written messages sent to e-therapists, number of written messages sent to participants, and total number of homework exercises submitted were significantly higher among adherers than among nonadherers. There were no significant differences between fathers and mothers regarding user engagement variables.

Straightforward techniques, such as behavioral activation, may be well-suited for digital delivery, and more complex techniques, such as worry management, may require modifications to improve user engagement. User engagement was measured behaviorally, for example, through log-data tracking, and future research should measure emotional and cognitive components of engagement.

ISRCTN Registry 57233429; https://doi.org/10.1186/ISRCTN57233429.

Localized provoked vulvodynia is a common sexual health condition for which there is a lack of consensus on effective management, even though it can have a significant negative impact on psychological wellbeing, sexual functioning, and quality of life for women and their partners.

To map the research landscape related to the effectiveness/efficacy of psychological treatments for localized provoked vulvodynia, identify gaps, and make recommendations for future research.

We used Arksey and O'Malley's approach to conducting a scoping review to identify, organize, and summarize research published between 2010 and 2023 that investigated the efficacy or effectiveness of interventions in the management of localized provoked vulvodynia. Inclusion and exclusion criteria and the search strategy were developed by subject experts in collaboration with a health sciences librarian. A PubMed search used controlled vocabulary and keyword terms relating to vulvodynia, which were then translated into other databases. Studies not published in English or French were excluded. We did not consider other subsets of vulvodynia.Articles were uploaded to Covidence, duplicates removed, and titles and abstracts screened. The remaining articles were subject to a 2-person, independent full-text review followed by a hand search of eligible articles. All intervention studies were included regardless of the study design. Study details were reported narratively and analyzed.

Of the 88 included articles published between January 2010 and March 2023, 15 reported on the efficacy/effectiveness of psychological treatments for localized provoked vulvodynia, including group educational seminars, cognitive behavioral therapy, acceptance and commitment therapy, and somatocognitive therapy.

Cognitive behavioral therapy was the most common form of psychological treatment studied (n = 7) with interventions for both individuals and couples. Education about the condition and the therapeutic process was a component of many interventions. Psychological therapies may be of some benefit, but only 1 RCT evaluating the efficacy of acceptance and commitment therapy appeared adequately powered to demonstrate improvement in dyspareunia. Studies sampled homogenous patient populations, primarily consisting of White, urban-dwelling, educated, partnered, heterosexual cis-women.

Evidence of efficacy/effectiveness, drawn mainly from small studies, is promising and highlights opportunities for more robust studies with heterogeneous populations, more research on the role of education in treatment success, and greater attention to assessing patient-driven outcomes in partnered and unpartnered women.

While the efficacy of digital interventions for the treatment of depression is well established, comprehensive knowledge on how therapeutic changes come about is still limited. This systematic review aimed to provide an overview of research on change mechanisms in digital interventions for depression and meta-analytically evaluate indirect effects of potential mediators.

The databases CENTRAL, Embase, MEDLINE, and PsycINFO were systematically searched for randomized controlled trials investigating mediators of digital interventions for adults with depression. Two reviewers independently screened studies for inclusion, assessed study quality and categorized potential mediators. Indirect effects were synthesized with a two-stage structural equation modeling approach (TSSEM).

Overall, 25 trials (8110 participants) investigating 84 potential mediators were identified, of which attentional (8 %), self-related (6 %), biophysiological (6 %), affective (5 %), socio-cultural (2 %) and motivational (1 %) variables were the scope of this study. TSSEM revealed significant mediation effects for combined self-related variables (ab = -0.098; 95 %-CI: [-0.150, -0.051]), combined biophysiological variables (ab = -0.073; 95 %-CI: [-0.119, -0.025]) and mindfulness (ab = -0.042; 95 %-CI: [-0.080, -0.015]). Meta-analytical evaluations of the other three domains were not feasible.

Methodological shortcomings of the included studies, the considerable heterogeneity and the small number of investigated variables within domains limit the generalizability of the results.

The findings further the understanding of potential change mechanisms in digital interventions for depression and highlight recommendations for future process research, such as the consideration of temporal precedence and experimental manipulation of potential mediators, as well as the application of network approaches.

This study investigates the efficacy of an InterRhythmic Care (IRC) for major depressive disorder (MDD). There is a lack of clinical studies on its effect on depression.

In this eight-week, randomized, single-blind, controlled trial, 120 patients with MDD were randomly assigned to receive IRC or Internet general psychoeducation (IGP). Participants' depressive and anxiety symptoms, interpersonal relationships, social function, and biological rhythms were assessed using the 17-item Hamilton Depression Rating Scale (HAMD-17), Hamilton Anxiety Scale (HAMA), Interpersonal Comprehensive Diagnostic Scale (ICDS), Sheehan Disability Scale (SDS), and Morning and Evening Questionnaire (MEQ) at baseline and the 8th week.

Compared to participants in IGP, participants in IRC had lower HAMD total scores, anxiety/somatization, weight, cognitive disturbance, retardation, and sleep disturbance subscores in patients with MDD (F = 190.94, p Bonferroni < 0.001; F = 83.13, p Bonferroni < 0.001; F = 4.15, p Bonferroni = 0.048; F = 65.42, p Bonferroni < 0.001; F = 53.15, p Bonferroni < 0.001; F = 67.76, p Bonferroni < 0.001, respectively); HAMA total score, somatic anxiety subscore, psychogenic anxiety subscore (F = 142.97, p Bonferroni < 0.001; F = 111.06, p Bonferroni < 0.001; F = 128.04, p Bonferroni < 0.001); ICDS total score and subscores for conversation, making friends, manners; and SDS subscores for work/school, social life, family life, and days underproductive (F = 17.38, p Bonferroni <0.001; F = 14.61, p Bonferroni < 0.001; F = 10.97, p Bonferroni = 0.001; F = 11.74, p Bonferroni = 0.001; F = 4.85, p Bonferroni = 0.031; F = 16.29, p Bonferroni < 0.001; F = 12.11, p Bonferroni = 0.001; F = 8.3, p Bonferroni = 0.005) at the end of the intervention period.

IRC helped patients with MDD improve clinical symptoms, including depressive and anxiety symptoms, interpersonal problems, and social function.

Diabetes distress is common among people with type 1 diabetes (T1D), negatively affecting quality of life, self management, and diabetes outcomes. E-health-based interventions could be an effective and low-cost way to improve the psychological care for people with T1D experiencing diabetes distress. The MyREMEDY study aims to test the effectiveness of the online unguided self-help intervention MyDiaMate in decreasing diabetes distress in adults with T1D. MyDiaMate is based on Cognitive Behavioural Therapy and consists of eight modules, each focusing on a different aspect of living with T1D that is often experienced as burdensome (e.g. hypoglycaemia, fatigue).

The effectiveness of MyDiaMate will be tested through a randomised-controlled trial across four European countries (the Netherlands, Germany, Spain and the United Kingdom). Six hundred and sixty adults (N = 165 per country) with T1D will be recruited and randomised with a balance of 2:1 into the intervention and care as usual groups. Intervention group members receive access to MyDiaMate for 6 months, care as usual group members receive access after 3 months for 3 months. Participants fill in questionnaires at 0 (baseline), 3 (effectiveness) and 6 months (follow-up). Primary outcome is diabetes distress at 3 months. Secondary outcomes are emotional well-being, psychological self-efficacy in relation to diabetes, social engagement, fatigue, and glycaemic outcomes. Moreover, logdata of MyDiaMate use is passively collected. Linear mixed model analyses will be used to test the effectiveness of MyDiaMate along with identifying which user subgroup benefits most from MyDiaMate use.

Clinicaltrials.gov NCT06308549.

Individuals with social anxiety disorder (SAD) experience overall emotion regulation difficulties, but less is known about the long-term role of such difficulties in cognitive behavior therapy (CBT) for SAD. Forty-six patients with SAD receiving internet-delivered CBT, and matched healthy controls (HCs; n = 39), self-reported the Difficulties in Emotion Regulation Scale (DERS), Liebowitz Social Anxiety Scale (LSAS-SR), and participated in anticipatory speech anxiety behavioral experiments. Patients were measured at seven time points before, during and after CBT over a total period of 28 months, and HCs at two timepoints. Disaggregated growth curve models with a total of 263 observations were used, as well as intra-class correlation coefficients and regression models. Patients' LSAS-SR and DERS ratings were reliable (ICC = .83 and .75 respectively), and patients, relative to controls, showed larger difficulties in emotion regulation at pre-treatment (p < .001). During CBT, within-individual improvements in emotion regulation significantly predicted later LSAS-SR reductions (p = .041, pseudo-R2 = 43%). Changes in emotion regulation may thus be important to monitor on an individual level and may be used to improve outcomes in future developments of internet-delivered CBT.

Anxiety disorders are common in alcohol use disorder (AUD) treatment patients. Such co-occurring conditions ("comorbidity") have negative prognostic implications for AUD treatment outcomes, yet they commonly go unaddressed in standard AUD care. Over a decade ago, we developed and validated a cognitive behavioral therapy intervention to supplement standard AUD care that, when delivered by trained therapists, improves outcomes in comorbid patients. However, this validated intervention, like many others in addiction care, has not been taken up in community-based AUD treatment programs. This phenomenon-empirically validated treatments that fail to be widely adopted in community care-has been termed the "research-to-practice gap." Researchers have suggested that the availability of fully autonomous digital equivalents of validated therapist-delivered therapies could reduce some barriers underlying the research-to-practice gap, especially by eliminating the need for costly and intensive therapist training and supervision.

With this in mind, we obtained a Program Development Grant (R34) to conduct formative work in the development of a fully autonomous digital version of our previously validated therapist-delivered intervention for AUD treatment patients with a comorbid anxiety disorder.

In the first phase of the project, we developed the digital intervention. This process included: (1) identifying appropriate collaborators and vendors; (2) consultation with an e-learning expert to develop a storyboard and accompanying graphics and narrative; (3) video production and editing; and (4) interactive programming. The second phase of the project was functional testing of the newly developed digital intervention conducted in 52 residential AUD treatment patients with a comorbid anxiety disorder. Patients underwent the 3 one-hour segments of the newly developed intervention and completed user surveys, knowledge quizzes, and behavioral competence tests.

While the development of the digital intervention was successful, the timeline was approximately double that projected (1 vs 2 years) due to false starts and inefficiencies that we describe, including lessons learned. Functional testing of the newly developed digital intervention showed that, on average, patients rated the user experience in the upper (favorable) 20% of the response scales. Knowledge quizzes and behavioral demonstrations showed that over 80% of participants gained functional mastery of the key skills and information taught in the program.

Functional testing results in this study justify a randomized controlled trial of the digital intervention's efficacy, which is currently ongoing. In sharing the details of our challenges and solutions in developing the digital intervention, we hope to inform others developing digital tools. The extent to which the availability of empirically validated, fully autonomous digital interventions achieves their potential to reduce the research-to-practice gap remains an open but important empirical question. The present work stands as a necessary first step toward that end.

Academic research on digital mental health tends to focus on its efficacy and effectiveness, with much less attention paid to user preferences and experiences in real-world settings.

This study aims to analyze service characteristics that service users value and compare the extent to which various digital and nondigital mental health treatments and management methods fulfill users' expectations.

A total of 114 people with at least moderate levels of depressive symptoms (as measured by Patient Health Questionnaire-9 score ≥10) completed a web-based questionnaire measuring their awareness and adoption of digital mental health services and their valuation of 15 psychological service attributes, including effectiveness, credibility, waiting time, and more. They were also assessed on their expectations toward seven common mental health treatments and management methods, including (1) face-to-face psychological intervention, (2) medication, (3) guided internet-based psychological intervention, (4) face-to-face counseling service, (5) self-guided mental health apps for depression, (6) self-help bibliotherapy, and (7) psychological intervention via videoconferencing.

A Friedman test with a Dunn posttest showed the average importance rank of "effectiveness" was significantly higher than all other measured attributes. "Privacy," "credibility," and "cost" were ranked as equally important. Participants rated face-to-face psychological intervention the most effective management method, while other digital management methods were perceived as less effective. Medication was perceived as the least appealing method, while other methods were deemed equally appealing. Face-to-face psychological intervention, medication, and counseling were considered less satisfactory due to their higher costs and longer waiting times when compared to digital services. Repeated measures ANOVA showed some forms of management method were more likely to be adopted, including guided internet-based psychological intervention, psychological intervention via videoconferencing, face-to-face psychological intervention, and face-to-face counseling services provided by a counselor as compared to self-guided mobile apps, self-help bibliotherapy, and medication.

The study highlights the importance of considering multiple service attributes beyond effectiveness in depression management methods, despite effectiveness being regarded as the most crucial factor using the rank method. Compared to nondigital services, digital services were identified as having specific strengths as perceived by users. Future dissemination and promotion efforts may focus on debunking myths of guided internet-based psychological intervention as a less effective option and promoting the particular service strengths of digital services.

The COVID-19 pandemic has exposed a devastating youth mental health crisis in the United States, characterized by an all-time high prevalence of youth mental illness. This crisis is exacerbated by limited access to mental health services and the reduction of mental health support in schools. Mobile health platforms offer a promising avenue for delivering tailored and on-demand mental health care.

To address the lack of youth mental health services, we created the Science Technology Engineering Math and Social and Emotional Learning (STEMSEL) study. Our aim was to investigate the efficacy of a digital mental health intervention, Neolth, in enhancing social and emotional well-being, reducing academic stress, and increasing mental health literacy and life skills among adolescents.

The STEMSEL study will involve the implementation and evaluation of Neolth across 4 distinct phases. In phase 1, a comprehensive needs assessment will be conducted across 3 diverse schools, each using a range of teaching methods, including in-person, digital, and hybrid modalities. Following this, in phase 2, school administrators and teachers undergo intensive training sessions on Neolth's functionalities and intervention processes as well as understand barriers and facilitators of implementing a digital mental health program at their respective schools. Phase 3 involves recruiting middle and high school students aged 11-18 years from the participating schools, with parental consent and student assent obtained, to access Neolth. Students will then be prompted to complete an intake questionnaire, enabling the customization of available modules to address their specific needs. Finally, phase 4 will include a year-long pre- and posttest pilot study to rigorously evaluate the usability and effectiveness of Neolth in addressing the mental health concerns of students across the selected schools.

Phase 1 was successfully completed in August 2022, revealing significant deficits in mental health resources within the participating schools. The needs assessment identified critical gaps in available mental health support services. We are currently recruiting a diverse group of middle and high school students to participate in the study. The study's completion is scheduled for 2024, with data expected to provide insights into the real-world use of Neolth among the adolescent population. It is designed to deliver findings regarding the intervention's efficacy in addressing the mental health needs of students.

The STEMSEL study plays a crucial role in assessing the feasibility and adoption of digital mental health interventions within the school-aged youth population in the United States. The findings generated from this study have the potential to dismantle obstacles to accessing mental health assistance and broaden the availability of care through evidence-based strategies.

DERR1-10.2196/59372.

Depression is a common and serious problem in older adults, but few have access to psychological treatments. Internet-delivered Cognitive Behavioral Therapy (ICBT) has the potential to improve access and has been found to be effective in adults with depression. The aim of this study was to examine the effects of tailored ICBT for depression in older adults aged 65 years or older. We also investigated if cognitive flexibility could predict outcome.

Following online recruitment from the community, included participants were randomly allocated to either ten weeks of clinician guided ICBT (n = 50) or to an active control group in the form of non-directive support (n = 51). Primary depression outcome was the Geriatric Depression Scale (GDS-15). Several secondary outcomes were used, such as the Beck Depression Inventory (BDI-II) and the Patient Health Questionnaire (PHQ-9).

Both treatment and active control groups significantly reduced their levels of depression, and the treatment group showed significantly greater improvement on the GDS-15 and BDI-II, but not on the PHQ-9. Between-group effect sizes as Cohen's d were 0.78 (CI95% 0.36-1.20) on the GDS-15 and 0.53 (CI95% 0.11-0.94) on the BDI-II.

Tailored ICBT is superior to an active control for older adults with depression. Between-group effects were smaller than in previous RCTs, most likely because of the use of an active control condition. Cognitive flexibility did not predict outcome. We conclude that ICBT can be used for older adults with depression, and thus increase access to psychotherapy for this group.

This trial was retrospectively registered in clinicaltrials.gov (no. NCT05269524) the 8th of March 2022.

Predicting who will not benefit enough from Internet-Based Cognitive Behavioral (ICBT) Therapy early on can assist in better allocation of limited mental health care resources. Repeated measures of symptoms during treatment is the strongest predictor of outcome, and we want to investigate if methods that explicitly account for time-dependency are superior to methods that do not, with data from (a) only two pre-treatment timepoints and (b) the pre-treatment timepoints and three timepoints during initial treatment.

We use 1) commonly used time-independent methods (i.e., Linear Regression and Random Forest models) and 2) time-dependent methods (i.e., multilevel model regression, mixed-effects random forest, and a Long Short-Term Memory model) to predict symptoms during treatment, including the final outcome. This is done with symptom scores from 6436 ICBT patients from regular care, using robust multiple imputation and nested cross-validation methods.

The models had a 14 %-12 % root mean squared error (RMSE) in predicting the post-treatment outcome, corresponding to a balanced accuracy of 67-74 %. Time-dependent models did not have higher accuracies. Using data for the initial treatment period (b) instead of only from before treatment (a) increased prediction results by 1.3 % percentage points (12 % to 10.7 %) RMSE and 6 % percentage points BACC (69 % to 75 %).

Training prediction models on only symptom scores of the first few weeks is a promising avenue for symptom predictions in treatment, regardless of which model is used. Further research is necessary to better understand the interaction between model complexity, dataset length and width, and the prediction tasks at hand.

Compared to efficacy research, studies investigating the processes of change in psychological therapy are rare, especially for internet-based interventions. While many online therapies are based on face-to-face therapy protocols, it is unknown whether the processes of clinical improvement differ between these treatment formats.

To examine candidate change processes in an online therapist-guided cognitive therapy intervention for social anxiety disorder (iCT-SAD), and compare the results to the corresponding face-to-face therapy (CT-SAD).

Data from a randomised controlled trial (n = 99) were analysed using Multilevel Structural Equation Models, incorporating the temporal precedence of the process variable, and disaggregating the within- and between-subject components of the predictors. These examined three candidate change processes: self-focused attention, negative social cognitions, and depressed mood. Moderated mediation models provided an additional test of the moderating effect of treatment format.

Negative social cognitions and self-focused attention were supported as significant mediators of clinical improvement in both CT-SAD and iCT-SAD. Effects were of similar strength and moderated mediation was not observed. There was also evidence of cyclical relationships between social anxiety symptoms and these process variables. Depressed mood also emerged as a significant but weak mediator in CT-SAD, but not in iCT-SAD. Moderated mediation was not observed.

The online format of therapy showed a similar pattern of change processes to face-to-face treatment, with self-focused attention and negative social cognitions mediating clinical improvement in both treatments. Efforts to improve the efficacy and efficiency of SAD interventions by targeting these factors may therefore be equally applicable to online and face-to-face interventions.

Health anxiety, also known as hypochondriasis, is a common psychiatric disorder which leads to considerable distress and is associated with high societal costs. Internet-based cognitive behavioural therapy (ICBT) for health anxiety has demonstrated efficacy in randomized controlled trials (RCTs), but there is limited knowledge regarding its effectiveness in real-world settings. This study aimed to evaluate the clinical effectiveness of guided ICBT for health anxiety in routine psychiatric care, including symptom change, treatment adherence, and potential negative effects. Additionally, we explored predictors of treatment adherence.

A longitudinal cohort study of 447 patients enrolled in 12 weeks of ICBT for health anxiety between 2018 and 2020 in an outpatient psychiatric clinic specializing in ICBT. Primary outcome measure was the 14-item Short Health Anxiety Inventory (SHAI-14) and a within-group design with repeated measures was utilized for the primary analysis.

Participants showed significant improvements from pre- to post-treatment (d = 1.61). At post-treatment, 60 % (95 % CI 58-62) demonstrated statistically reliable change (RCI), and 44 % (95 % CI 42-46) were in remission. On average, participants completed 7 (SD = 4) out of 12 treatment modules. For each additional completed module, the mean reduction was 0.31 (95 % CI 0.10 to 0.54) points on the SHAI-14.

Guided ICBT for health anxiety can be effective when delivered within the context of routine psychiatric care. The study suggests that effect sizes are comparable with those in RCTs and higher treatment adherence is associated with better outcomes in health anxiety. ICBT could be used to increase availability to effective therapy for health anxiety.

This study tested two versions of parent-led, Internet-delivered cognitive behavioral therapy for anxiety among autistic youth; one that provided weekly email support (iCBT-Email), and one that provided alternating bi-weekly emails and video calls (iCBT-Video) across 12 weeks. It was expected that those in the iCBT-Video condition would complete more treatment content, which in turn would lead to more anxiety improvement. Fifty-seven autistic youth (7-15 years-old) with anxiety disorders were randomized to iCBT-Email or iCBT-Video. There were no significant differences in improvement in clinician-rated, child-reported, or parent-reported anxiety severity or functional impairment. Posttreatment response rates were 55% in iCBT-Email and 67% in iCBT-Video. Module completion predicted improved treatment outcome, though there was no difference in module completion across groups. Therapists spent an average of 16.29 min/family/week (SD = 7.11) in the iCBT-Email condition and 24.13 min/family/week (SD = 6.84) in the iCBT-Video condition. Email and telehealth-supported, parent-led iCBT both appear to be effective treatments for autistic youth with anxiety disorders that require reduced therapist effort. Future research should seek novel methods to enhance engagement with iCBT content. CLINICALTRIALS.GOV IDENTIFIER: NCT05284435.

The prevalence of anxiety and depressive symptoms in young people have increased in many countries around the world. Web-based mental health interventions (or W-MHIs) have the potential to reduce anxiety and depression symptoms for young people. Although W-MHIs have become more widely used by young people since the coronavirus disease 2019 (COVID-19) pandemic, real-world engagement in these W-MHIs has remained low compared with engagement reported in research studies. Moreover, there are limited studies examining factors influencing engagement with W-MHIs in the post-COVID-19 pandemic years.

This study aims to explore barriers and facilitators of engagement with W-MHIs for anxiety and depression among young people.

Seventeen semi-structured interviews and one focus group with three participants were conducted online via Zoom between February and March 2023. Participants were young people aged 18-25 years who had self-reported experience of anxiety and/or depression in the past 6 months, lived in Australia, and considered using W-MHIs to manage their anxiety and/or depression symptoms. Inductive thematic analysis was performed to understand the key barriers and facilitators of young people's engagement with W-MHIs.

Both individual- and intervention-related factors influenced young people's engagement with W-MHIs. Facilitators of engagement included personal trust and beliefs in W-MHIs, ability to contact a health professional, programme suitability (e.g., affordability, content aligning with user needs), programme usability (e.g., user interface), and accessibility of the online platform. Barriers included concerns about online security, lack of human interaction and immediate responses from health professionals (if any), and negative experience with mental health programmes. Participants expressed greater willingness to pay if they could contact health professionals during the programme.

Better promotion strategies for mental health and W-MHI awareness are needed to increase the perceived importance and priority of mental health interventions among young people. Young people should be involved in the W-MHI co-design to enhance the programme suitability and usability for young people, fostering their engagement with W-MHIs.

Cyber aggression is prevalent among emerging adults and is associated with a range of mental and behavioral issues. One particularly concerning outcome is the widespread presence of suicidal ideation in this group, which poses a significant threat to their life. However, the specific impact of cyber aggression on suicidal ideation and the longitudinal mechanisms remains unclear. Hence, this study sought to address these gaps by applying the general aggression model (GAM). The investigation utilized three-wave longitudinal data with 6-month intervals from a large sample of Chinese emerging adults (N = 1568; 54.7% female; Mage = 19.70 [SD = 1.44], ranging from 17 to 26 years). The random-intercept cross-lagged panel model (RI-CLPM) was employed to explore the roles of depressive symptoms and nonsuicidal self-injury (NSSI) between cyber aggression and suicidal ideation at both the between- and within-person levels. The findings indicated that, at the between-person level, there were trait-like associations between depressive symptoms and cyber aggression, NSSI, and suicidal ideation. At the within-person level, cyber aggression exhibited unidirectional positive cross-lagged effects on depressive symptoms and NSSI, and could subsequently indirectly lead to suicidal ideation via the contemporaneous associations from depressive symptoms and NSSI to suicidal ideation. These results not only align with GAM but also shed light on the underlying mechanisms linking cyber aggression to suicidal ideation. Also, the findings underscore the significance of maintaining a positive network environment for the well-being of all internet users even cyber aggression perpetrators.