Training, supervision, and experience of coaches offering digital guided self-help for mental health concerns

Accessible, low-cost intervention options are necessary to address the rise in mental health problems among college students. Digital guided self-help, or coached, programs have been developed to provide such services, with many commercially available. As such, there are a large and growing number of individuals coaching these programs. However, an unmet need is to evaluate and assess best practices for training and supervising individuals in these positions. To this end, we describe how we recruited, trained, and supervised coaches as part of a large randomized controlled trial using a widely available digital commercial platform. Coaches were trained to provide digital guided self-help for depression, anxiety, and/or eating disorders for college students. Coaches initially attended three live training sessions over 2-3 weeks, viewed multiple training videos, and read a detailed coaching manual developed by our team. Thereafter, they attended weekly supervision. Following their term, coaches completed an exit survey to assess their supervision and training experiences. A total of 37 of 70 (53%) graduate-level student coaches completed the survey. The experience was reported as very positive (95%). In particular, the majority reported feeling well prepared, more confident, and felt they had developed useful skills for their own practice

Examining the Theoretical Framework of Behavioral Activation for Major Depressive Disorder: Smartphone-Based Ecological Momentary Assessment Study

Background: Behavioral activation (BA), either as a stand-alone treatment or as part of cognitive behavioral therapy, has been shown to be effective for treating depression. The theoretical underpinnings of BA derive from Lewinsohn et al's theory of depression. The central premise of BA is that having patients engage in more pleasant activities leads to them experiencing more pleasure and elevates their mood, which, in turn, leads to further (behavioral) activation. However, there is a dearth of empirical evidence about the theoretical framework of BA.Objective: This study aims to examine the assumed (temporal) associations of the 3 constructs in the theoretical framework of BA.Methods: Data were collected as part of the "European Comparative Effectiveness Research on Internet-based Depression Treatment versus treatment-as-usual" trial among patients who were randomly assigned to receive blended cognitive behavioral therapy (bCBT). As part of bCBT, patients completed weekly assessments of their level of engagement in pleasant activities, the pleasure they experienced as a result of these activities, and their mood over the course of the treatment using a smartphone-based ecological momentary assessment (EMA) application. Longitudinal cross-lagged and cross-sectional associations of 240 patients were examined using random intercept cross-lagged panel models.Results: The analyses did not reveal any statistically significant cross-lagged coefficients (all P>.05). Statistically significant cross-sectional positive associations between activities, pleasure, and mood levels were identified. Moreover, the levels of engagement in activities, pleasure, and mood slightly increased over the duration of the treatment. In addition, mood seemed to carry over, over time, while both levels of engagement in activities and pleasurable experiences did not.Conclusions: The results were partially in accordance with the theoretical framework of BA, insofar as the analyses revealed cross-sectional relationships between levels of engagement in activities, pleasurable experiences deriving from these activities, and enhanced mood. However, given that no statistically significant temporal relationships were revealed, no conclusions could be drawn about potential causality. A shorter measurement interval (eg, daily rather than weekly EMA reports) might be more attuned to detecting potential underlying temporal pathways. Future research should use an EMA methodology to further investigate temporal associations, based on theory and how treatments are presented to patients.</p

A Data-Driven Clustering Method for Discovering Profiles in the Dynamics of Major Depressive Disorder Using a Smartphone-Based Ecological Momentary Assessment of Mood

BackgroundAlthough major depressive disorder (MDD) is characterized by a pervasive negative mood, research indicates that the mood of depressed patients is rarely entirely stagnant. It is often dynamic, distinguished by highs and lows, and it is highly responsive to external and internal regulatory processes. Mood dynamics can be defined as a combination of mood variability (the magnitude of the mood changes) and emotional inertia (the speed of mood shifts). The purpose of this study is to explore various distinctive profiles in real-time monitored mood dynamics among MDD patients in routine mental healthcare. MethodsEcological momentary assessment (EMA) data were collected as part of the cross-European E-COMPARED trial, in which approximately half of the patients were randomly assigned to receive the blended Cognitive Behavioral Therapy (bCBT). In this study a subsample of the bCBT group was included (n = 287). As part of bCBT, patients were prompted to rate their current mood (on a 1-10 scale) using a smartphone-based EMA application. During the first week of treatment, the patients were prompted to rate their mood on three separate occasions during the day. Latent profile analyses were subsequently applied to identify distinct profiles based on average mood, mood variability, and emotional inertia across the monitoring period. ResultsOverall, four profiles were identified, which we labeled as: (1) "very negative and least variable mood" (n = 14) (2) "negative and moderate variable mood" (n = 204), (3) "positive and moderate variable mood" (n = 41), and (4) "negative and highest variable mood" (n = 28). The degree of emotional inertia was virtually identical across the profiles. ConclusionsThe real-time monitoring conducted in the present study provides some preliminary indications of different patterns of both average mood and mood variability among MDD patients in treatment in mental health settings. Such varying patterns were not found for emotional inertia

Editorial Introduction to Technological Approaches for the Treatment of Mental Health in Youth

Excerpt: [Note: In lieu of an abstract, this is an excerpt from the first page.] According to the World Health Organization (WHO), 10–20% of adolescents (10–19 years old) worldwide suffer from mental health conditions, with 50% starting at the age of 14 (World Health Organization 2020). Traditionally, mental health problems among youth have been addressed with psychotherapy conducted via face-to-face methods. However, many youth are actively seeking resources online for mental health support (Stephens et al. 2020; Rideout et al. 2018). Therefore, digital interventions can provide alternative methods to support youth patients while addressing and improving the limitations of face-to-face delivery formats. This has become more evident during the COVID-19 pandemic, where clinicians have been forced to use creative strategies, such as telehealth to reach their patients remotely. [...

Internet-based psychodynamic versus cognitive behaviour therapy for adolescents with depression: study protocol for a non-inferiority randomized controlled trial (the ERiCA study)

BACKGROUND: Adolescent depression is a common mental health problem and there is an urgent need for effective and accessible treatments. Internet-based interventions solve many obstacles for seeking and receiving treatment, thus increasing access to effective treatments. Internet-based cognitive behavioural therapy (ICBT) for adolescent depression has demonstrated efficacy in previous trials. In order to broaden the range of evidence-based treatments for young people, we evaluated a newly developed affect-focused Internet-based psychodynamic treatment (IPDT) in a previous study with promising results. The purpose of the planned study is to evaluate the efficacy of IPDT for adolescent depression in a non-inferiority trial, comparing it to ICBT. METHODS: The study will employ a parallel randomized non-inferiority design (ratio 1:1; n = 270). Eligible participants are adolescents 15-19 years suffering from depression. The primary hypothesis is that IPDT will be non-inferior to ICBT in reducing depressive symptoms from pre-treatment to end of treatment. Secondary research questions include comparing outcomes of IPDT and ICBT regarding anxiety symptoms, emotion regulation and self-compassion. Additional data will be collected to evaluate cost-effectiveness as well as investigating predictors, moderators and mediators of outcome. In addition, we will examine long-term outcome up to 1 year after end of treatment. Diagnostic interviews with MINI 7.0 will be used to establish primary diagnosis of depression as well as ruling out any exclusion criteria. Both treatments consist of eight modules over 10 weeks, complemented with therapist support through text messages and weekly chat sessions. Primary outcome measure is the Quick Inventory of Depressive Symptomatology in Adolescents Self-Rated (QIDS-A17-SR). Primary outcome will be analysed using data from all participants entering the study using a multilevel growth curve strategy based on the weekly measurements of QIDS-A17-SR. The non-inferiority margin is defined as d = 0.30. DISCUSSION: This trial will demonstrate whether IPDT is non-inferior to ICBT in the treatment of adolescent depression. The study might therefore broaden the range of evidence-based treatment alternatives for young people struggling with depression. Further analyses of data from this trial may increase our knowledge about "what works for whom" and the pathways of change for two distinct types of interventions. TRIAL REGISTRATION: ISRCTN12552584 , Registered on 13 August 2019

Digital Overload among College Students : Implications for Mental Health App Use

Mental health phone applications (apps) provide cost-effective, easily accessible support for college students, yet long-term engagement is often low. Digital overload, defined as information burden from technological devices, may contribute to disengagement from mental health apps. This study aimed to explore the influence of digital overload and phone use preferences on mental health app use among college students, with the goal of informing how notifications could be designed to improve engagement in mental health apps for this population. A semi-structured interview guide was developed to collect quantitative data on phone use and notifications as well as qualitative data on digital overload and preferences for notifications and phone use. Interview transcripts from 12 college students were analyzed using thematic analysis. Participants had high daily phone use and received large quantities of notifications. They employed organization and management strategies to filter information and mitigate the negative effects of digital overload. Digital overload was not cited as a primary barrier to mental health app engagement, but participants ignored notifications for other reasons. Findings suggest that adding notifications to mental health apps may not substantially improve engagement unless additional factors are considered, such as users motivation and preferences.Funding Agencies|National Institute of Mental HealthUnited States Department of Health &amp; Human ServicesNational Institutes of Health (NIH) - USANIH National Institute of Mental Health (NIMH) [R01 MH115128]; National Health and Medical Research CouncilNational Health and Medical Research Council of Australia [NHMRC APP1170937]; National Institutes of HealthUnited States Department of Health &amp; Human ServicesNational Institutes of Health (NIH) - USA [K08 MH120341, K01 DK120778]; Na-tional Institutes of HealthUnited States Department of Health &amp; Human ServicesNational Institutes of Health (NIH) - USA [K01 DK116925]; National Heart, Lung, and Blood InstituteUnited States Department of Health &amp; Human ServicesNational Institutes of Health (NIH) - USANIH National Heart Lung &amp; Blood Institute (NHLBI) [T32 HL130357]; Swedish Research CouncilSwedish Research CouncilEuropean Commission [2018-06585]</p

Computer and psychotherapy – do they fit? Review of the state of development of internet-based and blended interventions in psychotherapy

Die Verbreitung moderner Medien wirkt sich zunehmend auf psychologische Behandlungsangebote aus. Während die empirische Basis internetbasierter Interventionen zur Behandlung häufiger psychischer Beeinträchtigungen wächst und ihre Anwendung in der Regelversorgung gegenwärtig international erprobt wird, bestehen zusätzliche Bestrebungen, das gewonnene Knowhow mit konventioneller Psychotherapie zu kombinieren. Die daraus entstehende Behandlungsform der „gemischten Psychotherapie“ („blended therapy“) hat das deklarierte Ziel, das Beste aus beiden Welten zu vereinen. Nach einer einleitenden Begriffsbestimmung gibt die vorliegende Übersichtsarbeit Einblick in die Inhalte und die Bestandteile internetbasierter sowie gemischter Interventionen. Der aktuelle Forschungsstand wird skizziert und vor dem Hintergrund der praktischen Anwendbarkeit durch eine Zusammenschau quantitativer und qualitativer Studien dargelegt. Besonderes Augenmerk gilt der Rolle der therapeutischen Unterstützung und der Beschaffenheit der therapeutischen Allianz bei internetbasierten Interventionen sowie den Stärken und Schwächen beider Behandlungsstrategien. Ziel ist es, sowohl die Entwicklung als auch das Potenzial beider Forschungsrichtungen plausibel und realistisch darzustellen und in eine strategische Versorgungsperspektive zu setzen.Modern media have an increasing impact on psychological health services. While the empirical foundation of internet-based interventions for frequently occurring mental disorders grows and their effectiveness is investigated in routine care trials, efforts also exist to transfer the knowledge gained to classical psychotherapy. The resulting treatment format “blended therapy” aims to combine the best of both worlds. After an introductory definition of both terms this overview describes the contents and components of internet-based and blended interventions. Summarizing the current state of research with an emphasis on feasibility, selected quantitative and qualitative articles are presented. The article depicts the development, application and potential of both interventional strategies and focuses on the role of therapist support as well as on the nature of the therapeutic alliance. Strengths and weaknesses of each intervention are addressed and integrated into a strategic perspective