A Self-Guided Online Cognitive Behavioural Therapy to Reduce Fear of Falling in Older People: a Randomised Controlled Trial

Background: Traditional face-to-face cognitive behavioural therapy (CBT) has been successful at reducing fear of falling (FOF) in older people but can be labour-intensive and costly. Online CBT has been suggested as a cost-effective alternative but has not yet been tested in the context of FOF. This study evaluates the effectiveness of a readily available, self-guided and generalised online CBT program (myCompass) on reducing FOF in older people. Methods: Fifty community-dwelling older people with FOF received a paper-based health education program, and half were randomly assigned to receive three selected modules from myCompass for 6 weeks. The primary outcome was feared consequences of falling at 6 weeks. Secondary outcomes were concern about falling, balance confidence, activity avoidance, physical activity, exercise self-efficacy, health literacy and mental health at 6/26/52 weeks and falls incidence at 12 months. Results: All intervention participants completed at least 2-out-of-3 myCompass modules. There was a significant main effect of time on feared consequences of falling (Cohen’s f = 0.55). The group by time interactions for concern about falling (f = 0.28), stress (f = 0.26) and social support for health (health literacy) (f = 0.26) was also significant, favouring the control group. The overall attrition rate at 12 months was 24% (n = 12). Conclusion: The high program compliance and low attrition rate suggest that online CBT is feasible among older people. However, the myCompass program had no effect at reducing FOF in older people. A more targeted CBT program with a well-integrated psychoeducation module on FOF might be the solution to boost the therapeutic effects of a generalised CBT program at reducing FOF for older people

The Future Proofing Study: Design, methods and baseline characteristics of a prospective cohort study of the mental health of Australian adolescents

Objectives: The Future Proofing Study (FPS) was established to examine factors associated with the onset and course of mental health conditions during adolescence. This paper describes the design, methods, and baseline characteristics of the FPS cohort. Methods: The FPS is an Australian school-based prospective cohort study with an embedded cluster-randomized controlled trial examining the effects of digital prevention programs on mental health. Data sources include self-report questionnaires, cognitive functioning, linkage to health and education records, and smartphone sensor data. Participants are assessed annually for 5 years. Results: The baseline cohort (N = 6388, M = 13.9 years) is broadly representative of the Australian adolescent population. The clinical profile of participants is comparable to other population estimates. Overall, 15.1% of the cohort met the clinical threshold for depression, 18.6% for anxiety, 31.6% for psychological distress, and 4.9% for suicidal ideation. These rates were significantly higher in adolescents who identified as female, gender diverse, sexuality diverse, or Aboriginal and/or Torres Strait Islander (all ps < 0.05). Conclusions: This paper provides current and comprehensive data about the status of adolescent mental health in Australia. The FPS cohort is expected to provide significant insights into the risk, protective, and mediating factors associated with development of mental health conditions during adolescence

Comparative randomized trial of an online cognitive-behavioral therapy program and an online support group for depression and anxiety

This study examined the effects of an online cognitive behavior therapy (CBT) program (MoodGYM) compared with an online support group (MoodGarden) in decreasing symptoms of depression and anxiety, and improving dysfunctional thoughts, online social support, and CBT literacy in young adults. Thirty-nine university students (aged 18-25) with elevated scores on the Kessler Psychological Distress Scale were allocated to either the MoodGYM, MoodGarden or control condition. Relative to the control condition, participation in the MoodGYM group significantly improved anxiety symptoms and CBT literacy. Similarly, participation in the MoodGarden group significantly improved anxiety symptoms and online social support relative to the control condition. Although it appears that these online resources are beneficial, further research is needed to determine their long-term efficacy. Furthermore, qualitative participant evaluations indicated that improvements may need to be made to MoodGYM to ensure that young adults remain engaged with the program.7 page(s

Randomised controlled trial of an online mental health and suicide gatekeeper resource for parents and caregivers: study protocol

Introduction Rates of help-seeking for mental disorders and suicide are low among children and adolescents. Parents are viewed as gatekeepers for their care, yet they may lack the knowledge and skills to identify needs or facilitate service access. The primary aim is to test the effect of a new gatekeeper resource for parents and caregivers on their self-efficacy to recognise, respond and access support for mental health problems and suicide risk in their child.Methods and analysis A two-arm randomised controlled trial will compare an online mental health and suicide gatekeeper resource for parents and caregivers to a waitlist control. Australian parents of children aged 5–17 years recruited through social media and community advertising will participate in an online trial. Participants randomised to the intervention condition will be emailed the resource to work through at their own pace. The resource consists of three sections providing parents and caregivers with confidence, knowledge and skills to recognise and respond to mental health problems and suicide risk in their child, as well as support them in accessing professional help. The primary outcome measure is self-efficacy to recognise, respond and provide support for mental health problems and suicide risk, while secondary outcomes include perceived knowledge, stigma, literacy, help-seeking attitudes, intentions and barriers. Data will be collected at preintervention, postintervention (4 weeks after accessing the resource) and 12-week follow-up. Primary analyses will compare changes in self-efficacy in the intervention condition relative to the waitlist control using mixed-model repeated measures analyses.Ethics and dissemination The ethical aspects of the study were approved by the Australian National University Human Research Ethics Committee (Protocol 2023/195). If effective, the resource will fill an important gap in resources for parents, with the potential for dissemination through school groups, community organisations and clinical settings.Trial registration number Australian New Zealand Clinical Trials Registry, ACTRN12623000933651

The effectiveness of an online e-health application compared to attention placebo or Sertraline in the treatment of Generalised Anxiety Disorder

Background: Generalised Anxiety Disorder (GAD) is a high prevalence, chronic disorder that can be treated effectively through a number of web-based programs. However, online web programs for GAD have not been compared to standard pharmacological treatment. The present study compares an Internet Intervention (Active Website) for GAD and a selective serotonin re-uptake inhibitor (SSRI) (Sertraline), with an online attention placebo condition (Control Website). Objective: To evaluate the effectiveness of a web-based intervention for GAD in comparison to standard antidepressant medication and an online attention placebo condition over a 10. week period, and with a follow-up at 6 and at 12. months. Methods: The study was part of a larger scale prevention program. 152 people aged 18-30. years who met the criteria for GAD on the MINI received referrals to the treatment sub-study. The primary outcome was anxiety symptoms measured by the Generalised Anxiety Disorder 7-item Scale (GAD-7), and the secondary outcome was depression measured by the Center for Epidemiologic Studies Depression Scale (CES-D). Results: There was very poor uptake to the trial (around 14% of those referred). However, even in this small sample, Sertraline compared to the Control Website was significant at post-test and 6. months, and the Internet Intervention was significant at post-test. Relative to the Control Website condition at post-test, for the GAD-7 and CES-D respectively, the between group effect sizes were d=. 2.43 and d=. 0.68 for the Active Website condition, and 3.00 and 0.20 for the Sertraline condition. The within group effect size for the Control Website from baseline to post-test was -. 0.04 for the GAD-7 and 0.31 for CES-D respectively. Conclusions: The findings will need to be extended and confirmed in a larger trial. However, they do suggest that both standard pharmacological treatment and online interventions for GAD are effective in samples with a diagnosis of GAD recruited via online methods. The low rate of engagement for face-to-face treatment by those who opt first for a web program suggests that treatment preferences are important in help-seeking

Digital Interventions for Mental Disorders:Key Features, Efficacy, and Potential for Artificial Intelligence Applications

Mental disorders are highly prevalent and often remain untreated. Many limitations of conventional face-to-face psychological interventions could potentially be overcome through Internet-based and mobile-based interventions (IMIs). This chapter introduces core features of IMIs, describes areas of application, presents evidence on the efficacy of IMIs as well as potential effect mechanisms, and delineates how Artificial Intelligence combined with IMIs may improve current practices in the prevention and treatment of mental disorders in adults. Meta-analyses of randomized controlled trials clearly show that therapist-guided IMIs can be highly effective for a broad range of mental health problems. Whether the effects of unguided IMIs are also clinically relevant, particularly under routine care conditions, is less clear. First studies on IMIs for the prevention of mental disorders have shown promising results. Despite limitations and challenges, IMIs are increasingly implemented into routine care worldwide. IMIs are also well suited for applications of Artificial Intelligence and Machine Learning, which provides ample opportunities to improve the identification and treatment of mental disorders. Together with methodological innovations, these approaches may also deepen our understanding of how psychological interventions work, and why. Ethical and professional restraints as well as potential contraindications of IMIs, however, should also be considered. In sum, IMIs have a high potential for improving the prevention and treatment of mental health disorders across various indications, settings, and populations. Therefore, implementing IMIs into routine care as both adjunct and alternative to face-to-face treatment is highly desirable. Technological advancements may further enhance the variability and flexibility of IMIs, and thus even further increase their impact in people’s lives in the future