A low-intensity Internet-based intervention focused on the promotion of positive affect for the treatment of depression in primary care: a randomized control trial

La depresión es el trastorno mental más común en los servicios de salud. Específicamente, el 60% de los pacientes con depresión son atendidos en centros de atención primaria (Fernández et al., 2006). Este problema psicológico presenta una alta tasa de comorbilidad con otros trastornos, y si no se trata correctamente, su evolución tiende a ser crónica, interfiriendo significativamente en diferentes áreas del funcionamiento del individuo (Wittchen et al., 2011). Por lo tanto, se necesitan tratamientos efectivos que puedan aplicarse y diseminarse fácilmente (Collins et al., 2011). Hasta ahora, existen numerosos tratamientos psicológicos basados en la evidencia (por ejemplo, terapia cognitivo-conductual) para la depresión (Cuijpers, van Straten, van Oppen, Andersson, 2008; Cuijpers et al., 2013; Huhn et al., 2014). Sin embargo, a pesar de la existencia de estos tratamientos, la prestación de servicios de salud mental es considerablemente baja en términos de acceso y calidad (Kazdin & Blase, 2011). De hecho, menos del 50% de las personas reciben el tratamiento adecuado, debido al coste, el tiempo requerido o la falta de profesionales bien capacitados (Gaston, Abbot, Rapee, & Neary, 2006). Un reto fundamental en la investigación es la difusión de estos tratamientos, es decir, ponerlos a disposición de todos aquellos que los necesitan. Numerosos estudios ya han demostrado que es posible aplicar estos tratamientos a través de Internet sin perder su eficacia (Andersson & Cuijpers, 2009; Andersson, 2016; Andrews, Cuijpers, Craske, McEvoy, & Titov, 2010). Además, varios meta-análisis muestran que estos tratamientos tienen efectos comparables a los de los tratamientos cara a cara (Andersson, Cuijpers, Carlbring, Riper, & Hedman, 2014; Andersson, Topooco, Havik, & Nordgreen, 2016). Además, las intervenciones psicológicas de baja intensidad, aplicadas por las Tecnologías de la Información y la Comunicación, podrían ser una opción terapéutica eficaz y rentable para el tratamiento de la depresión en atención primaria, dadas sus potencialidades (Donker et al., 2015). Finalmente, aunque se dispone de buenos datos de eficacia, se necesitan esfuerzos adicionales para encontrar formas de tratar la depresión en sus diferentes manifestaciones (p.ej., grado de gravedad) y en diferentes ámbitos de la atención sanitaria (p.ej., atención primaria, atención especializada). En los últimos años, la perspectiva transdiagnóstica (Sauer-Zavala et al., 2017) ha recibido una importancia considerable como uno de los enfoques para mejorar la comprensión y el tratamiento de los trastornos emocionales, incluyendo la depresión y la ansiedad. Esta perspectiva enfatiza el papel de la regulación emocional como un concepto clave para entender y tratar los trastornos emocionales (Brown & Barlow, 2009). Además, es importante considerar un aspecto relevante para mejorar los tratamientos actualmente disponibles: la promoción del afecto positivo. Hasta ahora, los tratamientos psicológicos para los trastornos emocionales se han centrado principalmente en la dimensión del afecto negativo. Teniendo en cuenta los factores centrales defendidos desde la perspectiva transdiagnóstica para explicar la vulnerabilidad de los trastornos emocionales, es necesario mejorar las estrategias de intervención para la dimensión del afecto positivo (Carl, Soskin, Kerns, & Barlow, 2013). Otra perspectiva que surgió precisamente con el objetivo de mejorar los aspectos positivos del ser humano es el movimiento de la Psicología Positiva (Seligman & Csikszentmihalyi, 2000). Esta perspectiva es especialmente relevante para las personas que sufren de depresión (p.ej., Santos et al., 2013). Por lo tanto, el objetivo general de esta tesis es investigar la eficacia y coste-efectividad de un tratamiento habitual mejorado (THM) junto con una intervención computarizada de baja intensidad basada en Internet y centrada en la promoción del afecto positivo para el tratamiento de la depresión, en comparación con sólo el THM, en centros de atención primaria.Depression is the most common mental disorder in the health care services. Specifically, 60% of patients with depression are attended to in primary care centers (Fernández et al., 2006). This psychological problem presents a high rate of comorbidity with other disorders, and if not treated correctly, its course tends to become chronic, interfering significantly in different areas of the individual's functioning (Wittchen et al., 2011). Therefore, effective treatments that can be easily applied and disseminated are needed (Collins et al., 2011). So far, there are numerous evidence-based psychological treatments (e.g., cognitive-behavioral therapy) for depression (Cuijpers, van Straten, van Oppen, Andersson, 2008; Cuijpers et al., 2013; Huhn et al., 2014). However, despite the existence of these treatments, the provision of mental health services is considerably low in terms of access and quality (Kazdin & Blase, 2011). In fact, less than 50% of people receive appropriate treatment, due to the cost, time required or lack of well-trained professionals (Gaston, Abbot, Rapee, & Neary, 2006). A fundamental challenge in research is the dissemination of these treatments, that is, making them available to all those who need them. Numerous studies have already shown that it is possible to apply these treatments via the Internet without losing their effectiveness (Andersson & Cuijpers, 2009; Andersson, 2016; Andrews, Cuijpers, Craske, McEvoy, & Titov, 2010). In addition, several meta-analyses show that these treatments have effects comparable to those of face-to-face treatments (Andersson, Cuijpers, Carlbring, Riper, & Hedman, 2014; Andersson, Topooco, Havik, & Nordgreen, 2016). Moreover, low-intensity psychological interventions, applied by Information and Communication Technologies could be an efficacious and cost-effective therapeutic option for the treatment of depression in primary care, given their potentialities (Donker et al., 2015). Finally, although good efficacy data are available, further efforts are needed to find ways to treat depression in its different manifestations (e.g., degree of severity) and in different healthcare settings (e.g., primary care, specialized care). In recent years, the transdiagnostic perspective (Sauer-Zavala et al., 2017) has received considerable importance as one of the approaches to improve the understanding and treatment of emotional disorders, including depression and anxiety. This perspective emphasizes the role of emotional regulation as a key concept in understanding and treating emotional disorders (Brown & Barlow, 2009). It is worth to consider, in addition, a relevant aspect proposed to improve the currently available treatments: the promotion of positive affect. Thus far, psychological treatments for emotional disorders have focused primarily on the dimension of negative affect. Taking into account the central factors defended from the transdiagnostic perspective to explain the vulnerability of the emotional disorders, it is necessary to improve the intervention strategies for the positive affect dimension (Carl, Soskin, Kerns, & Barlow, 2013). Another perspective that emerged precisely with the aim of enhancing the positive aspects of the human being is the Positive Psychology movement (Seligman & Csikszentmihalyi, 2000). This perspective is especially relevant to people suffering from depression (e.g., Santos et al., 2013). Therefore, the general objective of this dissertation is to investigate the efficacy and cost-effectiveness of an improved treatment as usual (ITAU) with a low-intensity Internet-based computerized intervention focused on the promotion of positive affect (ITAU+IPPA) for the treatment of depression, compared to only the ITAU (only-ITAU) in Spanish primary care (PC) settings

Too many lemons to make lemonade? Disentangling mental health during the third wave of COVID-19 infections in Spain

The study aimed to analyze the longitudinal change in mental health during the third wave of COVID-19 infections in Spain. Negative (e.g., emotional distress) and positive (e.g., positive functioning variables) outcomes were analyzed. Protective factors (e.g., resilience) as predictors of psychological adjustment (i.e., positive mental health, openness to the future, and low burden due to COVID-19) after ten months of the pandemic were also examined. The sample consisted of 164 participants, and self-reported questionnaires were administered at the beginning of the lockdown (March 2020), at the end of the lockdown (June 2020), and during the third wave (January 2021). Linear mixed models showed that individuals’ emotional distress increased, and positive functioning variables (i.e., meaning in life, gratitude, resilience, and life satisfaction) decreased over time, but an increase was observed in some dimensions of posttraumatic growth. Regression analyses showed that resilience scores at all three data collection time points were significant predictors of positive mental health, openness to the future, and burden during the third wave. Mediation analyses showed that positive mental health and openness to the future were mediators of the effect of resilience on burden. The prolonged situation of the COVID-19 crisis had an important impact on positive and negative mental health. However, resilience may help to build up resources that can act as a buffer against adverse psychological effects

Cultural adaptation of the Smiling is Fun program for the treatment of depression in the Ecuadorian public health care system: A study protocol for a randomized controlled trial

Depression is one of the world's major health problems. Due to its high prevalence, it constitutes the first cause of disability among the Americas, where only a very low percentage of the population receives the adequate evidence-based psychological treatment. Internet-Based Interventions (IBIs) are a great alternative to reduce the treatment gap for mental disorders. Although there are several studies in low-and middle-income countries proving IBIs' feasibility and acceptability, there is still little evidence of the effectiveness in diverse social and cultural contexts such as Latin America

Working Alliance Inventory for Online Interventions-Short Form (WAI-TECH-SF): The Role of the Therapeutic Alliance between Patient and Online Program in Therapeutic Outcomes

Background: Therapeutic alliance (TA) between the patient and therapist has been related to positive therapeutic outcomes. Because Internet-based interventions are increasingly being implemented, a tool is needed to measure the TA with Internet-based self-guided programs. The Working Alliance Inventory for online interventions (WAI-TECH-SF) was adapted based on the WAI Short Form (Hatcher & Gillaspy, 2006). The objectives of this study were: (1) to analyse the psychometric properties of the WAI-TECH-SF; (2) to explore the differences in the WAI-TECH-SF scores according to different categories of the sample; and (3) to analyse whether the WAI-TECH-SF can predict therapeutic outcomes and satisfaction with the treatment. Methods: 193 patients diagnosed with depression were included and received blended Cognitive-Behavioural Therapy. Measures of preferences, satisfaction, and credibility about the treatment, TA with the online program, depressive symptoms, and satisfaction with the treatment were administered. Results: An exploratory factor analysis revealed a one-dimensional structure with adequate internal consistency. Linear regression analyses showed that the WAI-TECH-SF predicted changes in depressive symptoms and satisfaction with the treatment. Conclusions: WAI-TECH-SF is a reliable questionnaire to assess the TA between the patient and the online program, which is associated with positive therapeutic outcomes and satisfaction with the treatment

How the COVID-19 pandemic and its consequences affect the presence of and search for meaning of life: a longitudinal study

The presence of meaning in life (PML) and the search for meaning in life (SML) are crucial when facing difficult times. Although several theoretical frameworks have tried to explain the dynamics of meaning in life during adversity, empirical evidence about interactions among both constructs using longitudinal designs is scarce. This study examined the trajectories of both PML and SML during the COVID-19 lockdown period in Spain. In total, 220 adults fulfilled an online survey during two periods: a strict and a relaxed lockdown period. Latent growth models showed that both PML and SML declined slightly during the strict lockdown, but they reached a plateau during the relaxed lockdown. Results also showed that age and having a partner predicted higher PML and lower SML at baseline, whereas being male predicted higher scores on PML. PML and SML were negatively associated at baseline, higher SML at baseline was related to a steeper decreasing PML slope during the strict lockdown, and the PML and SML slopes in the relaxed lockdown period were negatively related. This study contributes to better understanding longitudinal fluctuations of meaning in life in situations of adversity

Clients'Experiences With Internet-Based Psychological Treatments for Mental Disorders: Protocol for a Metasynthesis of Qualitative Studies

Background Given the rise of internet-based treatments as an effective therapeutic tool for psychological disorders, it is necessary to carry out research that examines clients’ experiences with this type of intervention. The qualitative methodology has been found to be useful for analyzing clients’ perceptions in terms of facilitators and barriers, acceptability, and negative effects of internet-based treatments. However, a lack of integration of these primary studies has prevented their findings from being applied to new research and in clinical practice. Objective The objective of this paper is to describe the protocol for a metasynthesis of qualitative studies exploring the experiences of clients who underwent an internet-based treatment. Methods Elliot and Timulak’s metasynthesis approach will be used to review and synthesize qualitative studies related to client experiences in terms of the barriers and facilitators they perceived when undergoing internet-based treatment. For each search string, the features in the Sample, Phenomenon of Interest, Design, Evaluation, Research type (SPIDER) tool will be considered. Electronic databases (PubMed, PsycINFO, and Web of Science) will be searched. Two independent reviewers will analyze the material in order to determine whether the eligibility criteria are fulfilled. Findings will make it possible to create a hierarchy of domains in terms of their relevance across all the primary studies. The data obtained from primary studies will be cross-analyzed using descriptive and interpretative procedures. Results The search strategy is currently being conducted. First results are expected to be submitted for publication in 2019. Conclusions We will develop conceptual framework of the barriers and facilitators perceived by clients and propose their implications and recommendations for clinical practice, research, and training

A VR-Based Serious Game for Studying Emotional Regulation in Adolescents

[EN] We all use more or less adapted strategies to confront adverse emotional situations in our lives without being psychologically affected. Emotional Regulation (ER) strategies that we use determine the way in which we feel, express and behave. Moreover, ER strategies are particularly important in adolescents, a population in the age when the deficits of ER strategies can be linked to the appearance of numerous mental health disorders such as depression or anxiety, or disruptive behaviors. Thus, the early detection of dysfunctional ER strategies and the training in adaptive ER strategies will help us to prevent the future occurrence of possible behavioral and psychosocial disorders. In this paper, we present the GAMETEEN SYSTEM (GT-System), a novel instrument based on Virtual Reality and serious games for the assessment and training of ER strategies in adolescent population. The results of our preliminary evaluation suggest that this system is effective in training and evaluating emotional regulation strategies in the adolescent population.Rodriguez Ortega, A.; Rey, B.; Vara, MD.; Wrzesien, M.; Alcañiz Raya, ML.; Baños, RM.; Pérez Lopez, DC. (2015). A VR-Based Serious Game for Studying Emotional Regulation in Adolescents. IEEE Computer Graphics and Applications. 35(1):65-73. doi:10.1109/MCG.2015.8S657335

Corrigendum: Elena+ Care for COVID-19, a Pandemic Lifestyle Care Intervention: Intervention Design and Study Protocol (Front. Public Health, (2021), 9, (625640), 10.3389/fpubh.2021.625640)

In the published article, there were errors regarding the affiliations of several authors. For “Joseph Ollier”, instead of having affiliation “1,2”, they should have “1”. For “Olivia Clare Keller”, instead of having affiliations “1,2,15”, they should have “1,15”. For “Lorainne Tudor Car”, instead of having affiliations “3,27”, they should have “4,27”. For “Alicia Salamanca-Sanabria” instead of having affiliation “3”, they should have “4”. For “Jacqueline Louise Mair”, instead of having affiliation “3”, they should have “4”. For “Tobias Kowatsch”, instead of having affiliation(s) “1,2,15,28”, they should have “1,4,15”. In the published article, there was also an error in affiliation “29”. Instead of “Center for Digital Health, Berlin Institute of Health and Charité, Berlin, Germany”, it should be “Center for Digital Health, Berlin Institute of Health at Charité, Berlin, Germany”. There was also an error in affiliation “4”. Instead of “Future Health Technologies Programme, Singapore-Eidgenössische Technische Hochschule (ETH) Centre at Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore”, it should be “Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore”. Additionally, there was an error in affiliation “23” instead of “Swiss Research Institute for Public Health and Addiction, Zurich University, Zurich, Switzerland” it should be “Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland”. The authors apologize for these errors and state that this does not change the scientific conclusions of the article in any way. The original article has been updated

Elena+ Care for COVID-19, a Pandemic Lifestyle Care Intervention: Intervention Design and Study Protocol

Background: The current COVID-19 coronavirus pandemic is an emergency on a global scale, with huge swathes of the population required to remain indoors for prolonged periods to tackle the virus. In this new context, individuals\u27 health-promoting routines are under greater strain, contributing to poorer mental and physical health. Additionally, individuals are required to keep up to date with latest health guidelines about the virus, which may be confusing in an age of social-media disinformation and shifting guidelines. To tackle these factors, we developed Elena+, a smartphone-based and conversational agent (CA) delivered pandemic lifestyle care intervention. Methods: Elena+ utilizes varied intervention components to deliver a psychoeducation-focused coaching program on the topics of: COVID-19 information, physical activity, mental health (anxiety, loneliness, mental resources), sleep and diet and nutrition. Over 43 subtopics, a CA guides individuals through content and tracks progress over time, such as changes in health outcome assessments per topic, alongside user-set behavioral intentions and user-reported actual behaviors. Ratings of the usage experience, social demographics and the user profile are also captured. Elena+ is available for public download on iOS and Android devices in English, European Spanish and Latin American Spanish with future languages and launch countries planned, and no limits on planned recruitment. Panel data methods will be used to track user progress over time in subsequent analyses. The Elena+ intervention is open-source under the Apache 2 license (MobileCoach software) and the Creative Commons 4.0 license CC BY-NC-SA (intervention logic and content), allowing future collaborations; such as cultural adaptions, integration of new sensor-related features or the development of new topics. Discussion: Digital health applications offer a low-cost and scalable route to meet challenges to public health. As Elena+ was developed by an international and interdisciplinary team in a short time frame to meet the COVID-19 pandemic, empirical data are required to discern how effective such solutions can be in meeting real world, emergent health crises. Additionally, clustering Elena+ users based on characteristics and usage behaviors could help public health practitioners understand how population-level digital health interventions can reach at-risk and sub-populations

mHealth intervention to improve quality of life in patients with chronic diseases during the COVID-19 crisis in Paraguay: A study protocol for a randomized controlled trial

Background Patients with chronic disease represent an at-risk group in the face of the COVID-19 crisis as they need to regularly monitor their lifestyle and emotional management. Coping with the illness becomes a challenge due to supply problems and lack of access to health care facilities. It is expected these limitations, along with lockdown and social distancing measures, have affected the routine disease management of these patients, being more pronounced in low- and middle-income countries with a flawed health care system. Objectives The purpose of this study is to describe a protocol for a randomized controlled trial to test the efficacy of the Adhera® MejoraCare Digital Program, an mHealth intervention aimed at improving the quality of life of patients with chronic diseases during the COVID-19 outbreak in Paraguay. Method A two-arm randomized controlled trial will be carried out, with repeated measures (baseline, 1-month, 3-month, 6-month, and 12-month) under two conditions: Adhera® MejoraCare Digital Program or waiting list. The primary outcome is a change in the quality of life on the EuroQol 5-Dimensions 3-Levels Questionnaire (EQ-5D-3L). Other secondary outcomes, as the effect on anxiety and health empowerment, will be considered. All participants must be 18 years of age or older and meet the criteria for chronic disease. A total of 96 participants will be recruited (48 per arm). Conclusions It is expected that the Adhera® MejoraCare Digital Program will show significant improvements in quality of life and emotional distress compared to the waiting list condition. Additionally, it is hypothesized that this intervention will be positively evaluated by the participants in terms of usability and satisfaction. The findings will provide new insights into the viability and efficacy of mHealth solutions for chronic disease management in developing countries and in times of pandemic