Internet Interventions-The Application of Information Technology in Mental and Behavioural Health最新文献

{"title":"Assessing the feasibility, acceptability, and preliminary efficacy of the ‘TraumaRelief’ app for PTSD symptom management in Turkey: Study protocol for a pilot randomized controlled trial","authors":"Hasan Arslan,&nbsp;A. Esin Yilmaz","doi":"10.1016/j.invent.2024.100793","DOIUrl":"10.1016/j.invent.2024.100793","url":null,"abstract":"<div><div>The rate of exposure to traumatic events is high globally, and post-traumatic stress disorder (PTSD) is one of the most serious consequences. It was reported that approximately 14 million people were affected by earthquakes in Turkey in February 2023. Cognitive Behavioral Therapy (CBT) is a therapeutic approach to treating PTSD and has a proven efficacy. However, access to face-to-face therapies such as CBT is limited and there is a high dropout rate. Technology-based interventions can offer new solutions to make CBT more accessible and integrated into daily life. In this study, we will develop an application called TraumaRelief, which aims to relieve PTSD symptoms. We will test the feasibility, acceptability, and efficacy of this application through a pilot randomized controlled study conducted in Turkey, with 105 participants aged between 18 and 65 years who have experienced a traumatic event. Participants will be randomly assigned to the Application Plus Online Therapist Support Group (AT + OT Group), Application Only Group (Group A), and Waitlist Control Group (WLC Group). This study aims to evaluate symptoms of PTSD, depression, and anxiety, as well as their effects on quality of life. In addition, the feasibility and acceptability of the study; the attrition, consent, recruitment, and adherence rate to the application; fidelity of intervention delivery; system usability score; preferred and least preferred module components; app utilization frequency; and likelihood to recommend the application will be examined. Application efficacy will be monitored with follow-ups at one and three months. The results could provide important information on the integration of technology-based treatments with psychotherapy. In addition, it could allow the evaluation of potential mobile applications in the field of psychotherapy and represents an important step in the development and evaluation of a customized mobile application for a society with unique cultural and social dynamics, such as Turkey. It could also be an important resource for increasing the capacity to cope with the effects of traumatic events that have occurred in Turkey or future events.</div></div><div><h3>Clinical Trial Registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> Identifier <span><span>NCT06288594</span><svg><path></path></svg></span>. Unique Protocol ID: DEU-PSI-HA-001.</div></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"38 ","pages":"Article 100793"},"PeriodicalIF":3.6,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation trial II: Clinical outcomes and acceptability of an internet-delivered intervention for anxiety and depression delivered as part of routine care for university students in Australia","authors":"Blake F. Dear ,&nbsp;Andreea I. Heriseanu ,&nbsp;Bareena Johnson ,&nbsp;Letitia Norton ,&nbsp;Helen Nguyen ,&nbsp;Ali Richards ,&nbsp;Sheldon Pace ,&nbsp;Nickolai Titov","doi":"10.1016/j.invent.2024.100789","DOIUrl":"10.1016/j.invent.2024.100789","url":null,"abstract":"<div><h3>Background</h3><div>University students report high levels of psychological distress, which is a contributor to poorer academic, social and health outcomes. There is increasing interest in the use of internet-delivered psychological treatments in student counselling services as a strategy improving access to psychological care at scale. However, to date, few large-scale prospective effectiveness trials of internet-delivered psychological treatment have been conducted in “real world” settings with university student populations.</div></div><div><h3>Aim</h3><div>To investigate the effectiveness and acceptability of a brief transdiagnostic internet-delivered cognitive behavioural therapy (iCBT) intervention for anxiety and depression when delivered as part of routine care by the counselling service of an Australian university.</div></div><div><h3>Design</h3><div>A large, prospective, single-group Phase IV clinical trial.</div></div><div><h3>Method</h3><div>Students engaging with the university counselling service between 2018 and 2023 (<em>N</em> = 845; 8.5% of those presenting to the service) were given the option to receive the intervention based on their clinical needs and preferences. Students completed standardised measures of depression and anxiety severity at pre-treatment, each week of the intervention, and post-treatment. A subsample (<em>n</em> = 426) also completed the measures at 3-month follow-up.</div></div><div><h3>Results</h3><div>Over a 5-year period, 700 students participated in the intervention and 489 provided data at post-treatment. Significant reductions in depression symptoms (% reduction = 27%, Hedges' <em>g</em> = 0.35) and anxiety (% reduction = 37%, Hedges' <em>g</em> = 0.61) were observed, alongside high levels of satisfaction (&gt;70%) and adherence (68%). Over 50% of students had clinically significant improvements in symptom severity, and symptom deterioration was observed in &lt;15% of students.</div></div><div><h3>Conclusion</h3><div>The results of the current trial provide support for the effectiveness and acceptability of internet-delivered psychological interventions provided as part of routine care to university students with symptoms of anxiety and depression.</div></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"38 ","pages":"Article 100789"},"PeriodicalIF":3.6,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142704756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation trial I: Clinical outcomes and acceptability of an internet-delivered intervention for anxiety and depression delivered as part of routine care for university students in New Zealand","authors":"Blake F. Dear ,&nbsp;Andreea I. Heriseanu ,&nbsp;Bareena Johnson ,&nbsp;David Sander ,&nbsp;Kimberly Farmer ,&nbsp;Nickolai Titov","doi":"10.1016/j.invent.2024.100791","DOIUrl":"10.1016/j.invent.2024.100791","url":null,"abstract":"<div><h3>Background</h3><div>Psychological distress is highly prevalent among university students and can contribute to poor academic performance and drop-out. Help-seeking has increased in recent years, contributing to growing interest in employing internet-delivered psychological treatments to support the mental health of university students. However, few large-scale “real-world” effectiveness trials have been conducted in routine care settings for this population.</div></div><div><h3>Aim</h3><div>The aim of the current study was to examine the acceptability and effectiveness of a brief, five-week internet-delivered cognitive behavioural therapy (iCBT) intervention for anxiety and depression when delivered as part of routine care by a university counselling service in New Zealand.</div></div><div><h3>Design</h3><div>A large, prospective, single-group Phase IV clinical trial.</div></div><div><h3>Method</h3><div>Students (<em>N</em> = 1044) engaging with the university counselling service between 2018 and 2023 were provided the option to receive the intervention based on their needs and preferences. Students completed standardised measures of depression and anxiety severity at pre-treatment, each week of the intervention, and post-treatment. A subsample (<em>n</em> = 405) also completed these at 3-month follow-up.</div></div><div><h3>Results</h3><div>Over a 5-year period, 839 students participated in the intervention. Significant reductions in symptoms of depression (% reduction = 35%, Hedges' <em>g</em> = 0.56) and anxiety (% reduction = 36%, Hedges' <em>g</em> = 0.73) were observed, alongside high levels of satisfaction (&gt; 60%). Symptom deterioration was observed in &lt;10% of students.</div></div><div><h3>Conclusion</h3><div>The current results provide further support for the provision of internet-delivered psychological interventions as routine care to university students with symptoms of anxiety and depression.</div></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"38 ","pages":"Article 100791"},"PeriodicalIF":3.6,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142704814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Promoting safer gambling through social norms and goal setting: A qualitative process analysis of participants' experiences in the EROGamb 2.0 feasibility trial","authors":"Reece Bush-Evans ,&nbsp;Emily Arden-Close ,&nbsp;Sarah Thomas ,&nbsp;John McAlaney ,&nbsp;Ruijie Wang ,&nbsp;Elvira Bolat ,&nbsp;Sarah Hodge ,&nbsp;Abigail Hamson-Ford ,&nbsp;Keith Phalp","doi":"10.1016/j.invent.2024.100790","DOIUrl":"10.1016/j.invent.2024.100790","url":null,"abstract":"<div><div>Gambling, though a popular social activity, can lead to addiction and cause significant harm. This study aimed to explore the experiences of 36 low-to-moderate risk gamblers (PGSI score 0–7; 31 male, 5 female; 10 per each intervention arm, 6 per control group) in the ‘EROGamb 2.0’ feasibility trial (<em>n</em> = 168). The trial used social norm messages and goal setting feedback to promote safer gambling behaviour. Participants took part in semi-structured interviews via telephone or audio calls using Zoom or Wire, a secure messaging app. The interviews were analysed using Framework Analysis. Most participants found the interventions interesting and useful, though some reported no change in their gambling behaviour. Motivations for joining the trial included interest in the topic, altruism, and financial incentives. Participants appreciated the study's clear information, efficient processes, and helpful notifications, despite some technical issues. Reactions to social norm messages were mixed, with some expressing scepticism about the statistics. However, the goal setting intervention was well-received, with participants valuing the clarity and usefulness of the information. External factors, such as promotional offers from gambling companies, influenced gambling behaviour. The findings support the feasibility and acceptability of social norm and goal setting interventions to reduce gambling behaviour, highlighting the need for personalised approaches in future research.</div></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"38 ","pages":"Article 100790"},"PeriodicalIF":3.6,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142704758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a coaching manual to provide human support for the Mothers and Babies Online (eMB) perinatal mental health intervention","authors":"Lara Baez ,&nbsp;Jaime Hamil ,&nbsp;Elaine McBride ,&nbsp;Katherine A. Czech ,&nbsp;Bayley J. Taple ,&nbsp;Adriana Santillano ,&nbsp;Mingjing Huang ,&nbsp;Alinne Z. Barrera ,&nbsp;S. Darius Tandon","doi":"10.1016/j.invent.2024.100792","DOIUrl":"10.1016/j.invent.2024.100792","url":null,"abstract":"<div><h3>Background</h3><div>Depression that occurs in pregnancy or postpartum (perinatal depression) impacts 1 in 5 mothers, yet access to effective and high-quality preventative interventions remains elusive for most. Digital interventions are a promising solution to this treatment gap because of the ubiquity of mobile devices and internet access. The Mothers and Babies Online Course (eMB) is an online adaptation of Mothers and Babies, an evidence-based preventative program for postpartum depression. Preliminary studies of eMB point to its potential efficacy, but low engagement with eMB was a major limitation. Leveraging home visitors as coaches to guide clients through eMB may be a way to increase uptake and engagement, and ultimately improve outcomes when implemented in home visiting programs.</div></div><div><h3>Objective</h3><div>The aim of this study was to implement user-centered design methods to develop a coaching manual for home visitors to implement eMB.</div></div><div><h3>Methods</h3><div>10 parents and 10 home visitors were interviewed individually. Measures included a “think aloud” activity and a semi-structured interview focused on gaining insight into parent and home visitor needs and preferences regarding eMB coaching in the context of home visiting. Thematic analysis was used to derive themes and sub-themes from interview transcripts.</div></div><div><h3>Results</h3><div>Parents were enthusiastic about eMB, but noted barriers including limited time and forgetfulness. Parents also thought that their home visitor would be the ideal eMB coach because of the existing close relationship. Home visitors shared that eMB would fit seamlessly into their home visiting workflow. They also thought that home visitors could address challenges that parents encounter in using eMB and leverage their relationship with parents to crystalize learning. Home visitors also noted that a coaching manual would be a key part of successful eMB implementation. Thus, valuable insights from parents and home visitors were used to create a coaching manual.</div></div><div><h3>Conclusions</h3><div>Parents and home visitors were both enthusiastic about eMB with adjunctive coaching, and home visitors agreed that a coaching manual would be vital in guiding them to help parents through eMB. Results highlight the importance of engaging end-users in all aspects of online intervention design, including the coaching manual. The effectiveness of the intervention and utility of the coaching protocol will be evaluated in a future pilot trial.</div></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"38 ","pages":"Article 100792"},"PeriodicalIF":3.6,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142704813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of a guided multicomponent internet and mobile gratitude training program - A pragmatic randomized controlled trial","authors":"Dirk Lehr ,&nbsp;Henning Freund ,&nbsp;Bernhard Sieland ,&nbsp;Lina Kalon ,&nbsp;Matthias Berking ,&nbsp;Heleen Riper ,&nbsp;David Daniel Ebert","doi":"10.1016/j.invent.2024.100787","DOIUrl":"10.1016/j.invent.2024.100787","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the effectiveness of a guided, internet- and smartphone-based gratitude intervention on the transdiagnostic risk-factor ‘repetitive negative thinking’. The multicomponent intervention integrates a variety of gratitude exercises, targeting the cognitive, emotional and behavioural facets of gratitude.</div></div><div><h3>Method</h3><div>Two hundred adults with pronounced repetitive negative thinking were recruited from the general population. Participants were randomly assigned to either a four-session guided gratitude intervention (<em>n = 100</em>) or waiting list (<em>n = 100</em>). The primary outcome was repetitive negative thinking three months after randomization, with exploratory assessments at six weeks and six months, the latter just for participants in the intervention group.</div></div><div><h3>Results</h3><div>Following the intention-to-treat principle, by analyses of covariance (ANCOVA), the gratitude intervention group exhibited significantly lower levels of repetitive negative thinking than controls at three months, with <em>d</em> = 0.66, <em>95</em> <em>% CI</em> [0.37, 0.94] maintained at six-month follow-up. Significant and meaningful beneficial effects were observed in symptoms of depression (<em>d</em> = 0.42) and generalized anxiety (<em>d</em> = 0.38). These effects were notably stronger in intervention completers who finished at least three sessions.</div></div><div><h3>Conclusions</h3><div>Results suggest that a multicomponent gratitude intervention is effective at reducing repetitive negative thinking. Multicomponent interventions may be a next step needed to fully realize the potential of gratitude interventions. Such interventions could expand the repertoire of transdiagnostic interventions, especially for repetitive negative thinking. Furthermore, due to its positive connotations, gratitude is a candidate for an indirect intervention aimed at reducing the burden of depression in the general population.</div></div><div><h3>Trial registration</h3><div>The study is registered in the German Clinical Trial Register (approved primary register of the WHO) as DRKS00006825. The trial protocol can be assessed at: <span><span>https://www.drks.de/</span><svg><path></path></svg></span></div></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"38 ","pages":"Article 100787"},"PeriodicalIF":3.6,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142651804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sudden gains in internet cognitive therapy for social anxiety disorder in routine clinical practice","authors":"See Heng Yim ,&nbsp;David M. Clark ,&nbsp;Paul M. Salkovskis ,&nbsp;Graham R. Thew","doi":"10.1016/j.invent.2024.100788","DOIUrl":"10.1016/j.invent.2024.100788","url":null,"abstract":"<div><h3>Background</h3><div>Sudden gains are large symptom improvements between consecutive therapy sessions. They have been shown to occur in randomised controlled trials of internet-delivered psychological interventions, but little is known about their occurrence when such treatments are delivered in routine clinical practice.</div></div><div><h3>Objective</h3><div>This study examined the occurrence of sudden gains in a therapist-guided internet-delivered Cognitive Therapy intervention for social anxiety disorder (iCT-SAD) delivered in the UK NHS talking therapies for anxiety and depression (formerly known as IAPT services). It aimed to assess whether sudden gains were associated with better therapy outcomes, and examine changes in process variables around the period of sudden gains.</div></div><div><h3>Methods</h3><div>The study examined sudden gains based on the Liebowitz Social Anxiety Scale. Of 193 treated patients, 146 provided sufficient data to permit analysis. Linear mixed effects models were used to examine the impact of sudden gains on clinical outcomes, and examine changes in negative social cognitions, self-focused attention, and depressed mood.</div></div><div><h3>Results</h3><div>Seventy sudden gains were found among 57 participants. The occurrence rate of sudden gains was 39 %. Individuals who experienced sudden gains had a larger reduction in social anxiety symptoms at end of intervention and at three-month follow-up. There was evidence of a reduction in the frequency of negative social cognitions prior to the gain, whereas changes in self-focused attention occurred simultaneously with the gain. Depressed mood did not show significant changes over these timepoints.</div></div><div><h3>Conclusions</h3><div>Approximately 2 in 5 patients experienced a sudden gain whilst accessing the iCT-SAD intervention in routine practice. They were associated with better clinical outcomes following treatment compared to those who did not experience a sudden gain.</div></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"38 ","pages":"Article 100788"},"PeriodicalIF":3.6,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142704757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychotherapy 2.0 - Application context and effectiveness of sensor technology in psychotherapy with children and adolescents: A systematic review","authors":"Annika K. Alt ,&nbsp;Anja Pascher ,&nbsp;Lennart Seizer ,&nbsp;Marlene von Fraunberg ,&nbsp;Annette Conzelmann ,&nbsp;Tobias J. Renner","doi":"10.1016/j.invent.2024.100785","DOIUrl":"10.1016/j.invent.2024.100785","url":null,"abstract":"<div><h3>Background</h3><div>E-mental health applications have been increasingly used in the psychotherapeutic care of patients for several years. State-of-the-art sensor technology could be used to determine digital biomarkers for the diagnosis of mental disorders. Furthermore, by integrating sensors into treatment, relevant contextual information (e.g. field of gaze, stress levels) could be made transparent and improve the treatment of people with mental disorders. An overview of studies on this approach would be useful to provide information about the current status quo.</div></div><div><h3>Methods</h3><div>A systematic review of the use of sensor technology in psychotherapy for children and adolescents was conducted with the aim of investigating the use and effectiveness of sensory technology in psychotherapy treatment. Five databases were searched for studies ranging from 2000 to 2023. The study was registered by PROSPERO (CRD42023374219), conducted according to Cochrane recommendations and used the PRISMA reporting guideline.</div></div><div><h3>Results</h3><div>Of the 38.560 hits in the search, only 10 publications met the inclusion criteria, including 3 RCTs and 7 pilot studies with a total of 257 subjects. The study population consisted of children and adolescents aged 6 to 19 years with mental disorders such as OCD, anxiety disorders, PTSD, anorexia nervosa and autistic behavior. The psychotherapy methods investigated were mostly cognitive behavioral therapy (face-to-face contact) with the treatment method of exposure for various disorders. In most cases, ECG, EDA, eye-tracking and movement sensors were used to measure vital parameters. The heterogeneous studies illustrate a variety of potential useful applications of sensor technology in psychotherapy for adolescents. In some studies, the sensors are implemented in a feasible approach to treatment.</div></div><div><h3>Conclusion</h3><div>Sensors might enrich psychotherapy in different application contexts.</div><div>However, so far there is still a lack of further randomized controlled clinical studies that provide reliable findings on the effectiveness of sensory therapy in psychotherapy for children and adolescents. This could stimulate the embedding of such technologies into psychotherapeutic process.</div><div><span><span>https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023374219</span><svg><path></path></svg></span>, identifier [CRD42023374219].</div></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"38 ","pages":"Article 100785"},"PeriodicalIF":3.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Change processes in cognitive therapy for social anxiety disorder: A comparison of face-to-face and internet-based treatment formats","authors":"Graham R. Thew ,&nbsp;Anke Ehlers ,&nbsp;David M. Clark","doi":"10.1016/j.invent.2024.100786","DOIUrl":"10.1016/j.invent.2024.100786","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objective</h3><div>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).</div></div><div><h3>Methods</h3><div>Data from a randomised controlled trial (<em>n</em> = 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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"38 ","pages":"Article 100786"},"PeriodicalIF":3.6,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are there unique facets of therapeutic alliance for users of digital mental health interventions? An examination with the eHealth Therapeutic Alliance Inventory","authors":"Ohad Ashur,&nbsp;Chen R. Saar,&nbsp;Or Brandes,&nbsp;Amit Baumel","doi":"10.1016/j.invent.2024.100783","DOIUrl":"10.1016/j.invent.2024.100783","url":null,"abstract":"<div><div>Therapeutic alliance (TA) is a well-established predictor of clinical outcomes in traditional psychotherapy. However, its association with outcomes in eHealth interventions has been inconsistent, which might be due to the absence of measurements specifically designed to capture TA in eHealth settings. The eHealth Therapeutic Alliance Inventory (ETAI) incorporates conventional as well as unique eHealth TA subscales, enabling to examine the contribution of new facets of TA beyond traditional concepts. This study investigates the predictive contribution of eHealth TA subscales compared to conventional TA subscales on clinical outcomes and evaluates the concurrent criterion validity of the ETAI. The study was conducted within the framework of a randomized controlled trial involving a 10-week digital parent training program aimed at addressing child disruptive behaviors. Parents were randomly assigned to either an enhanced-quality or a standard-quality program. Parents from 68 families completed the ETAI at five weeks' post-program initiation and at the post-intervention phase. The primary outcome was the improvement in child behavior, measured by the Eyberg Child Behavior Inventory. Positive Pearson correlations were found between all ETAI subscales covering unique eHealth TA aspects, measured at the 5-week time-point, and improvement in child behavior at post-intervention (<em>r</em>_s ≥ 0.23, <em>p</em>_s &lt; 0.03). The conventional TA subscale showed no significant Pearson correlation with improvement in child behavior. When examining the unique contributions of ETAI-subscales to explain the improvement in child behavior, only ETAI-Perceived Emotional Investment subscale was found to have a unique contribution (<em>β</em> = 0.29, <em>p</em> = 0.019). In addition, scores on most ETAI subscales were significantly higher among parents using the enhanced-quality program compared with the standard program (Cohen's <em>d</em>_s &gt; 0.48), reinforcing ETAI's criterion validity. The development of TA scales that incorporates unique eHealth TA subscales show initial promise in predicting outcomes. Further research is needed to better understand how different factors of eHealth TA relate to clinical outcomes across diverse clinical targets and programs.</div></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"38 ","pages":"Article 100783"},"PeriodicalIF":3.6,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142560585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}