Jmir Mental Health最新文献

{"title":"Feasibility and Acceptability of a Smartphone-Delivered Mindfulness Intervention for Stress Reduction in Adult Singaporeans: Pilot Randomized Controlled Trial.","authors":"Alessandro Sparacio, Jonathan Nicholas Davies, Erin Lee, Jeroen Antonius Johannes Schmitt","doi":"10.2196/77793","DOIUrl":"10.2196/77793","url":null,"abstract":"<p><strong>Background: </strong>Fully decentralized self-administered mindfulness interventions show promise for stress reduction, but rigorous evaluations of their feasibility, acceptability, and effectiveness using both self-report and physiological measures remain limited. In Singapore, where mental health concerns rank as the top health care priority (46%), ahead of cancer (38%) and stress-related issues (35%), accessible and scalable interventions are urgently needed to address the significant economic burden of mental health conditions.</p><p><strong>Objective: </strong>This study aimed to evaluate a decentralized, 3-day self-administered mindfulness intervention with minimal supervision, compared with a sham control in Singaporean adults, examining effects on self-reported and physiologically measured stress responses. The inclusion of a sham control condition was intended to disentangle mindfulness-specific effects from demand characteristics and expectation effects, addressing a critical methodological gap in digital mindfulness research.</p><p><strong>Methods: </strong>This was a purely smartphone-based, decentralized pilot trial with no face-to-face components. Participants were recruited using web-based methods and, after providing informed consent, 60 adults were randomized to either a mindfulness intervention or a structurally matched sham control. The daily 10-minute mindfulness sessions guided participants to focus on present-moment breath and body sensations, while the sham control omitted a focus on present-moment awareness. Outcomes were assessed remotely, using self-report questionnaires (State-Trait Anxiety Inventory-6) and physiological data from smartphone-based photoplethysmography (heart rate variability; HRV). The study incorporated three methodological innovations: (1) a structurally equivalent sham control to match expectancy and credibility, (2) remote collection of HRV as an objective physiological biomarker, and (3) full decentralization allowing unsupervised multiplatform delivery. Feasibility was evaluated through recruitment, retention rates, and data quality. Acceptability was assessed through quantitative ratings and qualitative feedback.</p><p><strong>Results: </strong>The study demonstrated excellent feasibility, with near-perfect retention (59/60, 98.3%) and moderate HRV data quality (231/331, 69.8% valid signals). Acceptability ratings were high (mean 4.17, SD 0.53), with comfort/engagement receiving the highest scores (mean 4.27, SD 0.57) on a 5-point scale, exceeding established usability benchmarks for digital health interventions. Qualitative feedback identified technical challenges (HRV instability and device overheating) and scheduling difficulties. While Bayesian analyses did not detect significant group differences in stress reduction (Bayes factor<sub>10</sub> [BF<sub>10</sub>]=0.03) or HRV improvement (BF<sub>10</sub>=0.2), both groups showed significant stress reductions (BF<sub>10</sub>=3.01×10<","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e77793"},"PeriodicalIF":5.8,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876064","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":"The Ability of AI Therapy Bots to Set Limits With Distressed Adolescents: Simulation-Based Comparison Study.","authors":"Andrew Clark","doi":"10.2196/78414","DOIUrl":"10.2196/78414","url":null,"abstract":"<p><strong>Background: </strong>Recent developments in generative artificial intelligence (AI) have introduced the general public to powerful, easily accessible tools, such as ChatGPT and Gemini, for a rapidly expanding range of uses. Among those uses are specialized chatbots that serve in the role of a therapist, as well as personally curated digital companions that offer emotional support. However, the ability of AI therapists to provide consistently safe and effective treatment remains largely unproven, and those concerns are especially salient in regard to adolescents seeking mental health support.</p><p><strong>Objective: </strong>This study aimed to determine the willingness of therapy and companion AI chatbots to endorse harmful or ill-advised ideas proposed by fictional teenagers experiencing mental health distress.</p><p><strong>Methods: </strong>A convenience sample of 10 publicly available AI bots offering therapeutic support or companionship were each presented with 3 detailed fictional case vignettes of adolescents with mental health challenges. Each fictional adolescent asked the AI chatbot to endorse 2 harmful or ill-advised proposals, such as dropping out of school, avoiding all human contact for a month, or pursuing a relationship with an older teacher, resulting in a total of 6 proposals presented to each chatbot. The clinical scenarios presented were intended to reflect challenges commonly seen in the practice of therapy with adolescents, and the proposals offered by the fictional teenagers were intended to be clearly dangerous or unwise. The 10 AI bots were selected by the author to represent a range of chatbot types, including generic AI bots, companion bots, and dedicated mental health bots. Chatbot responses were analyzed for explicit endorsement, defined as direct support for the teenagers' proposed behavior.</p><p><strong>Results: </strong>Across 60 total scenarios, chatbots actively endorsed harmful proposals in 19 out of the 60 (32%) opportunities to do so. Of the 10 chatbots, 4 endorsed half or more of the ideas proposed to them, and none of the bots managed to oppose them all.</p><p><strong>Conclusions: </strong>A significant proportion of AI chatbots offering mental health or emotional support endorsed harmful proposals from fictional teenagers. These results raise concerns about the ability of some AI-based companion or therapy bots to safely support teenagers with serious mental health issues and heighten concern that AI bots may tend to be overly supportive at the expense of offering useful guidance when appropriate. The results highlight the urgent need for oversight, safety protocols, and ongoing research regarding digital mental health support for adolescents.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e78414"},"PeriodicalIF":5.8,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12360667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876066","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":"Mindful Nonreactivity, Anxiety, Depression, and Perceived Stress as Mediators of the Mindfulness Virtual Community Intervention-Pathways to Enhance Mental Health in University Students: Secondary Evaluation of Two Randomized Controlled Trials With Student Participants.","authors":"Meysam Pirbaglou, Christo El Morr, Farah Ahmad, Paul Ritvo","doi":"10.2196/65853","DOIUrl":"10.2196/65853","url":null,"abstract":"<p><strong>Background: </strong>Mindfulness-based interventions (MBIs) are widely used in mental health promotion and treatment. Despite widespread evidence of effectiveness with different populations and delivery modes, there are sparse findings concerning the mechanisms of action in MBIs.</p><p><strong>Objective: </strong>The objective of this paper was to understand the mediators of the Mindfulness Virtual Community (MVC) intervention, an 8-week, multicomponent, online mindfulness and cognitive-behavioral therapy (M-CBT) intervention, based on a secondary evaluation of 2 randomized controlled trials (RCTs) with student participants.</p><p><strong>Methods: </strong>Mediation analysis, using structural equation modeling, was used to assess direct and indirect relationships between study group (ie, intervention or wait list control) and outcomes. Consistent with the intervention's theoretical perspective and direct effects paths, a model was specified to evaluate whether mindful nonreactivity, as evaluated by the 5-factor mindfulness questionnaire, mediated the effect of MVC intervention on anxiety and depression (as symptom-driven outcomes), and perceived stress and quality of life (as functional outcomes). The model included additional mediating paths for perceived stress through anxiety and depression, and for quality of life through anxiety, depression, and perceived stress. The model was thereafter extended, adjusting for pre-intervention differences in mindfulness (ie, observing, describing, activity with awareness, nonjudgment, and nonreactivity) facets.</p><p><strong>Results: </strong>Direct (nonmediated) effects indicated statistically significant differences at 8 weeks between the MVC and waitlist control (WLC) groups on depression (-1.72; P=.002), anxiety (-3.40; P=.001), perceived stress (-2.44; P<.001), quality of life (4.31; P=.005), and the nonreactivity facet of mindfulness (1.63; P<.001), in favor of the MVC intervention. Mediation analysis supported the mediating role of the nonreactivity facet of mindfulness, depression, anxiety, and perceived stress through single and sequential mediation paths. Results indicated good fit characteristics for the main (comparative fit index [CFI]=.99; root-mean-square error of approximation [RMSEA]=.05; standardized root-mean-square residual [SRMR]=.05) and extended (CFI=.99; RMSEA=.04; SRMR=.04) models.</p><p><strong>Conclusions: </strong>This research underscores the importance of mindful nonreactivity, depression, and anxiety as key mediators of MVC intervention benefits.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e65853"},"PeriodicalIF":5.8,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12360729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876065","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":"Placebo, Nocebo, and Machine Learning: How Generative AI Could Shape Patient Perception in Mental Health Care.","authors":"Charlotte Blease","doi":"10.2196/78663","DOIUrl":"10.2196/78663","url":null,"abstract":"<p><strong>Unlabelled: </strong>The emergence of generative artificial intelligence (GenAI) in clinical settings-particularly in health documentation and communication-presents a largely unexplored but potentially transformative force in shaping placebo and nocebo effects. These psychosocial phenomena are especially potent in mental health care, where outcomes are closely tied to patients' expectations, perceived provider competence, and empathy. Drawing on conceptual understanding of placebo and nocebo effects and the latest research, this Viewpoint argues that GenAI may amplify these effects, both positive and negative. Through tone, assurance, and even the rapidity of responses, GenAI-generated text-either co-written with clinicians or peers, or fully automated-could influence patient perceptions in ways that mental health clinicians may not currently fully anticipate. When embedded in clinician notes or patient-facing summaries, AI language may strengthen expectancies that underlie placebo effects, or conversely, heighten nocebo effects through subtle cues, inaccuracies, or potentially via loss of human nuance. This article explores the implications of AI-mediated clinical communication particularly in mental health care, emphasizing the importance of transparency, ethical oversight, and psychosocial awareness as these technologies evolve.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e78663"},"PeriodicalIF":5.8,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12356606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859816","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":"An Examination of Generative AI Response to Suicide Inquires: Content Analysis.","authors":"Laurie O Campbell, Kathryn Babb, Glenn W Lambie, B Grant Hayes","doi":"10.2196/73623","DOIUrl":"10.2196/73623","url":null,"abstract":"<p><strong>Background: </strong>Generative artificial intelligence (AI) chatbots are an online source of information consulted by adolescents to gain insight into mental health and wellness behaviors. However, the accuracy and content of generative AI responses to questions related to suicide have not been systematically investigated.</p><p><strong>Objective: </strong>This study aims to investigate general (not counseling-specific) generative AI chatbots' responses to questions regarding suicide.</p><p><strong>Methods: </strong>A content analysis was conducted of the responses of generative AI chatbots to questions about suicide. In phase 1 of the study, generative chatbots examined include: (1) Google Bard or Gemini; (2) Microsoft Bing or CoPilot; (3) ChatGPT 3.5 (OpenAI); and (4) Claude (Anthropic). In phase 2 of the study, additional generative chatbot responses were analyzed, which included Google Gemini, Claude 2 (Anthropic), xAI Grok 2, Mistral AI, and Meta AI (Meta Platforms). The two phases occurred a year apart.</p><p><strong>Results: </strong>Findings included a linguistic analysis of the authenticity and tone within the responses using the Linguistic Inquiry and Word Count program. There was an increase in the depth and accuracy of the responses between phase 1 and phase 2 of the study. There is evidence that the responses by the generative AI chatbots were more comprehensive and responsive during phase 2 than phase 1. Specifically, the responses were found to provide more information regarding all aspects of suicide (eg, signs of suicide, lethality, resources, and ways to support those in crisis). Another difference noted in the responses between the first and second phases was the emphasis on the 988 suicide hotline number.</p><p><strong>Conclusions: </strong>While this dynamic information may be helpful for youth in need, the importance of individuals seeking help from a trained mental health professional remains. Further, generative AI algorithms related to suicide questions should be checked periodically to ensure best practices regarding suicide prevention are being communicated.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e73623"},"PeriodicalIF":5.8,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12371289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856767","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":"Anticipation and Motivation as Predictors of Leisure and Social Enjoyment and Engagement in Young People With Depression Symptoms: Ecological Momentary Assessment Study.","authors":"Angad Sahni, Ciara McCabe","doi":"10.2196/74427","DOIUrl":"10.2196/74427","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Participating in leisure and social activities can alleviate depression symptoms, yet effective strategies to enhance enjoyment and maintain long-term engagement remain scarce. Gaining insight into the reward subcomponents that influence daily experiences and drive behavior could uncover novel targets for intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study examines the role of anticipation and motivation in predicting enjoyment and engagement in leisure activities and socializing among young people, and how these relationships are moderated by depression severity, using intensive longitudinal ecological momentary assessments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Participants (N=80; mean age 20, SD 2.3 years) used the Psymate2 smartphone app to report mood, enjoyment, current and anticipated activities, and social company 7 times daily for 6 days. Activity categories were relaxation, exercise, other leisure, work or school, studying, chores, shopping, hygiene, eating or drinking, and traveling, and company categories were partner, friends, family, colleagues, acquaintances, strangers, and nobody. Anticipation (anticipatory pleasure and expectation) and motivation (interest and preference) for upcoming activities were rated on Likert scales. Participants were grouped by depression severity, measured using the Mood and Feelings Questionnaire (MFQ): high (HD, MFQ ≥27, N=42), moderate (MD, MFQ 16-27, N=16), and low, that is, controls (C, MFQ ≤16, N=22). Totally, 2316 assessments met inclusion criteria.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Leisure activities (relaxation, exercise, and other leisure) and social company (partner, friends, and family) were rated most enjoyable across all groups. Higher depression symptoms were associated with reduced enjoyment of studying (β=-.03; P=.005), eating or drinking (β=-.02; P=.02), and other leisure activities (β=-.02; P=.02), as well as lower engagement in work or school (β=-.26; P=.02) and hygiene (β=-.08; P=.03), and increased inactivity (β=.17; P=.03). Time-lagged multilevel analyses showed that anticipatory pleasure predicted greater enjoyment across all activities (β=.12; P&lt;.001) and social contexts (β=.33; P&lt;.001), with consistent effects in controls and the high depression group. However, the more an activity was expected to happen, the less enjoyment was experienced in the whole sample (β=-.006; P=.001) and high depression group (β=-.008; P=.001) but not controls. Anticipatory pleasure and motivation (preference) predicted leisure engagement in the whole sample (β=.19, P=.003; β=.11, P&lt;.001) and controls (β=.43, P=.005; β=.17, P=.048) but not the depression groups. Anticipatory pleasure predicted only leisure engagement in the high depression group when predictors and outcomes were matched for the same event (β=.22; P=.001). Anticipatory pleasure predicted social engagement in the whole sample (β=.095; P=.047) and controls (β=.34; P=.003), but not in the depression groups.&lt;/","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e74427"},"PeriodicalIF":5.8,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12349889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849438","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":"The Cost-Effectiveness of Digitally Supported Mental Well-Being Prevention and Promotion Targeting Nonclinical Adult Populations: Systematic Review.","authors":"Sara Claes, Fleur Van De Wielle, Els Clays, Lieven Annemans","doi":"10.2196/72458","DOIUrl":"https://doi.org/10.2196/72458","url":null,"abstract":"<p><strong>Background: </strong>In recent years, policymakers worldwide have been increasingly concerned with promoting public mental well-being. While digitally supported well-being interventions seem effective in general nonclinical populations, their cost-effectiveness remains unclear.</p><p><strong>Objective: </strong>This study aims to systematically synthesize evidence on the cost-effectiveness of digitally supported mental well-being interventions targeting the general population or adults with subclinical mental health symptoms.</p><p><strong>Methods: </strong>PubMed, Embase, Scopus, and Web of Science were systematically searched for health economic or cost-minimization studies. Eligibility criteria included interventions in the general population or adults showing risk factors or subclinical mental health symptoms, with at least 1 digital component. Study quality was comprehensively assessed using the Consensus Health Economic Criteria list.</p><p><strong>Results: </strong>Of 3455 records identified after duplicate removal, 12 studies were included: 3 studies evaluated universal prevention, 3 investigated selective prevention, and 6 covered indicated prevention. Six studies applied a societal perspective. Incremental cost-utility ratios were reported in 6 of the included studies and varied from dominant to €18,710 (US $ 23,185) per quality-adjusted life year. In general, digitally supported well-being interventions in nonclinical adults, and particularly indicated prevention strategies, seemed to generate improved health outcomes at lower costs from a societal perspective. The quality appraisal highlighted several shortcomings of the available literature.</p><p><strong>Conclusions: </strong>Overall, the use of digital tools for mental well-being prevention and promotion in nonclinical adult populations has the potential to be cost-effective. Nevertheless, to adequately guide policymaking, more evidence is still needed. Future studies should ensure valid argumentation for the applied time horizon and perspective, alongside rigorous sensitivity analyses in accordance with best practices to improve cost-effectiveness evidence. Furthermore, assessment methods more sensitive to changes in well-being such as the EQ Health and Well-being instrument could be considered.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e72458"},"PeriodicalIF":5.8,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12369993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975213","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":"Development of Telepresence Among Patients and Psychotherapists in the Actor-Partner Interdependence Model: Longitudinal Observational Study of 20 Dyads From a Randomized Trial on Video Consultations in Primary Care.","authors":"Markus W Haun, Deborah van Eickels, Isabella Stephan, Justus Tönnies, Mechthild Hartmann, Michel Wensing, Joachim Szecsenyi, Andrea Icks, Hans-Christoph Friederich","doi":"10.2196/70415","DOIUrl":"10.2196/70415","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic has accelerated the adoption of video consultations in mental health care, highlighting the importance of therapeutic alliances for successful treatment outcomes in both face-to-face and web-based settings. Telepresence, the sense of being present with the mental health specialist (MHS) rather than feeling remote, is a critical component of building a strong therapeutic alliance in video consultations. While patients often report high telepresence levels, MHSs express concerns about whether video consultations can replicate the quality of face-to-face interactions. Despite its importance, research on telepresence development in MHSs over time and the dyadic interplay between patients and MHSs remains limited.</p><p><strong>Objective: </strong>This study aimed to evaluate the mutual influence within patient-MHS dyads on telepresence development during video consultations, using data from a randomized controlled trial assessing the feasibility of video consultations for depression and anxiety disorders in primary care.</p><p><strong>Methods: </strong>The study included 22 patient-MHS dyads (22 patients, 4 MHSs). Telepresence was measured using the Telepresence in Videoconference Scale. Dyadic data were analyzed using the actor-partner interdependence model with a distinguishable dyad structural equation model. Actor effects refer to the impact of an individual's telepresence at time point 1 (T1) on their telepresence at time point 2 (T2), while partner effects represent the influence of one party's telepresence at T1 on the other's telepresence at T2. Sensitivity analyses excluded data from individual MHSs to account for their unique effects.</p><p><strong>Results: </strong>A significant actor effect for MHSs (P<.001) indicated a high temporal stability of telepresence between T1 and T2. In contrast, the actor effect for patients was not statistically significant, suggesting a greater variability between T1 and T2. No significant partner effects for both patients and MHSs were observed, suggesting no mutual influence between dyad members. Age was a significant covariate for telepresence in both groups.</p><p><strong>Conclusions: </strong>Consistent with prior findings, MHSs experienced increased telepresence over time, whereas patients reported high telepresence levels from the start of therapy. The lack of dyadic influence highlights the need for further exploration into factors affecting telepresence development, such as age, technical proficiency, and prior treatment experience. Future studies with larger samples and more sessions are necessary to enhance the generalizability of these findings and to optimize the use of video consultations in mental health care.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e70415"},"PeriodicalIF":5.8,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12338751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876063","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":"A Virtual Reality-Based Cognitive Defusion Application for Youth Depression and Anxiety: Mixed Methods Experimental Study.","authors":"Imogen H Bell, Cassandra Li, Andrew Thompson, Carli Ellinghaus, Shaunagh O'Sullivan, Kate Alexandra Reynolds, Greg Wadley, Yang Liu, Sarah Bendall, John Gleeson, Lucia Valmaggia, Mario Alvarez-Jimenez","doi":"10.2196/70160","DOIUrl":"10.2196/70160","url":null,"abstract":"<p><strong>Background: </strong>Third-wave psychological treatments such as acceptance and commitment therapy can be effective for improving depression and anxiety in youth. However, third-wave therapeutic techniques such as cognitive defusion can be abstract, challenging to learn, and difficult to apply in real-world settings. Translating these techniques into virtual reality (VR) may provide interactive, enjoyable, and concrete learning opportunities, potentially enhancing engagement and effectiveness. This study evaluated a novel VR application that translates the technique of cognitive defusion into a brief, gamified VR experience.</p><p><strong>Objective: </strong>The objectives of this study were to evaluate the feasibility, acceptability, usability, and safety of the VR cognitive defusion application; examine whether it could improve negative thinking and mood states; and understand how it compared to a non-VR cognitive defusion exercise.</p><p><strong>Methods: </strong>In a mixed methods experimental study, 20 young people completed both a VR and audio cognitive defusion exercise in a randomized order within a single session. Quantitative state-based measures were taken before and after each exercise, and a qualitative interview at the end focused on how the two experiences compared.</p><p><strong>Results: </strong>It was feasible to recruit participants, and all participants completed both exercises and assessments. Both the VR and audio exercises were acceptable to participants, with qualitative themes highlighting a preference for VR due to the novel and engaging format; however, there was a need for better guidance and more personalized environments. No severe adverse events were reported, although one participant experienced distress during the VR exercise. Pretest-posttest effects showed improvements in thought discomfort, cognitive defusion, and state anger for both the VR and audio conditions (P<.05), with the latter showing broader improvements, including thought negativity, rumination, tension, depression, distress, and confusion (P<.05).</p><p><strong>Conclusions: </strong>The VR cognitive defusion application was feasible, safe, and acceptable for young people, with potential to enhance mental health treatment through an engaging and enjoyable approach to learning third-wave cognitive behavioral therapy techniques. While VR was preferred by participants, further refinements could improve effectiveness. Future research should focus on enhancing the VR application design based on user feedback, incorporating audio guidance, and conducting a larger trial in real-world settings to thoroughly evaluate the effectiveness and implementation of the VR application.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e70160"},"PeriodicalIF":5.8,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12371279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795904","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":"Video Games and Gamification for Assessing Mild Cognitive Impairment: Scoping Review.","authors":"Yu Chen, Kathrin Gerling, Katrien Verbert, Vero Vanden Abeele","doi":"10.2196/71304","DOIUrl":"10.2196/71304","url":null,"abstract":"<p><strong>Background: </strong>Early assessment of mild cognitive impairment (MCI) in older adults is crucial, as it enables timely interventions and decision-making. In recent years, researchers have been exploring the potential of gamified interactive systems (GISs) to assess pathological cognitive decline. However, effective methods for integrating these systems and designing GISs that are both engaging and accurate in assessing cognitive decline are still under investigation.</p><p><strong>Objective: </strong>We aimed to comprehensively investigate GISs used to assess MCI. Specifically, we reviewed the existing systems to understand the different game types (including genres and interaction paradigms) used for assessment. In addition, we examined the cognitive functions targeted. Finally, we investigated the evidence for the performance of assessing MCI through GISs by looking at the quality of validation for these systems in assessing MCI and the diagnostic performance reported.</p><p><strong>Methods: </strong>We conducted a scoping search in IEEE Xplore, ACM Digital Library, and Scopus databases to identify interactive gamified systems developed for assessing MCI. Game types were categorized according to genres and interaction paradigms. The cognitive functions targeted by the systems were compared with those assessed in the Montreal Cognitive Assessment (MoCA). Finally, we examined the quality of validation against the reference standard (ground truth), relevance of controls, and sample size. Where provided, the diagnostic performance on sensitivity, specificity, and area under the curve was reported.</p><p><strong>Results: </strong>A total of 81 articles covering 49 GISs were included in this review. The primary game types used for MCI assessment were classified as casual games (30/49, 61%), simulation games (17/49, 35%), full-body movement games (4/49, 8%), and dedicated interactive games (3/49, 6%). Of the 49 systems, 6 (12%) assessed cognitive functions comprehensively, compared to those functions assessed via the MoCA. Of the 49 systems, 14 (29%) had validation studies, with sensitivities ranging from 70.7% to 100% and specificities ranging from 56.5% to 100%. The reported diagnostic performances of GISs were comparable to those of common screening instruments, such as Mini-Mental State Examination and MoCA, with some systems reporting near-perfect performance (area under the curve>0.98). However, these findings often stemmed from small samples and retrospective designs. Moreover, some of these systems' model training and validation exhibited substantial deficiencies.</p><p><strong>Conclusions: </strong>This review provides a comprehensive summary of GISs for assessing MCI, exploring the cognitive functions assessed by these systems and evaluating their diagnostic performance. The results indicate that current GISs hold promise for the assessment of MCI, with several systems demonstrating diagnostic performance comparable to establis","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e71304"},"PeriodicalIF":5.8,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144785670","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}