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

A protocol for a pilot randomised controlled trial of unguided internet cognitive behaviour therapy for grief in adolescents
Egan SJ, Munro C, Pauley-Gadd SB, O'Brien A, Callaghan T, Payne N, Raghav S, Myers B, Hall C, Wilson H, Eisma MC, Boelen PA, Smith KV, Wild J, Duffy M, Trickey D, Bills E and Breen LJ
Grief is highly prevalent in adolescents, however, there have been no studies investigating internet delivered cognitive behaviour therapy for grief in adolescents (ICBT-G-A). In this paper, the co-design of an unguided ICBT-G-A intervention is described, and a protocol outlined for a pilot randomised controlled trial of the intervention. Participants will be randomised to the intervention (delivered via eight modules over a four-week period) or a four-week waitlist control. Intervention participants will complete a follow-up assessment at one-month post-intervention (eight weeks from the pre-intervention assessment). The intervention outcomes assessed at pre-intervention, post-intervention and follow-up include wellbeing and symptoms of anxiety, depression, post-traumatic stress, and prolonged grief. User feedback on experiences and acceptability of the intervention will be sought and feasibility assessed via programmatic data on recruitment and attrition.
Preferences and perceived barriers for internet-based treatment among adolescents with anxiety or depressive disorders: A qualitative study
Emmelkamp J, Wisman MA, Nauta MH, Van Rijn NIE, Dekker JJM and Christ C
Over the past two decades, the development of internet-based treatments for adolescents with anxiety and depressive disorders has advanced rapidly. To date, adolescents' preferences and perceived barriers for internet-based treatment remain largely unknown, especially in clinical samples. Therefore, this study explored the preferences and perceived barriers of adolescents with anxiety or depression regarding internet-based treatment.
Making the most out of timeseries symptom data: A machine learning study on symptom predictions of internet-based CBT
Hentati Isacsson N, Zantvoort K, Forsell E, Boman M and Kaldo V
Predicting who will not benefit enough from Internet-Based Cognitive Behavioral (ICBT) Therapy early on can assist in better allocation of limited mental health care resources. Repeated measures of symptoms during treatment is the strongest predictor of outcome, and we want to investigate if methods that explicitly account for time-dependency are superior to methods that do not, with data from (a) only two pre-treatment timepoints and (b) the pre-treatment timepoints and three timepoints during initial treatment.
The effects of digital nature and actual nature on stress reduction: A meta-analysis and systematic review
Fan L and Baharum MR
The study aims to conduct a systematic literature review and meta-analysis to assess the effects of digital nature and actual nature on stress reduction.
Human centered design of AI-powered Digital Therapeutics for stress prevention: Perspectives from multi-stakeholders' workshops about the SHIVA solution
Bolpagni M, Pardini S and Gabrielli S
AI-powered Digital Therapeutics (DTx) hold potential for enhancing stress prevention by promoting the scalability of P5 Medicine, which may offer users coping skills and improved self-management of mental wellbeing. However, adoption rates remain low, often due to insufficient user and stakeholder involvement during the design phases.
Evaluation of the impact of a digital care navigator on increasing patient registration with digital mental health interventions in routine care
Jaso-Yim B, Eyllon M, Sah P, Pennine M, Welch G, Schuler K, Orth L, O'Dea H, Rogers E, Murillo LH, Barnes JB, Hoyler G, Peloquin G, Jarama K, Nordberg SS and Youn SJ
Less than half of adults with mental health disorders in the United States receive appropriate or timely care. Digital Mental Health Interventions (DMHIs) have the potential to bridge this gap. However, real-world adoption of DMHIs is impeded by patient and provider-level technological barriers. Care navigators have the potential to address these challenges by providing technical support and enhancing patients' experience with DMHIs.
Psychotherapy 2.0 - Application context and effectiveness of sensor technology in psychotherapy with children and adolescents: A systematic review
Alt AK, Pascher A, Seizer L, von Fraunberg M, Conzelmann A and Renner TJ
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.
The Sleep Course: An inclusive trial examining the feasibility, acceptability, and preliminary efficacy of a digital sleep intervention for adults with self-reported sleep difficulties
Scott AJ, Hathway T, Bisby MA, Titov N and Dear BF
Cognitive Behavioural Therapy for Insomnia (CBTi) is a well-established first-line treatment for insomnia and sleep difficulties, yet numerous barriers hinder its widespread adoption. One potential criticism of the existing evidence base for CBTi is that many trials exclude participants that would commonly be seen in in primary care, such as those aged over 65, with comorbid health conditions, or prescribed sleep medication. The current pilot study therefore aimed to assess the acceptability and efficacy of a brief, digitally delivered sleep intervention, the Sleep Course, using a broad range of participants. Participants ( = 74) completed the 6-week, 4-lesson intervention alongside measures of sleep disturbance, sleep-related impairment, depression, anxiety and sleep-wake patterns (via sleep diary). Generalized estimating equations analysis modelled change in participants' outcomes from pre- to post-treatment and 3-month follow-up, and subgroup analyses explored the role of possible moderators (e.g., age over 65, co-morbidities, and concurrent prescription medication use). The intervention was associated with good rates of satisfaction (79 %) and lesson completion (70 %). Results showed significant and large reductions in insomnia, sleep disturbance and associated symptoms (e.g.,  = 1.06-1.37 change in insomnia symptoms). Evidence of high acceptability and clinical improvement was found irrespective of age, physical comorbidity, and sleep medication use. However, there was evidence of less improvement among those taking medications or having tried psychological treatment in the past. These results provide strong preliminary evidence for the intervention as an acceptable, efficacious and scalable treatment for a broad range of participants with sleep difficulties. Larger randomised controlled trials are needed.
Online social platform engagement by young treatment seekers in a digital vaping cessation intervention: Effects on confidence in the ability to quit vaping and vaping abstinence
Do EK, Cha S, Tulsiani S, Edwards G, Yu LQ, Amato MS, Jacobs MA and Hair EC
The evidence-based vaping cessation program, This is Quitting (TIQ), has been found to be effective in promoting abstinence among young people who use e-cigarettes.
Effectiveness and prediction of treatment adherence to guided internet-based cognitive behavioral therapy for health anxiety: A cohort study in routine psychiatric care
Österman S, Axelsson E, Forsell E, Svanborg C, Lindefors N, Hedman-Lagerlöf E and Ivanov VZ
Health anxiety, also known as hypochondriasis, is a common psychiatric disorder which leads to considerable distress and is associated with high societal costs. Internet-based cognitive behavioural therapy (ICBT) for health anxiety has demonstrated efficacy in randomized controlled trials (RCTs), but there is limited knowledge regarding its effectiveness in real-world settings. This study aimed to evaluate the clinical effectiveness of guided ICBT for health anxiety in routine psychiatric care, including symptom change, treatment adherence, and potential negative effects. Additionally, we explored predictors of treatment adherence.
Internet-based cognitive behavioural therapy for insomnia comorbid with chronic benign pain - A randomized controlled trial
Bothelius K, Jernelöv S, Kaldo V, Lu C, Stråle MM and Jansson-Fröjmark M
Comorbid sleep disturbances are common among individuals with chronic pain, and Cognitive Behavioural Therapy for Insomnia (CBT-i) has proven effective for such individuals. Nonetheless, research on web-based CBT-i tailored for patients with both chronic pain and insomnia is limited. This study aimed to evaluate the feasibility and efficacy of internet-based CBT-i and to explore potential mechanisms underlying treatment outcomes.
Evaluating the web-based 'Partner in Balance' program for informal caregivers of people with Huntington's disease: A pilot study
Daemen MMJ, Boots LMM, Oosterloo M, de Vugt ME and Duits AA
Huntington's disease (HD) poses significant challenges for both affected individuals and their informal caregivers. With the progression of HD, caregivers frequently prioritize caring for the person with HD over their own well-being. 'Partner in Balance' (PiB) is an 8-week online self-management program guided by a personal coach, developed to help caregivers of people with HD cope with challenging situations and develop skills to increase resilience and prevent overburdening.
Are there unique facets of therapeutic alliance for users of digital mental health interventions? An examination with the eHealth Therapeutic Alliance Inventory
Ashur O, Saar CR, Brandes O and Baumel A
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 (  ≥ 0.23,  < 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 ( = 0.29,  = 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  > 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.
Change processes in cognitive therapy for social anxiety disorder: A comparison of face-to-face and internet-based treatment formats
Thew GR, Ehlers A and Clark DM
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.
How the COVID-19 pandemic reshaped telepsychology: Insights from an Italian survey
Ruggiero F, Zirone E, Mellace D, Capetti B, Molisso MT, Ferrucci R, Barbieri S, Di Guida L, Pizzo S and Mameli F
The coronavirus disease 2019 (COVID-19) pandemic rapidly boosted the introduction of certain changes in mental healthcare services, consequently driving up the adoption of remote care delivery options. We conducted an online Italian survey to evaluate telepsychology use, attitudes, acceptance, and training needs, as well as to understand patient-professional interactions in video-consultations, aiming to inform future mental healthcare practices and policies. The current study's survey responses were collected using an anonymous, self-reported questionnaire on the 'REDCap' platform from 25 October 2022 to 26 July 2023. In total, 128 mental health professionals and 113 patients completed the survey. In our sample, 69 % of patients and 79.7 % of mental health professionals reported having used telepsychology during COVID-19 pandemic; in particular, 84.6 % of patients and 95.1 % of professionals selected video-consultation modality. Data showed that participants expressed high satisfaction with this communication tool. The increase in satisfaction was directly proportional to increase in the quality of interactions and in relation to the quality of the experiences. The critical factors influencing the video-consultation experience include communication style, information completeness, patient-centredness, and the comfort underscoring the central role of the professional-patient relationship, which, substantially, remains a key element in the psychological treatment process. These findings reinforce the need for continued refinement and expansion of telepsychology services, thus highlighting the potential for integrating innovative technologies into mental health practise.
The therapeutic alliance in blended versus face-to-face cognitive behavioral therapy for adolescents and young adults with a depressive disorder
van Seters MLFM, Rasing SPA, Huvenaars MJ, Vermulst A, Bodden DHM and Stikkelbroek YAJ
A depressive disorder during adolescence is a serious and disabling disorder, which has a high impact on the development of adolescents. Blended treatment, combining online and face-to-face sessions, is effective and can reduce some of the barriers for adolescents to use mental health care. There is a lack of knowledge about whether therapeutic alliance is established in blended treatment for adolescents and young adults suffering from a depressive disorder. This study examines whether the quality of the therapeutic alliance differs when cognitive behavior therapy (CBT) is delivered in combination with online intervention (b-CBT) compared to solely face-to-face (FtF-CBT) and the extent to which a stronger therapeutic alliance is associated with better treatment outcome.
Experiences of digital physiotherapy during pregnancy and after childbirth: A qualitative study
Johnson F, Frygner Holm S and Hess Engström A
Pelvic girdle pain, low back pain, and pelvic floor dysfunction can affect women's mobility, quality of life, and well-being during pregnancy and the postpartum period. Digital interventions for treating perinatal depression and lifestyle changes have been studied. Research on digital physiotherapy for musculoskeletal issues related to pregnancy and the postpartum period is sparse.
Predictors of participant compliance with ecological momentary assessment among individuals with chronic pain who are using cannabis and opioids
Joo J, Devkota J, Stone BM, Dunn KE, Zipunnikov V, Vandrey R, Finan PH and Thrul J
Cannabis may be an alternative or adjunct to opioid therapy for chronic pain. However, there are limited data on patterns of opioid medication and medical cannabis use. The current study investigated the feasibility of using Ecological Momentary Assessment (EMA) to assess patterns of prescription opioids and medical cannabis among individuals experiencing chronic pain.
A web step-based digital solution's impact on physical, cognitive and psychosocial functioning of community-dwelling older adults: A mixed methods randomized and controlled trial
Silva AG, Martins AI, Andias R, Nery E, Silva T, Ribeiro Ó, Santinha G and Rocha NP
As the population ages, innovative responses are urgently needed to promote physical activity at scale. Thus, this study investigated whether a step-based activity mediated by a digital solution impacts the physical functioning of community-dwelling older adults. The secondary aims were to assess whether the same activity impacts cognitive and psychosocial functioning and explore participants' views towards the activity.
Corrigendum to "An early economic evaluation of Kooth, a web-based mental health platform for children and young people with emerging mental health needs" [Internet Interv. 36 (2024) 100748 10.1016/j.invent.2024.100748 (Published online 2024 May 11)]
Coote L, Kelly L, Graham C, Curtis-Gretton L, Green M, Salhi L, de Ossorno Garcia S, Sefi A and Holmes H
[This corrects the article DOI: 10.1016/j.invent.2024.100748.].
Editorial for INVENT special issue of the ISRII 2022 meeting
Chow PI, Buntrock C and van de Ven P