Background Internet-based interventions for perinatal depression reduce depressive symptoms in new and expectant mothers. However, modifiers of their effects, and prognostic factors of adherence, are unknown. Objective To assess modifiers of effectiveness and deterioration, and prognostic factors of adherence in internet-based interventions for perinatal depression. Methods Systematic searches were conducted in three bibliographic databases on February 7, 2025. Two independent researchers identified randomized controlled trials (RCTs) of internet-based interventions for perinatal depression. We conducted conventional and two-stage individual participant data meta-analysis (IPDMA). Results Eighteen studies were eligible, and data from nine (n = 1094 participants) were pooled in IPDMA. We found evidence of a difference in post-treatment depressive symptoms between participants in the internet-based intervention and controls (SMD = 0.29 [95%CI: 0.03–0.54], small effect size), increase in response (RR = 1.97 [95%CI: 1.57–2.47]) and remission (RR = 1.73 [95%CI: 1.38–2.18]). The interventions were effective for anxiety symptoms (SMD = 0.26 [95%CI: 0.11–0.40]) but not for reliable deterioration (OR = 0.80 [95%CI: 0.49–1.32]). No modifiers of effectiveness or deterioration, or prognostic factors of adherence were identified. Baseline depressive symptoms and comorbid anxiety were prognostic factors for higher depressive symptoms at post-treatment. Conclusions Internet-based interventions for perinatal depression are effective for depressive and anxiety symptoms in new and expectant mothers. They may be offered to patients regardless of their age, education, relationship status, employment, baseline depressive or anxiety symptoms, previous treatment, number of children, or ethnic minority status, if they wish to follow them. RCTs should collect more information on factors relevant to the perinatal period, such as partner's mental health and pregnancy complications. Study registration Open Science Framework (https://osf.io/98tms).
Background Understanding and optimizing engagement in digital interventions remains a significant challenge. This study aims to identify different patterns of engagement among users of a digital intervention to reduce cannabis use. Method We conducted a secondary analysis of engagement data from the intervention group of a study on the effectiveness of a digital cannabis intervention (ICan). Engagement patterns were identified through a latent class analysis using eight engagement indicator variables. The bias-adjusted three-step approach was used to examine differences in baseline characteristics across classes and associations with average change-from-baseline scores in cannabis use frequency and quantity. Results Three latent classes were identified: Class 1 (32%), ‘non-engagers’, showed minimal to no engagement; Class 2 (41%), ‘shorter-term engagers’, showed moderate engagement in the intervention, but with a shorter duration than recommended; Class 3 (27%), ‘long-term engagers’, showed high engagement in the intervention with a duration meeting the recommendations. The proportion of males was significantly higher in the ‘non-engagers’ class compared to the others. The ‘long-term engagers’ class reported fewer tobacco use days at baseline compared to the others. No differences were found between classes regarding average change-from-baseline scores in cannabis use frequency and quantity. Conclusions Users of digital interventions show distinct engagement patterns, and characteristics such as male gender and tobacco use may predict sub-optimal engagement. Importantly, also sub-optimal exposure to a digital intervention may be associated with changes in cannabis use, as higher engagement does not necessarily lead to greater effectiveness.
Objective:Depressive and anxiety disorders are highly comorbid and widely prevalent, yet a significant treatment gap remains. Scalable, unguided transdiagnostic internet interventions may increase access to care. This study evaluated the efficacy of two distinct unguided transdiagnostic treatments, internet-delivered cognitive behavioral therapy based on Unified Protocol (UP) and internet-delivered affect-focused psychodynamic therapy (IPDT). Furthermore the study examined the impact of treatment duration and assessed the value of peer support. Method:In a 3 × 2 × 2 factorial design, adults in Sweden with self-reported symptoms of depression and/or anxiety (N = 2477) were randomized to one of three conditions: UP, IPDT, or a waitlist control. Participants were also independently randomized to a treatment duration of 8 or 16 weeks, and to receiving access to a peer discussion forum or no forum access. The primary outcomes were symptom severity of depression and anxiety, while quality of life served as a secondary outcome. Data were analyzed using linear mixed models. Results:Overall, adherence was low, with participants completing fewer than half of the treatment modules on average and high attrition on measurements. At posttreatment, both UP and IPDT resulted in significant reductions in depressive and anxiety symptoms compared to the waitlist control, with small to moderate between-group effect sizes (d = 0.38-0.65). Results remained stable during a 24-month follow-up. Both interventions also led to greater improvements in quality of life than the control condition. Head-to-head comparisons revealed no significant differences in primary outcomes between UP and IPDT. Furthermore, extending the treatment duration from 8 to 16 weeks yielded no significant differences in symptom reduction. Access to a peer discussion forum provided no additional benefit. Conclusions:Unguided transdiagnostic internet interventions can effectively reduce symptoms of depression and anxiety and improve quality of life. Since the 16-week duration provided no added value over the 8-week format, the shorter duration appears sufficient for unguided delivery. However, the low adherence rates suggest that unguided self-help may not be suitable for everyone. The substantial attrition, particularly at follow-up, limits the interpretability of long-term outcomes and highlights the need for strategies to improve engagement in unguided formats. Trial registration:ClinicalTrials.govNCT05016843.
Objective:Childhood trauma (CT) profoundly impacts mental health. Negative attitudes and stigma surrounding mental health and trauma often deter survivors from seeking help. Previous research demonstrated that a brief video intervention significantly reduced stigma and enhanced openness to treatment among CT survivors. Given social media's pervasive role in young people's lives, Instagram offers a promising avenue for delivering evidence-based interventions. This study aimed to test the feasibility and acceptability of disseminating this intervention via Instagram. Methods:Two consecutive campaigns targeted U.S. youth aged 18-24. The first campaign featured a human-narrated personal story video shown to reduce stigma among CT survivors, alongside a psychoeducational control video without social-contact elements. The second campaign aimed to replicate these findings and explore the feasibility of additional videos, including artificial intelligence (AI)-generated videos. We assessed key engagement metrics: impressions (total views), reach (unique viewers), link clicks (engagement with treatment resources), and cost-per-click (CPC) for recruitment. Results:The campaigns generated approximately 997,000 impressions, reaching 387,068 Instagram users, resulting in 6417 link clicks. Using click-through rate (CTR), compared via two-proportion z-tests, as the primary comparative metric, the human-narrated intervention significantly outperformed the control videos on a per-impression basis in both campaigns, and on a per-reach basis against the 'About Me' control in Campaign 2, but not on a per-reach basis in Campaign 1 or against the psychoeducational control in Campaign 2. AI-generated videos showed significantly higher per-reach CTR than the human-narrated intervention in Campaign 2. Conclusion:These findings suggest Instagram's potential to disseminate cost-effective interventions previously shown to reduce negative attitudes toward CT and encourage youth to seek help. Future studies should examine long-term effects on treatment-seeking behaviors in different populations.Clinical trial number: not applicable.
Objective:Burnout is a persistent issue among healthcare professionals, impairing both patient care and provider well-being. This pilot feasibility study evaluated the preliminary effects of a brief, mobile app-based mindfulness training (MT) program, developed using a user-centered design approach, in reducing burnout and improving psychological outcomes among registered nurses and resident physicians. Methods:Two single-arm pilot trials were conducted. Participants completed the digital MT intervention and online assessments at pre-intervention, post-intervention, and one-month follow-up. Study 1 included 27 registered nurses; Study 2 included 29 resident physicians. While the intervention consisted of seven digital modules, the average completion time was 28 days (SD = 15) for nurses and 30 days (SD = 16) for residents, reflecting a self-paced delivery model. The primary outcome was cynicism, with secondary outcomes including emotional exhaustion, anxiety, depression, intolerance of uncertainty, self-compassion, nonreactivity, non-judgment, worry, sleep disturbances, and emotion regulation difficulties. Results:Among nurses, significant reductions were associated with participation for cynicism (27%) and emotional exhaustion (28%), with decreased scores maintained at follow-up. Additional post-intervention improvements included reduced anxiety (46%), depression (52%), worry (7%), sleep disturbances (16%), and emotion regulation difficulties (11%). Increases were also found in self-compassion (13%), nonreactivity (8%), and non-judgment (9%). Among residents, significant reductions in cynicism did not persist after correction for multiple comparisons. However, residents showed significant reductions in emotional exhaustion (19%), anxiety (32%), intolerance of uncertainty (14%), emotion regulation difficulties (13%) and sleep disturbances (15%) at follow-up as well as early increases in self-compassion (21%) and nonreactivity (19%) and reduction in worry (13%). Emotional exhaustion and anxiety were consistently correlated across time points in both groups. Conclusions:These findings replicate and extend previous evidence among physicians, supporting the feasibility and preliminary benefits of brief and self-paced app-based mindfulness training (MT) in addressing burnout and anxiety among both nurses and residents. These pilot results provide a basis for future randomized controlled trials to further evaluate the intervention's effectiveness.
Background:Privacy and data security concerns are frequently cited barriers to the adoption of internet-based interventions. Allowing anonymous use may reduce these barriers, but whether anonymity affects clinical outcomes is unclear. Objective:This study compared an internet-based self-help intervention for social anxiety offering platform-level anonymity with a conventional account-based version and investigated whether anonymity preferences were associated with outcomes. Methods:In this partially randomized patient preference trial, 452 adults with heightened social anxiety symptoms were assigned by randomization or preference to an anonymous or account-based 8-week unguided cognitive behavioral self-help program. Assessments occurred at baseline, post-treatment, and 24-week follow-up. The primary outcome was social anxiety severity, analyzed with mixed-effects models testing superiority of the account-based version. Results:Participants showed substantial reductions in social anxiety symptoms (within-group d = -0.81 to -0.62). The account-based version was not superior in either arm. The post-treatment between-version difference was small (d = 0.09, 95% CI: -0.17 to 0.35) and robust across sensitivity analyses. Secondary outcomes including depressive symptoms and mental quality of life also improved. Improvements were maintained at follow-up. Most participants preferred the account-based version. Exploratory analyses provided no robust evidence of outcome differences by preference or preference match. Discussion:The platform-level anonymous intervention was not outperformed by the conventional account-based program. Because the trial was powered for superiority and included no non-active control, formal equivalence and absolute efficacy remain to be established. Within these limits, the findings provide no evidence that the privacy-protective, account-free design came at the cost of reduced symptom improvement.
Objective:This review examined the design features of digital public health interventions for mental health, sexual health and substance use that may affect equitable reach, engagement, and effectiveness for underserved young people. Materials and methods:We searched MEDLINE, Embase and PsycINFO for relevant systematic reviews published since 2020. We assessed them using the Peer Review of Electronic Search Strategies guidelines. We extracted randomised trials from six reviews and used them to inform searches in PsycINFO and CENTRAL for additional trials. We included mental health, sexual health and substance use interventions delivered solely or primarily through digital technologies to those aged 13-25 from underserved groups. Results:We included 62 trials of 56 interventions. Thirty-eight were sexual health interventions. We identified four coproduction components and six delivery components which may engage young people with interventions and turn knowledge into action. Evidence of effectiveness was strongest for substance use, with mixed or non-significant effects across other behavioural and biological outcomes. Discussion:Similar delivery components were evidenced across all outcome domains and underserved groups, indicating potential synergies in the ways interventions may help young people to navigate these interlinked issues. Coproduction was not well evidenced outside of sexual health interventions and those for sexual and ethnic minoritised youth. Conclusion:Whilst there is some indication of effectiveness for tailored interventions, further evaluations across a broader range of underserved groups are needed. Our framework supports an understanding of how tailored interventions may work for underserved young people that may inform future intervention design and evaluation.
This study evaluated the effectiveness and usability of an app-based CBT program for international students in South Korea. Mind Booster Green, originally developed for Korean college students, was translated and modified for international students. In a randomized controlled trial, 43 eligible participants were assigned to either the intervention group (n = 23) or waitlist control group (n = 20), with online assessments at baseline, post-intervention, and 2-month follow-up. Participants in the intervention group were instructed to complete the CBT sessions independently over 30 days, with adherence monitoring and technical support but no therapeutic guidance, while the waitlist control group maintained their usual routines without access to the intervention. Of the randomized participants, 19 of 23 (82.61%) in the intervention group and all 20 (100%) in the waitlist control group completed assessments at all three time points. Depressive symptoms were specified as the primary outcome, and college life adaptation, negative automatic thoughts, and positive automatic thoughts were examined as secondary outcomes. Generalized estimating equations indicated significant Group × Time interactions for depressive symptoms and negative automatic thoughts, with greater reductions in the intervention group. No significant interactions were found for college life adaptation or positive automatic thoughts. These findings suggest that app-based CBT may provide a feasible approach to delivering evidence-based treatment for depressive symptoms among international students in South Korea.
Background:Digital Mental Health Interventions (DMHIs) that include therapist support achieve higher adherence and greater effectiveness than fully self-help applications. Compared to face-to-face therapy, guided DMHIs can expand access by reducing the amount of therapist time required while still supporting a therapeutic relationship. However, "therapist time" is operationalised inconsistently. Many studies appear to report only direct patient contact (e.g., messaging, calls) or platform-based monitoring, leaving uncertainty about whether other patient-related tasks, such as documentation, are included.This scoping review examined how much therapist or other health-care professional (HCP) time is reported when delivering guided DMHIs or stepped/blended care interventions with a core digital component. A secondary aim was to describe the categories of time allocated. A case study from the Norwegian eTreatment service complemented the review. Methods:Following PRISMA-ScR guidelines, we searched for studies that quantitatively reported therapist or HCP time in guided or blended DMHIs. Eligible studies were in English, used a core digital treatment component with human support, and targeted mental health conditions. Pure self-help apps and teletherapy-only interventions were excluded. Results:Fifty-four studies published between 2005 and 2026 were included. Therapists spent a mean of 214.57 min (3 h 35 m; SD 214.76; range 46-1198; median 146; IQR 142.98) per patient per intervention, with an average program duration of 10.6 weeks. Forty-eight studies quantified only direct patient-related work such as calls, messaging, or platform monitoring. Other time categories were rarely quantified. In the case study, 73.7% of patient-related time occurred outside the platform, including diagnostic interviews. Conclusions:Studies predominantly report direct contact and monitoring, likely underestimating actual time use. Still, guided DMHIs appear to offer meaningful time savings compared to face-to-face therapy. More comprehensive reporting of direct, indirect, and administrative time would better support scaling and implementation.
Objective The present study evaluated the effectiveness of a new online behavioral intervention (Listening type Check) as an extension to an online hearing test, to increase safe ear- and headphone use and change the underlying psychological factors in persons 16–21 years old. Design An intensive longitudinal study with experimental design, using the experience sampling method, measured listening behavior and psychological factors two weeks before and after doing an online hearing test plus Listening type Check (intervention) or hearing test alone (control). Additionally, a process evaluation was performed. Study sample Persons aged 16 to 21 years living in the Netherlands and using head- or earphones for at least one hour per week. Participants (n = 54) were on average 17 years old, 57% was male, and 90% theoretically educated. Results Participants in the two weeks pre-intervention, used ear- or headphones for about 6 days a week, 2 h a day, mostly choosing a sound volume around 60% (on 0–100% scale). A loud volume (i.e. ≥60% when <18 years) was used for 40 min a day. These behaviors and underlying psychological factors did not change in the two weeks after doing the intervention. Conclusions Participation in a new online behavioral intervention plus online hearing test did not increase safe ear- and headphone use or change underlying psychological factors. Participants were primarily theoretically educated and exhibited relatively safe listening behavior at baseline, which may explain the absence of an intervention effect. A new effect study with vocationally educated participants or other high-risk groups is recommended.
Background:Adverse childhood experiences (ACEs) are associated with increased risk for psychopathology and reduced psychosocial functioning across the life course. However, digital selective prevention targeting individuals with a history of ACEs remains scarce. Impairments in emotion regulation and social information processing were confirmed as mechanisms linking ACEs with mental health and potential targets for interventions. This randomised controlled trial evaluated the uptake, efficacy, and differential component effects of the guided FACE app, a theory-based preventive intervention for emerging adults with self-reported ACEs that targets these mechanisms. Methods:Emerging adults (18-24 years) reporting at least one ACE category in a population-based cohort were invited to participate. Of 1514 eligible individuals, 167 (11%) enrolled and were randomised to immediate access to the FACE app or care as-usual with minimal intervention (CAU-MI). The 10-week intervention comprised two transdiagnostic components delivered in a cross-over design: Self- and Emotion Regulation (SER) and Social Skills and Social Information Processing (SSIP). Primary outcomes were resilience and well-being. Secondary outcomes included self-efficacy for managing emotions, social problem-solving, fear of negative evaluation, social avoidance, and self-esteem. Ecological momentary assessments captured real-life affect, burden, resilience, and social distress. Linear mixed models were applied under intention-to-treat and per-protocol principles. Results:Linear mixed models showed significant improvements over time (intervention and CAU-MI) in resilience, self-esteem, self-efficacy for managing emotions, adaptive problem-solving, momentary positive affect. Group × time interaction effects in favour of the app compared to CAU-MI emerged for some more proximal mechanism-related outcomes: self-efficacy for managing emotions, fear of negative evaluation and negative problem orientation but not for resilience and well-being, which were already at normative levels at baseline. Effects were largely maintained at follow-up. Improvements were stronger and more consistent following the SER compared to the SSIP component. Average time of app use was three hours. Conclusions:The FACE app did not improve the primary distal outcomes resilience and well-being beyond the CAU-MI condition. Nevertheless, the FACE app demonstrated modest but consistent improvements in proximal mechanisms associated with ACE-related vulnerability. Findings support the relevance of targeting emotion regulation and social-cognitive processes in digital selective prevention. However, limited uptake highlights challenges in active recruitment of unselected high risk populations and underscores the importance of integrating preventive apps into stepped-care or blended care models. Trial registration:ClinicalTrials.gov NCT05824182.
Background:Blended care can enhance Acceptance and Commitment Therapy (ACT) by combining face-to-face sessions with digital tools. The ACT in Daily Life (ACT-DL) intervention integrates therapy sessions with a smartphone-based Ecological Momentary Intervention to promote psychological flexibility and to transfer ACT into daily life. Aim:This study describes an iterative optimization and evaluation of ACT-DL, in terms of feasibility (i.e., practical implementation), usability (i.e., ease of using ACT-DL), and integration into clinical practice by clinicians. Methods:ACT-DL was optimized using qualitative interviews with clients and resulted in adding a third component: a clinician dashboard to review app data. In a second step, we evaluated ACT-DL 2.0 in an uncontrolled pre-post implementation pilot study with 7 clinicians and 30 clients. Feasibility was assessed using indicators including adoption, attrition, engagement, attendance and adaptability. Usability data were gathered via weekly and post-intervention questionnaires. Integration in care was explored through thematic template analysis of clinician interviews. Results:ACT-DL was feasible, with clients attending on average 6.75 (SD = 7.83) sessions and engaging with 37.3% (SD = 27.16) of the programmed Ecological Momentary Assessment (EMA) questionnaires. Clients and clinicians found several elements usable (e.g. exercises, EMA items), though advanced features such as visualizing data remained challenging. Dashboard complexity, lack of time, limited mastery and client characteristics were barriers to integrating ACT-DL into practice. Conclusion:ACT-DL is feasible, however mixed usability results highlight the need for further optimization and implementation strategies to support clinicians in fully integrating ACT-DL across clinical care contexts.
Background: Women face unique and diverse mental health challenges and therefore require tailored interventions that address their specific needs and lived realities. Research has shown a lack of digital interventions designed for and with women from marginalized backgrounds, such as minority racial/ethnic backgrounds or with low socioeconomic status. If Digital Mental Health Interventions (DMHI) are not designed with active involvement of women from diverse backgrounds, they may fail to reach their public health objectives, which potentially exacerbates existing health disparities. How Human-Centered design methods are applied and reported, and whether women from diverse backgrounds are involved in the design and development of Digital Mental Health Interventions (DMHI), is under-researched. Objective: This study examined the methods and frameworks used in the design and development processes of DMHIs, whether and how studies include women from diverse backgrounds, and whether they tailor to their diverse needs related to intersectional identities (e.g., race/ethnicity, socioeconomic status, age) in the design and development process. Methods: We conducted a scoping review following the PRISMA-ScR guidelines. The databases included are Scopus, PubMed and IEEE Xplore, and the databases are searched from the inception until the 31st of May 2026. We included 77 articles that described the design process of digital mental health solutions for women. Results: Among the 77 reviewed studies, 18 (23.4%) did not explicitly state their design methods, and most of them provided limited information on the characteristics of the included populations. Only 16 (20.8%) studies consistently involved users across all design stages. Intersectional identities were considered in only 26 (33.8%) studies. We observed an overrepresentation of research in higher-income countries, an underrepresentation of women from racial/ethnic minority backgrounds, a narrow age range of participants, and a lack of consideration of intersectional identities. Conclusions: Our findings reveal critical gaps in the development of DMHIs for women, including the superficial reporting and application of Human-Centered Design methods in the design process, limited user involvement, and a lack of consideration of diversity, inclusivity and intersectionality. Future research should emphasize active involvement of end-users from the earliest design phases onwards and adopting an intersectional lens in their design processes. We propose a research agenda for better reporting and applying HCD methods in future DMHI research, towards designing diverse, inclusive and equitable digital solutions for all women. Registry and registry number for systematic reviews or meta-analyses: A protocol of this study is pre-registered at Open Science Framework (DOI 10.17605/OSF.IO/WC79P).
Background:Digital therapeutics (DTx) have the potential to improve the accessibility and personalization of cognitive behavioral therapy (CBT) for panic disorder. However, trials comparing DTx with structured active comparators remain limited. Objective:We evaluated the efficacy and safety of PanicDoc, a mobile app-based DTx for panic disorder, versus structured psychoeducation. Methods:In this open-label randomized trial, 52 patients with panic disorder were randomly assigned to PanicDoc or psychoeducation, both delivered with therapist guidance (n = 26 per group). PanicDoc provided CBT-based modules with algorithm-based personalization over an 8- to 12-week treatment period, whereas the control group received biweekly structured psychoeducation over 12 weeks. The primary outcome was change from baseline in clinician-rated panic severity, assessed using the Panic Disorder Severity Scale (PDSS). Results:The PanicDoc group showed significantly greater improvement in PDSS in the end-of-intervention mixed-effects model for repeated measures (least squares mean difference = -3.71, P = .02). Post-treatment Clinical Global Impression-Improvement also favored PanicDoc over controls (t(39)= - 2.78, P = .008). Among participants allocated to PanicDoc, 21 of 26 (80.8%) completed the program; mean app usage was 47.9 (±39.8) minutes/week. No significant between-group differences were observed on self-reported outcomes, although both groups showed within-group improvements on several secondary measures over time. No serious adverse events were reported. Conclusions:Guided DTx for panic disorder was associated with greater improvement in clinician-rated panic severity than an active psychoeducation control. However, superiority was not observed on self-reported outcomes, and the open-label design with unblinded clinician ratings warrants cautious interpretation.Trial Registration: KCT0009912 (https://cris.nih.go.kr/).
Background:Internet-delivered cognitive behavioral therapy (iCBT) is a scalable approach to address the mental health treatment gap. Its effectiveness for People of Diverse Ethnocultural Backgrounds (PDEGs) remains uncertain due to persistent underrepresentation in research and routine care. Objective:This secondary analysis examined ethnocultural differences in symptom change, engagement, and adherence in a healthcare-embedded iCBT program, and whether engagement or adherence mediated ethnocultural differences in treatment outcomes. Methods:Data from 2604 adults receiving guided iCBT for depression and anxiety through the Online Therapy Unit in Saskatchewan, Canada (February 2020-December 2021) were analyzed. Participants were categorized as White (n = 2281) or PDEGs (n = 323; multiple ethnocultural subgroups). Engagement metrics included logins, therapist messages, and phone contacts. Adherence metrics included lessons completed, program completion (≥4 lessons), and weekly questionnaire submission. Depression and anxiety were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Regression and mixed-effects models compared outcomes across groups, controlling for age, dataset, and baseline symptoms. Exploratory mediation analyses were conducted. Results:Both groups showed significant reductions in depression and anxiety, with no differences in symptom improvement. Engagement was comparable. However, PDEGs were less likely to complete the program. Mediation analyses did not indicate engagement or adherence explained outcome differences. Conclusions:Our findings did not indicate differences in symptom improvement or engagement between White participants and PDEGs, although aggregation due to small subgroup sizes may have obscured subgroup-specific differences. Modest adherence differences and PDEG underrepresentation highlight the need for further research to understand barriers to program completion and equitable access to iCBT.
Background Psychoactive substance use often begins during adolescence, and early initiation increases risks of problematic use and adverse health outcomes. Few evidence-based, technology-supported substance use prevention programs for adolescents exist in Europe. OurFutures (previously Climate Schools) is a web-based substance use prevention program developed in Australia that has been shown to improve substance-related knowledge and strengthen refusal and harm-minimization skills. This study aimed to adapt the OurFutures Alcohol and Cannabis course for German schools and to evaluate its feasibility and preliminary effectiveness. To strengthen the link between prevention and early intervention, the program was connected to the Mobile Online Portal for Questions on Addiction (MOFA), enabling students to access counseling services via chat, email, or telephone. Methods The Alcohol and Cannabis course was adapted for the German school and addiction systems, and the online portal was created. Effectiveness and implementation were assessed in four German secondary schools using a controlled pilot study with quantitative surveys, complemented by exploratory qualitative feedback from a focus group (n = 2) and three individual interviews. Results Analyses of covariance demonstrated that the intervention group's knowledge about alcohol (n = 62) and cannabis (n = 63) increased significantly more than of controls (n = 28 and 31). No significant differences were observed for attitudes or intentions to use. Most students evaluated the Alcohol module positively and relevant. Qualitative findings indicated satisfaction among students and teachers, with suggestions for school implementation. Conclusion This blended-learning program increased substance-related knowledge and may strengthen school-based prevention in Germany. Wider implementation requires coordination between education and addiction systems.
Introduction:Despite the clinical relevance and high prevalence of AjD, there is limited research on psychological treatments for this disorder. The scientific literature suggests that low-intensity interventions, such as blended treatments, could be a promising option given how well they would fit with the characteristics of the disorder. The aim of this study was to analyze the feasibility and potential efficacy of a blended intervention for AjD. Method:An open-label, single-group feasibility trial was conducted. After completing the eligibility assessment, 41 participants with an AjD diagnosis received the blended intervention. This combined a 7-module internet-based CBT intervention with videoconference sessions with a therapist every 12 days. Patients were assessed at four time points: pre-treatment, post-treatment, and at 3- and 12-month follow-ups. Feasibility was assessed both quantitatively and qualitatively, including measures of adherence, satisfaction and expectations, participants' opinions, preferences, therapeutic alliance, and usability. In addition, different clinical measures were included. Results:The treatment proved to be well accepted and valued by the participants, showing high adherence rates, a preference for the blended format, and high expectations, satisfaction, usability, and therapeutic alliance scores. Overall, the participants reported positive opinions, both quantitatively and qualitatively, emphasizing the importance of the therapist's support. The dropout rate was 14.6%. The intervention was effective in improving both primary and secondary measures. Discussion:This blended intervention for AjD appears to be a viable and effective option for addressing the symptomatology of the disorder. The results of this study will aid in the design of future randomized controlled trials. Trial registration:Protocol registration: ClinicalTrials.gov Identifier: NCT05464121. Registered 19 July 2022, https://clinicaltrials.gov/ct2/show/NCT05464121.Protocol publication: https://doi.org/10.1016/j.invent.2024.100715.
Stress is associated with many negative effects, including inadequate sleep, reduced learning and memory, and a higher risk of mental health conditions. Given these effects, it is important to explore effective strategies for stress management and intervention. One promising approach is the use of ecological momentary assessments (EMAs), which allow us to measure an individuals’ experiences in their natural environments, offering valuable data to inform just-in-time adaptive interventions (JITAIs). Machine learning can further enhance JITAIs by forecasting stress-related emotional states, enabling proactive intervention delivery to prevent heightened stress. In this study, we focus on forecasting stress utilizing data from a large mental health project. During this project, EMA data was collected from different vulnerable target groups across Europe, including youth, older adults, migrants, and individuals with low socioeconomic status. We formulated the forecasting task as a binary classification problem: predicting either transitions from normal to elevated stress or the stability of normal stress, based on a person’s stress distribution. This approach simplifies the task, supports personalized predictions, and enables actionable insights, as predicting elevated stress can directly trigger support. Our results demonstrate that machine learning models are capable of forecasting stress transitions (ROC-AUC = 0.70 vs. 0.50 for a random classifier), although predicting transitions to elevated stress proved more challenging than identifying stable normal stress. Models trained on combined data from all populations performed comparable to those trained on individual populations. Furthermore, cross-country evaluations indicated that population-specific models generalized well across most populations.
Chronic pain (CP) disproportionately affects underserved populations who often experience barriers to evidence-based nonpharmacologic treatments. Digital health interventions can address these barriers by providing scalable and accessible CP management resources. However, culturally and linguistically tailored digital interventions are rare, which may limit engagement and effectiveness. The Integrating Nonpharmacologic Strategies for Pain with Inclusion, Respect, and Equity (INSPIRE) intervention combines a tailored mobile app with culturally and linguistically concordant health coaching to deliver cognitive behavioral therapy (CBT), mindfulness-based interventions (MBI), and movement-focused interventions (MFI) for CP management. This manuscript describes the process of linguistically and culturally tailoring the INSPIRE app for three target adult populations—African American/Black, Spanish-speaking Latinx, and Cantonese-speaking Chinese.Iterative tailoring was driven by multiple rounds of stakeholder focus groups followed by generative artificial intelligence (GenAI) and expert review to ensure accuracy and cultural congruence while optimizing limited resources. After initial GenAI content generation in English, the adaptation process began with surface-level adjustments in language translation and cultural representation in visual and audio elements. Deep-level adaptations incorporating culturally rooted values and beliefs about CP were made to address culturally specifically experiences with stigma and bias relevant to CP.This study highlights a replicable, efficient framework for adapting digital health interventions to improve equity and inclusion in CP management by combining AI-driven tools with human expertise to achieve optimal cultural and linguistic adaptations. Future research will evaluate the effectiveness of the INSPIRE intervention in a randomized controlled trial to assess engagement, acceptability, and improved pain outcomes across diverse populations.
Background:Despite the well-documented efficacy of exposure therapy for phobic disorders, its real-world implementation remains limited due to barriers in accessibility, acceptability, and generalization. Objective:This proof-of-concept study examined the feasibility and preliminary effects of a novel gamified augmented reality (AR) intervention designed to support in vivo exposure by embedding playful, non-threatening virtual stimuli into real-world anxiety-provoking contexts. Methods:Twenty individuals with various phobic disorders participated in a multiple-baseline design. At a randomly assigned time point, participants used a smartphone-based AR application, or in some cases, a VR headset version, to interact with virtual game elements within individualized fear-relevant environments. The task involved physically navigating individualized fear-relevant environments while collecting color-coded virtual objects presented via augmented reality within the real-world setting. Results:Linear mixed-effects analyses indicated a significant reduction in self-reported situational fear following the intervention, with a large within-subject effect size estimate (Cohen's d = 2.21). Secondary outcomes related to anxiety sensitivity, agoraphobic cognitions, and depressive symptoms also showed pre-post improvements with small to moderate effect sizes. No significant differences were observed across device types or treatment settings. Conclusion:The findings provide preliminary support for a low-threshold, smartphone-based AR approach that may complement exposure-based interventions in naturalistic settings. However, given the small and heterogeneous sample and the absence of a control group, these results should be interpreted cautiously. Future randomized controlled studies with larger and more homogeneous samples, validated behavioral outcome measures, and follow-up assessments are needed to clarify efficacy, mechanisms of change, and long-term effects.
