Digital health literacy is increasingly vital for equitable healthcare, yet adults aged 45+ may face age-related and psychosocial barriers that limit digital engagement. Interventions targeting these barriers are crucial. This review mapped the design and effectiveness of current digital health literacy interventions for adults 45+ years, assessing how they addressed biological, psychological, and social (biopsychosocial) dimensions and key outcomes. The review followed Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Five databases were searched for English-language studies published between 2015 and 2025. Twenty-four studies met inclusion criteria, comprising randomized controlled trials, quasi-experimental studies, qualitative research, and systematic and scoping reviews. Data were synthesized and thematically mapped against biopsychosocial dimensions and effectiveness outcomes, including competence, critical thinking, empowerment, sustained engagement, and health outcomes. Most interventions were associated with improvements in digital skills, confidence, and self-efficacy, particularly when delivered face-to-face, in small groups, or through blended formats. However, most focused on psychological factors, with biological and social dimensions addressed inconsistently. Only one study incorporated all three biopsychosocial dimensions, and none assessed all effectiveness outcomes simultaneously. There was limited evidence for improvements in sustained engagement, critical thinking, and longer-term health outcomes following intervention. Digital health literacy interventions for adults aged 45+ years may therefore benefit from extending beyond a focus on technical skills to address the broader range of age-related biopsychosocial barriers. In this context, a biopsychosocial-digital framework appears to offer a more comprehensive foundation for the design and evaluation of interventions aimed at supporting meaningful and sustained health outcomes.

This paper proposes a hierarchical time-based framework for wide-ranging domains of mental activity, emotion, and behavior. Expanding on an integrated model of cognitive and emotional intelligence (i.e., Systema Temporis) that ranged up to the timescales of human memory (cf. decades), the current approach incorporates longer timescales relevant to sociocultural and biological evolution (cf. up to millions of years). Extended timescales are drawn from the Hierarchically Mechanistic Mind (HMM) model of the embodied human brain that proposes a temporal basis for four ontological levels of description, namely adaptation, phylogeny, ontogeny, and mechanism. The resulting model (i.e., Systema Psyches) furnishes real-time processes of the HMM with theoretical details relevant to cognitive and emotional intelligence. The hierarchical structure is also amenable to further theoretical assignment within domains of integrative personality as described by the New Big Five, namely the role of culture, development, trait psychology, and biological structure. An example is given of how Systema Psyches can be applied using predictive processing to differentiate mental disorders such as depression and autism.

The integration of digital mental health interventions (DMHIs) into mainstream mental health services can reduce access barriers for young people and enhance client outcomes. To support effective implementation of DMHIs into routine care, it is vital to understand the factors supporting their uptake. This study aimed to better understand how Australian mental health professionals currently use DMHIs in their personal and professional practice, and how they select effective, evidence-based interventions. An overview of a proposed DMHI platform for children and adolescents was disseminated to mental health professionals from hospital, community, education and crisis support hotline settings. Participants (n=87) then completed a mixed methods survey, exploring relevant domains of the Consolidated Framework for Implementation Research. Quantitative data (electronic-therapy attitudes and process questionnaire, bespoke items) were summarised descriptively and compared between organisation types. Open-ended questions were examined via qualitative content analysis. Survey results indicate strong support for DMHIs; 78% of participants incorporated DMHIs into clinical practice, and 86% had recommended DMHIs to friends, family and colleagues. Common reasons for recommending DMHIs to clients were utility for monitoring symptoms, providing support, and offering another source of information. When selecting DMHIs, the minority of participants independently sought out research evidence. More often, participants relied on endorsements from their workplace and trusted third parties, the source of the intervention, or self-assessment of intervention quality. Assessing client and family needs, preferences and feedback was the most common strategy for determining if interventions were effective for young people. While DMHIs are commonly used and recommended by mental health professionals, there is variation in how practitioners assess and select appropriate and effective interventions. Findings highlight the importance of strategically communicating evidence of intervention efficacy. Disseminating evidence via commonly accessed platforms may support improved evidence-informed decision making when selecting DMHIs in clinical practice.

[This corrects the article DOI: 10.1016/j.lanwpc.2025.101685.].

BackgroundChronic diseases represent a significant global burden, accounting for 85% of the total disease burden in Australia. This burden is particularly pronounced in rural areas, where chronic disease rates are higher, and access to health care services is more limited. Digital technology has the potential to address these disparities by overcoming challenges such as workforce shortages and geographic isolation. ObjectiveOur objective is to develop a digital health platform (DHP) to support the monitoring and management of chronic disease in collaboration with rural and regional stakeholders, including researchers, health care providers, and patients. The platform is being designed to be flexible, enabling applications across a range of chronic health conditions relevant to rural contexts. MethodsGuided by implementation science methodologies, we are adopting an evidence-based approach to developing a DHP for chronic disease management. Informed by co-design frameworks and best-practice guidelines, our development plan comprises three key phases: (1) stakeholder needs analysis, (2) co-design and platform development, and (3) postdesign evaluation and testing. The Federation University Human Research Ethics Committee (HREC Ref: 2023/169) granted ethics approval for this study. ResultsData collection is underway. The phase 1 review has been completed, and we have 84 survey responses. Phase 2 has commenced, with 9 workshops and 2 interviews conducted to date. Phase 3 will not commence until phase 2 has been completed. At this stage, project completion is anticipated by late 2026. ConclusionsFindings will inform the desirability, feasibility, and acceptability of co-designed DHPs for chronic disease management in rural Australia. Further, the study will contribute to the evidence base on collaborative, context-sensitive digital health innovation for resource-limited populations. International Registered Report Identifier (IRRID)DERR1-10.2196/77844

BackgroundSymptoms of insomnia, nightmares, and trauma are highly prevalent. However, there are significant barriers to accessing evidence-based treatments for these conditions, leading to poor mental health outcomes. ObjectiveThis pilot trial evaluated the feasibility of a 4-week, digital self-paced intervention combining cognitive behavioral therapy for insomnia and exposure, relaxation, and rescripting therapy for nightmares in survivors of wildfires from Australia, Canada, and the United States. MethodsStudy participants were recruited between May 2023 and December 2023 through social media platforms, workshops, conferences, and radio interviews. Participants had to meet at least one of the following criteria: a score of ≥8 on the Insomnia Severity Index, a score of ≥3 on the Nightmare Disorder Index, or a score of ≥31 on the PTSD Checklist for DSM-5. In total, 30 survivors of wildfires were allocated to either the treatment group (n=16, 53%) or the waitlist control group (n=14, 47%) in a sequential manner. Participants’ ages ranged from 18 to 79 years, with a mean age of 52.50 (SD 16.26) years. The cohort consisted of 63% (19/30) female and 37% (11/30) male participants. Participants also completed self-report secondary outcome measures, including the Generalized Anxiety Disorder–7, the Patient Health Questionnaire–9, and the Pittsburgh Sleep Quality Index, via the HealthZone digital platform. Assessments were conducted at baseline, the posttreatment time point, and the 3-month follow-up, with the waitlist group undergoing an additional assessment at the pretreatment time point, after 4 weeks of waiting and before crossing over to treatment. This study used intention-to-treat analysis as a primary analysis and per-protocol analysis as a secondary analysis. ResultsMixed-effects linear regression models and difference-in-differences analyses were used to assess the intervention’s effects. The intention-to-treat analysis revealed significant improvements over time (main effect of time), with a 1.64-point reduction (P=.001) on the Nightmare Disorder Index and 10.64-point reduction (P=.009) on the PTSD Checklist for DSM-5 at the postintervention time point. No significant changes were observed in insomnia symptoms. On the secondary measures, there was an interaction effect of condition × time, with a 2.22-point reduction (P<.001) on the Pittsburgh Sleep Quality Index, and a main effect of time, with a 6.48-point reduction (P<.001) on the Patient Health Questionnaire–9. No changes were detected on the Generalized Anxiety Disorder–7. The per-protocol analysis yielded comparable results for both the primary and secondary measures. ConclusionsThe findings of this pilot trial demonstrated a reduction in nightmares and trauma symptoms. Future research studies should aim at evaluating the intervention in a more definitive trial with a larger sample size. Trial RegistrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623000415606; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385054

This paper presents a model of the commercial determinants of health in the context of gambling-related harm, suicidality and suicide. It outlines the ways the gambling ecosystem undermines suicide prevention efforts by driving harmful engagement with gambling. Using the dominant, orthodox discourse of ‘responsible gambling’, the ecosystem relies on the effects of addiction to underpin, sustain, and grow its power. Attempts to introduce effective interventions to prevent gambling-related harms are often blocked by the gambling ecosystem actors, using an evidence base that is biased by its focus on individual level causation and the attendant ‘responsible gambling’ responses. This emphasis on individual responsibility diverts attention from the practices of the industry, generates stigma and shame for those harmed, downplays serious harms caused by gambling, and contributes to the suicide toll. As most gambling activity is unrecorded, and systems for monitoring harms are underdeveloped, the true extent of these consequences have been largely invisible. This makes it more difficult to hold governments to account to regulate and prevent gambling-related harms, including suicidality and suicide. With growing evidence of harms linked to gambling, including suicide and increasing public concern, we present measures that could be adopted to disrupt these determinants and improve accountability to prevent harms and save lives.

Importance:Despite the availability of effective interventions, fear of cancer recurrence (FCR) remains a prevalent concern among cancer survivors, underscoring the need for approaches that balance accessibility (eg, an online program with asynchronous therapist guidance) with engagement and effectiveness. Objective:To evaluate the efficacy of a 10-week therapist-guided (TG) e-health intervention, TG-iConquerFear, to reduce FCR in colorectal cancer (CRC) survivors. Design, Setting, and Participants:This single-site, Danish population-based randomized clinical trial enrolled cancer-free adult CRC survivors aged 18 years or older from May 8, 2023, to April 8, 2024, with clinical FCR (FCR Inventory-Short Form [FCRI-SF] score ≥22). Eligible participants had completed curative-intent CRC treatment between March 1, 2014, and December 31, 2018. Follow-up was 6 months. Interventions:Participants were randomized 1:1 (stratified by age and sex) to receive TG-iConquerFear or augmented control. TG-iConquerFear comprised 6 modules with written therapist guidance delivered remotely, individually, and asynchronously as needed over 10 weeks. Augmented control was a diagnostic interview and referral to a webpage with self-help mindfulness exercises. Main Outcomes and Measures:The primary outcome was change in FCRI total score at 3 months postintervention, analyzed according to intention-to-treat. Results:Of 9946 eligible CRC survivors, 103 with clinically significant FCR were randomized. Prior to the intervention, 2 were excluded due to cancer and 6 dropped out. Of the remaining 95 participants (median age, 63 [IQR 57-72] years; 60 [63%] female; median time since diagnosis, 7 [IQR 6-9] years), 42 were analyzed in the TG-iConquerFear group and 53 in the augmented control group. Intervention participants completed a mean (SD) of 4.5 (1.9) of 6 modules. Total FCRI score decreased significantly from baseline to 3 months in the TG-iConquerFear group (mean change, -21.7 [95% CI, -30.1 to -13.3] points) but not in the control group (mean change, -2.6 [95% CI, -7.8 to 2.6] points). This represents a between-group difference of 19.1 (95% CI, 10.0-28.3) points (P < .001) and a standardized effect size (Cohen d) of 0.62 (95% CI, 0.13-1.10). A significantly higher proportion of TG-iConquerFear participants had FCRI-SF scores below the cutoff for clinical FCR at 3 months postintervention compared with self-help participants (22 of 27 [81%] vs 18 of 42 [43%]; P = .002). The number needed to treat was 3. Conclusions and Relevance:In this randomized clinical trial, TG-iConquerFear intervention participants reported a significant and clinically meaningful reduction in FCR compared with the control group, suggesting an e-health intervention may expand the range of FRC treatment options beyond face-to-face interventions. Trial Registration:ClinicalTrials.gov Identifier: NCT04287218.

Therapist-guided eHealth interventions have been shown to engage users more effectively and achieve better outcomes than self-guided interventions when addressing psychological symptoms. Building on this evidence, this viewpoint aimed to describe the adaptation of iConquerFear, a self-guided eHealth intervention targeting fear of cancer recurrence, into a therapist guided version (TG-iConquerFear) tailored specifically for survivors of colorectal cancer (CRC). The goal was to optimize patient outcomes while minimizing the need for extensive resources. The adaptation process followed the Information System research framework, which facilitated a systematic integration of knowledge and iterative testing. Drawing on insights from the original iConquerFear development, as well as feedback from end users, oncologists, and therapists, we began by identifying areas for improvement. These insights formed the foundation for the first design cycle. Initial internal testing revealed the need for several adjustments to enhance the intervention. While the core concept of iConquerFear remained unchanged, we made significant modifications to improve access by optimizing the platform for mobile devices, to support adherence by expanding the exercises, and to equip therapists with tools such as reflective questions and a monitoring control panel. External field testing with 5 survivors of CRC provided further validation. Participants reported a high level of acceptability, and their feedback guided additional minor points to consider incorporating in future versions. This study illustrates how a self-guided eHealth intervention can be successfully adapted into a therapist-guided format for fear of cancer recurrence, tailored to meet the needs of survivors of CRC. The described approach serves as a valuable framework for integrating therapist guidance into similar interventions, ensuring their relevance and effectiveness for targeted populations.

12004 Background: Despite the availability of effective interventions, fear of cancer recurrence (FCR) remains a prevalent and significant concern among cancer survivors, underscoring the need for more accessible and scalable approaches. This trial assessed the effectiveness of a therapist-guided eHealth intervention, TG-iConquerFear. Methods: This parallel randomized controlled trial (ClinicalTrial.org #NCT04287218) enrolled Danish colorectal cancer survivors (CRCS) who had completed curative-intent primary treatment between March 2014 and December 2018, were aged ≥ 18 years, and reported Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF) scores ≥22 (i.e. clinical FCR). After diagnostic interview, eligible participants were randomized to TG-iConquerFear (intervention) or a webpage with self-help mindfulness exercises (augmented control) in a 1:1 ratio. The 10-week TG-iConquerFear program comprised six modules with written therapist guidance delivered asynchronously. Follow-up questionnaires were administered at two weeks (T1), three months (T2), and six months (T3) post-intervention. The primary outcome was predefined as the difference in the change scores of the total FCRI score at T2, analyzed as intention-to-treat. Secondary outcomes were anxiety, depression, emotional distress, health-related quality of life (HrQoL) and physical symptom burden. Pre- and post-intervention mean within and between groups were pairwise compared using Student’s t-test. Results: Of 9,946 eligible CRCS, 5,515 (55.4%) completed FCR screening, and 299 (5.4%) CRCS reported clinically significant FCR (FCRI score ≥ 22). Among them, 221 (73.9%) expressed interested in FCR treatment, and 103 (46.6 %) were randomized to TG-iConquerFear (n = 49) or control (n = 54). Main reasons for non-randomization included new cancer diagnoses or FCR not affecting everyday life. Participants completed 4.5 modules on average, and 55% completed the intervention. Baseline total FCRI score was 84.6/168 in both groups. Total FCRI score decreased more from baseline to T2 in the TG-iConquerFear group (mean -21.7, 95% CI [-30.1, -13.3]) compared to the augmented control group (mean -2.6 95% CI [-7.8, 2.6]). This represents a between-group difference at T2 of 19.1 (95% CI [10.0, 28.3], p < 0.001) corresponding to a standardized effect size (Cohen’s d ) of 0.62 (95% CI [0.13 - 1.1]). A higher proportion of TG-iConquerFear participants were in the non-clinical range at T2 compared to control participants (81.5% vs. 42.9%, p = 0.002). Statistically significant differences favoring the intervention group were observed across all secondary outcomes. Conclusions: The TG-iConquerFear intervention demonstrated a statistical and clinically significant reduction in fear of cancer recurrence in a population of long-term CRCS. The effects were sustained at six months post-intervention. Clinical trial information: NCT04287218 .

Despite the availability of effective interventions, fear of cancer recurrence (FCR) remains a prevalent concern among cancer survivors, underscoring the need for approaches that balance accessibility (eg, an online program with asynchronous therapist guidance) with engagement and effectiveness. To evaluate the efficacy of a 10-week therapist-guided (TG) e-health intervention, TG-iConquerFear, to reduce FCR in colorectal cancer (CRC) survivors. This single-site, Danish population–based randomized clinical trial enrolled cancer-free adult CRC survivors aged 18 years or older from May 8, 2023, to April 8, 2024, with clinical FCR (FCR Inventory–Short Form [FCRI-SF] score ≥22). Eligible participants had completed curative-intent CRC treatment between March 1, 2014, and December 31, 2018. Follow-up was 6 months. Participants were randomized 1:1 (stratified by age and sex) to receive TG-iConquerFear or augmented control. TG-iConquerFear comprised 6 modules with written therapist guidance delivered remotely, individually, and asynchronously as needed over 10 weeks. Augmented control was a diagnostic interview and referral to a webpage with self-help mindfulness exercises. The primary outcome was change in FCRI total score at 3 months postintervention, analyzed according to intention-to-treat. Of 9946 eligible CRC survivors, 103 with clinically significant FCR were randomized. Prior to the intervention, 2 were excluded due to cancer and 6 dropped out. Of the remaining 95 participants (median age, 63 [IQR 57-72] years; 60 [63%] female; median time since diagnosis, 7 [IQR 6-9] years), 42 were analyzed in the TG-iConquerFear group and 53 in the augmented control group. Intervention participants completed a mean (SD) of 4.5 (1.9) of 6 modules. Total FCRI score decreased significantly from baseline to 3 months in the TG-iConquerFear group (mean change, −21.7 [95% CI, −30.1 to −13.3] points) but not in the control group (mean change, −2.6 [95% CI, −7.8 to 2.6] points). This represents a between-group difference of 19.1 (95% CI, 10.0-28.3) points ( P < .001) and a standardized effect size (Cohen d ) of 0.62 (95% CI, 0.13-1.10). A significantly higher proportion of TG-iConquerFear participants had FCRI-SF scores below the cutoff for clinical FCR at 3 months postintervention compared with self-help participants (22 of 27 [81%] vs 18 of 42 [43%]; P = .002). The number needed to treat was 3. In this randomized clinical trial, TG-iConquerFear intervention participants reported a significant and clinically meaningful reduction in FCR compared with the control group, suggesting an e-health intervention may expand the range of FRC treatment options beyond face-to-face interventions. ClinicalTrials.gov Identifier: NCT04287218

The trauma of wildfires leads to one of the most challenging and treatment resistant mental health conditionsnamely-post-traumatic stress disorder (PTSD). Research addressing the contribution of pre-existing mental health conditions to the development of PTSD symptoms following traumatization by wildfires is limited. This study examined whether people with pre-existing diagnoses of anxiety, depression, PTSD, insomnia and nightmares, by a mental health professional, are more likely to develop symptoms of PTSD than those with no previous diagnosis following the trauma of wildfires. A total of 126 wildfire survivors from Australia, Canada and the United States of America completed an online survey. An independent sample t-tests revealed that pre-existing diagnosed conditions of depression, an anxiety disorder and PTSD significantly increased the likelihood of developing PTSD symptoms following traumatization by wildfires (t = -2.51, p = 0.014, 95% CI [-18.91 to -2.20], t = - 2.61, p = 0.01, 95% CI [-18.91 to -2.57], t = -2.57, p = 0.012, 95% CI [-22.36 to -2.87] respectively). Practitioners working in communities subjected to wildfires need to run a thorough screening of their patients' pre-existing mental health conditions to provide the right treatment and referral pathways to those affected by the trauma of wildfires.

Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools.

The purpose of this article is to qualitatively explore participant and therapist experiences of the therapeutic alliance, perceived benefits, challenges, and areas for improvement when using video chat as a mode of therapist assistance within an adaptive digital mental health intervention. In total, 74 semistructured interviews were completed with participants and therapists who participated in an adaptive clinical trial. The participant interviews explored experiences of attending a clinical assessment via video chat and experiences of receiving low- or high-intensity therapist assistance via video chat. Interviews completed with therapists explored their experience of administrating a clinical assessment tool and delivering therapist assistance, both via video chat. Reflexive thematic analysis identified four themes: using video chat, characteristics of therapeutic relationships, task-specific experiences, and utility and adoption of video chat. Both participants and therapists were able to adapt to the modality of video chat and develop positive therapeutic alliances. They reported satisfaction with video chat for conducting clinical assessments and delivering therapist assistance. Concerns were identified by both participants and therapists with low-intensity therapist assistance. This study identified elements of task-specific experiences and human characteristics as more influential in participant and therapist experience than the modality of video chat technology. Implications for assessing suitability for the modality of video chat and low- and high-intensity models of therapist assistance are discussed.

ObjectiveThis qualitative study investigated therapist training experiences, elements of skill acquisition, and barriers and facilitators associated with conducting assessments, and the delivery of low- and high-intensity therapist assistance delivered via video chat technology, adjunctive to a transdiagnostic digital mental health intervention programme for anxiety and depression. MethodologyIn total, 34 semistructured interviews were conducted with 20 therapists. Twenty interviews explored experiences of training to administer a clinical assessment tool, and 14 additional interviews explored training experiences of delivering low- and high-intensity therapist assistance via video chat technology. ResultsReflexive thematic analysis identified three themes: video chat skill acquisition, competencies transferrable to video chat and video chat service quality. Training and supervision were identified as important to scaffold skill development, and therapists described surprise that their skill set was transferrable to video chat. The most cited barrier to the adoption of video chat was the management of risk and distress, along with environmental suitability. Frequently cited facilitators to the adoption of video chat included stable Internet connection, protocols and resources. ConclusionThe benefits of video chat technology and digital mental health interventions can be maximised through the expansion and integration of training into existing teaching curricula. If therapists are familiarised and competent to deliver mental health services via the Internet, as well as in person, the future adoption of blended and stepped-care models is likely to be increased.

OBJECTIVE(S):The aim of this paper was to report on qualitative survey responses provided by older Australian adults regarding their preferences for Internet-based services and content.METHODS:Two qualitative questions ('What type of Internet-based mental health and well-being (1) services, and (2) content would be of most interest to you?') from a broader survey investigating the mental and physical health of older Australians were thematically analysed for commonly occurring themes. Eighty-nine participants aged 65 years or older (mean age = 71 years, SD = 5.30) responded to at least one qualitative question. Participants were primarily female (60%, n = 53), born in Australia (65%, n = 58), in a relationship (58%, n = 52), living in the community (79%, n = 70) and relatively well educated, with the majority having completed a university degree (38%, n = 34).RESULTS:Themes indicated that participants were most interested in Facebook-style services (n = 17), chat groups (n = 16) and email-based services (n = 4) designed specifically for older adults (n = 14). However, some concerns were raised regarding the trustworthiness of Internet-based services, with the largest proportion of participants (n = 22) noting that they were unlikely to use Internet- or social media-based services. The primary content-related themes were mental fitness (n = 34), grief and loss (n = 20), health information (n = 13), socialisation (n = 11) and physical fitness (n = 10).CONCLUSIONS:Participants indicated interest in tailor-made Facebook-style services for older adults that allow them to communicate with their peers and create new social networks and incorporate content relating to strategies for working on mental and physical fitness, information on coping with grief and loss, as well as health information. These findings can be used by organisations to develop Internet-based services and content for older Australian adults.

Introduction: Benzodiazepines (BDZs) are often inappropriately prescribed to manage anxiety and insomnia for longer-term use, despite guidelines recommending short-term use (i.e., <4 weeks). A range of harms can occur rapidly with regular use, and dependence can make stopping BDZs challenging. Evidence shows that a combination of BDZ tapering and psychological support are effective interventions, yet are not widely accessible. Methods: This was a one-group pilot trial of a 6-week fully automated self-help BDZ digital intervention ('BDZ digital health'), providing guidance on how to safely taper BDZs as well as psychological support. The trial was undertaken with Australian adults considering a reduction and/or withdrawal from their BDZ (N = 43). Participants were assessed at pre-intervention (Week 0), during intervention (Week 3), post-intervention (Week 6), and at a 3-and 6-month follow-up (Week 18 and 30 respectively). Results: Reductions in BDZ use and self-reported dependency were observed over the course of the intervention. Significant symptom reductions in anxiety, insomnia, depression, psychological distress, and emotional dysregulation, as well as improvements in mental wellbeing and quality of life were observed when looking across all timepoints. However, the specific assessment timepoint changes for depression and psychological distress did not reach significance from the pre- to post-intervention timepoint. The intervention acceptability ratings were in the moderately high to high range. Discussion: The preliminary results of the pilot trial suggest that BDZ digital health is an acceptable and promising self-help digital intervention to assist adults reducing and withdrawing from their BDZs, and to improve their mental health and wellbeing. (c) 2023 Association Franc,aise de Therapie Comportementale et Cognitive. Published by Elsevier Masson SAS. All rights reserved.

Anxiety disorders and depression are prevalent disorders with high comorbidity, leading to greater chronicity and severity of symptoms. Given the accessibility to treatment issues, more evaluation is needed to assess the potential benefits of fully automated self-help transdiagnostic digital interventions. Innovating beyond the current transdiagnostic one-size-fits-all shared mechanistic approach may also lead to further improvements. The primary objective of this study was to explore the preliminary effectiveness and acceptability of a new fully automated self-help biopsychosocial transdiagnostic digital intervention (Life Flex) aimed at treating anxiety and/or depression, as well as improving emotional regulation; emotional, social, and psychological well-being; optimism; and health-related quality of life. This was a real-world pre-during-post-follow-up feasibility trial design evaluation of Life Flex. Participants were assessed at the preintervention time point (week 0), during intervention (weeks 3 and 5), at the postintervention time point (week 8), and at 1- and 3-month follow-ups (weeks 12 and 20, respectively). The results provided early support for the Life Flex program in reducing anxiety (Generalized Anxiety Disorder 7), depression (Patient Health Questionnaire 9), psychological distress (Kessler 6), and emotional dysregulation (Difficulties in Emotional Regulation 36) and increasing emotional, social, and psychological well-being (Mental Health Continuum—Short Form); optimism (Revised Life Orientation Test); and health-related quality of life (EQ-5D-3L Utility Index and Health Rating; all false discovery rate [FDR]<.001). Large within-group treatment effect sizes (range |d|=0.82 to 1.33) were found for most variables from pre- to postintervention assessments and at the 1- and 3-month follow-up. The exceptions were medium treatment effect sizes for EQ-5D-3L Utility Index (range Cohen d=−0.50 to −0.63) and optimism (range Cohen d=−0.72 to −0.79) and small-to-medium treatment effect size change for EQ-5D-3L Health Rating (range Cohen d=−0.34 to −0.58). Changes across all outcome variables were generally strongest for participants with preintervention clinical comorbid anxiety and depression presentations (range |d|=0.58 to 2.01) and weakest for participants presenting with nonclinical anxiety and/or depressive symptoms (|d|=0.05 to 0.84). Life Flex was rated as acceptable at the postintervention time point, and participants indicated that they enjoyed the transdiagnostic program and biological, wellness, and lifestyle-focused content and strategies. Given the paucity of evidence on fully automated self-help transdiagnostic digital interventions for anxiety and/or depressive symptomatology and general treatment accessibility issues, this study provides preliminary support for biopsychosocial transdiagnostic interventions, such as Life Flex, as a promising future mental health service delivery gap filler. Following large-scale, randomized controlled trials, the potential benefits of fully automated self-help digital health programs, such as Life Flex, could be considerable. Australian and New Zealand Clinical Trials Registry ACTRN12615000480583; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368007