JMIR Mental Health

Internet interventions, technologies and digital innovations for mental health and behaviour change

The effectiveness of internet-based interventions for managing stress and anxiety in students in higher education: a systematic review

Background: Students in higher education (college and university) often experience stress and anxiety, but do not routinely seek advice or support in managing this. Students identify a number of barriers to accessing formal support, such as time, travel, balancing commitments and embarrassment. One option for these students is to complete online, self-directed therapy or counselling. Objective: The aim of this systematic review was to assess the overall effectiveness of online programmes aimed at students experiencing stress, as an alternative to traditional therapeutic support. Methods: The Cochrane Library Database, PsycINFO, MEDLINE, Psychology and Behavioral Sciences Collection were searched. Articles were also obtained from appropriate reference lists and a general interest search on Google Scholar. Articles were limited to higher education student populations, written in English, and published up to and including November 2013. Randomised wait-list control trials exploring the effectiveness of a variety of internet-based interventions to help manage and reduce college & university related distress, including stress, anxiety, and worry were included. The reviewer screened abstracts to determine eligibility. Results: Five full-text articles met the inclusion criteria. Online interventions aimed to reduce stress and anxiety in student populations have mixed results. All studies reviewed showed some positive effect on reducing distress experienced by students, even if the intervention was short, and even without active input from a coach or prompter. One study found that the wait-list control group actually increased in anxiety whilst waiting for the intervention to help manage their distress, suggesting that widely disseminated and easily accessible therapeutic interventions for non-clinical populations such as students are urgently needed, in order to prevent distressed individuals from having to wait long periods for formal therapy. Conclusions: It is not suggested that online interventions replace formal therapy (only one study demonstrated longer-term effects of the intervention) but these types of intervention should be offered as a valuable tool for managing distress in student populations.

2014-10-17

As in previous years, JMIR will produce a theme issue (e-collections) on Internet Interventions which will also include some of the best papers presented at the ISRII meeting in Valencia. For previous examples see for example:

The e-collection will comprise of papers published in multiple JMIR journals, although most will be published in JMIR Mental Health (http://mental.jmir.org/), which is the best venue for this kind of work and currently offers publication free of charge. Another new journal which publishes articles free of charge is JMIR Human Factors (http://humanfactors.jmir.org/) which may be suitable for usability evaluations.

JMIR Research Protocols (http://researchprotocols.org) publishes proposals, protocols, and formative/pilot evaluations, and JMIR mHealth (http://mhealth.jmir.org/) and JMIR Serious Games (http://games.jmir.org/) (the latter also has no submission or article processing fees) are further options for papers in these respective areas.

The submission site is at http://mental.jmir.org/author (if you presented at the ISRII meeting in Valencia please select "JMIR ISRII Theme Issue 2014" on submission) or the respective submission site from other JMIR journals (when in doubt which journal is best suited, submit to JMIR at http://www.jmir.org/author.

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Journal Description

JMIR Mental Health (JMH, ISSN 2368-7959) is a new spin-off journal of JMIR, the leading eHealth journal (Impact Factor 2013: 4.7). 

JMIR Mental Health focusses on digital health and Internet interventions, technologies and electronic innovations (software and hardware) for mental health, addictions, online counselling and behaviour change. This includes formative evaluation and system descriptions, theoretical papers, review papers, viewpoint/vision papers, and rigorous evaluations.

JMIR Mental Health publishes even faster and has a broader scope with including papers which are more technical or more formative/developmental than what would be published in the Journal of Medical Internet Research

JMIR Mental Health features a rapid and thorough peer-review process, professional copyediting, professional production of PDF, XHTML, and XML proofs (ready for deposit in PubMed Central/PubMed), and an ipad App (in prep.).

JMIR Mental Health adheres to the same quality standards as JMIR and all articles published here are also cross-listed in the Table of Contents of JMIR, the worlds' leading medical journal in health sciences / health services research and health informatics.

Editorial Board members are currently being recruited, please contact us if you are interested (jmir.editorial.office at gmail.com).

 

Recent Articles:

  • Screenshot from information video about the study.

    Preferences of Young Adults With First-Episode Psychosis for Receiving Specialized Mental Health Services Using Technology: A Survey Study

    Abstract:

    Background: Despite the potential and interest of using technology for delivering specialized psychiatric services to young adults, surprisingly limited attention has been paid to systematically assess their perspectives in this regard. For example, limited knowledge exists on the extent to which young people receiving specialized services for a first-episode psychosis (FEP) are receptive to using new technologies as part of mental health care, and to which types of technology-enabled mental health interventions they are amenable to. Objective: The purpose of this study is to assess the interest of young adults with FEP in using technology to receive mental health information, services, and supports. Methods: This study uses a cross-sectional, descriptive survey design. A convenience sample of 67 participants between the ages of 18 and 35 were recruited from two specialized early intervention programs for psychosis. Interviewer-administered surveys were conducted between December 2013 and October 2014. Descriptive statistics are reported. Results: Among the 67 respondents who completed the survey, the majority (85%, 57/67) agreed or strongly agreed with YouTube as a platform for mental health-related services and supports. The top five technology-enabled services that participants were amenable to were (1) information on medication (96%, 64/67); (2) information on education, career, and employment (93%, 62/67); (3) decision-making tools pertaining to treatment and recovery (93%, 62/67); (4) reminders for appointments via text messaging (93%, 62/67); and (5) information about mental health, psychosis, and recovery in general (91%, 61/67). The top self-reported barriers to seeking mental health information online were lack of knowledge on how to perform an Internet search (31%, 21/67) and the way information is presented online (27%, 18/67). Two thirds (67%; 45/67) reported being comfortable in online settings, and almost half (48%; 32/67) reported a preference for mixed formats when viewing mental health information online (eg, text, video, visual graphics). Conclusions: Young people diagnosed with FEP express interest in using the Internet, social media, and mobile technologies for receiving mental health-related services. Increasing the awareness of young people in relation to various forms of technology-enabled mental health care warrants further attention. A consideration for future research is to obtain more in-depth knowledge on young people’s perspectives, which can help improve the design, development, and implementation of integrated technological health innovations within the delivery of specialized mental health care.

  • (cc) Ali et al. CC-BY-SA-2.0, please cite as (http://mental.jmir.org/article/viewFile/4418/1/58999).

    Online Peer-to-Peer Support for Young People With Mental Health Problems: A Systematic Review

    Abstract:

    Background: Adolescence and early adulthood are critical periods for the development of mental disorders. Online peer-to-peer communication is popular among young people and may improve mental health by providing social support. Previous systematic reviews have targeted Internet support groups for adults with mental health problems, including depression. However, there have been no systematic reviews examining the effectiveness of online peer-to-peer support in improving the mental health of adolescents and young adults. Objective: The aim of this review was to systematically identify available evidence for the effectiveness of online peer-to peer support for young people with mental health problems. Methods: The PubMed, PsycInfo, and Cochrane databases were searched using keywords and Medical Subject Headings (MeSH) terms. Retrieved abstracts (n=3934) were double screened and coded. Studies were included if they (1) investigated an online peer-to-peer interaction, (2) the interaction discussed topics related to mental health, (3) the age range of the sample was between 12 to 25 years, and (4) the study evaluated the effectiveness of the peer-to-peer interaction. Results: Six studies satisfied the inclusion criteria for the current review. The studies targeted a range of mental health problems including depression and anxiety (n=2), general psychological problems (n=1), eating disorders (n=1), and substance use (tobacco) (n=2). The majority of studies investigated Internet support groups (n=4), and the remaining studies focused on virtual reality chat sessions (n=2). In almost all studies (n=5), the peer support intervention was moderated by health professionals, researchers or consumers. Studies employed a range of study designs including randomized controlled trials (n=3), pre-post studies (n=2) and one randomized trial. Overall, two of the randomized controlled trials were associated with a significant positive outcome in comparison to the control group at post-intervention. In the remaining four studies, peer-to-peer support was not found to be effective. Conclusions: This systematic review identified an overall lack of high-quality studies examining online peer-to-peer support for young people. Given that peer support is frequently used as an adjunct to Internet interventions for a variety of mental health conditions, there is an urgent need to determine the effectiveness of peer support alone as an active intervention.

  • The image comes from the homepage of the corresponding author’s lab (Computational Cyber Psychology Lab, Institute of Psychology, Chinese Academy of Sciences). The image was designed by the lab members and copyright is owned by our lab.

    Identifying Chinese Microblog Users With High Suicide Probability Using Internet-Based Profile and Linguistic Features: Classification Model

    Abstract:

    Background: Traditional offline assessment of suicide probability is time consuming and difficult in convincing at-risk individuals to participate. Identifying individuals with high suicide probability through online social media has an advantage in its efficiency and potential to reach out to hidden individuals, yet little research has been focused on this specific field. Objective: The objective of this study was to apply two classification models, Simple Logistic Regression (SLR) and Random Forest (RF), to examine the feasibility and effectiveness of identifying high suicide possibility microblog users in China through profile and linguistic features extracted from Internet-based data. Methods: There were nine hundred and nine Chinese microblog users that completed an Internet survey, and those scoring one SD above the mean of the total Suicide Probability Scale (SPS) score, as well as one SD above the mean in each of the four subscale scores in the participant sample were labeled as high-risk individuals, respectively. Profile and linguistic features were fed into two machine learning algorithms (SLR and RF) to train the model that aims to identify high-risk individuals in general suicide probability and in its four dimensions. Models were trained and then tested by 5-fold cross validation; in which both training set and test set were generated under the stratified random sampling rule from the whole sample. There were three classic performance metrics (Precision, Recall, F1 measure) and a specifically defined metric “Screening Efficiency” that were adopted to evaluate model effectiveness. Results: Classification performance was generally matched between SLR and RF. Given the best performance of the classification models, we were able to retrieve over 70% of the labeled high-risk individuals in overall suicide probability as well as in the four dimensions. Screening Efficiency of most models varied from 1/4 to 1/2. Precision of the models was generally below 30%. Conclusions: Individuals in China with high suicide probability are recognizable by profile and text-based information from microblogs. Although there is still much space to improve the performance of classification models in the future, this study may shed light on preliminary screening of risky individuals via machine learning algorithms, which can work side-by-side with expert scrutiny to increase efficiency in large-scale-surveillance of suicide probability from online social media.

  • From the cover image of a self-help manual for adjustment disorders in burglary victims, (c) the author.

    Adjustment Disorders Are Uniquely Suited for eHealth Interventions: Concept and Case Study

    Abstract:

    Background: Adjustment disorders (also known as mental distress in response to a stressor) are among the most frequently diagnosed mental disorders in psychiatry and clinical psychology worldwide. They are also commonly diagnosed in clients engaging in deliberate self-harm and in those consulting general practitioners. However, their reputation in research-oriented mental health remains weak since they are largely underresearched. This may change when the International Statistical Classification of Diseases-11 (ICD-11) by the World Health Organization is introduced, including a new conceptualization of adjustment disorders as a stress-response disorder with positively defined core symptoms. Objective: This paper provides an overview of evidence-based interventions for adjustment disorders. Methods: We reviewed the new ICD-11 concept of adjustment disorder and discuss the the rationale and case study of an unguided self-help protocol for burglary victims with adjustment disorder, and its possible implementation as an eHealth intervention. Results: Overall, the treatment with the self-help manual reduced symptoms of adjustment disorder, namely preoccupation and failure to adapt, as well as symptoms of depression, anxiety, and stress. Conclusions: E-mental health options are considered uniquely suited for offering early intervention after the experiences of stressful life events that potentially trigger adjustment disorders.

  • Image courtesy of Vlado at FreeDigitalPhotos.net.

    Twitter: A Novel Tool for Studying the Health and Social Needs of Transgender Communities

    Abstract:

    Background: Limited research has examined the health and social needs of transgender and gender nonconforming populations. Due to high levels of stigma, transgender individuals may avoid disclosing their identities to researchers, hindering this type of work. Further, researchers have traditionally relied on clinic-based sampling methods, which may mask the true heterogeneity of transgender and gender nonconforming communities. Online social networking websites present a novel platform for studying this diverse, difficult-to-reach population. Objective: The objective of this study was to attempt to examine the perceived health and social needs of transgender and gender nonconforming communities by examining messages posted to the popular microblogging platform, Twitter. Methods: Tweets were collected from 13 transgender-related hashtags on July 11, 2014. They were read and coded according to general themes addressed, and a content analysis was performed. Qualitative and descriptive statistics are presented. Results: There were 1135 tweets that were collected in total. Both “positive” and “negative” events were discussed, in both personal and social contexts. Violence, discrimination, suicide, and sexual risk behavior were discussed. There were 34.36% (390/1135) of tweets that addressed transgender-relevant current events, and 60.79% (690/1135) provided a link to a relevant news article or resource. Conclusions: This study found that transgender individuals and allies use Twitter to discuss health and social needs relevant to the population. Real-time social media sites like Twitter can be used to study issues relevant to transgender communities.

  • Screenshot from the BlueBoard Homepage.

    An Online, Moderated Peer-to-Peer Support Bulletin Board for Depression: User-Perceived Advantages and Disadvantages

    Abstract:

    Background: Online, peer-to-peer support groups for depression are common on the World Wide Web and there is some evidence of their effectiveness. However, little is known about the mechanisms by which Internet support groups (ISGs) might work. Objective: This study aimed to investigate consumer perceptions of the benefits and disadvantages of online peer-to-peer support by undertaking a content analysis of the spontaneous posts on BlueBoard, a well-established, moderated, online depression bulletin board. Methods: The research set comprised all posts on the board (n=3645) for each of 3 months selected at 4 monthly intervals over 2011. The data were analyzed using content analysis and multiple coders. Results: A total of 586 relevant posts were identified, 453 (77.3%) reporting advantages and 133 (22.7%) reporting disadvantages. Positive personal change (335/453, 74.0%) and valued social interactions and support (296/453, 65.3%) emerged as perceived advantages. Other identified benefits were valued opportunities to disclose/express feelings or views (29/453, 6.4%) and advantages of the BlueBoard environment (45/453, 9.9%). Disadvantages were negative personal change (50/133, 37.6%), perceived disadvantages of board rules/moderation (42/133, 31.6%), unhelpful social interactions/contact with other members (40/133, 30.1%), and technical obstacles to using the board (14/133, 10.5%). Conclusions: Consumers value the opportunity to participate in an online mutual support group for mental health concerns. Further research is required to better understand how and if these perceived advantages translate into positive outcomes for consumers, and whether the perceived disadvantages of such boards can be addressed without compromising the safety and positive outcomes of the board.

  • Screenshot from https://www.youtube.com/watch?t=193&v=74Qmv-Au8WI.

    Effectiveness of Computer-Assisted Therapy for Substance Dependence Using Breaking Free Online: Subgroup Analyses of a Heterogeneous Sample of Service Users

    Abstract:

    Background: Substance misuse services within the United Kingdom have traditionally been oriented to opiate and crack users, and attended predominantly by male service users. Groups who do not fit this demographic, such as women or those whose primary drug of choice is neither heroin nor crack, have tended to be underrepresented in services. In addition, there can be stigma associated with traditional opiate and crack-centric services. Therefore, the computerized treatment and recovery program, Breaking Free Online (BFO), was developed to enable service users to access confidential support for dependence on a wide range of substances. BFO is delivered as computer-assisted therapy (CAT), or, where appropriate, used as self-help. Objective: The aim of this study was to report psychometric outcomes data from 393 service users accessing online support for substance misuse via BFO. Methods: Following initial referral to substance misuse services, all participants were supported in setting up a BFO login by a practitioner or peer mentor, and, where required, assisted as they completed an online baseline assessment battery contained within the BFO program. Following a period of engagement with BFO, all participants completed the same battery of assessments, and changes in the scores on these assessments were examined. Results: Significant improvements were found across the 393 service users in several areas of psychosocial functioning, including quality of life, severity of alcohol and drug dependence, depression, and anxiety (P=<.001 across all aspects of functioning). Additionally, significant improvements were found within specific subgroups of participants, including females (P=.001-<.001), males (P=.004-<.001), service users reporting alcohol dependence (P=.002-<.001), opiate and crack dependence (P=.014-<.001), and those seeking support for other substances that may be less well represented in the substance misuse sector (P=.001-<.001). Conclusions: Data from this study indicates that BFO is an effective clinical treatment for a wide range of individuals requiring support for substance misuse. Further work is currently underway to examine more closely the clinical effectiveness of the program.

  • (c) Daniele Zullino.

    Factor Structure of the Internet Addiction Test in Online Gamers and Poker Players

    Abstract:

    Background: The Internet Addiction Test (IAT) is the most widely used questionnaire to screen for problematic Internet use. Nevertheless, its factorial structure is still debated, which complicates comparisons among existing studies. Most previous studies were performed with students or community samples despite the probability of there being more problematic Internet use among users of specific applications, such as online gaming or gambling. Objective: To assess the factorial structure of a modified version of the IAT that addresses specific applications, such as video games and online poker. Methods: Two adult samples—one sample of Internet gamers (n=920) and one sample of online poker players (n=214)—were recruited and completed an online version of the modified IAT. Both samples were split into two subsamples. Two principal component analyses (PCAs) followed by two confirmatory factor analyses (CFAs) were run separately. Results: The results of principal component analysis indicated that a one-factor model fit the data well across both samples. In consideration of the weakness of some IAT items, a 17-item modified version of the IAT was proposed. Conclusions: This study assessed, for the first time, the factorial structure of a modified version of an Internet-administered IAT on a sample of Internet gamers and a sample of online poker players. The scale seems appropriate for the assessment of such online behaviors. Further studies on the modified 17-item IAT version are needed.

  • Serious game design elements.

    Integrating Health Behavior Theory and Design Elements in Serious Games

    Abstract:

    Background: Internet interventions for improving health and well-being have the potential to reach many people and fill gaps in service provision. Serious gaming interfaces provide opportunities to optimize user adherence and impact. Health interventions based in theory and evidence and tailored to psychological constructs have been found to be more effective to promote behavior change. Defining the design elements which engage users and help them to meet their goals can contribute to better informed serious games. Objective: To elucidate design elements important in SPARX, a serious game for adolescents with depression, from a user-centered perspective. Methods: We proposed a model based on an established theory of health behavior change and practical features of serious game design to organize ideas and rationale. We analyzed data from 5 studies comprising a total of 22 focus groups and 66 semistructured interviews conducted with youth and families in New Zealand and Australia who had viewed or used SPARX. User perceptions of the game were applied to this framework. Results: A coherent framework was established using the three constructs of self-determination theory (SDT), autonomy, competence, and relatedness, to organize user perceptions and design elements within four areas important in design: computer game, accessibility, working alliance, and learning in immersion. User perceptions mapped well to the framework, which may assist developers in understanding the context of user needs. By mapping these elements against the constructs of SDT, we were able to propose a sound theoretical base for the model. Conclusions: This study’s method allowed for the articulation of design elements in a serious game from a user-centered perspective within a coherent overarching framework. The framework can be used to deliberately incorporate serious game design elements that support a user’s sense of autonomy, competence, and relatedness, key constructs which have been found to mediate motivation at all stages of the change process. The resulting model introduces promising avenues for future exploration. Involving users in program design remains an imperative if serious games are to be fit for purpose.

  • TOC thumbnail (author-generated image: original artwork by zhaolifang and freevector, Vecteezy).

    Privacy Issues in the Development of a Virtual Mental Health Clinic for University Students: A Qualitative Study

    Abstract:

    Background: There is a growing need to develop online services for university students with the capacity to complement existing services and efficiently address student mental health problems. Previous research examining the development and acceptability of online interventions has revealed that issues such as privacy critically impact user willingness to engage with these services. Objective: To explore university student perspectives on privacy issues related to using an online mental health service within the context of the development of an online, university-based virtual mental health clinic. Methods: There were two stages of data collection. The first stage consisted of four 1.5-hour focus groups conducted with university students (n=19; 10 female, 9 male, mean age = 21.6 years) to determine their ideas about the virtual clinic including privacy issues. The second stage comprised three 1-hour prototype testing sessions conducted with university students (n=6; 3 male, 3 female, mean age = 21.2 years) using participatory design methods to develop and refine a service model for the virtual clinic and determine student views on privacy within this context. Results: The students raised a number of issues related to privacy in relation to the development of the university virtual clinic. Major topics included the types of personal information they would be willing to provide (minimal information and optional mental health data), concern about potential access to their personal data by the university, the perceived stigma associated with registering for the service, and privacy and anonymity concerns related to online forums contained within the virtual clinic. Conclusions: Students would be more comfortable providing personal information and engaging with the virtual clinic if they trust the privacy and security of the service. Implications of this study include building the clinic in a flexible way to accommodate user preferences.

  • Mental Health Mobile Apps: From Infusion to Diffusion in the Mental Health Social System.

    Mental Health Mobile Apps: From Infusion to Diffusion in the Mental Health Social System

    Abstract:

    The roles of mental health educators and professionals in the diffusion of mental health mobile apps are addressed in this viewpoint article. Mental health mobile apps are emerging technologies that fit under the broad heading of mobile health (mHealth). mHealth, encompassed within electronic health (eHealth), reflects the use of mobile devices for the practice of public health. Well-designed mental health mobile apps that present content in interactive, engaging, and stimulating ways can promote cognitive learning, personal growth, and mental health enhancement. As key influencers in the mental health social system, counselor educators and professional associations may either help or hinder diffusion of beneficial mHealth technologies. As mental health mobile apps move towards ubiquity, research will continue to be conducted. The studies published thus far, combined with the potential of mental health mobile apps for learning and personal growth, offer enough evidence to compel mental health professionals to infuse these technologies into education and practice. Counselor educators and professional associations must use their influential leadership roles to train students and practitioners in how to research, evaluate, and integrate mental health mobile apps into practice. The objectives of this article are to (1) increase awareness of mHealth and mental health mobile apps, (2) demonstrate the potential for continued growth in mental health mobile apps based on technology use and acceptance theory, mHealth organizational initiatives, and evidence about how humans learn, (3) discuss evidence-based benefits of mental health mobile apps, (4) examine the current state of mHealth diffusion in the mental health profession, and (5) offer solutions for impelling innovation diffusion by infusing mental health mobile apps into education, training, and clinical settings. This discussion has implications for counselor educators, mental health practitioners, associations, continuing education providers, and app developers.

  • Screenshot of the PTSD Coach mobile phone application: (A) home screen and primary content areas: Education (Learn), Self-Assessment, Manage Symptoms (Tools), and Support; (B) Distress Thermometer (ie, subjective units of distress, measured before and after use of a symptom management tools).

    mHealth in the Wild: Using Novel Data to Examine the Reach, Use, and Impact of PTSD Coach

    Abstract:

    Background: A majority of Americans (58%) now use smartphones, making it possible for mobile mental health apps to reach large numbers of those who are living with untreated, or under-treated, mental health symptoms. Although early trials suggest positive effects for mobile health (mHealth) interventions, little is known about the potential public health impact of mobile mental health apps. Objective: The purpose of this study was to characterize reach, use, and impact of “PTSD Coach”, a free, broadly disseminated mental health app for managing posttraumatic stress disorder (PTSD) symptoms. Methods: Using a mixed-methods approach, aggregate mobile analytics data from 153,834 downloads of PTSD Coach were analyzed in conjunction with 156 user reviews. Results: Over 60% of users engaged with PTSD Coach on multiple occasions (mean=6.3 sessions). User reviews reflected gratitude for the availability of the app and being able to use the app specifically during moments of need. PTSD Coach users reported relatively high levels of trauma symptoms (mean PTSD Checklist Score=57.2, SD=15.7). For users who chose to use a symptom management tool, distress declined significantly for both first-time users (mean=1.6 points, SD=2.6 on the 10-point distress thermometer) and return-visit users (mean=2.0, SD=2.3). Analysis of app session data identified common points of attrition, with only 80% of first-time users reaching the app’s home screen and 37% accessing one of the app’s primary content areas. Conclusions: These findings suggest that PTSD Coach has achieved substantial and sustained reach in the population, is being used as intended, and has been favorably received. PTSD Coach is a unique platform for the delivery of mobile mental health education and treatment, and continuing evaluation and improvement of the app could further strengthen its public health impact.

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  • The effectiveness of internet-based interventions for managing stress and anxiety in students in higher education: a systematic review

    Date Submitted: May 6, 2015

    Open Peer Review Period: May 16, 2015 - Jul 11, 2015

    Background: Students in higher education (college and university) often experience stress and anxiety, but do not routinely seek advice or support in managing this. Students identify a number of barri...

    Background: Students in higher education (college and university) often experience stress and anxiety, but do not routinely seek advice or support in managing this. Students identify a number of barriers to accessing formal support, such as time, travel, balancing commitments and embarrassment. One option for these students is to complete online, self-directed therapy or counselling. Objective: The aim of this systematic review was to assess the overall effectiveness of online programmes aimed at students experiencing stress, as an alternative to traditional therapeutic support. Methods: The Cochrane Library Database, PsycINFO, MEDLINE, Psychology and Behavioral Sciences Collection were searched. Articles were also obtained from appropriate reference lists and a general interest search on Google Scholar. Articles were limited to higher education student populations, written in English, and published up to and including November 2013. Randomised wait-list control trials exploring the effectiveness of a variety of internet-based interventions to help manage and reduce college & university related distress, including stress, anxiety, and worry were included. The reviewer screened abstracts to determine eligibility. Results: Five full-text articles met the inclusion criteria. Online interventions aimed to reduce stress and anxiety in student populations have mixed results. All studies reviewed showed some positive effect on reducing distress experienced by students, even if the intervention was short, and even without active input from a coach or prompter. One study found that the wait-list control group actually increased in anxiety whilst waiting for the intervention to help manage their distress, suggesting that widely disseminated and easily accessible therapeutic interventions for non-clinical populations such as students are urgently needed, in order to prevent distressed individuals from having to wait long periods for formal therapy. Conclusions: It is not suggested that online interventions replace formal therapy (only one study demonstrated longer-term effects of the intervention) but these types of intervention should be offered as a valuable tool for managing distress in student populations.

  • Pilot Evaluation of Changes in Physical Activity and Psychological Variables Following a Novel Web-based Motivational Interviewing Intervention

    Date Submitted: May 6, 2015

    Open Peer Review Period: May 14, 2015 - Jul 9, 2015

    Background: Web-based interventions for enhancing physical activity (PA) participation are in demand for application in healthcare settings. Recent research suggests web-based interventions that are...

    Background: Web-based interventions for enhancing physical activity (PA) participation are in demand for application in healthcare settings. Recent research suggests web-based interventions that are based on Motivational Interviewing (MI) are effective to increase PA. There is limited research into the mechanisms of interventions based on MI. It also is unclear whether MI can influence targeted psychological variables (PVs)such as perceived readiness, willingness, and ability to participate in PA. Objective: The aims of the current study were to determine whether there were changes in PA as well as changes in PVs associated with readiness, willingness, and perceived ability to participate in PA following participation in a novel web-based intervention. The goal of the MI-based intervention was to increase PA. Methods: Twenty-three underactive or inactive urban dwelling adults were recruited at a medical office for participation in a novel 4-session web-based intervention lasting approximately 15 minutes per week. Sessions were based on principles of MI. Objective PA assessment was conducted using pedometers immediately prior to intervention participation (pre) and immediately post intervention (post1). Self-report assessments of PA and PVs were conducted using online surveys at pre, post1, and again at one month following intervention participation (post2). Results: Comparisons of pre and post1 pedometer recordings revealed significant increases in steps per day (t 22=2.085, P=.049). There were also significant changes in total PA energy expenditure per week (χ2=8.430, P=.015) and in moderate intensity PA energy expenditure per week (χ2=13.853, P=.001) over time following participation in the web-based intervention. Significant changes in PVs following participation in the web-based intervention included: (1) change in stage classification over time (χ2 21.500, P=.001), where the percentage of participants classified in the action or maintenance stages of change in PA increased over time (pre=25.00%, post1=70.81%, post2=68.18%); (2) decreases in self-reported decisional balance cons (F 2,42= 12.755, P < .001); (3) increases in self-reported decisional balance pros (F 2,42= 16.192, P < .001); (4) increases in PA enjoyment (F 2,20 =3.851, P =.038) (F 2,42=3.297, P =.047); and (5) increases in self-efficacy F 2,42= 3.297, P = .047). Conclusions: The web-based intervention piloted in the current study shows preliminary promise as a tool to promote PA in healthcare settings. Additional research is needed to test the effectiveness of MI compared to a control condition and to refine content by considering mediation by PVs in a larger sample.

  • How to benefit from blended care in mental health care?

    Date Submitted: Apr 14, 2015

    Open Peer Review Period: Apr 20, 2015 - Jun 15, 2015

    Background: Blended care, a combination of online and face-to-face therapy, is increasingly being applied in mental health care to benefit optimally from the advantages both treatment modalities hav...

    Background: Blended care, a combination of online and face-to-face therapy, is increasingly being applied in mental health care to benefit optimally from the advantages both treatment modalities have. Promising results have been reported, but a variety in descriptions and ways of operationalizing blended care exists. Currently, what type of ‘blend’ works for whom, and why, is unclear. Furthermore, a rationale for setting up and initializing blended care often lacks. Objective: In this viewpoint paper, we describe postulates for blended care and provide an instrument (Fit for blended care) that helps therapists and patients to decide on the setup op blended care treatment Methods: The postulates and instrument are based on a review of the literature, and consultations with therapists and clients. Results: Postulates for blended care are presented as well as the ‘Fit for blended care’ instrument which addresses relevant themes that patient and therapist can discuss to set up blended treatment. Conclusions: More research into the reasons why and for whom blended care works, is needed. To benefit from blended care, face-to-face and online care should be combined in such way that the potentials of both treatment modalities are used optimally, depending on patient abilities, needs, and preferences. To facilitate the process of setting up a personalized blended treatment, the ‘fit for blended care’ instrument can be used. By applying this approach in research and practice, more insight into the working mechanisms and optimal (personal) 'blends' of online and face-to-face therapy becomes within reach.