JMIR Mental Health

The COVID-19 pandemic threatened to impact mental health by disrupting access to care due to physical distance measures and the unexpected pressure on public health services. Tele–mental health was rapidly implemented to deliver health care services.

The growing prevalence of digital approaches to mental health care raises a range of questions and considerations. A notion that has recently emerged is that of the digital therapeutic alliance, prompting consideration of whether and how the concept of therapeutic alliance, which has proven to be a central ingredient of successful traditional psychotherapy, could translate to mental health care via digital technologies. This special issue editorial article outlines the topic of digital therapeutic alliance and introduces the five articles that comprise the special issue.

Available smartphone-based interventions for depression predominantly use evidence-based strategies from cognitive-behavioral therapy (CBT), but patient engagement and reported effect sizes are small. Recently, studies have demonstrated that smartphone-based interventions combining CBT with gamified approach-avoidance bias modification training (AAMT) can foster patient engagement and reduce symptoms of several mental health problems.

There is a need to regularly update the evidence base on the effectiveness of online mindfulness-based interventions (MBIs), especially considering how fast this field is growing and developing.

Internet- and mobile-based interventions are most efficacious in the treatment of depression when they involve some form of guidance, but providing guidance requires resources such as trained personnel, who might not always be available (eg, during lockdowns to contain the COVID-19 pandemic).

Mental illness is a growing concern within many college campuses. Limited access to therapy resources, along with the fear of stigma, often prevents students from seeking help. Introducing supportive interventions, coping strategies, and mitigation programs might decrease the negative effects of mental illness among college students.

There is increasing concern around communities that promote eating disorders (Pro-ED) on social media sites through messages and images that encourage dangerous weight control behaviors. These communities share group identity formed through interactions between members and can involve the exchange of “tips,” restrictive dieting plans, extreme exercise plans, and motivating imagery of thin bodies. Unlike Instagram, Facebook, or Tumblr, the absence of adequate policy to moderate Pro-ED content on Twitter presents a unique space for the Pro-ED community to freely communicate. While recent research has identified terms, themes, and common lexicon used within the Pro-ED online community, very few have been longitudinal. It is important to focus upon the engagement of Pro-ED online communities over time to further understand how members interact and stay connected, which is currently lacking.

Young adults with serious mental illness (SMI) have higher smoking rates and lower cessation rates than young adults without SMI. Scalable interventions such as smartphone apps with evidence-based content (eg, the National Cancer Institute’s [NCI’s] QuitGuide and quitSTART) could increase access to potentially appealing and effective treatment for this group but have yet to be tested in this population.

Mental ill-health presents a major public health problem. A potential part solution that is receiving increasing attention is computer-delivered psychological therapy, particularly during the COVID-19 pandemic as health care systems moved to remote service delivery. However, computerized cognitive behavioral therapy (cCBT) requires active engagement by service users, and low adherence may minimize treatment effectiveness. Therefore, it is important to investigate the acceptability of cCBT to understand implementation issues and maximize potential benefits.

A majority of youth who need anxiety treatment never access support. This disparity reflects a need for more accessible, scalable interventions—particularly those that may prevent anxiety in high-risk children, mitigating future need for higher-intensity care. Self-guided single-session interventions (SSIs) may offer a promising path toward this goal, given their demonstrated clinical utility, potential for disseminability, and low cost. However, existing self-guided SSIs have been designed for completion by adolescents already experiencing symptoms, and their potential for preventing anxiety in children—for instance, by mitigating known anxiety risk factors—remains unexplored.

The resources of West African mental health care systems are severely constrained, which contributes to significant unmet mental health needs. Consequently, people with psychiatric conditions often receive care from traditional and faith healers. Healers may use practices that constitute human rights violations, such as flogging, caging, forced fasting, and chaining.

The COVID-19 pandemic has challenged the worldviews of most people. Social isolation after the COVID-19 lockdown has not only led to economic difficulties but also resulted in adverse psychological reactions. As in most countries, including Poland, this situation has been very challenging for patients with type 1 diabetes mellitus (T1DM). In Poland, a crisis intervention team for patients with T1DM was established. The goal of the team was to provide psychological support for these patients, if needed, and to present information concerning how these patients may obtain medical consultations and prescriptions.