While many adolescent patients resistantly engage in psychotherapy, they are attracted by new technologies and video games. A development and research project was implemented to design an online adventure video game as a psychotherapeutic tool for depressed adolescents and to evaluate its acceptability. The game design followed the narrative structure of the hero’s journey and ideas from the cognitive behavioral and interpersonal psychotherapy models for depression. Five psychotherapists and fifteen of their female adolescent patients with symptoms of depression tested the game. Some patients valued the video game in terms of learning helpful social and mental health-related behaviors. Therapists manifested that a video game like Maya could be a useful complementary tool for psychotherapy of adolescent girls. The study suggests that future developments of video games for mental health are worthwhile and it provides some ideas on how to incorporate psychotherapeutic notions in ludic environments.

ASCENSO appears to be a promising complement to regular care for depression. Following improvements of the program based on participants' feedback, future research should evaluate its efficacy and cost-effectiveness.

Background Internet-based interventions promise to enhance the accessibility of mental health care for a greater number of people and in more remote places. Their effectiveness has been shown for the prevention and treatment of various mental disorders. However, their potential when delivered as add-on to conventional treatment (ie, blended care) is less clear. Objective The aim of this study is to study the effectiveness of an internet intervention (ASCENSO) implemented in addition to face-to-face treatment as usual (TAU) for depression. Methods A 2-arm, parallel-group, randomized controlled trial was conducted in an outpatient private mental health care center in Chile. In all, 167 adults, diagnosed with major depressive disorder, without severe comorbidities, and with internet access, were included. Eighty-four participants were assigned to the intervention group and received medical and psychological TAU from the mental health center plus access to the ASCENSO online platform. The control group (n=83) received only TAU. The ASCENSO platform includes psycho-educational information, depressive symptom monitoring and feedback, and managing emergencies based on the principles of cognitive behavioral therapy. Emergency management was mental health provider–assisted. TAU includes access to primary care physicians and psychiatrists, to a brief individual psychotherapy, and to medication when needed. The baseline questionnaires were administered in person, and 6- and 9-months assessments were conducted online. Depression symptoms and quality of life were measured by self-administered questionnaires, and treatment adherence was determined via the Mental Health Center’s internal records. The usage of ASCENSO was assessed by server logs. Reduction on depressive symptomatology was considered as the primary outcome of the intervention and quality of life as a secondary outcome. Results Of the 84 participants in the intervention group, 5 participants (6%) never accessed the online platform. Of the remaining 79 participants who accessed ASCENSO, 1 (1%, 1/79) did not answer any of the symptom questionnaire, and most participants (72/79, 91%) answered the monitoring questionnaires irregularly. The ASCENSO intervention implemented in addition to face-to-face care did not improve the outcome of the usual care delivered at the mental health center, either in terms of reduction of depressive symptoms (F2,6087= 0.48; P=.62) or in the improvement of quality of life (EQ-5D-3L: F2,7678=0.24; P=.79 and EQ-VAS: F2,6670= 0.13; P=.88). In contrast, for the primary (F2,850=78.25; P<.001) and secondary outcomes (EQ-5D-3L: F2,1067=37.87; EQ-VAS: F2,4390= 51.69; P<.001) in both groups, there was an improvement from baseline to 6 months (P<.001), but there was no change at 9 months. In addition, no effects on adherence to or use of TAU were found. Finally, the dropout rate for the face-to-face treatment component was 54% (45/84) for the intervention group versus 39% (32/83) for the control group (P=.07). Conclusions The fact that the adjunctive access to ASCENSO did not improve outcome could be due to both the rather high effectiveness of TAU and to patients’ limited use of the online platform. Trial Registration ClinicalTrials.gov NCT03093467; https://clinicaltrials.gov/ct2/show/NCT03093467

Introduction: SIN-E-STRES is an adjunct Internet-based intervention for patients with posttraumatic stress disorder (PTSD). Patients interact with the program via a weekly monitoring email and by visiting a website that provides access to psychoeducational information and distance counseling. Aim: to evaluate the acceptability and feasibility of SIN-E-STRES. Methods: forty-five adult PTSD patients were registered to use SIN-E-STRES for three months. This study explores feasibility in terms of patients’ interest in joining the program, reported connectivity and use of the website components, and adherence to monitoring. Acceptability is evaluated through the satisfaction expressed by the participants, their opinions regarding the usefulness of the program, and their evaluation of its positive and negative aspects. Results: most of the patients invited to the program were interested in using SIN-E-STRES, and 73% of the registered patients completed at least one of the monitoring assessments and most of them interacted with the website. The overall monitoring response rate was 35%. Most patients stated that the feedback messages helped them remember themes covered in therapy, they also valued the psychoeducational resources on the website. Conclusions: The program may be especially useful for patients who are frequent Internet and email users. The intervention can be enhanced by improving the monitoring and feedback components as well as by adding complementary psychoeducational information. More research about adherence and dropout of PTSD interventions is necessary. The alignment and coherence of SIN-E-STRES with the main treatment contributes to reinforcing treatment indications and consequently may promote treatment adherence and recovery.