"You Need to Get Them Where They Feel it": Conflicting Perspectives on How to Maximize the Structure of Text-Message Psychological Interventions for Adolescents

Abstract

Mobile psychological interventions are of growing interest, particularly for populations with little access to traditional mental health services. Optimum structural components of these interventions are unknown. In this study, twenty-one adolescents (age 13-17) with past two week depressive symptoms were recruited from the emergency department to participate in a semi-structured interview, to inform development of a text-message-based depression prevention intervention. Teens expressed conflict about intervention structure. Although trust and reliability were essential to sustain engagement, teens disagreed about how to best maintain reliability; whether the program should be “pushed” or “pulled”; and what the ideal degree of human interaction would be. These findings highlight the challenges in automating psychological interventions that are normally delivered face-to-face. Data indicate a broad desire for developing tailoring methods for system design (duration, frequency, and level of interactivity). The paper closes with thoughts about potential solutions to these structural issues for mobile psychological interventions.

A Depression Prevention Intervention for Adolescents in the Emergency Department

“…Both components were developed and refined from motivational interviewing and cognitive behavioral therapy (CBT), existing in-person and text-message preventive interventions,(6, 12, 17, 19) and participant feedback during a formative development phase. (9, 10, 14)…”

“…The in-ED session was a 15–20 minute scripted, PowerPoint-guided session delivered by a trained research assistant (RA) (Table 1, Figure 1)(10) covering: 1) basic CBT concepts (e.g., connecting thoughts, behavior, and mood), 2) motivational enhancement for intervention engagement (e.g., personalized feedback about mood and frequency of fights), and 3) introduction to the text-message component. The RA underwent structured training in intervention theory and methods prior to recruitment.…”

“…Based on formative work(9, 10), three text-message content streams were created: for low-violence girls, low-violence boys, and high-violence adolescents of both genders. The streams had similar basic content, but differed slightly in types of behavioral activation activities, types of stressors, and language.…”

“…(9, 10) Publicly available text-message services are frequently used by adolescents during mental health crises, although to our knowledge no scholarly literature describes its use or effectiveness. (11) Text-messaging is an acceptable, reliable, and valid intervention method for adolescents on numerous topics.…”

Texting to Increase Contraceptive Initiation Among Adolescents in the Emergency Department

“…Recent literature suggests that pushing noninteractive messages to older teens with repetitive information or too often might cause disinterest [15]. The future of texting interventions may lie with innovative, bidirectional, tailored messaging, which changes behavior by creating an automated yet engaging conversation [4,5,7].…”