Is Therapist Support Needed? Comparing Therapist- and Self-Guided Internet-Based CBT for Somatic Symptom Distress (iSOMA) in Emerging Adults

Hennemann, Severin; Böhme, Katja; Kleinstäuber, Maria; Ruckes, Christian; Baumeister, Harald; Ebert, David Daniel; Küchler, Ann-Marie; Witthöft, Michael

doi:10.1016/j.beth.2022.06.006

Cited by 9 publications

(19 citation statements)

References 53 publications

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Section: Discussionsupporting

confidence: 86%

“…The finding that physical disorders were associated with optimality of guided i-CBT is consistent with the suggestion in previous i-CBT trials that a human coach is useful in addressing interference related to psychosomatic distress. [31][32][33] The associations of psychiatric comorbidities with HTE expand on prior studies finding mixed evidence for psychiatric comorbidities predicting i-CBT response. [34][35][36] The important associations of bullying with HTE highlight the importance of institutionally embedded antibullying policies and the value of guided i-CBT in facilitating stress management efforts related to this salient student stressor.…”

Section: Discussionmentioning

confidence: 99%

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A Precision Treatment Model for Internet-Delivered Cognitive Behavioral Therapy for Anxiety and Depression Among University Students

et al. 2023

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ImportanceGuided internet-delivered cognitive behavioral therapy (i-CBT) is a low-cost way to address high unmet need for anxiety and depression treatment. Scalability could be increased if some patients were helped as much by self-guided i-CBT as guided i-CBT.ObjectiveTo develop an individualized treatment rule using machine learning methods for guided i-CBT vs self-guided i-CBT based on a rich set of baseline predictors.Design, Setting, and ParticipantsThis prespecified secondary analysis of an assessor-blinded, multisite randomized clinical trial of guided i-CBT, self-guided i-CBT, and treatment as usual included students in Colombia and Mexico who were seeking treatment for anxiety (defined as a 7-item Generalized Anxiety Disorder [GAD-7] score of ≥10) and/or depression (defined as a 9-item Patient Health Questionnaire [PHQ-9] score of ≥10). Study recruitment was from March 1 to October 26, 2021. Initial data analysis was conducted from May 23 to October 26, 2022.InterventionsParticipants were randomized to a culturally adapted transdiagnostic i-CBT that was guided (n = 445), self-guided (n = 439), or treatment as usual (n = 435).Main Outcomes and MeasuresRemission of anxiety (GAD-7 scores of ≤4) and depression (PHQ-9 scores of ≤4) 3 months after baseline.ResultsThe study included 1319 participants (mean [SD] age, 21.4 [3.2] years; 1038 women [78.7%]; 725 participants [55.0%] came from Mexico). A total of 1210 participants (91.7%) had significantly higher mean (SE) probabilities of joint remission of anxiety and depression with guided i-CBT (51.8% [3.0%]) than with self-guided i-CBT (37.8% [3.0%]; P = .003) or treatment as usual (40.0% [2.7%]; P = .001). The remaining 109 participants (8.3%) had low mean (SE) probabilities of joint remission of anxiety and depression across all groups (guided i-CBT: 24.5% [9.1%]; P = .007; self-guided i-CBT: 25.4% [8.8%]; P = .004; treatment as usual: 31.0% [9.4%]; P = .001). All participants with baseline anxiety had nonsignificantly higher mean (SE) probabilities of anxiety remission with guided i-CBT (62.7% [5.9%]) than the other 2 groups (self-guided i-CBT: 50.2% [6.2%]; P = .14; treatment as usual: 53.0% [6.0%]; P = .25). A total of 841 of 1177 participants (71.5%) with baseline depression had significantly higher mean (SE) probabilities of depression remission with guided i-CBT (61.5% [3.6%]) than the other 2 groups (self-guided i-CBT: 44.3% [3.7%]; P = .001; treatment as usual: 41.8% [3.2%]; P &lt; .001). The other 336 participants (28.5%) with baseline depression had nonsignificantly higher mean (SE) probabilities of depression remission with self-guided i-CBT (54.4% [6.0%]) than guided i-CBT (39.8% [5.4%]; P = .07).Conclusions and RelevanceGuided i-CBT yielded the highest probabilities of remission of anxiety and depression for most participants; however, these differences were nonsignificant for anxiety. Some participants had the highest probabilities of remission of depression with self-guided i-CBT. Information about this variation could be used to optimize allocation of guided and self-guided i-CBT in resource-constrained settings.Trial RegistrationClinicalTrials.gov Identifier: NCT04780542

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

A Precision Treatment Model for Internet-Delivered Cognitive Behavioral Therapy for Anxiety and Depression Among University Students

et al. 2023

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“…All participants displayed emerging subclinical symptomatology. Youth COMPASS (Lappalainen et al, 2021(Lappalainen et al, , 2023, iSOMAguided (Hennemann et al, 2022a(Hennemann et al, , 2022b and BREATHE (6-module version) (O'Connor et al, 2022;Radomski et al, 2020). Table 4 provides a detailed description of included interventions.…”

Section: Participant Characteristicsmentioning

confidence: 99%

“…Intervention engagement period ranged from 20 days to 12 weeks (M = 7.34 weeks). Where reported, the average number of modules per intervention was 6.22 (range 3-12, n = 22 interventions), and the average number of modules intended to be completed per week of the intervention (Lappalainen et al, 2021(Lappalainen et al, , 2023, iSOMA-guided (Hennemann et al, 2022a(Hennemann et al, , 2022b and BREATHE (O'Connor et al, 2022;Radomski et al, 2020)], in no cases were the human support methods compared. Mental health professionals were the primary providers of guided intervention content (n = 12 interventions, 43%), followed by interventions delivered by clinicians and psychology students together (n = 6 interventions, 21%), and peers (n = 3, Harra & Vargas, 2023;Klimczak et al, 2023;Rodriguez et al, 2021).…”

Section: Intervention Characteristicsmentioning

confidence: 99%

Outcomes of Best-Practice Guided Digital Mental Health Interventions for Youth and Young Adults with Emerging Symptoms: Part I. A Systematic Review of Socioemotional Outcomes and Recommendations

Opie,

Vuong,

Welsh

et al. 2024

Clin Child Fam Psychol Rev

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Youth-specific digital mental health interventions (DMHI) represent an emerging field of study, and aim to increase access, improve socioemotional outcomes, and, where required, support triage to targeted interventions. However, prior reviews have reported inconsistent findings on the clinical effectiveness of such interventions in young adults (12–25 years). Further, shortfalls remain for the impact of guided interventions based on the mode of delivery and the type of human support personnel (e.g., professional or peer) guiding the intervention. In response, this systematic review, co-designed with Australia’s leading mental health organization, aims to assess the effectiveness of guided digital programs in improving youth socioemotional outcomes. Included studies involve young people experiencing mental ill-health, receiving brief (i.e., 1–12 sessions), digitally delivered (at least partially) psychological interventions that were guided or partially guided, tested in a type of experimental study, with a socioemotional outcome. Specific socioemotional outcomes examined were depression, anxiety, stress, wellbeing, mindfulness, and quality of life. A systematic search of the contemporary published and grey literature identified 22,482 records with 32 relevant records published between 2018 and 2023. A narrative synthesis guided integration of findings. Results demonstrated strong evidence for the effectiveness of guided interventions on socioemotional outcomes (i.e., depression, anxiety, stress) yet these effects were short-lived. When factoring in the use of different control groups (i.e., active vs. inactive), inconsistent effects were observed for the socioemotional outcomes of depression, anxiety, and stress. The mode of delivery (i.e., asynchronous, synchronous, combined) and the type of human support personnel did not appear to impact socioemotional outcomes. Results indicate efficacious brief digital interventions for depression and anxiety include refresher/follow-up content, goal setting content, and relapse prevention content. In contrast, poor efficacy is associated with interventions that include homework tasks, self-monitoring, and log-keeping content.PROSPERO, ID CRD42023405812.

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“…In one study (Cook et al, 2019), clinicians sent personalized reminder emails if there was inactivity for more than a week, while another app allowed users to adjust the frequency and the type of notifications received (Van Doorn et al, 2022). (Hennemann et al 2022, Küchler et al, 2023; and Health Information Technology Usability Evaluation Model [Health-ITUES], (van Doorn et al, 2022)). Unvalidated measures were also employed in 12 studies.…”

Section: Personalizationmentioning

confidence: 99%

Outcomes of Best-Practice Guided Digital Mental Health Interventions for Youth and Young Adults with Emerging Symptoms: Part II. A Systematic Review of User Experience Outcomes

Opie,

Vuong,

Welsh

et al. 2024

Clin Child Fam Psychol Rev

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Although many young people demonstrate resilience and strength, research and clinical evidence highlight an upward trend in mental health concerns among those aged 12 to 25 years. Youth-specific digital mental health interventions (DMHIs) aim to address this trend by providing timely access to mental health support for young people (12–25 years). However, there is a considerable gap in understanding young people user experiences with digital interventions. This review, co-designed with Australia’s leading mental health organization Beyond Blue, utilizes a systematic methodology to synthesize evidence on user experience in youth-oriented digital mental health interventions that are fully or partially guided. Five relevant online databases were searched for articles published from 2018 to 2023, yielding 22,482 articles for screening and 22 studies were included in the present analysis. User experience outcomes relating to satisfaction and engagement were assessed for each included intervention, with experience indicators relating to usefulness, usability, value, credibility, and desirability being examined. Elements associated with positive/negative outcomes were extracted. Elements shown to positively influence user experience included peer engagement, modern app-based delivery, asynchronous support, and personalized content. In contrast, users disliked static content, homework/log-keeping, the requirement for multiple devices, and social media integration. Asynchronous interventions showed high satisfaction but faced engagement issues, with combined asynchronous/synchronous interventions reporting better completion rates. DMHIs offer a promising platform for youth mental health support and has the potential to dramatically increase the reach of interventions through the adoption of technological and user experience best practices. While young people respond positively to many aspects of intervention modernization, such as interactive, app-based design, other concepts, such as social media integration, they need to be adopted by the field more cautiously to ensure trust and engagement.Trial Registration CRD42023405812

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Is Therapist Support Needed? Comparing Therapist- and Self-Guided Internet-Based CBT for Somatic Symptom Distress (iSOMA) in Emerging Adults

Cited by 9 publications

References 53 publications

A Precision Treatment Model for Internet-Delivered Cognitive Behavioral Therapy for Anxiety and Depression Among University Students

A Precision Treatment Model for Internet-Delivered Cognitive Behavioral Therapy for Anxiety and Depression Among University Students

Outcomes of Best-Practice Guided Digital Mental Health Interventions for Youth and Young Adults with Emerging Symptoms: Part I. A Systematic Review of Socioemotional Outcomes and Recommendations

Outcomes of Best-Practice Guided Digital Mental Health Interventions for Youth and Young Adults with Emerging Symptoms: Part II. A Systematic Review of User Experience Outcomes

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