Pub Date : 2025-11-02DOI: 10.1016/j.invent.2025.100887
Blake F. Dear , Alana Fisher , Madelyne Bisby , Amelia Scott , Nickolai Titov
Entirely self-guided transdiagnostic internet-delivered psychological interventions have considerable potential for increasing access to care for adults with anxiety and depression. The current study sought to examine such an intervention under real-world conditions using minimal inclusion and exclusion criteria. Three-hundred and ninety participants were randomised to either an immediate treatment group or a waitlist control group. The intervention consisted of 5 core modules delivered over 8 weeks, according to a structured timetable and with automated emails. Fifty-three percent of participants completed ≥4 of the core modules, and 75 % reported being satisfied with the intervention. At post-treatment, significant improvements were observed in the treatment group compared with control in both anxiety (treatment = 19 % [95 % CI: 12, 26]; control = 8 % [95 % CI: 2, 15]) and depression (treatment = 21 % [95 % CI: 13, 28]; control = 5 % [95 % CI: −1, 12]). These improvements were reflected in significantly greater proportions of participants meeting criteria for clinically meaningful change (≥50 % reduction) in the treatment group for both anxiety (treatment = 25 % [95 % CI: 19, 31]; control = 9 % [95 % CI: 5, 16]) and depression (treatment = 27 % [95 % CI: 20, 36]; control = 8 % [95 % CI: 5, 14]), with numbers needed to treat (NNTs) of 6.6 and 5.3, respectively. The findings of the current study support the potential of entirely self-guided transdiagnostic internet-delivered interventions, particularly for people for whom speaking with a clinician represents a barrier to care, or contexts where the resources for clinician-guided intervention are not available.
{"title":"Examining an entirely self-guided transdiagnostic internet-delivered intervention ‘in the wild’: A randomised controlled trial for anxiety and depression with minimal inclusion criteria","authors":"Blake F. Dear , Alana Fisher , Madelyne Bisby , Amelia Scott , Nickolai Titov","doi":"10.1016/j.invent.2025.100887","DOIUrl":"10.1016/j.invent.2025.100887","url":null,"abstract":"<div><div>Entirely self-guided transdiagnostic internet-delivered psychological interventions have considerable potential for increasing access to care for adults with anxiety and depression. The current study sought to examine such an intervention under real-world conditions using minimal inclusion and exclusion criteria. Three-hundred and ninety participants were randomised to either an immediate treatment group or a waitlist control group. The intervention consisted of 5 core modules delivered over 8 weeks, according to a structured timetable and with automated emails. Fifty-three percent of participants completed ≥4 of the core modules, and 75 % reported being satisfied with the intervention. At post-treatment, significant improvements were observed in the treatment group compared with control in both anxiety (treatment = 19 % [95 % CI: 12, 26]; control = 8 % [95 % CI: 2, 15]) and depression (treatment = 21 % [95 % CI: 13, 28]; control = 5 % [95 % CI: −1, 12]). These improvements were reflected in significantly greater proportions of participants meeting criteria for clinically meaningful change (≥50 % reduction) in the treatment group for both anxiety (treatment = 25 % [95 % CI: 19, 31]; control = 9 % [95 % CI: 5, 16]) and depression (treatment = 27 % [95 % CI: 20, 36]; control = 8 % [95 % CI: 5, 14]), with numbers needed to treat (NNTs) of 6.6 and 5.3, respectively. The findings of the current study support the potential of entirely self-guided transdiagnostic internet-delivered interventions, particularly for people for whom speaking with a clinician represents a barrier to care, or contexts where the resources for clinician-guided intervention are not available.</div></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"42 ","pages":"Article 100887"},"PeriodicalIF":4.1,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The immersive capabilities of virtual reality (VR) make it a promising medium for psychotherapeutic interventions. This randomized controlled trial aimed to develop and evaluate a VR-based adaptation of Emotion-Focused Therapy for Unfinished Business (EFT-UFB). Specifically, we examined its effects on unresolved emotional experiences, self-compassion, self-protection, self-criticism, and perceived stress. Participants (N = 52) were randomly assigned to either the intervention group (n = 26) or a waitlist control group (n = 26), with assessments conducted at pre-test, post-test, and follow-up. The primary between-group analyses revealed no statistically significant differences between the intervention and control groups at post-test (unfinished business: t(50) = −2.00, p = .051, Cohen's d = −0.38, 95 % CI [−0.77, 0.01]) or at follow-up (t(50) = 0.60, p = .551, d = 0.08, 95 % CI [−0.31, 0.47]). Within the intervention group, unfinished business demonstrated a large pre–post reduction that was sustained at follow-up, whereas other effects were small or transient. Effect size estimates suggested small advantages for the intervention arm across several outcomes, including unfinished business (d = −1.01 vs. 0.44 in controls), self-criticism (Inadequate Self d = −0.47), and perceived stress (helplessness d = −0.33; self-efficacy d = 0.37). Other domains, including self-compassion and self-protection, showed negligible or inconsistent differences. While the VR-based EFT-UFB did not outperform the waitlist condition, these pilot findings provide preliminary evidence of feasibility and potential benefits for unfinished business. Importantly, the intervention was effectively delivered by a non-psychotherapist (a trained psychologist), underscoring its potential scalability within digital mental health applications.
{"title":"Unfinished business in virtual reality: Development and preliminary evaluation of an empty chair intervention grounded in emotion-focused therapy","authors":"Júlia Halamová , Lenka Ottingerová , Zuzana Berger Haladova , Leslie S. Greenberg","doi":"10.1016/j.invent.2025.100885","DOIUrl":"10.1016/j.invent.2025.100885","url":null,"abstract":"<div><div>The immersive capabilities of virtual reality (VR) make it a promising medium for psychotherapeutic interventions. This randomized controlled trial aimed to develop and evaluate a VR-based adaptation of Emotion-Focused Therapy for Unfinished Business (EFT-UFB). Specifically, we examined its effects on unresolved emotional experiences, self-compassion, self-protection, self-criticism, and perceived stress. Participants (<em>N</em> = 52) were randomly assigned to either the intervention group (<em>n</em> = 26) or a waitlist control group (n = 26), with assessments conducted at pre-test, post-test, and follow-up. The primary between-group analyses revealed no statistically significant differences between the intervention and control groups at post-test (unfinished business: t(50) = −2.00, <em>p</em> = .051, Cohen's d = −0.38, 95 % CI [−0.77, 0.01]) or at follow-up (t(50) = 0.60, <em>p</em> = .551, d = 0.08, 95 % CI [−0.31, 0.47]). Within the intervention group, unfinished business demonstrated a large pre–post reduction that was sustained at follow-up, whereas other effects were small or transient. Effect size estimates suggested small advantages for the intervention arm across several outcomes, including unfinished business (d = −1.01 vs. 0.44 in controls), self-criticism (Inadequate Self d = −0.47), and perceived stress (helplessness d = −0.33; self-efficacy d = 0.37). Other domains, including self-compassion and self-protection, showed negligible or inconsistent differences. While the VR-based EFT-UFB did not outperform the waitlist condition, these pilot findings provide preliminary evidence of feasibility and potential benefits for unfinished business. Importantly, the intervention was effectively delivered by a non-psychotherapist (a trained psychologist), underscoring its potential scalability within digital mental health applications.</div></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"42 ","pages":"Article 100885"},"PeriodicalIF":4.1,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-21DOI: 10.1016/j.invent.2025.100884
Vajisha Udayangi Wanniarachchi , Chris Greenhalgh , Jim Warren
Digital mental health interventions (DMHIs) can be effective for adolescents and young people experiencing depression and anxiety. However, maintaining engagement remains a persistent challenge. While internal factors such as interface design, interactivity and personalisation have been widely examined, less is known about how young people themselves perceive barriers and facilitators to engaging with these tools. This scoping review explores adolescents' and young people's perceived experiences of engagement with DMHIs. A systematic search in PubMed, Scopus and PsycInfo identified 37 studies that met the inclusion criteria. Analysis revealed a broad range of perceived facilitators, including accessibility, perceived usefulness, opportunities for social connection and supportive human involvement. Commonly reported barriers included stigma, privacy concerns, low motivation, lack of personalisation, technical difficulties and limited trust in the interventions. Notably, most studies reported these perceptions qualitatively, with limited systematic assessment of their impact on engagement. This highlights a gap in the evidence base and underscores the need for future research to quantify how perceived barriers and facilitators shape engagement and adherence. Addressing barriers while building on facilitators may enhance sustained engagement and improve the real-world effectiveness of DMHIs for adolescent mental health.
{"title":"Adolescents' and youths' perceived barriers and facilitators to engaging with digital mental health interventions for depression and anxiety: A scoping review","authors":"Vajisha Udayangi Wanniarachchi , Chris Greenhalgh , Jim Warren","doi":"10.1016/j.invent.2025.100884","DOIUrl":"10.1016/j.invent.2025.100884","url":null,"abstract":"<div><div>Digital mental health interventions (DMHIs) can be effective for adolescents and young people experiencing depression and anxiety. However, maintaining engagement remains a persistent challenge. While internal factors such as interface design, interactivity and personalisation have been widely examined, less is known about how young people themselves perceive barriers and facilitators to engaging with these tools. This scoping review explores adolescents' and young people's perceived experiences of engagement with DMHIs. A systematic search in PubMed, Scopus and PsycInfo identified 37 studies that met the inclusion criteria. Analysis revealed a broad range of perceived facilitators, including accessibility, perceived usefulness, opportunities for social connection and supportive human involvement. Commonly reported barriers included stigma, privacy concerns, low motivation, lack of personalisation, technical difficulties and limited trust in the interventions. Notably, most studies reported these perceptions qualitatively, with limited systematic assessment of their impact on engagement. This highlights a gap in the evidence base and underscores the need for future research to quantify how perceived barriers and facilitators shape engagement and adherence. Addressing barriers while building on facilitators may enhance sustained engagement and improve the real-world effectiveness of DMHIs for adolescent mental health.</div></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"42 ","pages":"Article 100884"},"PeriodicalIF":4.1,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-13DOI: 10.1016/j.invent.2025.100882
Per Carlbring , Gerhard Andersson
Background
Reports of artificial intelligence (AI) chatbots fueling delusions in vulnerable users have popularized the notion of “AI psychosis”. We argue the risk is not unprecedented. Individuals with psychosis have long incorporated books, films, music, and emerging technologies into their delusional thinking.
Methods
We review historical parallels, summarize why large language models (LLMs) may reinforce psychotic thinking via sycophancy (excessive agreement or flattery to avoid confrontation), and provide two vignettes contrasting unsafe and safe responses.
Results
Contemporary LLMs often avoid confrontation and may collude with delusions, contrary to clinical best practice.
Conclusion
The phenomenon is not new in principle, but interactivity potentially changes the risk profile. Clinically aware LLMs that detect and gently redirect early psychotic ideation, while encouraging professional help seeking, could reduce harm. Design should be guided by therapeutic principles and evidence about current model failures.
{"title":"Commentary: AI psychosis is not a new threat: Lessons from media-induced delusions","authors":"Per Carlbring , Gerhard Andersson","doi":"10.1016/j.invent.2025.100882","DOIUrl":"10.1016/j.invent.2025.100882","url":null,"abstract":"<div><h3>Background</h3><div>Reports of artificial intelligence (AI) chatbots fueling delusions in vulnerable users have popularized the notion of “AI psychosis”. We argue the risk is not unprecedented. Individuals with psychosis have long incorporated books, films, music, and emerging technologies into their delusional thinking.</div></div><div><h3>Methods</h3><div>We review historical parallels, summarize why large language models (LLMs) may reinforce psychotic thinking via sycophancy (excessive agreement or flattery to avoid confrontation), and provide two vignettes contrasting unsafe and safe responses.</div></div><div><h3>Results</h3><div>Contemporary LLMs often avoid confrontation and may collude with delusions, contrary to clinical best practice.</div></div><div><h3>Conclusion</h3><div>The phenomenon is not new in principle, but interactivity potentially changes the risk profile. Clinically aware LLMs that detect and gently redirect early psychotic ideation, while encouraging professional help seeking, could reduce harm. Design should be guided by therapeutic principles and evidence about current model failures.</div></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"42 ","pages":"Article 100882"},"PeriodicalIF":4.1,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-10DOI: 10.1016/j.invent.2025.100879
Nils Hentati Isacsson , Lucía Gómez-Zaragozá , Fehmi Ben Abdesslem , Magnus Boman , Viktor Kaldo
Objective
Predicting treatment outcome has the potential to enhance Internet-delivered Cognitive Behavioral Therapy (ICBT). One aspect of guided ICBT is patient-therapist interaction through written messages. With Natural language processing (NLP) these could be leveraged to predict outcome; however current evidence is limited. This study investigates the predictive accuracy of NLP models for treatment outcomes and evaluates whether NLP provides additional predictive value beyond symptom variables.
Methods
Patient-therapist messages from 6613 patients undergoing 12 weeks of treatment were used to train three types of NLP models: Term Frequency-Inverse Document Frequency (TF-IDF), Bidirectional Encoder Representations from transformers (BERT), and BERT for Longer Text (BELT). These were trained both with and without symptom variables from the initial treatment period to predict post-treatment symptoms. A dummy model was also used, and a linear regression model acted as a symptoms only benchmark. Multiple imputation addressed missing data, and nested cross-validation was used.
Results
The symptom only model performed best. Only BERT outperformed the dummy model, achieving a Root Mean Squared Error (RMSE) of 0.17 compared to RMSE of 0.18. Adding symptom variables to the BERT model significantly increased its accuracy, but not the RMSE metric. The best linear regression benchmark based on symptoms only had a BACC of 70 % (F1-score of 0.66) which outperformed the BERT model with 60 % (F1: 0.55) and the combined BERT plus symptoms model achieved 68 % (F1: 0.62).
Conclusion
These initial findings indicate a small predictive value from patient-therapist written message interaction but added no value beyond using only symptoms to predict post-treatment symptoms. Further research is needed to refine NLP-methods for use in psychological treatment, and more accurately assess the predictive potential of text-based interactions during ICBT.
目的预测治疗结果有可能增强互联网提供的认知行为治疗（ICBT）。指导性ICBT的一个方面是通过书面信息进行患者与治疗师的互动。有了自然语言处理（NLP），这些可以用来预测结果；然而，目前的证据有限。本研究探讨了NLP模型对治疗结果的预测准确性，并评估NLP是否提供了除症状变量之外的其他预测价值。方法使用6613例接受12周治疗的患者的患者-治疗师信息来训练三种类型的NLP模型：Term Frequency- inverse Document Frequency （TF-IDF）、双向编码器表示（BERT）和BERT for Longer Text （BELT）。对这些患者进行了有或无症状变量的训练，以预测治疗后的症状。还使用了虚拟模型，并使用线性回归模型作为仅症状基准。多重输入解决了缺失数据，并使用嵌套交叉验证。结果单纯症状模型效果最好。只有BERT优于虚拟模型，实现了0.17的均方根误差（RMSE），而RMSE为0.18。将症状变量添加到BERT模型中可以显著提高其准确性，但不能提高RMSE度量。基于症状的最佳线性回归基准的BACC仅为70% (F1-score为0.66)，优于BERT模型的60% (F1: 0.55)， BERT +症状联合模型达到68% （F1: 0.62）。结论这些初步发现表明，患者-治疗师书面信息互动的预测价值很小，但除了仅使用症状来预测治疗后症状之外，没有任何价值。需要进一步的研究来完善nlp方法用于心理治疗，并更准确地评估ICBT期间基于文本的互动的预测潜力。
{"title":"Natural language processing models for predicting treatment outcomes in internet-delivered cognitive behavioral therapy","authors":"Nils Hentati Isacsson , Lucía Gómez-Zaragozá , Fehmi Ben Abdesslem , Magnus Boman , Viktor Kaldo","doi":"10.1016/j.invent.2025.100879","DOIUrl":"10.1016/j.invent.2025.100879","url":null,"abstract":"<div><h3>Objective</h3><div>Predicting treatment outcome has the potential to enhance Internet-delivered Cognitive Behavioral Therapy (ICBT). One aspect of guided ICBT is patient-therapist interaction through written messages. With Natural language processing (NLP) these could be leveraged to predict outcome; however current evidence is limited. This study investigates the predictive accuracy of NLP models for treatment outcomes and evaluates whether NLP provides additional predictive value beyond symptom variables.</div></div><div><h3>Methods</h3><div>Patient-therapist messages from 6613 patients undergoing 12 weeks of treatment were used to train three types of NLP models: Term Frequency-Inverse Document Frequency (TF-IDF), Bidirectional Encoder Representations from transformers (BERT), and BERT for Longer Text (BELT). These were trained both with and without symptom variables from the initial treatment period to predict post-treatment symptoms. A dummy model was also used, and a linear regression model acted as a symptoms only benchmark. Multiple imputation addressed missing data, and nested cross-validation was used.</div></div><div><h3>Results</h3><div>The symptom only model performed best. Only BERT outperformed the dummy model, achieving a Root Mean Squared Error (RMSE) of 0.17 compared to RMSE of 0.18. Adding symptom variables to the BERT model significantly increased its accuracy, but not the RMSE metric. The best linear regression benchmark based on symptoms only had a BACC of 70 % (F<sub>1</sub>-score of 0.66) which outperformed the BERT model with 60 % (F<sub>1</sub>: 0.55) and the combined BERT plus symptoms model achieved 68 % (F<sub>1</sub>: 0.62).</div></div><div><h3>Conclusion</h3><div>These initial findings indicate a small predictive value from patient-therapist written message interaction but added no value beyond using only symptoms to predict post-treatment symptoms. Further research is needed to refine NLP-methods for use in psychological treatment, and more accurately assess the predictive potential of text-based interactions during ICBT.</div></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"42 ","pages":"Article 100879"},"PeriodicalIF":4.1,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145266296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-05DOI: 10.1016/j.invent.2025.100883
Bryant P.H. Hui , Tao Zhang , Jeffrey C.F. Ho , Sophie Kai Lam Cheng , Chen Li , Rosetta Wong , Sylvia Xiaohua Chen
Background
Adolescent well-being is an urgent global concern. While engaging in prosocial behavior has been shown to enhance well-being, traditional interventions are often resource-intensive, contextually limited, and typically delivered in 2D formats. Virtual Reality (VR) offers a novel and immersive alternative by allowing adolescents to experience lifelike social scenarios and practice prosocial behaviors across diverse, everyday contexts.
Objective
This protocol outlines a randomized controlled trial to evaluate the feasibility, acceptability, and preliminary effectiveness of a gamified VR-based prosocial intervention, Cradle for Kids, among adolescents.
Methods
A total of 396 adolescents aged 10 to 16 will be randomly assigned to one of the three groups: a five-week VR-based intervention, a video-based intervention, or a waitlist control group. Prosocial behaviors and well-being will be assessed at baseline, immediately post-intervention, and at a one-month follow-up, with parents also completing proxy reports of participants' well-being at baseline and post-intervention. Daily diary assessments will also be collected throughout the intervention period. Feasibility and acceptability will be examined via completion rate, retention rate, and participant satisfaction. Data will be analyzed using repeated-measures ANOVA and multilevel modeling.
Discussion
To our knowledge, this will be the first trial to evaluate a gamified VR intervention designed to promote prosocial behavior and well-being in adolescents. Theoretically, it will contribute empirical evidence on the potential of immersive VR-based interventions to enhance well-being through prosocial engagement. Practically, if found effective, the program may offer a scalable and resource-efficient tool for schools and community organizations seeking to foster prosocial development in youth.
{"title":"Promoting prosocial behavior and well-being in adolescents through a gamified virtual reality intervention: A randomized controlled trial protocol","authors":"Bryant P.H. Hui , Tao Zhang , Jeffrey C.F. Ho , Sophie Kai Lam Cheng , Chen Li , Rosetta Wong , Sylvia Xiaohua Chen","doi":"10.1016/j.invent.2025.100883","DOIUrl":"10.1016/j.invent.2025.100883","url":null,"abstract":"<div><h3>Background</h3><div>Adolescent well-being is an urgent global concern. While engaging in prosocial behavior has been shown to enhance well-being, traditional interventions are often resource-intensive, contextually limited, and typically delivered in 2D formats. Virtual Reality (VR) offers a novel and immersive alternative by allowing adolescents to experience lifelike social scenarios and practice prosocial behaviors across diverse, everyday contexts.</div></div><div><h3>Objective</h3><div>This protocol outlines a randomized controlled trial to evaluate the feasibility, acceptability, and preliminary effectiveness of a gamified VR-based prosocial intervention, <em>Cradle for Kids</em>, among adolescents.</div></div><div><h3>Methods</h3><div>A total of 396 adolescents aged 10 to 16 will be randomly assigned to one of the three groups: a five-week VR-based intervention, a video-based intervention, or a waitlist control group. Prosocial behaviors and well-being will be assessed at baseline, immediately post-intervention, and at a one-month follow-up, with parents also completing proxy reports of participants' well-being at baseline and post-intervention. Daily diary assessments will also be collected throughout the intervention period. Feasibility and acceptability will be examined via completion rate, retention rate, and participant satisfaction. Data will be analyzed using repeated-measures ANOVA and multilevel modeling.</div></div><div><h3>Discussion</h3><div>To our knowledge, this will be the first trial to evaluate a gamified VR intervention designed to promote prosocial behavior and well-being in adolescents. Theoretically, it will contribute empirical evidence on the potential of immersive VR-based interventions to enhance well-being through prosocial engagement. Practically, if found effective, the program may offer a scalable and resource-efficient tool for schools and community organizations seeking to foster prosocial development in youth.</div></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"42 ","pages":"Article 100883"},"PeriodicalIF":4.1,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145266297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-03DOI: 10.1016/j.invent.2025.100881
Reidar Nævdal , Christiaan Vis , Robin Maria Francisca Kenter
Background
Internet-delivered cognitive behavioral therapy (iCBT) has been available in Norwegian specialist mental health care for a decade. Despite strong evidence and national support, uptake remains limited, with little known about therapists delivering iCBT or factors influencing engagement.
Objective
Using an extended Technology Acceptance Model (TAM), this study aimed to provide a national overview of therapists delivering iCBT, their work environment, and acceptance, as well as explore group differences between clinics established through different implementation approaches.
Methods
The study identified all therapists using iCBT in routine care. Using a cross-sectional survey, data regarding therapists' characteristics, their context, and TAM constructs was collected. Therapists were grouped by whether their clinics used bottom-up or top-down implementation approaches and compared on all TAM constructs.
Results
Sixty-seven therapists were identified as actively delivering iCBT nationally. Of these, 45 therapists from 18 clinics responded (67 % response rate). Therapists were experienced clinicians with varying backgrounds and work environments. High acceptance was found across all TAM dimensions except for Image. Therapists in clinics with structured top-down implementation and ongoing supervision reported highest acceptance.
Conclusion
Despite high therapist acceptance of iCBT, experienced loss in professional regard presents a cultural barrier hindering widespread adoption. Despite a decade of use, iCBT remains a small part of routine care. However, successful implementation across diverse therapist backgrounds is achievable, and mandated top-down implementation appears useful when supported by experienced supervision.
Trial registration
Haukeland University Hospital e-procotol, project ID: 4696–4696.
{"title":"Therapist characteristics and acceptance of internet-delivered cognitive behavioral therapy: A national cross-sectional survey using the technology acceptance model after ten years of iCBT in Norway","authors":"Reidar Nævdal , Christiaan Vis , Robin Maria Francisca Kenter","doi":"10.1016/j.invent.2025.100881","DOIUrl":"10.1016/j.invent.2025.100881","url":null,"abstract":"<div><h3>Background</h3><div>Internet-delivered cognitive behavioral therapy (iCBT) has been available in Norwegian specialist mental health care for a decade. Despite strong evidence and national support, uptake remains limited, with little known about therapists delivering iCBT or factors influencing engagement.</div></div><div><h3>Objective</h3><div>Using an extended Technology Acceptance Model (TAM), this study aimed to provide a national overview of therapists delivering iCBT, their work environment, and acceptance, as well as explore group differences between clinics established through different implementation approaches.</div></div><div><h3>Methods</h3><div>The study identified all therapists using iCBT in routine care. Using a cross-sectional survey, data regarding therapists' characteristics, their context, and TAM constructs was collected. Therapists were grouped by whether their clinics used bottom-up or top-down implementation approaches and compared on all TAM constructs.</div></div><div><h3>Results</h3><div>Sixty-seven therapists were identified as actively delivering iCBT nationally. Of these, 45 therapists from 18 clinics responded (67 % response rate). Therapists were experienced clinicians with varying backgrounds and work environments. High acceptance was found across all TAM dimensions except for Image. Therapists in clinics with structured top-down implementation and ongoing supervision reported highest acceptance.</div></div><div><h3>Conclusion</h3><div>Despite high therapist acceptance of iCBT, experienced loss in professional regard presents a cultural barrier hindering widespread adoption. Despite a decade of use, iCBT remains a small part of routine care. However, successful implementation across diverse therapist backgrounds is achievable, and mandated top-down implementation appears useful when supported by experienced supervision.</div></div><div><h3>Trial registration</h3><div>Haukeland University Hospital e-procotol, project ID: 4696–4696.</div></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"42 ","pages":"Article 100881"},"PeriodicalIF":4.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145266295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-03DOI: 10.1016/j.invent.2025.100880
Ewelina Smoktunowicz , Jan Maciejewski , Magdalena Lesnierowska , Justyna Ziolkowska , Marta Roczniewska
Some psychosocial challenges are inherently relational and may be addressed more effectively with dyadic rather than individual interventions. Although uptake and engagement of internet interventions have been widely studied, existing evidence focuses on individually oriented programmes, leaving their potential for dyadic phenomena—such as work–family conflict (WFC) and family–work conflict (FWC)—largely unexplored. To identify barriers and facilitators specific to a dyadic internet intervention aimed at reducing interrole conflict, we conducted semi-structured interviews with 20 heterosexual, dual-earner couples (N = 40). Thematic analysis revealed five key themes related to potential participation in such an intervention. Motivation for uptake was tied to recognized need, curiosity, and belief in efficacy. Involving both partners promised relational benefits yet introduced scheduling difficulties, highlighting the challenge of “doing it together.” Participants felt ambivalent about disclosing personal matters online, with subtle gendered differences in willingness to share. They also emphasized the importance of flexible, engaging, and personalized pedagogical design. Finally, participants viewed the online format ambivalently—while time constraints were often raised, they were frequently mitigated by the flexibility of access. These findings suggest that effective dyadic internet interventions for WFC/FWC must balance individual and joint activities, incorporate gender-sensitive communication pathways, and tailor content to different couple profiles (e.g., with or without children). Such efforts may enhance engagement and implementation feasibility.
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Pub Date : 2025-10-02DOI: 10.1016/j.invent.2025.100877
Minita Franzen , Lonneke I.M. Lenferink
Background
While people's symptomatology levels may change through self-monitoring of symptoms in daily life using experience sampling methodology (ESM), no controlled studies have examined such reactivity effects in the grief field.
Objective
We investigated reactivity effects of self-monitoring prolonged grief reactions to determine whether self-monitoring leads to clinically significant changes in early prolonged grief disorder (PGD), post-traumatic stress disorder (PTSD), and depression symptoms at both group and individual levels.
Methods
184 adults, bereaved 3 to 6 months earlier, were randomized to an ESM (n = 90) or waitlist condition (n = 94). Over two weeks, participants reported their prolonged grief reactions 5×/day. Early PGD, PTSD, and depression symptoms were assessed at baseline, post-ESM, and post-waiting. Reactivity effects on psychopathology symptom severity were examined between the ESM and waitlist group. Reliable change indices indicated clinically relevant changes in psychopathology severity and logistic regression models used to test if certain characteristics were related to the clinically relevant changes.
Results
At the group level, no significant reactivity effect of self-monitoring on symptom severity for PGD, PTSD, and depression was found. Individual-level analyses indicated that most participants did not experience clinically relevant changes from pre- to post-ESM. However, people with higher baseline-PGD-scores were more likely to experience clinically relevant improvements.
Conclusion
Self-monitoring prolonged grief in daily life does not seem to induce reactivity effects in symptom severity, supporting ESM as a suitable method for monitoring early prolonged grief in everyday life. Self-monitoring may benefit those with more severe initial symptoms, offering potential for targeted self-management strategies in bereavement care.
{"title":"Exploring reactivity effects of self-monitoring prolonged grief reactions in daily life: A randomized waitlist-controlled trial using experience sampling methodology","authors":"Minita Franzen , Lonneke I.M. Lenferink","doi":"10.1016/j.invent.2025.100877","DOIUrl":"10.1016/j.invent.2025.100877","url":null,"abstract":"<div><h3>Background</h3><div>While people's symptomatology levels may change through self-monitoring of symptoms in daily life using experience sampling methodology (ESM), no controlled studies have examined such reactivity effects in the grief field.</div></div><div><h3>Objective</h3><div>We investigated reactivity effects of self-monitoring prolonged grief reactions to determine whether self-monitoring leads to clinically significant changes in early prolonged grief disorder (PGD), post-traumatic stress disorder (PTSD), and depression symptoms at both group and individual levels.</div></div><div><h3>Methods</h3><div>184 adults, bereaved 3 to 6 months earlier, were randomized to an ESM (<em>n</em> = 90) or waitlist condition (<em>n</em> = 94). Over two weeks, participants reported their prolonged grief reactions 5×/day. Early PGD, PTSD, and depression symptoms were assessed at baseline, post-ESM, and post-waiting. Reactivity effects on psychopathology symptom severity were examined between the ESM and waitlist group. Reliable change indices indicated clinically relevant changes in psychopathology severity and logistic regression models used to test if certain characteristics were related to the clinically relevant changes.</div></div><div><h3>Results</h3><div>At the group level, no significant reactivity effect of self-monitoring on symptom severity for PGD, PTSD, and depression was found. Individual-level analyses indicated that most participants did not experience clinically relevant changes from pre- to post-ESM. However, people with higher baseline-PGD-scores were more likely to experience clinically relevant improvements.</div></div><div><h3>Conclusion</h3><div>Self-monitoring prolonged grief in daily life does not seem to induce reactivity effects in symptom severity, supporting ESM as a suitable method for monitoring early prolonged grief in everyday life. Self-monitoring may benefit those with more severe initial symptoms, offering potential for targeted self-management strategies in bereavement care.</div></div>","PeriodicalId":48615,"journal":{"name":"Internet Interventions-The Application of Information Technology in Mental and Behavioural Health","volume":"42 ","pages":"Article 100877"},"PeriodicalIF":4.1,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-29DOI: 10.1016/j.invent.2025.100878
Arpana Amarnath , Sevin Ozmen , Chris van Klaveren , Annemieke van Straten , Julia Pei , Leonore de Wit , Rasmus E. Raabe , Caring Universities Consortium , Pim Cuijpers , Sascha Y. Struijs
Procrastination is highly prevalent among students and has several negative consequences, affecting academic performance, mental health, and prospects for future professional development. However, there exists a treatment gap, with there being many more students with problems than those receiving help. This study aims to assess the effectiveness of a guided internet-based intervention, GetStarted, in addressing procrastination among college students. In this two-arm randomized controlled trial, 403 students were randomly assigned to GetStarted or waitlist control. The primary outcome was the difference in self-reported procrastination behaviours between intervention and control measured on the Irrational Procrastination scale (IPS) at post-test (4 weeks post-baseline). In addition, long-term effects based on the difference in the IPS scores from baseline to 6-months follow-up were assessed in the intervention group. Secondary outcomes were differences in depressive symptoms, anxiety, stress, and mental health-related quality of life. All analyses were based on the intent to treat principle. The Random Forest Lee bounds approach was applied as a sensitivity and robustness analysis. The sociodemographic characteristics of the participants were examined as treatment moderators. Finally, treatment acceptability was assessed through satisfaction with treatment, program usability, satisfaction with e-coach, and treatment adherence. Our results revealed that GetStarted was significantly effective in reducing procrastination at the post-test (Cohen's d = 0.40), and this effect remained stable at 6-month follow-up (p < .001). The intervention group also experienced reductions in depressive symptoms, anxiety, and stress, along with an increase in quality of life from baseline to post-test and 6-month follow-up, although these changes were not statistically significant apart from perceived stress. No significant moderators influenced treatment effectiveness. Overall, participants reported good acceptability of the treatment. GetStarted offers an effective, flexible, and low-intensity solution for treating procrastination, with the potential to prevent common mental health issues among college students.
Trial registration
This trial is registered at ClinicalTrials.gov Protocol Registration and Results System (Trial number: NCT05478096).
拖延症在学生中非常普遍，并有一些负面影响，影响学习成绩、心理健康和未来专业发展的前景。然而，存在着治疗差距，有问题的学生比得到帮助的学生多得多。本研究旨在评估一种基于互联网的指导性干预方法GetStarted在解决大学生拖延症方面的有效性。在这项两组随机对照试验中，403名学生被随机分配到“开始”组或候补组。主要结果是在测试后（基线后4周）用不合理拖延量表（IPS）测量干预组和对照组自我报告拖延行为的差异。此外，基于IPS评分从基线到6个月随访的差异，对干预组的长期影响进行了评估。次要结局是抑郁症状、焦虑、压力和精神健康相关生活质量的差异。所有的分析都是基于治疗意图原则。采用随机森林李氏界方法进行敏感性和稳健性分析。参与者的社会人口学特征作为治疗调节因素进行了检查。最后，通过治疗满意度、程序可用性、电子教练满意度和治疗依从性来评估治疗可接受性。我们的研究结果显示，在测试后，GetStarted在减少拖延症方面显著有效（Cohen’s d = 0.40），并且在6个月的随访中，这种效果保持稳定（p < .001）。干预组也经历了抑郁症状、焦虑和压力的减少，从基线到测试后和6个月随访的生活质量也有所提高，尽管这些变化除了感知到的压力外没有统计学意义。无显著调节因子影响治疗效果。总体而言，参与者报告了良好的治疗可接受性。GetStarted为治疗拖延症提供了一个有效、灵活、低强度的解决方案，有可能预防大学生中常见的心理健康问题。试验注册本试验在ClinicalTrials.gov方案注册和结果系统上注册（试验号：NCT05478096）。
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