Appreciating the Good Things in Life During the Covid-19 Pandemic: A Randomized Controlled Trial and Evaluation of a Gratitude App

Digital Psychological Interventions for Adults in the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

This study evaluates the effect of digital psychological interventions on anxiety, depression, and stress symptoms in adults affected by the pandemic. A systematic search across five digital databases, from 1 January 2020 to 6 March 2024, identified 36 studies encompassing 8,662 participants. Compared with all control conditions, random-effects meta-analyses indicated that digital psychological interventions significantly reduced anxiety (g = -0.374; 95% CI, -0.529 to -0.218), depression (g = -0.568; 95% CI, -0.776 to -0.360), and stress (g = -0.452; 95% CI, -0.608 to -0.295). Smaller effect sizes were observed when compared with active controls than with inactive controls. Notable heterogeneity across three outcomes was observed. Publication bias was noted in depression symptoms. Several moderators were identified compared with inactive controls, including participant type for anxiety (psubgroup = 0.005), and region for depression symptoms (psubgroup = 0.000). Larger sample sizes (b = 0.0004; p = 0.028) related to stronger effects on depression symptoms. Publication year positively correlated with effects on stress (b = 0.1573; p = 0.032). This study supports the efficacy of digital psychological interventions in alleviating anxiety, depression, and stress symptoms for adults during the pandemic, offering insights for developing targeted mental health strategies in future public health crises.

ReNeuWell mental well-being app: protocol for a randomised controlled trial

INTRODUCTION

The field of mental well-being interventions includes numerous studies of smartphone app-based programs, but there is a research-to-retail gap where many studies pertain to apps that are not publicly available, not used as standalone programs, or not tested in the general population, and many publicly available apps (or their proprietary in-app measures) have yet to be submitted to empirical testing. Furthermore, few well-being apps offer multicomponent interventions, despite such interventions having demonstrated efficacy outside the smartphone context. In response to these openings in the literature and marketplace, we have developed ReNeuWell, an iPhone app designed to measure the user's mental well-being (via the validated Composure, Own-worth, Mastery, Positivity, Achievement and Satisfaction for Well-being (COMPAS-W) scale) and improve their well-being via a personalised, multicomponent program of activities informed by the peer-reviewed evidence base. This article describes the protocol for the preregistered randomised controlled trial (RCT) of ReNeuWell, to test the app in adult participants from the general population of Apple App Store users. It is hypothesised that ReNeuWell users will experience significant increases in mental well-being and decreases in mental distress over the 6-12-week trial period, relative to users of an active control version of the app.

METHODS AND ANALYSIS

The RCT will recruit participants from Apple Store users who choose to download ReNeuWell in the normal course of browsing the marketplace. Following consent, the app will randomly allocate participants to receive either the full version of the app or the active control version. The full version assesses the user's well-being via the validated COMPAS-W scale, provides feedback on their well-being across six dimensions and creates a personalised schedule of daily positive psychology activities designed to enhance well-being along each dimension. Participants will be instructed to use the app for at least 10 min (at least one activity) per day for the first 6 weeks, and as they wish for the following 6 weeks. Trial outcomes will be measured via in-app surveys administered in weeks 1, 6 and 12. Data collection will begin when the app is officially launched on the Apple Store. Data will be analysed using linear mixed models to estimate condition-by-time interaction effects on the primary and secondary outcomes, and to assess whether any such effects are themselves moderated by other key variables.

ETHICS AND DISSEMINATION

This protocol has been approved by the Human Research Ethics Committee of the University of New South Wales (reference number: HC210302). Trial outcomes will be published in accordance with the preregistered protocol described here, both in the peer-reviewed literature and on the registry website.

TRIAL REGISTRATION NUMBER

This protocol was preregistered with the Australian New Zealand Clinical Trials Registry (registration approved on 4 August 2021; trial ID number: ACTRN12621001014842p).

Digital Mental Health: Role of Artificial Intelligence in Psychotherapy

Background

It is estimated that 6%-7% of the population suffers from mental disorders. WHO reported that one in four families is likely to have at least one member with a behavioural or mental disorder. Post-pandemic, the world has experienced a huge surge in mental health issues. Unfortunately, not everyone is able to access the available mental health services due to constraints such as lack of financial assistance, living in remote areas, fear of being stigmatised and lack of awareness. The emergence of online mental health services could solve some of these problems, as these are easily accessible to people from anywhere, are cost effective and also reduce the fear of being judged or labelled. Lots of efforts are being made today to integrate artificial intelligence with the traditional form of psychotherapy. The role of chatbots for mental health services in the form of e-therapies has been found to be highly relevant and important.

Summary

The present study aims to systematically review the evidence on the use of AI-based methods for treating mental health issues. Overall, 95 studies were extracted using some of the popular databases such as Mendeley, PubM, INFO and DOAJ. The terms used in the search included 'psychotherapy', 'online therapies', 'artificial intelligence' and 'online counselling'. Finally, after screening, 13 studies were selected based on the eligibility criteria. Most of these studies had employed conversational agents as an intervention. The results obtained showed the significant positive consequences of using AI-based approaches in treating mental health issues.

Key Message

The study strongly suggests integrating AI with the traditional form of counselling.

A Mobile App-Based Gratitude Intervention's Effect on Mental Well-Being in University Students: Randomized Controlled Trial

Background

Gratitude interventions are used to cultivate a sense of gratitude for life and others. There have been mixed results of the efficacy of gratitude interventions' effect on psychological well-being with a variety of populations and methodologies.

objectives

The objective of our study was to test the effectiveness of a gratitude intervention smartphone app on university students' psychological well-being.

Methods

We used a randomized experimental design to test our objective. Participants were recruited undergraduate students from a web-based university study recruitment system. Participants completed 90 web-based survey questions on their emotional well-being and personality traits at the beginning and end of the 3-week research period. Their depression, anxiety, and stress levels were measured with the Depression, Anxiety, and Stress Scale (DASS-21). After the baseline survey, participants were randomly assigned to either the control or the intervention. Participants in the intervention group used both a fully automated mobile sensing app and a gratitude intervention mobile iOS smartphone app designed for youth users and based on previous gratitude interventions and exercises. The gratitude intervention app prompted users to complete daily gratitude exercises on the app including a gratitude journal, a gratitude photo book, an imagine exercise, a speech exercise, and meditation. Participants in the control group used only the mobile sensing app, which passively collected smartphone sensory data on mobility, screen time, sleep, and social interactions.

Results

A total of 120 participants met the inclusion criteria, and 27 were lost to follow-up for a total of 41 participants in the intervention group and 52 in the control group providing complete data. Based on clinical cutoffs from the baseline assessment, 56 out of 120 participants were identified as being in a subsample with at least moderate baseline symptomatology. Participants in the subsample with at least moderate baseline symptomatology reported significantly lower symptoms of depression, anxiety, and stress postintervention (Cohen d=-0.68; P=.04) but not in the full sample with low baseline symptomatology (Cohen d=0.16; P=.46). The number of times the app was accessed was not correlated with changes in either the subsample (r=0.01; P=.98) or the full sample (r=-0.04; P=.79).

Conclusions

University students experiencing moderate to severe distress can benefit from a gratitude intervention smartphone app to improve symptoms of depression, anxiety, and stress. The number of times the gratitude intervention app was used is not related to well-being outcomes. Clinicians could look at incorporating gratitude apps with other mental health treatments or for those waitlisted as a cost-effective and minimally guided option for university students experiencing psychological distress.

A randomized trial investigating the impact of response expectancy on the counting blessings intervention: the role of optimism as a moderator

Introduction

This randomized controlled trial aimed to address a knowledge gap concerning the mechanisms responsible for the efficacy of gratitude interventions. Specifically, we investigated how various response expectancies (positive, ambiguous + negative, and no expectancy) impact the efficacy of the "counting blessings" intervention in influencing positive and negative emotions. Additionally, the study explores how optimism levels (high, medium, low) interact with these expectancies to influence intervention efficacy.

Method

A total of 529 adult volunteers were recruited through social media and randomly assigned to one of three experimental conditions, Positive Condition (PC), Ambiguous + Negative Condition (ANC), No Expectancy Condition (NEC), using a Random Sequence Generator. Of these, 142 participants completed the seven-day counting blessings intervention, and 111 participated in a follow-up assessment 1 month later. Missing data were addressed using multiple imputation. The main outcomes were changes in positive and negative emotions, with moderation analysis assessing the interaction between optimism levels and response expectancies. The study adhered to the CONSORT guidelines.

Results

While no significant interaction was found between experimental conditions and time regarding emotional outcomes (p ˃ 0.05), moderation analysis revealed differential interactions between optimism levels and expectancies, particularly influencing positive emotions (p < 0.009). For participants with low optimism, positive emotions significantly increased from post-intervention to follow-up in the PC (t = -2.42, p < 0.016) and from pre-intervention to post-intervention in the ANC (t = 2.41, p < 0.018). Participants with medium optimism experienced an increase in positive emotions across all conditions from pre-intervention to follow-up and from post-intervention to follow-up (ps  < 0.05). High optimism participants showed an increase in positive emotions from pre-intervention to follow-up and post-intervention to follow-up in the PC (t = 2.09, p < 0.038 and t = 3.06, p < 0.003) and NEC c (t = -2.76, p < 0.006 and t = 2.74, p < 0.007).

Conclusion

Our findings emphasize the effectiveness of a brief gratitude journal and underscore the nuanced role of response expectancy, especially in interaction with the initial level of optimism, in enhancing positive emotions. These results hold significance for both theoretical understanding and clinical applications.

Effectiveness of a guided multicomponent internet and mobile gratitude training program - A pragmatic randomized controlled trial

Objective

To investigate the effectiveness of a guided, internet- and smartphone-based gratitude intervention on the transdiagnostic risk-factor 'repetitive negative thinking'. The multicomponent intervention integrates a variety of gratitude exercises, targeting the cognitive, emotional and behavioural facets of gratitude.

Method

Two hundred adults with pronounced repetitive negative thinking were recruited from the general population. Participants were randomly assigned to either a four-session guided gratitude intervention (n = 100) or waiting list (n = 100). The primary outcome was repetitive negative thinking three months after randomization, with exploratory assessments at six weeks and six months, the latter just for participants in the intervention group.

Results

Following the intention-to-treat principle, by analyses of covariance (ANCOVA), the gratitude intervention group exhibited significantly lower levels of repetitive negative thinking than controls at three months, with d = 0.66, 95 % CI [0.37, 0.94] maintained at six-month follow-up. Significant and meaningful beneficial effects were observed in symptoms of depression (d = 0.42) and generalized anxiety (d = 0.38). These effects were notably stronger in intervention completers who finished at least three sessions.

Conclusions

Results suggest that a multicomponent gratitude intervention is effective at reducing repetitive negative thinking. Multicomponent interventions may be a next step needed to fully realize the potential of gratitude interventions. Such interventions could expand the repertoire of transdiagnostic interventions, especially for repetitive negative thinking. Furthermore, due to its positive connotations, gratitude is a candidate for an indirect intervention aimed at reducing the burden of depression in the general population.

Trial registration

The study is registered in the German Clinical Trial Register (approved primary register of the WHO) as DRKS00006825. The trial protocol can be assessed at: https://www.drks.de/.

Effectiveness of a positive psychology and mindfulness-based app on mental health for parents of children with a neurodevelopmental disorder: study protocol of a pragmatic international randomized controlled trial

INTRODUCTION

Parents of children with a neurodevelopmental disorder (NDD) experience more stress than parents of typically developing children. In a cocreation process with experts and parents, a low-threshold application that uses exercises based on the principles of positive psychology and mindfulness was developed. This application, called "Adappt," aims at enhancing the ability to adapt of the parents and caregivers of children with NDDs and at supporting their mental health. This protocol describes the evaluation study of the effectiveness of Adappt, its core working mechanisms and user experiences.

METHOD

A pragmatic international multicenter randomized controlled trial will compare the effectiveness of Adappt with a (delayed) waitlist control condition. At least 212 parents or primary caregivers of children younger than 18 years diagnosed with or suspected of a NDD will be randomly assigned to the intervention or waitlist control condition. Participants are excluded if they have severe anxiety or depression levels or are in treatment for mental health issues. Measures will be collected online at baseline, post-intervention (1 month after baseline), and 4 and 7 months after baseline. The primary outcome is the improvement in generic sense of ability to adapt as measured with the Generic Sense of Ability to Adapt Scale (GSAAS; (Front Psychol 14:985408, 2023)) at 4-month follow-up. Secondary outcomes are mental well-being, (parental) distress, and client satisfaction with "Adappt."

DISCUSSION

Results of this study will contribute to knowledge on the effectiveness of a low-threshold application for parents of children with a NDD in multiple countries. If the application is found to be effective in improving mental health, recommendations will be made for implementation in health care.

TRIAL REGISTRATION

This study is registered on clinicaltrials.gov (NCT06248762) on February 8, 2024, and the Open Science Framework ( https://osf.io/5znqv ).

The promotive and protective effects of parents' perceived changes during the COVID-19 pandemic on emotional well-being among U.S. households with young children: an investigation of family resilience processes

Introduction

The COVID-19 pandemic may constitute a traumatic event for families with young children due to its acute onset, the unpredictable and ubiquitous nature, and the highly distressing disruptions it caused in family lives. Despite the prevalent challenges such as material hardships, child care disruptions, and social isolation, some families evinced remarkable resilience in the face of this potentially traumatic event. This study examined domains of changes perceived by parents of young children that were consistent with the post-traumatic growth (PTG) model as factors that facilitate family resilience processes.

Methods

This study drew data from the RAPID project, a large ongoing national study that used frequent online surveys to examine the pandemic impact on U.S. households with young children. A subsample of 669 families was leveraged for the current investigation, including 8.07% Black, 9.57% Latino(a), 74.44% non-Latino(a) White families, and 7.92% households of other racial/ethnic backgrounds. In this subsample, 26.36% were below 200% federal poverty level.

Results

Approximately half of the parents reported moderate-to-large degrees of changes during the pandemic, and the most prevalent domain of change was appreciation of life, followed by personal strengths, new possibilities, improved relationships, and spiritual growth. Black and Latino(a) parents reported more changes in all five domains than White parents and more spiritual growth than parents of the other racial/ethnic groups. Moreover, parent-reported improved relationships were found to indirectly reduce young children's overall fussiness/defiance and fear/anxiety symptoms through reducing parents' emotional distress. Perceived changes in the new possibilities, personal strengths, and appreciation of life domains were found to serve as protective factors that buffered the indirect impacts of material hardship mean levels on child behavioral symptoms via mitigating parents' emotional distress.

Discussion

These findings shed light on resilience processes of a family system in a large-scale, disruptive, and stressful socio-historical event such as the COVID-19 pandemic. The five PTG domains could inform therapeutic and intervention practices in the face of future similar events. Importantly, these findings and the evinced family resilience should not negate the urgent needs of policy and program efforts to address material hardships, financial instabilities, and race/ethnicity-based structural inequalities for families of young children.

First validation of the model of sustainable mental health: Structural model validity and the indirect role of adaptation

OBJECTIVES

There is a growing interest in mental well-being as a vital outcome in clinical practice in addition to mental illness. The model of sustainable mental health (SMH) was recently introduced to delineate how interventions can improve mental health by targeting barriers and resources of adaptation to life stressors, improving the ability to adapt and thereby reducing mental illness and improving mental well-being. The aim of the current study is to empirically validate the conceptual model of SMH as well as the assumed indirect role of ability to adapt.

METHODS

This study used an existing dataset of the general population with self-reported reduced well-being due to the corona crisis (n = 849, mean age 53 years, SD = 15). Measurements of mental illness (depression and anxiety), mental well-being, ability to adapt, a specific barrier for adaptation (i.e., repetitive negative thinking), and a specific resource for adaptation (i.e., positive reframing) were included. Structural equation modeling was used to assess both the structural validity of the model and the indirect effect of ability to adapt.

RESULTS

An acceptable to good fit was found for the model of SMH and all paths between the proposed elements of the model were significant and in the hypothesized direction. Ability to adapt served as an indirect pathway trough which repetitive negative thinking (B = 0.149, 95% confidence interval [CI] = 0.016-0.028) and positive reframing (B = 0.163, 95% CI = 0.065-0.123) were linked with mental illness and mental well-being.

CONCLUSION

The current study provides the first empirical support of the internal validity of the model of SMH in a sample of the general population with reduced well-being, suggesting that barriers and resources to adaptation have an effect on mental illness and mental well-being through the ability to adapt. The model of SMH may therefore be a good model to use in research and clinical practice for developing, implementing, and evaluating a balanced treatment approach targeting both barriers and resources for adaptation.

What we know about grief intervention: a bibliometric analysis

Background

Grief is a natural and individualized response to different losses, but if grief persists or becomes pathological, professional interventions are required. Grief and corresponding interventions have received increasing attention, as the related concepts have been incorporated into the DSM-5 and ICD-11. Therefore, we conducted a bibliometric analysis to explore the developments in the field of grief intervention research.

Methods

Articles on grief interventions were systematically searched and screened from the Web of Science Core Collection. The retrieved data were analyzed and visualized using VOSviewer and Bibliometrix software for journals, authors, institutions, countries, references, and keywords.

Results

A total of 9,754 articles were included. The number of articles on grief interventions has increased significantly each year since 1990. Death Studies was the journal that published the most articles in this field. We identified 25,140 authors contributed to this research area and these authors were from 123 countries and 6,630 institutions. Boelen PA secured the first position in article production, Columbia University emerged as the most productive affiliation and the United States was the foremost leading in grief intervention research. The prevalent keywords utilized in this field comprised bereavement, grief, death, depression, and palliative care.

Conclusion

The quantity of publications regarding grief interventions is increasing. Although most prior studies have focused on mortality, grief, and health, emerging themes such as COVID-19, grief among workers, and disfranchised grief have drawn increasing attention in recent years. Future studies may focus on investigating the complexities and challenges of grief, including its underlying mechanisms and impact on mental well-being.

Longitudinal Relations Between School Climate and Prosocial Behavior: The Mediating Role of Gratitude

Purpose

The school climate, which refers to the quality and character of school life, is associated with a wide range of developmental outcomes. Although researchers have shown considerable interest in uncovering the links between school climate and prosocial behavior, the mechanisms underlying this association remain unclear. Therefore, the current study was designed to investigate the mediating role of gratitude between school climate and adolescents' prosocial behavior.

Methods

A sample of 632 Chinese adolescents (363 girls and 269 boys; M_age = 16.83 years at time 1, SD = 0.68 years) completed a battery of sociometric and self-report questionnaires that measured school climate, gratitude, and prosocial behavior in three waves.

Results

Correlation analysis showed that school climate, gratitude, and prosocial behavior were all significantly and positively intercorrelated across the three waves. Importantly, gratitude completely mediated the relationship between school climate and prosocial behavior (β = 0.005 [95% confidence interval = 0.001, 0.013]) in the three-wave longitudinal mediation model.

Conclusion

As a positive disposition, gratitude fosters prosocial behavior and serves as a mediator between school climate and prosocial behavior. This study provides a theoretical explanation for cultivating adolescents' prosocial behavior and theoretical guidelines for interventions of schools and other socializing agents.