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Wüllner S, Hermenau K, Krutkova M, Petras IK, Hecker T, Siniatchkin M. Mobile applications in adolescent psychotherapy during the COVID-19 pandemic: a systematic review. Front Public Health 2024; 12:1345808. [PMID: 38420028 PMCID: PMC10899334 DOI: 10.3389/fpubh.2024.1345808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/31/2024] [Indexed: 03/02/2024] Open
Abstract
Background To bridge the gap in adolescent psychotherapy created by the increasing need for mental health interventions and the limited possibilities of in-person treatment during the pandemic, many health care providers opted to offer online mental health care programs. As a result, the number of mental health apps available in app stores experienced a sharp increase during the COVID-19 pandemic. Objective The aim of the current review is to provide an overview of feasibility and effectiveness studies testing mobile applications in adolescent psychotherapy during the peak phase of the COVID-19 pandemic. Methods We conducted a literature search in Pubmed, PsychInfo, Google Scholar, OpenSIGLE and OpenGREY for papers published from June 2020 to June 2023. Studies were included if they evaluated app-based interventions intended for psychotherapeutic treatment and targeted adolescents between 12 and 27 years of age with symptoms of psychological disorders. The quality of each study was assessed using the Systematic Assessment of Quality in Observational Research (SAQOR). Effectiveness outcomes were analyzed by vote counting and calculating a binomial probability test. Results The search yielded 31 relevant studies that examined 27 different apps with a total of 1,578 adolescent participants. Nine articles were primary effectiveness studies and 22 focused on feasibility measures as primary outcome. There was evidence that mental health apps influenced adolescents' psychotherapy, with 83% of the studies with effectiveness outcomes favoring the intervention (p = 0.002). Sixty-one percent of the included studies were rated at low or very low quality. Conclusions The pandemic has given apps a firm and important role in healthcare that will probably continue to expand in the future. To ensure that mental health apps are truly effective and beneficial for adolescents' psychotherapy, we need a standardized measurement of quality features of mental health apps and higher quality app evaluation studies. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=406455, PROSPERO International Prospective Register of Systematic Reviews [CRD42023406455].
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Affiliation(s)
- Sarah Wüllner
- University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital Bethel, Bielefeld University, Medical School East Westphalia, Bielefeld, Germany
| | - Katharin Hermenau
- University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital Bethel, Bielefeld University, Medical School East Westphalia, Bielefeld, Germany
| | - Mariya Krutkova
- University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital Bethel, Bielefeld University, Medical School East Westphalia, Bielefeld, Germany
| | - Ira-Katharina Petras
- University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital Bethel, Bielefeld University, Medical School East Westphalia, Bielefeld, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics of Children and Adolescents, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Tobias Hecker
- Institute for Interdisciplinary Conflict and Violence Research, Bielefeld University, Bielefeld, Germany
- Department of Psychology, Faculty of Psychology and Sports Science, Bielefeld University, Bielefeld, Germany
| | - Michael Siniatchkin
- University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital Bethel, Bielefeld University, Medical School East Westphalia, Bielefeld, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics of Children and Adolescents, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
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Treves IN, Olson HA, Ozernov-Palchik O, Li CE, Wang KL, Arechiga XM, Goldberg SB, Gabrieli JDE. At-home use of app-based mindfulness for children: A randomized active-controlled trial. Mindfulness (N Y) 2023; 14:2728-2744. [PMID: 38654938 PMCID: PMC11034918 DOI: 10.1007/s12671-023-02231-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2023] [Indexed: 04/26/2024]
Abstract
Objectives School-based mindfulness interventions in children have shown benefits to child well-being. Here, we investigated the effectiveness of a remote, app-based mindfulness intervention for promoting well-being in children. Methods We conducted a randomized controlled trial (RCT) with two control groups to examine the effects of an 8-week mindfulness intervention in U.S. children ages 8-10. We compared pre-post effects between a mindfulness intervention using the Inner Explorer app, and two audiobook control interventions. The 279 children who participated in the interventions were assessed on self-report measures of anxiety and depression symptoms, perceived stress and trait mindfulness and we also collected parental reports. Results Over 80% of children completed the intervention in each condition. There was evidence for reduced self-perceived stress in children and reduced negative affect in children by parental reports using the mindfulness app, but no significant reduction for anxiety or depression symptoms. In general, between-group effect sizes were small (ds < 0.45). Regular use, defined as at least 30 days of mindfulness practice within the study period, was associated with reduced child negative affect by parental reports, as well as reduced parental stress and child self-perceived stress. Conclusions These findings suggest that home use of a mindfulness app in young children can have a positive impact on children's emotional well-being if the app is used regularly, specifically for at least 30 days in the 8-week study period. Strategies aimed at promoting regular use of the mindfulness app at home could lead to even better outcomes for children. Preregistration Preregistered on OSF at https://osf.io/23vax.
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Affiliation(s)
- Isaac N Treves
- Department of Brain and Cognitive Sciences and McGovern Institute for Brain Research, Massachusetts Institute of Technology, 43 Vassar Street, Cambridge, MA 02139, USA
- Hock E. Tan and K. Lisa Yang Center for Autism Research at Massachusetts Institute of Technology, Cambridge, MA
| | - Halie A Olson
- Department of Brain and Cognitive Sciences and McGovern Institute for Brain Research, Massachusetts Institute of Technology, 43 Vassar Street, Cambridge, MA 02139, USA
| | - Ola Ozernov-Palchik
- Department of Brain and Cognitive Sciences and McGovern Institute for Brain Research, Massachusetts Institute of Technology, 43 Vassar Street, Cambridge, MA 02139, USA
| | - Cindy E Li
- Hock E. Tan and K. Lisa Yang Center for Autism Research at Massachusetts Institute of Technology, Cambridge, MA
| | - Kimberly L Wang
- Department of Brain and Cognitive Sciences and McGovern Institute for Brain Research, Massachusetts Institute of Technology, 43 Vassar Street, Cambridge, MA 02139, USA
| | - Xochitl M Arechiga
- Department of Brain and Cognitive Sciences and McGovern Institute for Brain Research, Massachusetts Institute of Technology, 43 Vassar Street, Cambridge, MA 02139, USA
| | - Simon B Goldberg
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI, USA
- Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI, USA
| | - John D E Gabrieli
- Department of Brain and Cognitive Sciences and McGovern Institute for Brain Research, Massachusetts Institute of Technology, 43 Vassar Street, Cambridge, MA 02139, USA
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Litke SG, Resnikoff A, Anil A, Montgomery M, Matta R, Huh-Yoo J, Daly BP. Mobile Technologies for Supporting Mental Health in Youths: Scoping Review of Effectiveness, Limitations, and Inclusivity. JMIR Ment Health 2023; 10:e46949. [PMID: 37610818 PMCID: PMC10467602 DOI: 10.2196/46949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/01/2023] [Accepted: 07/07/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Over the past decade, there has been growing support for the use of mobile health (mHealth) technologies to improve the availability of mental health interventions. While mHealth is a promising tool for improving access to interventions, research on the effectiveness and efficacy of mHealth apps for youths is limited, particularly for underrepresented populations, including youths of color and economically marginalized youths. OBJECTIVE This scoping review study sought to evaluate the following research questions: (1) What is the extent of the current literature on mHealth apps that provide intervention for mental health problems in children and adolescents? (2) What is known from the existing literature about the effectiveness or efficacy of delivering mental health services via mHealth apps? (3) What are the gaps in the knowledge base in the fields of technology and mental health? (4) Do the reviewed mHealth apps address issues of cultural sensitivity or have they been tested with underrepresented groups (ie, youths of color or economically marginalized groups)? METHODS An electronic database search was conducted using relevant search terms. Seven independent reviewers screened identified studies, including title and abstract review to determine if studies met the following inclusion criteria: (1) targeted samples with mental health symptomology or disorders, (2) studied youth participants aged 6-17 years, and (3) examined the use of a mobile app-based platform for intervention. Relevant studies were subjected to full-text review to extract and chart relevant data based on a priori research questions. RESULTS The initial database search yielded 304 papers published from 2010 to 2021. After screening and selection, the final review included 10 papers on the effectiveness and efficacy of mental health intervention apps for youths aged 8 to 17 years. Identified apps targeted a broad range of mental health challenges in youths (ie, depression, self-harm, autism spectrum disorder, anxiety, and obsessive-compulsive disorder). Results identified only a small number of studies suggesting that current effectiveness and efficacy research in this area are limited. While some studies provided general support for the effectiveness of mHealth apps in improving mental health outcomes in youths, several notable limitations were present across the literature, reducing the generalizability of findings. Additionally, considerations around racial, ethnic, and socioeconomic diversity were scarce across studies. CONCLUSIONS Although some studies cited in this scoping review provide support for the effectiveness and efficacy of mHealth apps targeting mental health concerns in youths, the overall body of literature remains quite limited. Moreover, mHealth apps expressly developed to be culturally responsive are almost nonexistent. Further efforts are needed to recruit youths who are typically underrepresented in research and invite stakeholder participation and collaborative input in the early stages of the mHealth app development process.
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Affiliation(s)
- Shannon Grace Litke
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, United States
| | - Annie Resnikoff
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, United States
| | - Ashley Anil
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, United States
| | - Meredith Montgomery
- Department of Information Science, Drexel University, Philadelphia, PA, United States
| | - Rishabh Matta
- Department of Information Science, Drexel University, Philadelphia, PA, United States
| | - Jina Huh-Yoo
- Department of Information Science, Drexel University, Philadelphia, PA, United States
| | - Brian P Daly
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, United States
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Zainal NH, Newman MG. A randomized controlled trial of a 14-day mindfulness ecological momentary intervention (MEMI) for generalized anxiety disorder. Eur Psychiatry 2023; 66:e12. [PMID: 36645098 PMCID: PMC9970156 DOI: 10.1192/j.eurpsy.2023.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Little is known about whether brief mindfulness ecological momentary interventions (MEMIs) yield clinically beneficial effects. This gap exists despite the rapid growth of smartphone mindfulness applications. Specifically, no prior brief MEMI has targeted generalized anxiety disorder (GAD). Moreover, although theories propose that MEMIs can boost executive functioning (EF), they have largely gone untested. Thus, this randomized controlled trial (RCT) aimed to address these gaps by assessing the efficacy of a 14-day smartphone MEMI (versus self-monitoring placebo [SMP]). METHOD Participants with GAD were randomly assigned to either condition (68 MEMI and 42 SMP). MEMI participants exercised multiple core mindfulness strategies and were instructed to practice mindfulness continually. Comparatively, SMP participants were prompted to practice self-monitoring and were not taught any mindfulness strategies. All prompts occurred five times a day for 14 consecutive days. Participants completed self-reports and neuropsychological assessments at baseline, posttreatment, and 1-month follow-up (1MFU). Piecewise hierarchical linear modeling analyses were conducted. RESULTS MEMI (versus SMP) produced greater pre-1MFU reductions in GAD severity and perseverative cognitions (between-group d = 0.393-0.394) and stronger improvements in trait mindfulness and performance-based inhibition (d = 0.280-0.303). Further, MEMI (versus SMP) led to more considerable pre- to posttreatment reduction in state-level depression and anxiety and more mindfulness gains (d = 0.50-1.13). Overall, between-treatment effects were stronger at pre-1MFU than pre- to posttreatment for trait-level than state-level treatment outcome measures. CONCLUSIONS Preliminary findings suggest that the beneficial effect of an unguided brief MEMI to target pathological worry, trait mindfulness, and EF is modest yet potentially meaningful. Other theoretical and clinical implications were discussed.
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Affiliation(s)
- Nur Hani Zainal
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychology, National University of Singapore, Singapore
| | - Michelle G Newman
- Department of Psychology, The Pennsylvania State University, State College, Pennsylvania, USA
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Hilt LM, Swords CM, Webb CA. Randomized Controlled Trial of a Mindfulness Mobile Application for Ruminative Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023:1-14. [PMID: 36622879 PMCID: PMC10329729 DOI: 10.1080/15374416.2022.2158840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Rumination is a risk factor for the development of internalizing psychopathology that often emerges during adolescence. The goal of the present study was to test a mindfulness mobile app intervention designed to reduce rumination. METHOD Ruminative adolescents (N = 152; 59% girls, 18% racial/ethnic minority, Mage = 13.72, SD = .89) were randomly assigned to use a mobile app 3 times per day for 3 weeks that delivered brief mindfulness exercises or a mood monitoring-only control. Participants reported on rumination, depressive symptoms and anxiety symptoms at baseline, post-intervention and at 3 follow-up timepoints: 6 weeks, 12 weeks, and 6 months post-intervention. Parents reported on internalizing symptoms. RESULTS There was a significant Time X Condition effect at post-intervention for rumination, depressive symptoms, and anxiety symptoms, such that participants in the mindfulness intervention showed improvements relative to those in the control condition. The effect for rumination lasted through the 6-week follow-up period; however, group differences were generally not observed throughout the follow-up period, which may indicate that continued practice is needed for gains to be maintained. CONCLUSIONS This intervention may have the potential to prevent the development of psychopathology and should be tested in a longitudinal study assessing affective disorder onset, especially in populations with limited access to conventional, in person mental health care.This study was registered with Clinicaltrials.gov (Identifier NCT03900416).
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Affiliation(s)
- Lori M. Hilt
- Department of Psychology, Lawrence University, 711 E. Boldt Way, Appleton, WI 54911, U.S
| | - Caroline M. Swords
- Department of Psychology, Lawrence University, 711 E. Boldt Way, Appleton, WI 54911, U.S
| | - Christian A. Webb
- Department of Psychiatry, Harvard Medical School and McLean Hospital, MA, U.S
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