State of the Science on Racial Microaggressions

Teen Perspectives on Integrating Digital Mental Health Programs for Teens Into Public Libraries ("I Was Always at the Library"): Qualitative Interview Study

BACKGROUND

Rising rates of anxiety among teens necessitate innovative approaches for implementing evidence-based mental health support. Public libraries, seen as safe spaces for patrons with marginalized identities, offer free public services such as broadband internet access. Many teens spend significant amounts of time in their local libraries due to the safety of this space as well as the trusted adults working there. The American Library Association has shifted its priorities to focus more on mental health through employing social workers and providing mental health programs. As such, public libraries may be promising sites for the implementation of digital mental health (DMH) programs for teens.

OBJECTIVE

This study aimed to examine how teens who attended their local public library experienced and managed their anxiety, what mental health supports they were interested in receiving, and how DMH programs and public libraries can meet their needs.

METHODS

We interviewed 16 teens aged 12-18 (mean 15.2, SD 2.0) years who used the library frequently at the time of the interviews. Of these teen patrons, 56% (9/16) identified as female, 31% (5/16) identified as male, and 12% (2/16) identified as nonbinary. Most (11/16, 69%) identified as either White or Black or African American individuals, with the remainder (5/16, 31%) identifying as Hispanic or Latino or Chinese American individuals or with ≥2 races. The interviews were individual and semistructured, designed to elicit recommendations for designing and implementing digital tools in libraries to improve teen mental health. Interview transcripts were coded by multiple coders using thematic analysis to synthesize key themes.

RESULTS

Teens reported experiencing uncontrollability, unpredictability, and anger related to their anxiety, which they managed using strategies such as guided breathing, distress tolerance, and social connection. They also talked about other helpful management techniques (eg, progressive muscle relaxation, journaling, and mood tracking). Teens underscored the importance of pairing mood tracking with daily activities to reveal patterns. They also stressed the significance of context and anxiety severity when choosing anxiety management strategies. Teens underscored the centrality of the public library in their lives and their view of it as a safe space where they can easily access resources and connect with friends and trusted adults. When considering the design of a DMH program implemented in libraries, they suggested including personalization for different identities, gamification, and simple navigation. Teens emphasized the importance of protecting their privacy within digital programs and that their end goal was to use the skills learned in the DMH program offline.

CONCLUSIONS

Teens who frequently used their local public library expressed interest in receiving digital tools via libraries to help them manage anxiety. Their recommendations will help inform future research on the adaptation and implementation of DMH programs for teens in public libraries.

Exploring the Effectiveness and Acceptability of a Self-Help Acceptance-Based Behavior Intervention for Anxiety in Black Adults: An Uncontrolled Pilot Study

An estimated one in five Black Americans meet criteria for an anxiety disorder in their lifetimes (Alvarez et al., 2019), but only about 20% of these receive mental health services. Self-help materials that have been shown to be effective in reducing anxiety and worry could be one method of increasing access to evidence-informed treatments for Black Americans. The current study explored the acceptability and effectiveness of the Worry Less, Live More: The Mindful Way Through Anxiety Workbook (WLLM), a self-help workbook based on acceptance-based behavioral therapy, for reducing anxiety in a sample of Black individuals. Sixty-five Black individuals residing in the United States received the WLLM workbook and were asked to read it over 16 weeks at their own pace without intervention from researchers: 40 of those participants completed the follow-up survey. A majority of the participants agreed that the approach was a good match for them (70%) that it aligned with their personal and cultural views (60%), and that the strategies from the workbook were helpful for them when dealing with the stress related to encountering racial stressors (71%). There were significant improvements over time on self-reported general anxiety (d = .50, anxious arousal (d = .41), cognitive fusion (d = .45), and acceptance (d = .76), but no significant changes in engagement in values-based action over time. This study provided preliminary support for the acceptability of WLLM's acceptance-based approach for Black adults.

State of the Science in Behavior Therapy: Taking Stock and Looking Forward

The scope and burdens of mental health challenges in today's world are staggering. Among the available psychological treatment approaches, cognitive and behavioral therapies, and their combinations, have garnered the strongest evidence base. That said, progress has not always been linear and most of the work is still ahead of us. Against this backdrop, Behavior Therapy has launched its State of the Science series-an exciting new journal feature offering a curated set of authoritative reviews of research in major areas of relevance to applied cognitive-behavioral science, written by distinguished scientists in each area and peer-reviewed. The vision for the Behavior Therapy State of the Science series is to launch with an initial set of articles that make up this special journal issue, with continued publication of additional State of the Science articles in future journal issues. The current article launches the State of the Science series, providing a brief summary of progress in cognitive and behavioral practice and related areas, as well as various missteps and harmful legacies that remind us that the state of the science for research focused on mental health and the alleviation of human suffering is always in flux and evolving. The 16 inaugural reviews in this special issue are then introduced one by one. Collectively, these State of the Science reviews take stock of what has been learned across key areas in the field, highlight critical knowledge gaps in need of research, and provide expert guidance for improving the effectiveness and reach of care, particularly for marginalized and underserved populations.