Online Positive Interventions to Promote Well-being and Resilience in the Adolescent Population: A Narrative Review

Sense of coherence and health in adolescents: a longitudinal cohort study

OBJECTIVE

Several studies indicate an association between adolescents' sense of coherence (SOC) and health. However, a few longitudinal studies have been conducted. The aim of the study was to analyze the association between SOC and health among adolescents during secondary education.

METHODS

Participants of longitudinal cohort study were followed by questionnaires at the age of 15 (N = 441), and 17 (N = 354). The data were analyzed using the methods of descriptive and inferential statistics. We used hierarchical regression to examine significant predictors of health.

RESULTS

Adolescents' SOC was stable during the analyzed two-year period (128.84 ± 22.17; 129.24 ± 23.06). A strong significant positive correlation was found between SOC and mental health (r = 0.635, p<.001; r = 0.670, p<.001). A significant difference was found between adolescents with a low SOC and those with a high SOC in physical functioning (p<.018), general health (p<.001), vitality (p<.001), social functioning (p<.001), emotional role functioning (p<.013) and mental health (p<.001). Boys had higher SOC and most of the health dimensions. Having a stronger SOC, being male, and living with both parents were predictors of better mental health.

CONCLUSIONS

Sense of coherence was a significant and stable factor associated with mental health. Thus, salutogenic interventions for improving the sense of coherence during adolescence should be explored.

Advancing Patient-Centered Care: An International Survey of Adolescent Perspectives on Insomnia

OBJECTIVE

The study objective was to inform patient-centered care for adolescent insomnia by describing adolescents' perspectives on insomnia. Specific constructs of interest included: 1) factors that contributed to insomnia development or maintenance, 2) impact of insomnia on day-to-day life, 3) recommended research priorities, and 4) overall experience living with insomnia.

METHOD

A convenience sample of adolescents (ages 13-18 years) self-identifying with insomnia symptoms was recruited through social media. Respondents (n = 3,014) completed an online survey. Responses to an open-ended item assessing patient experience were coded using thematic analysis.

RESULTS

Participants identified as 70.8% White non-Hispanic, 77.0% female, and lived in one of five English-speaking countries (United States, United Kingdom, Canada, Australia, or New Zealand). Most (87.5%) met DSM-V diagnostic criteria for insomnia. The most common contributory factors to insomnia endorsed were stress (72.1%) and depressed mood (63.6%), while common impact areas were mood (72.2%), focus (61.0%), and pain (49.7%). Patient-centered research priorities were identifying insomnia causes (66.4%) and early detection (66.1%). Common adolescent experiences included high distress levels, feelings of invalidation, and helplessness about their insomnia.

CONCLUSIONS

Adolescents with insomnia offer a unique perspective that should inform patient-centered research and care. There is a need for heightened screening and awareness about insomnia as a condition that causes significant distress and impairment for adolescents. To provide validating care, providers should recognize the multifaceted causes of insomnia.

Italian university students' future time perspective and well-being during the COVID-19 pandemic

Introduction

During the COVID-19 pandemic, young adults worldwide showed signs of distress as they were affected in their specific developmental tasks, including the construction of personal and professional futures.

Methods

The present study aimed to assess the situational future time perspective of Italian university students during the second pandemic wave, as measured by an ad hoc constructed instrument, to explore its interaction with some dispositional traits relevant in future construction, such as optimism, sense of life, aggression, and dispositional future time perspective, and to test their effect on psychological well-being. The total sample consisted of 389 subjects (18-35 years, M = 23.5, SD = 4.4).

Results and discussion

The results indicated that the pandemic experience, assessed by surveying specific indicators, negatively affected the future time perspective of students, particularly those dispositionally optimistic and convinced that life has meaning. However, awareness of the negative impact that the pandemic brought to the vision of the future seems to have dampened the levels of depression and stress, while anxiety was found to be related only to dispositional traits. The results also suggested the need for educational and economic policies that help young adults develop confidence in the future and in their ability to build it.

Internet Use as a Moderator of the Relationship Between Personal Resources and Stress in Older Adults: Cross-Sectional Study

BACKGROUND

Internet use has dramatically increased worldwide, with over two-thirds of the world's population using it, including the older adult population. Technical resources such as internet use have been shown to influence psychological processes such as stress positively. Following the Conservation of Resources theory by Hobfoll, stress experience largely depends on individuals' personal resources and the changes in these resources. While personal resource loss has been shown to lead to stress, we know little regarding the role that technical resources may play on the relationship between personal resources and stress.

OBJECTIVE

This study aims to investigate the moderating effect of technical resources (internet use) on the relationship between personal resources and stress in younger and older adults.

METHODS

A total of 275 younger adults (aged 18 to 30 years) and 224 older adults (aged ≥65 years) indicated their levels of stress; change in personal resources (ie, cognitive, social, and self-efficacy resource loss and gain); and internet use. Variance analyses, multiple regression, and moderation analyses were performed to investigate the correlates of stress.

RESULTS

Results showed that older adults, despite experiencing higher levels of resource loss (questionnaire scores: 1.82 vs 1.54; P<.001) and less resource gain (questionnaire scores: 1.82 vs 2.31; P<.001), were less stressed than younger adults (questionnaire scores: 1.99 vs 2.47; P<.001). We observed that the relationship among resource loss, resource gain, and stress in older adults was moderated by their level of internet use (β=.09; P=.05). Specifically, older adults who used the internet more frequently were less stressed when they experienced high levels of both loss and gain compared to their counterparts who used internet the less in the same conditions. Furthermore, older adults with low resource gain and high resource loss expressed less stress when they used the internet more often compared to those with low internet use.

CONCLUSIONS

These findings highlight the importance of internet use in mitigating stress among older adults experiencing resource loss and gain, emphasizing the potential of digital interventions to promote mental health in this population.

Acceptability and Utility of a Smartphone App to Support Adolescent Mental Health (BeMe): Program Evaluation Study

BACKGROUND

Adolescents face unprecedented mental health challenges, and technology has the opportunity to facilitate access and support digitally connected generations. The combination of digital tools and live human connection may hold particular promise for resonating with and flexibly supporting young people's mental health.

OBJECTIVE

This study aimed to describe the BeMe app-based platform to support adolescents' mental health and well-being and to examine app engagement, usability, and satisfaction.

METHODS

Adolescents in the United States, aged 13 to 20 years, were recruited via the web and enrolled between September 1 and October 31, 2022. App engagement, feature use, clinical functioning, and satisfaction with BeMe were examined for 30 days. BeMe provides content based on cognitive behavioral therapy, dialectical behavior therapy, motivational interviewing, and positive psychology; interactive activities; live text-based coaching; links to clinical services; and crisis support tools (digital and live).

RESULTS

The average age of the sample (N=13,421) was 15.04 (SD 1.7) years, and 56.72% (7612/13,421) identified with she/her pronouns. For the subsample that completed the in-app assessments, the mean scores indicated concern for depression (8-item Patient Health Questionnaire mean 15.68/20, SD 5.9; n=239), anxiety (7-item Generalized Anxiety Disorder Questionnaire mean 13.37/17, SD 5.0; n=791), and poor well-being (World Health Organization-Five Well-being Index mean 30.15/100, SD 16.1; n=1923). Overall, the adolescents engaged with BeMe for an average of 2.38 (SD 2.7) days in 7.94 (SD 24.1) sessions and completed 11.26 (SD 19.8) activities. Most adolescents engaged with BeMe's content (12,270/13,421, 91.42%), mood ratings (13,094/13,421, 97.56%), and interactive skills (10,098/13,421, 75.24%), and almost one-fifth of the adolescents engaged with coaching (2539/13,421, 18.92%), clinical resources (2411/13,421, 17.96%), and crisis support resources (2499/13,421, 18.62%). Overall app engagement (total activities) was highest among female and gender-neutral adolescents compared with male adolescents (all P<.001) and was highest among younger adolescents (aged 13-14 years) compared with all other ages (all P<.001). Satisfaction ratings were generally high for content (eg, 158/176, 89.8% rated as helpful and 1044/1139, 91.66% improved coping self-efficacy), activities (5362/8468, 63.32% helpful and 4408/6072, 72.6% useful in coping with big feelings), and coaching (747/894, 83.6% helpful and 747/894, 83.6% improved coping self-efficacy). Engagement (total activities completed) predicted the likelihood of app satisfaction (P<.001).

CONCLUSIONS

Many adolescents downloaded the BeMe app and completed multiple sessions and activities. Engagement with BeMe was higher among female and younger adolescents. Ratings of BeMe's content, activities, and coaching were very positive for cognitive precursors aimed at reducing depression and anxiety and improving well-being. The findings will inform future app development to promote more sustained engagement, and future evaluations will assess the effects of BeMe on changes in mental health outcomes.

Developing Public Health Promotion Strategies for Social Networking Sites: Perspectives of Young Immigrant Women in Norway

BACKGROUND

Social networking sites (SNS) have emerged as digital settings for youth participation and health promotion. Understanding the complex dynamic of analog/digital participation has become crucial for settings-based health promotion strategies that aim to enable people to increase control over their health and environments. Previous research demonstrates that SNS influence young people's health in complex ways, but less is known about how processes related to intersectionality are reflected in digital settings. This study asked the following question: how do young women with immigrant backgrounds experience and navigate SNS and how can this inform settings-based health promotion strategies?

METHODS

The study included three focus groups with 15 women aged 16-26 years and used thematic content analysis.

FINDINGS AND CONCLUSION

Young women with immigrant backgrounds reported that transnational networks provided a sense of belonging. However, their presence on SNS strengthened negative social control and had consequences for endeavors to connect with local peers in both digital and analog settings. Both challenges and resources were amplified. The participants reported that sharing strategies to navigate complex networks was useful; they emphasized the importance of anonymous chats, they shared health-related information with extended networks with lower e-literacy, and they saw opportunities for the cocreation of health promotion strategies.

A Stage 1 Pilot Cohort Exploring the Use of EMDR Therapy as a Videoconference Psychotherapy During COVID-19 With Frontline Mental Health Workers: A Proof of Concept Study Utilising a Virtual Blind 2 Therapist Protocol

Objective

The COVID-19 pandemic has had a major impact on the delivery of psychological treatment. Due to social distancing requirements, the provision moved to videoconferencing psychotherapy (VCP). There is a paucity of empirical data supporting the efficacy of EMDR therapy as a VCP. This stage 1 pilot study tested an EMDR therapy scripted protocol, such as Virtual Blind 2 Therapist (VB2Tr), on frontline mental health workers as a VCP regarding fitness for purpose, distinctiveness, relevance, and efficiency.

Methods

A total of 24 participants were recruited for the study. The design included a one-session treatment intervention with pre, post, 1-month, and 6-month follow-up (FU) measurements. This treatment session used a “Blind 2 Therapist” EMDR therapy scripted protocol as videoconference psychotherapy that involves non-disclosure of traumatic memory. The research explored the treatment effect on the core characteristics of trauma memory, including subjective disturbance, belief systems, memory intensity (MI), vividness, and levels of emotionality. Additionally, the research explored participants’ experiences of adverse and benevolent childhood experiences (ACEs/BCEs) during their childhood.

Results

Regarding the four tests, namely, fitness for purpose, distinctiveness, relevance, and efficiency, results are favourably suggesting potential clinical benefits of using EMDR as videoconference psychotherapy. Although this is a proof-of-concept study showing positive results, no clinical population or control group was used. The purpose of the study is to explore the potential for scalability toward a larger clinical trial. The treatment intervention was achieved irrespective of either ACEs/BCEs during childhood.

Conclusion

The research tentatively supports the case for EMDR therapy as a credible treatment when used as video conference psychotherapy and in using the Blind 2 Therapist protocol. However, more research is needed to scale toward a clinical trial.

Clinical Trial Registration

Clinical Trial Registration:https://www.isrctn.com/ISRCTN12099530, identifier ISRCTN12099530.

Online Multicomponent Program for Mental Health Promotion of Medical Students: An Intervention Study

Background: Youth mental health is a significant public health concern. Mental health issues are increasing in severity and number in college campuses. Improving adolescent mental well-being remains a challenge for most societies. Aim: Promote the well-being and mental health outcomes of Kasr Al-Ainy medical school students. Methods: An intervention study conducted at Kasr Al-Ainy Faculty of medicine. Study Participants (n=664) from 4th and 5th graders were assigned to either of two conditions: Fourth graders (n=325) to intervention (Horizon Egypt) website which provided information across positive psychology domains and Fifth graders (n=312) to control neutral entertainment-based website. Participants were assessed pre- and post-intervention on Depression Anxiety Stress Scale-Short form (DASS-21) and the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS). Results: There was no pre-intervention statistically significant differences between Horizon Egypt and control group on demographic variables, DASS-21, or WEMWBS scores. Qualitative data indicated that all participants reported that Horizon Egypt website was easy to use, 85% agreed the program was fun, 91% agreed the activities were interesting and 77% agreed they would continue to use it after study completion. Compared to the control condition, participants in the Horizon Egypt condition with high levels of adherence reported significant decrease in depression, anxiety, stress and improvements in well-being score. Conclusion & Recommendations: Acceptability of Horizon Egypt website was high. The online delivery of positive psychology programs may be an alternative way to address mental health issues and improve youth well-being.  

Trauma and psychosis: a qualitative study exploring the perspectives of people with psychosis on the influence of traumatic experiences on psychotic symptoms and quality of life

BACKGROUND

Despite experiencing high rates of trauma and trauma-related conditions, people with psychosis are seldomly asked about possible traumatic events. While there are some barriers to discussing trauma in clinical services, research has shown that disclosure is not only possible but also beneficial to both psychotic and traumatic symptoms. The current study is the first to evaluate service users' perception of the influence of trauma on the development and maintenance of their psychotic symptoms, as well as their views on how their life and mental health have been affected by traumatic events and their disclosure (or lack of).

METHODS

Eleven participants with experiences of psychosis and trauma took part in semi-structured interviews.

RESULTS

Consistently with previous literature, our participants reported high rates of interpersonal trauma, but had rarely had the opportunity to discuss any of these events. Using thematic analysis, we identified three major themes that have important implications for healthcare: factors that facilitate or hinder talking about trauma; consequences of talking or not; and relationship between trauma and psychosis. Participants generally benefited from talking about trauma and concerningly often associated the prolonged lack of opportunities to discuss traumatic events with negative feelings towards the self and with a deterioration of their mental health. Participants also recognised direct links between past traumas and the content and characteristics of their psychotic experiences.

CONCLUSIONS

Our findings highlight the importance, as perceived by service users, of discussing trauma and looking at psychosis through a "trauma lens". These results stress the need to systematically assess trauma history and traumatic symptoms in psychosis and might potentially help to overcome clinicians' worries about discussing trauma with service users. Our findings underscore the need to change current practice and implement trauma-informed approaches to understand clients' difficulties and provide support.

An Internet-Based Multi-Approach Intervention Targeting University Students Suffering from Psychological Problems: Design, Implementation, and Evaluation

Despite the widespread prevalence of mental health problems, most psychological distress remains untreated. Internet-based psychological interventions can be an essential tool for increasing treatment availability and accessibility. The main objective of the MindBlooming project is to design and implement an innovative Internet-based multi-approach treatment for university students suffering from psychological or physical problems. The intervention will focus on symptoms of depression, anxiety, sleep problems, self-destructive thoughts, job- and study-related stress and burnout, and chronic pain. It will be based on different approaches, primarily psychoeducation, Cognitive-Behavioral Treatment (CBT), and third-wave CBT. At the end of the treatment, user satisfaction and usability will be assessed. In addition, two further aims will be evaluating the treatment efficacy through a randomized controlled trial and tuning a predictive model through Machine Learning techniques. The intervention consists of a 7-week treatment on two problematic areas according to each students’ personal needs, identified through an initial assessment. Besides the treatment assigned following the initial screening, participants will also be assigned to a different module to improve their relational skills. The treatment, which can be accessed through a mobile app, consists of psychoeducational videos followed by related exercises. We expect MindBlooming to be a remarkable tool for promoting the mental health of university students.

Adolescer in Time of COVID-19's Pandemic: Rationale and Construction Process of a Digital Intervention to Promote Adolescents' Positive Development

The coronavirus pandemic has severely impacted children's and adolescents' lives due to policies and regulations implemented to slow the virus from spreading, which led to a loss of routine, structure, academic support, and social contacts. Literature also reports a lack of outdoor activity, inappropriate diet, and disruption of sleeping habits as affecting children's and adolescents' lifestyles and well-being. Remarkably, these consequent psychological, behavioral, and emotional changes can compromise their self-esteem, sense of self-efficacy, and self-concept, affecting their immune systems. These maladaptive coping strategies and associated effects may emerge as a failure to access some of the sources of support that might help them cope. Facing this crisis, we aimed at promoting well-being, growth, and the positive development of Portuguese adolescents through an intervention focused on positive coping strategies. We developed "Adolescer in time of COVID-19-A good practices Guide for adolescents in social distancing" as a digital document to be quickly disseminated online, answering the emergent needs of Portuguese youth between 13 and 18 years old during the COVID-19 pandemic. In this article, we present the rationale and process of construction of this intervention while living within a quarantine period, considering the restrictive measures adopted at the time.

Psychological capital development effectiveness of face-to-face, online, and Micro-learning interventions

There is growing empirical support for the benefits of developing psychological capital (PsyCap), and the effectiveness of PsyCap interventions (PCIs) in the workplace. However, to-date, PCI delivery modes have not been compared. The first study in this article compares a face-to-face to an online PCI. The second study compares an online PCI to a micro-learning PCI utilizing a mobile application. Results from 228 participants assessed three times (before, immediately after, and six weeks after PCI completion) support the effectiveness and comparability of the three delivery modes, but also highlight notable advantages for online and micro-learning.

Theoretical adequacy, methodological quality and efficacy of online interventions targeting resilience: a systematic review and meta-analysis

BACKGROUND

There is a growing interest in the promotion of mental health, and concepts as resilience are re-emerging and taking relevance. In addition, Information and Communication Technologies can provide potential benefits in the field of mental health, and the treatment of mental disorders in particular. This study aims to synthesize the evidence of internet-based resilience interventions, analyzing the theoretical adequacy, methodological quality and efficacy.

METHODS

A systematic search was performed. The eligibility criteria stated for this article were: randomized controlled trials targeted at adults or adolescents and including any psychological intervention focussing on resilience in its rationale or design. Studies with direct (e.g. resilience scales) and proximal resilience measures (e.g. scales on well-being) were included. Risk of bias was assessed for each trial using Cochrane's Collaboration Tool. Two reviewers worked independently in order to identify potential articles. A total of 11 articles were selected. A random-effects pooling model using the Hartung-Knapp-Sidik-Jonkman method based on direct and proximal resilience measures at post-test was used.

RESULTS

The overall effects of online resilience training compared to control groups at post-test were not significant; the effect size concerning the improvement of resilience was g=0.12 (95% CI: -0.14 to 0.38). In addition, a potential association between the type of outcome and the effect size could be revealed.

CONCLUSIONS

The results of the present meta-analysis showed that the overall effect of online resilience trainings was not significant. Nonetheless, a tendency for a higher benefit for resilience was found in the studies with a clear assessment theory, indicating some promising effects.

REGISTRATION NUMBER

PROSPERO CRD42018083339.

Health-related integration interventions for migrants by civil society organizations: an integrative review

Purpose: Migrants are a vulnerable group concerning health and integration. Civil society organizations are deemed important for the integration and health of migrants and have been encouraged to help. This study explored health and acculturation, as expressed in research into health-related integration interventions for migrant groups provided by civil society organizations.

Methods: Databases, journal websites and reference lists were searched in an integrative review. Thirteen articles were found and analysed using concepts of health strategies/perspectives and of acculturation with regard to general and health culture.

Results: Studies were divided between two primary spectrums: 1) assimilation-integration and 2) integration-separation spectrum. Spectrum 1 interventions tend to promote assimilation into the present host culture and into a Western view of health. They are mostly driven by representatives of the host culture. Spectrum 2 interventions are characterized by a greater openness concerning the home-culture understandings of health, alongside an appreciation of the home culture in general. They are mostly migrant-driven.

Conclusions: The different acculturating approaches in migrant and native-driven civil society organizations call for an awareness of their guiding health and acculturation assumptions and their applied perspectives and strategies. This awareness is considered crucial in order to achieve desired health and acculturation outcomes.

"Staying Home - Feeling Positive": Effectiveness of an on-line positive psychology group intervention during the COVID-19 pandemic

The current study investigated the effectiveness of a group on-line positive psychology intervention (OPPI) designed to mitigate the psychological impact of the COVID-19 pandemic and the subsequent measures to control it. Study participants (N = 82, M age  = 33.07, SD = 9.55) were all Greek adults divided into an intervention (n = 44) and a control group (n = 38). The intervention group attended a voluntary, online, two-week, six-session (each 50 min), group intervention. The intervention aimed at enhancing participants' personal strengths and resilience in order to cope more effectively with the psychological impact of social distancing (e.g., feelings of anxiety, sadness, fear, and/or loneliness). All participants completed an online questionnaire one week before the intervention's implementation, which included scales measuring their: demographic characteristics, empathy, resilience, affectivity, feelings of loneliness, depression and anxiety levels, and feelings of fear regarding the outbreak. Participants in both the intervention and control group completed the same measures the week following the intervention's termination to examine its effects, and two weeks later to examine its long-term effectiveness. The intervention was found to be effective in alleviating the impact of the pandemic and in strengthening participants' resilience. More specifically, the results showed significant decreases for the intervention group in all measures of psychosocial distress (anxiety, depression, loneliness and fear) and significant increases in empathy, resilience, and experience of positive emotions. The study's implications for the development and implementation of online psychological interventions during a crisis are discussed.

Development and Validation of a Virtual Reality-Based Training Program for Promoting Subjective Well-Being

OBJECTIVE

Enhancing subjective well-being is an effective way to improve mental health. This study aimed to validate a virtual realitybased interactive feedback program as an intervention tool for promoting subjective well-being.

METHODS

Thirty-six males participated in this program, consisting of three tasks constructed based on the theories of positive psychology: 'Experience-based problem recognition task', 'Future self-based success story expression task', and 'Strength expression task'. Participants rated visual analog scores associated with each of the tasks' contents. The concurrent validity of task scores was evaluated by correlations with the psychological scale scores.

RESULTS

The total task score was positively correlated with scores of Mental Health Continuum-Short Form (MHC-SF) emotional wellbeing and psychological well-being, Rosenberg's Self-Esteem Scale, Dispositional Hope Scale agency dimension and pathways dimension, and Life Orientation Test Revised, but not with MHC-SF social well-being scores. After controlling for the effects of the other task scores, the task scores had linear relationships with certain psychological assessments.

CONCLUSION

Since the task scores are closely related to indicators of well-being, self-esteem, hope, and optimism, the program contents are well associated with certain aspects of subjective well-being and thus may be available for training that improves subjective well-being through interactive feedback.

Assessing the Efficacy and Acceptability of a Web-Based Intervention for Resilience Among College Students: Pilot Randomized Controlled Trial

BACKGROUND

College students are at elevated risk for developing mental health problems and face specific barriers around accessing evidence-based treatment. Web-based interventions that focus on mental health promotion and strengthening resilience represent one possible solution. Providing support to users has shown to reduce dropout in these interventions. Further research is needed to assess the efficacy and acceptability of these interventions and explore the viability of automating support.

OBJECTIVE

This study investigated the feasibility of a new web-based resilience program based on positive psychology, provided with human or automated support, in a sample of college students.

METHODS

A 3-armed closed pilot randomized controlled trial design was used. Participants were randomized to the intervention with human support (n=29), intervention with automated support (n=26), or waiting list (n=28) group. Primary outcomes were resilience and well-being, respectively measured by the Connor-Davidson Resilience Scale and Pemberton Happiness Index. Secondary outcomes included measures of depression and anxiety, self-esteem, and stress. Outcomes were self-assessed through online questionnaires. Intention-to-treat and per-protocol analyses were conducted.

RESULTS

All participants demonstrated significant improvements in resilience and related outcomes, including an unexpected improvement in the waiting list group. Within- and between-group effect sizes ranged from small to moderate and within-group effects were typically larger for the human than automated support group. A total of 36 participants began the program and completed 46.46% of it on average. Participants were generally satisfied with the program and found it easy to use.

CONCLUSIONS

Findings support the feasibility of the intervention. Preliminary evidence for the equal benefit of human and automated support needs to be supported by further research with a larger sample. Results of this study will inform the development of a full-scale trial, from which stronger conclusions may be drawn.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number (ISRCTN) 11866034; http://www.isrctn.com/ISRCTN11866034.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1016/j.invent.2019.100254.

Coping Skills Mobile App to Support the Emotional Well-Being of Young People During the COVID-19 Pandemic: Protocol for a Mixed Methods Study

Background

The COVID-19 pandemic is likely to increase anxiety and distress in young people worldwide. It is important to prioritize mental health during crisis events to mitigate the negative and often long-term effects of the crises on young people, families, and society. Mental health and well-being apps represent a scalable approach for improving psychological outcomes in young people and have potential to improve the equity of service access.

Objective

The Whitu: 7 Ways in 7 Days well-being app was recently developed by our group to address the urgent need for innovative approaches to reach young New Zealanders who are struggling to cope with the COVID-19 pandemic. The aim of this study is twofold: to evaluate the acceptability of the prototype app and to examine the effectiveness of the refined app at improving mental and emotional well-being and reducing depression, anxiety, and stress in young people in New Zealand.

Methods

A two-phase mixed methods study will be undertaken to achieve these aims. During the first phase, 20 young people aged 16-30 years (including those of Māori and Pacific ethnicity) will participate in a qualitative study to help refine the prototype app. During the second phase, 90 young people aged 16-30 years will participate in a randomized waitlist-controlled trial (RCT) to evaluate the efficacy of the refined Whitu app at 4 weeks and 3 months after baseline. Outcomes will be evaluated using validated web-based questionnaires at baseline, 4 weeks, and 3 months.

Results

The study received ethics approval in May 2020, and recruitment for the focus groups commenced in June 2020. Recruitment for the RCT is expected to commence in October 2020. Participants for both study phases will be recruited via social media and web-based communities. Data collection for the RCT is expected to be completed by January 2021, and analyses are expected to be completed by March 2021. Linear mixed modelling will be used to determine between-group differences in psychological outcomes.

Conclusions

There is an urgent need to develop culturally appropriate, scalable mental health interventions to address the psychological consequences of the COVID-19 pandemic. In this study, we will develop and test an evidence-based well-being app that, if effective, can be made available to all young people in New Zealand and internationally.

Trial Registration

Australian New Zealand Clinical Trials Registry (ACTRN12620000516987); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379597.

International Registered Report Identifier (IRRID)

PRR1-10.2196/23716

Efficacy of a self-applied online program to promote resilience and coping skills in university students in four Spanish-speaking countries: study protocol for a randomized controlled trial

BACKGROUND

There is evidence of a high prevalence of depression and anxiety in university students. Therefore, college time is a key period where prevention of mental disorders through interventions that promote resilience and mental health can be relevant. Currently, there are interventions available, but these are insufficient for those who need them. Online interventions are tools that can facilitate global accessibility and are easy for young people to use. CORE (Cultivating Our Resilience) is a self-administered online program, based on Ryff's psychological well-being model, to promote resilience and coping skills in university students at risk of developing symptoms of depression or anxiety. The objective is to evaluate the effectiveness of this intervention protocol in comparison with an active control condition targeting healthy lifestyle, and a waiting list control condition. The study will be conducted in four populations of Spanish-speaking university students (Spain, Argentina, Colombia, and Mexico).

METHODS

The study design is a randomized controlled trial (RCT). At least 324 university students will be randomly assigned to three conditions: 1) CORE, a 6-week training program to improve resilience; 2) HLP, a 6-week training to promote a healthy lifestyle; and 3) WL, waiting list control condition. The primary outcome measure will be the Connor-Davidson resilience scale. Additionally, measures of anxiety, depression, quality of life and socio-demographic variables (age, sex, incomes, marital status, among others) will be collected. Participants will be evaluated at pre-treatment, after each module, 6 weeks after allocation, and at 3-month follow-up. Intention-to-treat and per-protocol analyses will be performed.

DISCUSSION

The results of this study will contribute to research on Internet-administered interventions and the implementation of a protocol that includes a series of components designed to improve resilience and coping skills, increase psychological well-being, and prevent depression and anxiety disorders in Spanish-speaking university students. In addition, avenues will be opened up for new research on the effectiveness of these interventions focused on the prevention and promotion of mental health in Spanish-speaking countries.

TRIAL REGISTRATION

Registered at ClinicalTrials.gov NCT03903978 on April 2, 2019.

Effectiveness of a guided online mindfulness-focused intervention in a student population: Study protocol for a randomised control trial

BACKGROUND

Previous studies show that university students experience higher psychological stress than the general population, resulting in increased vulnerability for mental disorders for the student population. Online mindfulness interventions will be delivered to students as a potentially promising and more flexible approach compared to face-to-face interventions with the aim of improving their mental health. This study purposes to investigate the effectiveness of a guided online mindfulness-focused intervention for university students by using both self-reported and psychobiological measures.

METHODS AND ANALYSES

In this multicentre, two-armed randomised controlled trial with a parallel design, a guided version of the online mindfulness-focused intervention 'StudiCare Mindfulness' will be compared with a waitlist control group. In total, 120 participants will be recruited at different universities (of Applied Sciences) in (Neu-) Ulm. Data will be assessed prior to randomisation, after eight weeks (post-intervention) and six months after randomisation (follow-up). The primary outcome measure is mindfulness. The secondary outcome measures include depression, anxiety and stress levels, well-being, interoceptive sensibility, emotion regulation and alexithymia. Psychobiological parameters comprise interoceptive accuracy, hair cortisol and FKBP5 genotype. Sociodemographic variables, treatment expectations, side and adverse side effects, as well as intervention satisfaction and adherence will be assessed. All data analyses will be conducted according to the intention-to-treat principle.

ETHICS AND DISSEMINATION

All study procedures have been approved by the Ethics Committee of Ulm University (application No. 48/18). The findings will be disseminated widely through peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER

DRKS00014701.

The Benefits of emotion Regulation Interventions in Virtual Reality for the Improvement of Wellbeing in Adults and Older Adults: A Systematic Review

The impact of emotion regulation interventions on wellbeing has been extensively documented in literature, although only in recent years virtual reality (VR) technologies have been incorporated in the design of such interventions, in both clinical and non-clinical settings. A systematic search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, was therefore carried out to explore the state of the art in emotion regulation interventions for wellbeing using virtual reality. The literature on this topic was queried, 414 papers were screened, and 11 studies were included, covering adults and older adults. Our findings offer an overview of the current use of VR technologies for the enhancement of emotion regulation (ER) and wellbeing. The results are promising and suggest that VR-based emotion regulation training can facilitate the promotion of wellbeing. An overview of VR-based training interventions is crucial for better understanding how to use these tools in the clinical settings. This review offers a critical debate on the structure of such intervention protocols. It also analyzes and highlights the crucial role played by the selection of the objective and subjective wellbeing assessment measures of said intervention protocols.

Applicability of the Ego-Resilience Scale (ER89) in the Chinese Cultural Context: A Validation Study

This study examined the cross-cultural validity of the Ego-Resilience Scale (ER89) in the Chinese cultural context. The ER89 was translated and culturally adapted into Chinese by following the psychometric validation procedures, in an adolescent sample ( N = 943) of 13- to 18-year-olds. A series of psychometric analyses were conducted, including exploratory factor analysis (EFA), confirmatory factor analysis (CFA), analysis for measurement invariance across gender groups, analysis for criterion-related validity evidence, and internal consistency reliability estimates. The results supported the use of ER89 scale in the Chinese cultural context (ER89-C). The empirical findings suggest a two-factor structure of ER89-C (openness to life experiences [OL] and optimal regulation [OR]). The findings also revealed that ER89-C has the expected correlations with external and theoretically related constructs. Overall, ER89-C is shown to possess favorable psychometric characteristics for its use as an assessment tool for ego-resilience level of Chinese adolescents.

Can Between-Session Homework Be Delivered Digitally? A Pilot Randomized Clinical Trial of CBT for Adjustment Disorders

Adjustment disorder (AjD) is one of the most common disorders in clinical practice, and its symptoms are severe enough to cause great distress and functional impairment. The AjD CBT protocol specifically developed for this disorder has shown positive results when delivered face to face and through virtual reality. Despite existing evidence supporting the benefits of therapeutic homework as part of a psychological intervention, little is known about how to increase homework engagement in psychotherapy. This study examines the feasibility (doability, initial efficacy and acceptability) of a digital support system to deliver homework via the Internet in the treatment of AjD. Participants were randomly assigned to a traditional homework condition or a digital support system condition. Both interventions resulted in statistically significant improvements, with large effect sizes, in all the outcome measures at post-treatment, with no significant differences between groups. At 12-month follow-up, these therapeutic gains were maintained, and an improvement was even observed in both conditions, with no significant differences between groups. Additionally, treatment satisfaction predicted efficacy in both groups separately and when the whole group was considered. This is the first study to explore the feasibility an initial efficacy of delivering a therapeutic homework component for AjD through the Internet.

German Translation of the Satisfaction With Life Scale for Children and Adolescents

The research in the field of positive psychology is alive for children and adolescents, and especially the effects of intervention studies are promising. While a large number of instruments exist for adults, there is a need for greater attention to basic measurement work of constructs for children. The Satisfaction With Life Scale is one of the most common questionnaires used in the field of positive psychology. Whereas the adult version is translated into many languages, the child version has only been translated into a few languages yet. This is a limitation for countries where young students are not familiar with the English language. The aim of the present study was to translate the Satisfaction With Life Scale–child version (SWLS-C) into German with the use of a backtranslation-proceeding (Study 1) and to validate the questionnaire with a sample of 1,099 students aged 8 to 17 years (Study 2). This included retesting of reliability as well as concurrent and discriminant validity by additionally measuring several established constructs of positive psychology. Model fit indices, internal consistencies, retest reliability as well as concurrent and discriminant validity evidence were satisfying. The German version of the SWLS-C can be used in future studies, but to compare SWLS-C data of different nationalities more translations of the questionnaire as well as crosscultural measurement invariance studies are needed.

An Internet based intervention for improving resilience and coping strategies in university students: Study protocol for a randomized controlled trial

BACKGROUND

The literature shows a high prevalence of depression and anxiety in young people. The university represents a change in the lives of students, and is considered a stress factor. Therefore, it is particularly relevant to develop interventions specifically addressed to students and foster supportive environments and resilient communities. As students are "digital natives", online interventions offer several potential advantages in doing this. This study aims to develop and evaluate the efficacy of an Internet-based intervention (CORE: Cultivating our Resilience), based on the Ryff model of well-being, to promote resilience and coping skills, decrease symptoms of depression and anxiety, and increase overall wellbeing in young people confronting a crucial life event (the university). This paper summarizes the study protocol.

METHOD

The design of the planned study is a randomized controlled trial. A minimum of 464 participants will be randomly assigned to two conditions: 1) an unguided Internet-based intervention to enhance resilience (N = 232); 2) a care-as-usual condition (CAU) (N = 232). The primary outcome will be the Connor-Davidson resilience scale. Secondary outcomes will - among others - include other relevant clinical measures, such as anxiety and depressive symptoms, quality of life, and social support. Outcomes will be assessed 4 and 8 weeks, and 6 and 12-months follow-ups. Intention-to-treat and per-protocol analyses will be performed.

DISCUSSION

The results of this study will contribute to the growing research on Internet-delivered interventions. The expected results may have a major impact on the prevention of mental disorders and possible negative consequences in at-risk populations, such as college students.

The Future of Technology in Positive Psychology: Methodological Advances in the Science of Well-Being

Advances in biotechnology and information technology are poised to transform well-being research. This article reviews the technologies that we predict will have the most impact on both measurement and intervention in the field of positive psychology over the next decade. These technologies include: psychopharmacology, non-invasive brain stimulation, virtual reality environments, and big-data methods for large-scale multivariate analysis. Some particularly relevant potential costs and benefits to individual and collective well-being are considered for each technology as well as ethical considerations. As these technologies may substantially enhance the capacity of psychologists to intervene on and measure well-being, now is the time to discuss the potential promise and pitfalls of these technologies.

The Potential and Challenges of Digital Well-Being Interventions: Positive Technology Research and Design in Light of the Bitter-Sweet Ambivalence of Change

Along with the dissemination of technical assistance in nearly every part of life, there has been growing interest in the potential of technology to support well-being and human flourishing. "Positive technology" thereby takes the responsible role of a "digital coach," supporting people in achieving personal goals and behavior change. The design of such technology requires knowledge of different disciplines such as psychology, design and human-computer interaction. However, possible synergies are not yet used to full effect, and it needs common frameworks to support a more deliberate design of the "therapeutic interaction" mediated through technology. For positive technology design, positive psychology, and resource oriented approaches appear as particularly promising starting point. Besides a general fit of the basic theoretical conceptions of human change, many elements of established interventions could possibly be transferred to technology design. However, besides the power of focusing on the positive, another psychological aspect to consider are the bitter components inherent to change, such as the confrontation with a negative status quo, threat of self-esteem, and the effort required. The present research discusses the general potential and challenges within positive technology design from an interdisciplinary perspective with theoretical and practical contributions. Based on the bitter-sweet ambivalence of change as present in many psychological approaches of motivation and behavior change, the bitter-sweet continuum serves as a proxy for the mixed emotions and cognitions related to change. An empirical investigation of those factors among 177 users of self-improvement technologies provides initial support for the usefulness of the bitter-sweet perspective in understanding change dynamics. In a next step, the bitter-sweet concept is transformed into different design strategies to support positive change. The present article aims to deepen the discussion about the responsible role of technology as a well-being enhancement tool and to provide a fruitful frame for different disciplines involved in positive technology. Two aspects are highlighted: First, investigating well-being technology as a form of "therapeutic interaction," focusing on the need for sensible design solutions in the emerging dialogue between technology and user. Second, a stronger consideration of the bitter-sweet ambivalence of change, utilizing (positive) psychology interventions to full effect.

Positive Technologies for Understanding and Promoting Positive Emotions

Information and Communication Technologies (ICTs) have become increasingly present in our lives, and their use has spread considerably. This paper presents a review of the way ICTs can help practitioners and researchers to study, promote, and train positive emotions. It is framed within the field of Positive Technologies: the applied scientific approach to the study of the use of technology to improve the quality of personal experience, with the goal of increasing wellbeing. First, the article presents an introduction to the topic of technologies and positive emotions. Then, it describes how ICTs can aid in monitoring, assessing, promoting, modifying, and training positive emotions. Finally, implications and future directions of the role of Positive Technologies in positive emotions are discussed. The authors conclude that, in the near future, Positive Technologies and the field of positive emotions will interact synergistically, producing an exponential growth in the understanding and promotion of positive emotions.

Mental health promotion: a narrative review of emerging trends

PURPOSE OF REVIEW

The current review aims to provide an update on the recent work in mental health promotion with a special emphasis on emerging evidence and innovations in the field.

RECENT FINDINGS

Studies reviewed across settings like the home, school, workplace, communities, and internet-based platforms, have indicated a growing evidence base for effective mental health promotion strategies that are holistic, multicomponent, and targeted at both, specific vulnerable groups and whole populations. Innovative approaches involving online delivery platforms, sports and exercise, positive psychology and lifestyle interventions, mobilizing community networks, and mental health first aid, are some exciting and upcoming areas for future research.

SUMMARY

Mental health promotion interventions are applicable to individuals, groups, and whole populations and can be delivered in many ways, including media and communication technology. They can be applied in low-resource settings by mobilizing existing community resources like opinion leaders, health workers, and peer educators, thereby increasing cost-efficiency, cultural acceptability, and local capacity. There needs to be a greater focus on study designs and variable measures that examine process-factors affecting well being outcomes. Early interventions through intersectorial collaborations may result in improved long-term positive mental health outcomes for individuals, families, and communities.