ABSTRACT
The number of college students who need mental health treatment outpaces the resources available to counseling centers to provide these needed services, presenting a need for low-cost, scalable interventions for college populations. We conducted a pilot implementation-effectiveness trial of a scalable treatment package that consisted of a single (telehealth) workshop plus a companion app that provided ecological momentary intervention. Participants (nâ¯=â¯177) received a workshop provided by counseling center staff and trainees. We were interested in (1) engagement with the app, (2) acceptability of the treatment package, and (3) initial effectiveness of the treatment package. Regarding engagement with the app, we found that participants preferred two reminder prompts per day and identified two key breakpoints when engagement declined significantly: at day 15, when just over half of the sample practiced a skill on the app at least once during the day and at day 41, when just over one third of people practiced a skill on the app each day. Regarding acceptability of the treatment package, students generally reported positive attitudes about the single-session workshop and app, but also noted that the content and assessments in the app needed to be more dynamic to improve how engaging it is. Regarding effectiveness, we found that about 75% of the sample experienced a significant reduction in negative affect from pre- to post-ecological momentary intervention. Moreover, there were significant pre- to post-study decreases in experiential avoidance and symptoms of anxiety and depression and increases in self-efficacy for managing negative emotions. The results of this study are promising in terms of providing initial support for this novel treatment package and provide useful information for researchers planning to develop and test similar interventions.
Subject(s)
Smartphone , Telemedicine , Cognition , Emotions , Humans , Pilot Projects , StudentsABSTRACT
BACKGROUND: Brief interventions such as mental health apps and single-session interventions are increasingly popular, efficacious, and accessible delivery formats that may be beneficial for college students whose mental health needs may not be adequately met by college counseling centers. However, no studies so far have examined the effectiveness of these modes of treatment for college students who are already receiving traditional therapy, despite it being common among this population. OBJECTIVE: The aim of this study was to compare the differences in self-reported momentary negative affect between college students in therapy and not in therapy who received a brief single-session intervention delivered by counseling center staff and a supplemental mobile app. METHODS: Data for this study were drawn from E-Manage, a brief mobile health intervention geared toward college students. Participants in the study were 173 college students who indicated whether they had received therapy. We conducted a multilevel model to determine whether there were differences between those in therapy versus not in therapy in negative affect reported throughout the study. Following this, we conducted multilevel models with therapy status as the predictor and negative affect as the outcome. RESULTS: Results of the multilevel model testing showed that the cross-level interaction between the time point (ie, pre- vs postexercise) and therapy status was significant (P=.008), with the reduction in negative affect from pre- to postexercise greater for those in therapy (b=-0.65, 95% CI -0.91 to -0.40; P<.001) than it was for those not in therapy (b=-0.31, 95% CI -0.43 to -0.19; P<.001). Therapy status was unassociated with both the pre-exercise (b=-1.69, 95% CI -3.51 to 0.13; P=.07) and postexercise (b=-1.37, 95% CI -3.17 to 0.43; P=.14) ratings of negative affect. CONCLUSIONS: These findings suggest that app-based and single-session interventions are also appropriate to use among college students who are receiving traditional therapy. A randomized controlled trial comparing students receiving therapy to students receiving therapy and E-Manage will be necessary to determine to what extent E-Manage contributed to the reductions in negative affect that therapy-attending college students experienced.
ABSTRACT
The COVID-19 outbreak has simultaneously increased the need for mental health services and decreased their availability. Brief online self-help interventions that can be completed in a single session could be especially helpful in improving access to care during the crisis. However, little is known about the uptake, acceptability, and perceived utility of these interventions outside of clinical trials in which participants are compensated. Here, we describe the development, deployment, acceptability ratings, and pre-post effects of a single-session intervention, the Common Elements Toolbox (COMET), adapted for the COVID-19 crisis to support graduate and professional students. Participants (n = 263), who were not compensated, were randomly assigned to two of three modules: behavioral activation, cognitive restructuring, and gratitude. Over 1 week, 263 individuals began and 189 individuals (72%) completed the intervention. Participants reported that the intervention modules were acceptable (93% endorsing), helpful (88%), engaging (86%), applicable to their lives (87%), and could help them manage COVID-related challenges (88%). Participants reported pre- to post-program improvements in secondary control (i.e., the belief that one can control their reactions to objective events; d av = 0.36, d z = 0.50, p < 0.001) and in the perceived negative impact of the COVID-19 crisis on their quality of life (d av = 0.22, d z = 0.25, p < 0.001). On average, differences in their perceived ability to handle lifestyle changes resulting from the pandemic were positive, but small and at the level of a non-significant trend (d av = 0.13, d z = 0.14, p = 0.066). Our results highlight the acceptability and utility of an online intervention for supporting individuals through the COVID-19 crisis.
