Usage of unguided, guided, and blended care for depression offered in routine clinical care: Lessons learned.

Introduction: Internet-delivered psychotherapy is often considered to be a promising way to extend mental healthcare services around the world. Research findings that have emerged over the past two decades have strengthened this claim. However, very little is known about the usage of internet-delivered psychotherapy in real-life circumstances. Methods: The current study explored the real-life usage of depressiehulp.be, a publicly available online platform for depression that offers pure self-help, online guided self-help, and blended treatment for depression in Flanders, Belgium, using data collected from 2656 participants between May 2018 and May 2022. Results: Both duration of engagement with the online platform and number of exercises completed increased with increasing levels of therapist guidance. Findings also showed a particular pattern of engagement for each of the online treatments. Overall, participants completed most exercises during the first days of treatment. However, participants using pure online self-help showed the fastest decrease of engagement over time, with most dropping out after completing a few exercises, and more than half of all participants who enrolled in the self-help programme did not even begin the programme. In both guided and blended treatment, participants tended to show higher levels of engagement with the online platform. In each treatment modality, a relatively small but notable group of participants showed high levels of engagement. There was no relationship between severity of depression and duration of engagement. Conclusions: The current study demonstrates the importance of therapist support in online interventions and offers additional insights into how, and to what extent, online platforms are used. Future research should explore clinical impact and policy implications.

Online consultations in mental healthcare: Modelling determinants of use and experience based on an international survey study at the onset of the pandemic.

Introduction: While online consultations have shown promise to be a means for the effective delivery of high-quality mental healthcare and the first implementations of these digital therapeutic contacts go back nearly two decades, uptake has remained limited over the years. The onset of the COVID-19 pandemic dramatically altered this relative standstill and created a unique turning point, with a massive amount of both professionals and clients having first hands-on experiences with technology in mental healthcare. Objective: The current study aimed to document the uptake of online consultations and explore if specific characteristics of mental health professionals across and beyond Europe could predict this. Methods: An international survey was designed to assess mental health professionals' (initial) experiences with online consultations at the onset of the pandemic: their willingness to make use of them and their prior and current experiences, alongside several personal characteristics. Logistic mixed-effects models were used to identify predictors of the use of online consultations, personal experience with this modality, and the sense of telepresence. Results: A total of 9115 healthcare professionals from 73 countries participated of which about two-thirds used online consultations during the initial COVID-19 outbreak. The current study identifies multiple determinants relating to the use and experience of online consultations, including the professionals' age, experience with the technology before the outbreak, the professional context, and training. Conclusions: Despite strong evidence supporting the relevance of training in digital mental health, this is clearly still lacking. Nevertheless, the COVID-19 pandemic presented a first, and potentially transformative, experience with online consultations for many healthcare professionals. The insights from this study can help support professionals and, importantly, (mental) healthcare organisations to create optimal circumstances for selective and high-quality continued use of online consultations.

E-mental health implementation in inpatient care: Exploring its potential and future challenges.

Background: There is a great evidence base today for the effectiveness of e-mental health, or the use of technology in mental healthcare. However, large-scale implementation in mental healthcare organisations is lacking, especially in inpatient specialized mental healthcare settings. Aim: The current study aimed to gain insights into the factors that promote or hinder the implementation of e-mental health applications on organisational, professional and patient levels in Belgium. Methods: Four Belgian psychiatric hospitals and psychiatric departments of general hospitals invited their professionals and patients to use Moodbuster, which is a modular web-based platform with a connected smartphone application for monitoring. The platform was used in addition to treatment as usual for three to four months. The professionals and patients completed pre- and post-implementation questionnaires on their reasons to participate or to decline participation and experiences with the Moodbuster platform. Results: Main reasons for the organisations to participate in the implementation study were a general interest in e-mental health and seeing it is a helpful add-on to regular treatment. The actual use of Moodbuster by professionals and patients proved to be challenging with only 10 professionals and 24 patients participating. Implementation was hindered by technical difficulties and inpatient care specific factors such as lack of structural facilities to use e-mental health and patient-specific factors. Professionals saw value in using e-mental health applications for bridging the transition from inpatient to outpatient care. Twenty-two professionals and 31 patients completed the questionnaire on reasons not to participate. For the patients, lack of motivation because of too severe depressive symptoms was the most important reason not to participate. For professionals, it was lack of time and high workload. Conclusions: The current implementation study reveals several important barriers to overcome in order to successfully implement e-mental health in inpatient psychiatric care.

Online consultations in mental healthcare during the COVID-19 outbreak: An international survey study on professionals' motivations and perceived barriers.

INTRODUCTION: While the general uptake of e-mental health interventions remained low over the past years, physical distancing and lockdown measures relating to the COVID-19 pandemic created a need and demand for online consultations in only a matter of weeks. OBJECTIVE: This study investigates the uptake of online consultations provided by mental health professionals during lockdown measures in the first wave of the COVID-19 pandemic in the participating countries, with a specific focus on professionals' motivations and perceived barriers regarding online consultations. METHODS: An online survey on the use of online consultations was set up in March 2020. The Unified Theory of Acceptance and Use of Technology (UTAUT) guided the deductive qualitative analysis of the results. RESULTS: In total, 2082 mental health professionals from Austria, Belgium, Cyprus, France, Germany, Italy, Lebanon, Lithuania, the Netherlands, Norway, Portugal, Spain, and Sweden were included. The results showed a high uptake of online consultations during the COVID-19 pandemic but limited previous training on this topic undergone by mental health professionals. Most professionals reported positive experiences with online consultations, but concerns about the performance of online consultations in a mental health context (e.g., in terms of relational aspects) and practical considerations (e.g., relating to privacy and security of software) appear to be major barriers that hinder implementation. CONCLUSIONS: This study provides an overview of the mental health professionals' actual needs and concerns regarding the use of online consultations in order to highlight areas of possible intervention and allow the implementation of necessary governmental, educational, and instrumental support so that online consultations can become a feasible and stable option in mental healthcare.

Dropping the E: The potential for integrating e-mental health in psychotherapy.

E-mental health, or the use of technology in mental healthcare, has been the focus of research for over two decades. Over that period, the evidence base for the potential of technology to improve psychotherapeutic practice has grown steadily. This sharply contrasts with the actual use of e-mental health by psychotherapists, which has remained limited. In this article, we aim to illustrate how and when different technological tools and applications can play a role in psychotherapy. At the same time, we also highlight current limitations and discuss challenges for future research. A specific, yet hypothetical case, is used to guide this narrative review and make proposed applications tangible and concrete.

Technological and Digital Interventions for Mental Health and Wellbeing: An Overview of Systematic Reviews.

Background: Research increasingly shows how selective and targeted use of technology within care and welfare can have several advantages including improved quality of care and active user involvement. Purpose: The current overview of reviews aims to summarize the research on the effectiveness of technology for mental health and wellbeing. The goal is to highlight and structure the diverse combinations of technologies and interventions used so far, rather than to summarize the effectiveness of singular approaches. Methods: The current overview includes reviews published in the past five years with a focus on effectiveness of digital and technological interventions targeting mental health and wellbeing. Results: A total of 246 reviews could be included. All reviews examined the effectiveness of digital and technological interventions in the context of care and welfare. A combination of two taxonomies was created through qualitative analysis, based on the retrieved interventions and technologies in the reviews. Review classification shows a predominance of reviews on psychotherapeutic interventions using computers and smartphones. It is furthermore shown that when smartphone applications as stand-alone technology are researched, the primary focus is on self-help, and that extended reality is the most researched emerging technology to date. Conclusion: This overview of reviews shows that a wide range of interventions and technologies, with varying focus and target populations, have been studied in the field of care and wellbeing. The current overview of reviews is a first step to add structure to this rapidly changing field and may guide both researchers and clinicians in further exploring the evidence-base of particular approaches.

Is there adaptation of speech production after speech perception in bilingual interaction?

In dialogue, speakers tend to adapt their speech to the speech of their interlocutor. Adapting speech production to preceding speech input may be particularly relevant for second language (L2) speakers interacting with native (L1) speakers, as adaptation may facilitate L2 learning. Here we asked whether Dutch-English bilinguals adapt pronunciation of the English phonemes /æ/ and coda /b/ when reading aloud sentences after exposure to native English speech. Additionally, we tested whether social context (presence or absence of a native English confederate) and time lag between perception and production of the phoneme affected adaptation. Participants produced more English-like target words that ended in word-final /b/ after exposure to target phonemes produced by a native speaker, but the participants did not change their production of the phoneme /æ/ after exposure to native /æ/. The native English speaking confederate did not show consistent changes in speech production after exposure to target phonemes produced by L2 speakers. These findings are in line with Gambi and Pickering's simulation theory of phonetic imitation (Gambi & Pickering, 2013). (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The relationship between second language acquisition and nonverbal cognitive abilities.

We monitored the progress of 40 children when they first started to acquire a second language (L2) implicitly through immersion. Employing a longitudinal design, we tested them before they had any notions of an L2 (Time 0) and after 1 school year of L2 exposure (Time 1) to determine whether cognitive abilities can predict the success of L2 learning. Task administration included measures of intelligence, cognitive control, and language skills. Initial scores on measures of inhibitory control seemed predictive of L2 Dutch vocabulary acquisition. At the same time, progress on IQ, inhibitory control, attentional shifting, and working memory were also identified as contributing factors, suggesting a more intricate relationship between cognitive abilities and L2 learning than previously assumed. Furthermore, L1 development was mainly predicted by performance on inhibitory control and working memory. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Can Faces Prime a Language?

Bilinguals have two languages that are activated in parallel. During speech production, one of these languages must be selected on the basis of some cue. The present study investigated whether the face of an interlocutor can serve as such a cue. Spanish-Catalan and Dutch-French bilinguals were first familiarized with certain faces, each of which was associated with only one language, during simulated Skype conversations. Afterward, these participants performed a language production task in which they generated words associated with the words produced by familiar and unfamiliar faces displayed on-screen. When responding to familiar faces, participants produced words faster if the faces were speaking the same language as in the previous Skype simulation than if the same faces were speaking a different language. Furthermore, this language priming effect disappeared when it became clear that the interlocutors were actually bilingual. These findings suggest that faces can prime a language, but their cuing effect disappears when it turns out that they are unreliable as language cues.

Whole-language and item-specific control in bilingual language production.

The current study investigated the scope of bilingual language control differentiating between whole-language control involving control of an entire lexicon specific to 1 language and lexical-level control involving only a restricted set of recently activated lexical representations. To this end, we tested 60 Dutch-English (Experiment 1) and 64 Chinese-English bilinguals (Experiment 2) on a verbal fluency task in which speakers produced members of letter (or phoneme for Chinese) categories first in 1 language and then members of either (a) the same categories or (b) different categories in their other language. Chinese-English bilinguals also named pictures in both languages. Both bilingual groups showed reduced dominant language fluency after producing exemplars from the same categories in the nondominant language, whereas nondominant language production was not influenced by prior production of words from the same categories in the other language. Chinese-English, but not Dutch-English, bilinguals exhibited similar testing order effects for different letter/phoneme categories. In addition, Chinese-English bilinguals who exhibited significant testing order effects in the repeated categories condition of the fluency task exhibited no such effects when naming repeated pictures after a language switch. These results imply multiple levels of inhibitory control in bilingual language production. Testing order effects in the verbal fluency task pinpoint a lexical locus of bilingual control, and the finding of interference effects for some bilinguals even when different categories are tested across languages further implies a whole-language control process, although the ability to exert such global inhibition may only develop for some types of bilinguals.

Phonological recoding in error detection: a cross-sectional study in beginning readers of Dutch.

The present cross-sectional study investigated the development of phonological recoding in beginning readers of Dutch, using a proofreading task with pseudohomophones and control misspellings. In Experiment 1, children in grades 1 to 3 rejected fewer pseudohomophones (e.g., wein, sounding like wijn 'wine') as spelling errors than control misspellings (e.g., wijg). The size of this pseudohomophone effect was larger in grade 1 than in grade 2 and did not differ between grades 2 and 3. In Experiment 2, we replicated the pseudohomophone effect in beginning readers and we tested how orthographic knowledge may modulate this effect. Children in grades 2 to 4 again detected fewer pseudohomophones than control misspellings and this effect decreased between grades 2 and 3 and between grades 3 and 4. The magnitude of the pseudohomophone effect was modulated by the development of orthographic knowledge: its magnitude decreased much more between grades 2 and 3 for more advanced spellers, than for less advanced spellers. The persistence of the pseudohomophone effect across all grades illustrates the importance of phonological recoding in Dutch readers. At the same time, the decreasing pseudohomophone effect across grades indicates the increasing influence of orthographic knowledge as reading develops.

Frequency drives lexical access in reading but not in speaking: the frequency-lag hypothesis.

To contrast mechanisms of lexical access in production versus comprehension we compared the effects of word frequency (high, low), context (none, low constraint, high constraint), and level of English proficiency (monolingual, Spanish-English bilingual, Dutch-English bilingual) on picture naming, lexical decision, and eye fixation times. Semantic constraint effects were larger in production than in reading. Frequency effects were larger in production than in reading without constraining context but larger in reading than in production with constraining context. Bilingual disadvantages were modulated by frequency in production but not in eye fixation times, were not smaller in low-constraint contexts, and were reduced by high-constraint contexts only in production and only at the lowest level of English proficiency. These results challenge existing accounts of bilingual disadvantages and reveal fundamentally different processes during lexical access across modalities, entailing a primarily semantically driven search in production but a frequency-driven search in comprehension. The apparently more interactive process in production than comprehension could simply reflect a greater number of frequency-sensitive processing stages in production.

Does bilingualism change native-language reading? Cognate effects in a sentence context.

Becoming a bilingual can change a person's cognitive functioning and language processing in a number of ways. This study focused on how knowledge of a second language influences how people read sentences written in their native language. We used the cognate-facilitation effect as a marker of cross-lingual activations in both languages. Cognates (e.g., Dutch-English schip [ship]) and controls were presented in a sentence context, and eye movements were monitored. Results showed faster reading times for cognates than for controls. Thus, this study shows that one of people's most automated skills, reading in one's native language, is changed by the knowledge of a second language.

Letter position information and printed word perception: the relative-position priming constraint.

Six experiments apply the masked priming paradigm to investigate how letter position information is computed during printed word perception. Primes formed by a subset of the target's letters facilitated target recognition as long as the relative position of letters was respected across prime and target (e.g., "arict" vs. "acirt" as primes for the target "apricot"). Priming effects were not influenced by whether or not absolute, length-dependent position was respected (e.g., "a-ric-t" vs. "arict"/"ar-i-ct"). Position of overlap of relative-position primes (e.g., apric-apricot; ricot-apricot; arict-apricot) was found to have little influence on the size of priming effects, particularly in conditions (i.e., 33 ms prime durations) where there was no evidence for phonological priming. The results constrain possible schemes for letter position coding.

A study of relative-position priming with superset primes.

Four lexical decision experiments are reported that use the masked priming paradigm to study the role of letter position information in orthographic processing. In Experiments 1 and 2, superset primes, formed by repetition of 1 or 2 letters of the target (e.g., jusstice-JUSTICE) or by insertion of 1 or 2 unrelated letters (e.g., juastice-JUSTICE), generated significant priming compared with unrelated primes and did not differ significantly from an identity priming condition. In Experiment 3, identity primes generated significantly faster responses than subset primes formed by removal of 2 letters from the target (e.g., jutie-JUSTICE), and subset primes generated faster responses than substitution primes formed by substitution of 2 letters of the target with unrelated letters (e.g., jumlice-JUSTICE). In Experiment 4, insertion of 3 unrelated letters continued to generate facilitation relative to unrelated primes but significantly less so than the identity prime condition. The authors discuss the implications of these results for letter-position coding schemes.