Match and Mismatch between Lived Experiences of Daytime Sleepiness and Diagnostic Instruments: A Qualitative Study amongst Patients with Sleep Disorders.

Excessive daytime sleepiness is a common symptom of sleep disorders. Despite its prevalence, it remains difficult to define, detect, and address. The difficulties surrounding sleepiness have been linked to an ambiguous conceptualization, a large variety of scales and measures, and the overlap with other constructs, such as fatigue. The present study aims to investigate patients' descriptions of sleepiness-related daytime complaints and their phenomenology. We performed semi-directed interviews with patients diagnosed with obstructive sleep apnea (N = 15) or narcolepsy (N = 5). The interviewers took care of utilizing the participants' terminology when describing daytime complaints related to their sleep disorder. Various aspects of the daytime complaints were investigated, such as their description and temporality. The transcribed content was thematically analyzed using an eclectic coding system, yielding five themes. The participants used different interchangeable descriptors (tired, sleepy, fatigued, exhausted) to express their daytime complaints. They enriched their description with indexes of magnitude (ranging from 'not especially' to 'most gigantic, extreme'), oppositions to other states (using antipodes like energy, alertness, wakefulness, or rest), and indications of fluctuations over the day. Interestingly, the participants often used metaphors to express their experiences and their struggles. The lived experiences of the patients were found to not always align with common self-reported monitoring tools of sleepiness and to relate only in part with current conceptions. In practice, it is important to probe daytime complaints, such as daytime sleepiness, with a broader consideration, for example, by exploring antipodes, consequences, and time-of-day fluctuations.

Characterizing light-dark cycles in the Neonatal Intensive Care Unit: a retrospective observational study.

Objectives: To characterize bedside 24-h patterns in light exposure in the Neonatal Intensive Care Unit (NICU) and to explore the environmental and individual patient characteristics that influence these patterns in this clinical setting. Methods: We conducted a retrospective cohort study that included 79 very preterm infants who stayed in an incubator with a built-in light sensor. Bedside light exposure was measured continuously (one value per minute). Based on these data, various metrics (including relative amplitude, intradaily variability, and interdaily stability) were calculated to characterize the 24-h patterns of light exposure. Next, we determined the association between these metrics and various environmental and individual patient characteristics. Results: A 24-h light-dark cycle was apparent in the NICU with significant differences in light exposure between the three nurse shifts (p < 0.001), with the highest values in the morning and the lowest values at night. Light exposure was generally low, with illuminances rarely surpassing 75 lux, and highly variable between patients and across days within a single patient. Furthermore, the season of birth and phototherapy had a significant effect on 24-h light-dark cycles, whereas no effect of bed location and illness severity were observed. Conclusion: Even without an official lighting regime set, a 24-h light-dark cycle was observed in the NICU. Various rhythmicity metrics can be used to characterize 24-h light-dark cycles in a clinical setting and to study the relationship between light patterns and health outcomes.

Smartphone Keyboard Interaction Monitoring as an Unobtrusive Method to Approximate Rest-Activity Patterns: Experience Sampling Study Investigating Interindividual and Metric-Specific Variations.

BACKGROUND: Sleep is an important determinant of individuals' health and behavior during the wake phase. Novel research methods for field assessments are required to enable the monitoring of sleep over a prolonged period and across a large number of people. The ubiquity of smartphones offers new avenues for detecting rest-activity patterns in everyday life in a noninvasive an inexpensive manner and on a large scale. Recent studies provided evidence for the potential of smartphone interaction monitoring as a novel tracking method to approximate rest-activity patterns based on the timing of smartphone activity and inactivity throughout the 24-hour day. These findings require further replication and more detailed insights into interindividual variations in the associations and deviations with commonly used metrics for monitoring rest-activity patterns in everyday life. OBJECTIVE: This study aimed to replicate and expand on earlier findings regarding the associations and deviations between smartphone keyboard-derived and self-reported estimates of the timing of the onset of the rest and active periods and the duration of the rest period. Moreover, we aimed to quantify interindividual variations in the associations and time differences between the 2 assessment modalities and to investigate to what extent general sleep quality, chronotype, and trait self-control moderate these associations and deviations. METHODS: Students were recruited to participate in a 7-day experience sampling study with parallel smartphone keyboard interaction monitoring. Multilevel modeling was used to analyze the data. RESULTS: In total, 157 students participated in the study, with an overall response rate of 88.9% for the diaries. The results revealed moderate to strong relationships between the keyboard-derived and self-reported estimates, with stronger associations for the timing-related estimates (ß ranging from .61 to .78) than for the duration-related estimates (ß=.51 and ß=.52). The relational strength between the time-related estimates was lower, but did not substantially differ for the duration-related estimates, among students experiencing more disturbances in their general sleep quality. Time differences between the keyboard-derived and self-reported estimates were, on average, small (<0.5 hours); however, large discrepancies were also registered for quite some nights. The time differences between the 2 assessment modalities were larger for both timing-related and rest duration-related estimates among students who reported more disturbances in their general sleep quality. Chronotype and trait self-control did not significantly moderate the associations and deviations between the 2 assessment modalities. CONCLUSIONS: We replicated the positive potential of smartphone keyboard interaction monitoring for estimating rest-activity patterns among populations of regular smartphone users. Chronotype and trait self-control did not significantly influence the metrics' accuracy, whereas general sleep quality did: the behavioral proxies obtained from smartphone interactions appeared to be less powerful among students who experienced lower general sleep quality. The generalization and underlying process of these findings require further investigation.

Using a low-dose ultraviolet-B lighting solution during working hours: An explorative investigation towards the effectivity in maintaining healthy vitamin D levels.

OBJECTIVE: This study examined whether daily safe, low-dose ultraviolet-B (UVB) exposure using a home-based lighting solution could maintain healthy serum 25(OH)D during winter. METHODS: Twenty-eight (12 male, 16 female) daytime (~9:00 to 17:00) indoor workers (mean age = 42.46; SD = 14.23) participated in this study and were allocated to one of the two study conditions. During an 8-week period, fourteen participants received extra UVB exposure (max 0.3 standard erythema dose (SED) daily), while fourteen participants in the control group did not receive extra UVB exposure. Daily questionnaires were used to measure UVB exposure time, exposed body surface area (BSA), and time spent outside in daylight. Serum 25(OH)D, vitamin D related food intake, and secondary parameters (i.e., subjective fatigue, sleep timing and quality) were investigated at baseline, Week 4, and Week 8. RESULTS: Serum 25(OH)D significantly declined over the 8-week study period in both groups. The combination of using a low-dose UVB exposure, a small BSA, and a lower-than-expected amount of exposure hours likely resulted in an insufficient UVB dose to significantly improve serum 25(OH)D. Changes in serum 25(OH)D over time did not significantly correlate with changes in secondary parameters of sleep and fatigue. CONCLUSION: The received low-dose UVB exposure in this study did not significantly change serum 25(OH)D during the winter period. Future research could explore whether a longer lasting exposure period and/or using different exposure positions of the device (maximizing exposed skin surface) yields more promising results for improving serum 25(OH)D. TRIAL REGISTRATION: Trial registration: https://www.isrctn.com/ISRCTN47902923.

The influence of distractions of the home-work environment on mental health during the COVID-19 pandemic.

Previous research showed that office workers are mainly distracted by noise, influencing their mental health. Little investigation has been done into the influence of other workspace characteristics (i.e. temperature, amount of space, visual privacy, adjustability of furniture, wall colours, and workspace cleanliness) on distractions at the office, and even fewer while working from home (WFH). The influence of home-workspace distractions on mental health also received limited attention. This research aims to investigate relationships between home-workspace and personal characteristics, distraction, and mental health while WFH during COVID-19. A path analysis approach was used, to find that, at home, employees were distracted by noise and when having a small desk. Those with a dedicated workroom were less distracted. Distractions mediated most relationships between home-workspace characteristics and mental health, while personal characteristics influenced mental health directly. Employers can use these results to redesign policies regarding home-and-office working to stimulate a healthy work environment.Practitioner summary: The investigation of the influence of home-workspace characteristics on distractions and mental health while WFH during COVID-19 appears to be limited. This research filled this gap by performing a path analysis, using a holistic definition of mental health. Findings showed that distractions mediate relationships between home-workspace characteristics and mental health.

Satisfaction with activity-support and physical home-workspace characteristics in relation to mental health during the COVID-19 pandemic.

Previous research indicates that employees' mental health might be influenced by their satisfaction with physical office characteristics, such as noise, daylight, and ventilation. However, similar research on mental health in relation to working from home (WFH) is limited. Therefore, this study aimed to identify the relationships between satisfaction with physical home workspace characteristics and support of work activities and mental health while WFH during the COVID-19 pandemic. Relationships were analysed using a path analysis approach, based on a sample of 1219 office workers, who had to work fully from home. The internal relationships between the ten considered mental health variables were also studied. Results showed that satisfaction with daylight, artificial light, greenery, and views outside were directly related to one of the mental health variables and indirectly to several others. Surprisingly, satisfaction with temperature, noise, ventilation, and air quality did not seem to play a role at the home workplace. In addition, unlike at the office, personal characteristics did not relate to workspace satisfaction nor perceived support of activities at home. Furthermore, all mental health variables were related to at least one other mental health variable. Workplace managers could use these insights to formulate recommendations for employees on how to design their home-workspace.

Integrating technology in mental healthcare practice: A repeated cross-sectional survey study on professionals' adoption of Digital Mental Health before and during COVID-19.

As a consequence of the outbreak of the COVID-19 global pandemic in the spring of 2020, large-scale social distancing measures were implemented, resulting in the forced adoption of online or digital forms of psychological treatment. This sudden transition to digital care offered a unique opportunity to investigate if and how this experience impacted mental healthcare professionals' perceptions and use of Digital Mental Health tools. The current paper presents findings of a repeated cross-sectional study consisting of three iterations of a national online survey in the Netherlands. This survey contained open and closed questions on professionals' adoption readiness, frequency of use, perceived competency, and perceived value of Digital Mental Health collected in 2019 (before the pandemic), in 2020 (after the first wave), and in 2021 (after the second wave). The inclusion of data gathered prior to the COVID-19 pandemic offers a unique window to assess how professionals' adoption has developed through this transition from voluntary to mandatory use of Digital Mental Health tools. Our study also re-assesses the drivers, barriers, and needs of mental healthcare professionals after having gained experience with Digital Mental Health. In total, 1,039 practitioners completed the surveys (Survey 1: n = 432, Survey 2: n = 363, and Survey 3: n = 244). Results indicate that compared to the period before the pandemic, there was a particularly large increase in use, competency, and perceived value regarding videoconferencing. Small differences were also found for some other basic tools that were crucial to ensure the continuation of care, such as e-mail, text messaging, and online screening, but not for more innovative technologies, such as virtual reality and biofeedback. Many practitioners reported to have gained skills regarding Digital Mental Health and experienced several benefits of it. They expressed the intention to continue with a blended approach, using Digital Mental Health tools in combination with face-to-face care, focused on situations in which they found it to have specific added value, such as when clients are unable to travel. Others were less satisfied with the technology-mediated interactions and remained more reluctant to future use of DMH. Implications for broader implementation of Digital Mental Health and future research are discussed.

The effects of a novel personal comfort system on thermal comfort, physiology and perceived indoor environmental quality, and its health implications - Stimulating human thermoregulation without compromising thermal comfort.

The classical textbook interpretation of thermal comfort is that it occurs when the thermoregulatory effort is minimized. However, stimulating human thermoregulatory systems may benefit health and increase body thermal resilience. To address this gap, we tested a novel personal comfort system (PCS) that targets only the extremities and the head, leaving the rest of the body exposed to a moderately drifting temperature (17-25°C). A randomized, cross-over study was conducted under controlled laboratory conditions, mimicking an office setting. Eighteen participants completed two scenarios, one with a PCS and another one without a PCS in 17-25°C ambient conditions. The results indicate that the PCS improved thermal comfort in 17-23°C and retained active thermoregulatory control. The torso skin temperature, underarm-finger temperature gradients, energy expenditure, substrate oxidations and physical activity were not affected by the PCS in most cases. Only slight changes in cardiovascular responses were observed between the two scenarios. Moreover, the PCS boosted pleasure and arousal. At 25°C, the PCS did not improve thermal comfort, but significantly improved air quality perceptions and mitigated eye strain. These findings suggest that human physiological thermoregulation can be stimulated without compromising thermal comfort by using a PCS that only targets the extremities in cold conditions.

Assessing Professionals' Adoption Readiness for eMental Health: Development and Validation of the eMental Health Adoption Readiness Scale.

BACKGROUND: The last few decades have witnessed significant advances in the development of digital tools and applications for mental health care. Despite growing evidence for their effectiveness, acceptance and use of these tools in clinical practice remain low. Hence, a validated and easy-to-use instrument for assessing professionals' readiness to adopt eMental health (EMH) is necessary to gain further insights into the process of EMH adoption and facilitate future research on this topic. OBJECTIVE: The aim of this study is to develop and validate an instrument for assessing mental health care professionals' readiness to adopt EMH. METHODS: Item generation was guided by literature and inputs from mental health care professionals and experts in survey development. Exploratory factor analyses were conducted on an initial set of 29 items completed by a sample of mental health care professionals (N=432); thereafter, the scale was reduced to 15 items in an iterative process. The factor structure thus obtained was subsequently tested using a confirmatory factor analysis with a second sample of mental health care professionals (N=363). The internal consistency, convergent validity, and predictive validity of the eMental Health Adoption Readiness (eMHAR) Scale were assessed. RESULTS: Exploratory factor analysis resulted in a 3-factor solution with 15 items. The factors were analyzed and labeled as perceived benefits and applicability of EMH, EMH proactive innovation, and EMH self-efficacy. These factors were confirmed through a confirmatory factor analysis. The total scale and subscales showed a good internal consistency (Cronbach α=.73-.88) along with acceptable convergent and predictive relationships with related constructs. CONCLUSIONS: The constructed eMHAR Scale showed a conceptually interpretable 3-factor structure having satisfactory characteristics and relationships with relevant concepts. Its ease of use allows for quick acquisition of data that can contribute to understanding and facilitating the process of adoption of EMH by clinical professionals.

Abrupt light transitions in illuminance and correlated colour temperature result in different temporal dynamics and interindividual variability for sensation, comfort and alertness.

Detailed insights in both visual effects of light and effects beyond vision due to manipulations in illuminance and correlated color temperature (CCT) are needed to optimize study protocols as well as to design light scenarios for practical applications. This study investigated temporal dynamics and interindividual variability in subjective evaluations of sensation, comfort and mood as well as subjective and objective measures of alertness, arousal and thermoregulation following abrupt transitions in illuminance and CCT in a mild cold environment. The results revealed that effects could be uniquely attributed to changes in illuminance or CCT. No interaction effects of illuminance and CCT were found for any of these markers. Responses to the abrupt transitions in illuminance and CCT always occurred immediately and exclusively amongst the subjective measures. Most of these responses diminished over time within the 45-minute light manipulation. In this period, no responses were found for objective measures of vigilance, arousal or thermoregulation. Significant interindividual variability occurred only in the visual comfort evaluation in response to changes in the intensity of the light. The results indicate that the design of dynamic light scenarios aimed to enhance human alertness and vitality requires tailoring to the individual to create visually comfortable environments.

Behavioural biometrics: Using smartphone keyboard activity as a proxy for rest-activity patterns.

Rest-activity patterns are important aspects of healthy sleep and may be disturbed in conditions like circadian rhythm disorders, insomnia, insufficient sleep syndrome, and neurological disorders. Long-term monitoring of rest-activity patterns is typically performed with diaries or actigraphy. Here, we propose an unobtrusive method to obtain rest-activity patterns using smartphone keyboard activity. The present study investigated whether this proposed method reliably estimates rest and activity timing compared to daily self-reports within healthy participants. First-year students (n = 51) used a custom smartphone keyboard to passively and objectively measure smartphone use behaviours and completed the Consensus Sleep Diary for 1 week. The time of the last keyboard activity before a nightly absence of keystrokes, and the time of the first keyboard activity following this period were used as markers. Results revealed high correlations between these markers and user-reported onset and offset of resting period (r ranged from 0.74 to 0.80). Linear mixed models could estimate onset and offset of resting periods with reasonable accuracy (R2 ranged from 0.60 to 0.66). This indicates that smartphone keyboard activity can be used to estimate rest-activity patterns. In addition, effects of chronotype and type of day were investigated. Implementing this method in longitudinal studies would allow for long-term monitoring of (disturbances to) rest-activity patterns, without user burden or additional costly devices. It could be particularly interesting to replicate these findings in studies amongst clinical populations with sleep-related problems, or in populations for whom disturbances in rest-activity patterns are secondary complaints, such as neurological disorders.

Integration of Online Treatment Into the "New Normal" in Mental Health Care in Post-COVID-19 Times: Exploratory Qualitative Study.

BACKGROUND: The COVID-19 pandemic has necessitated an immediate and large-scale uptake of online treatment for mental health care. However, there is uncertainty about what the "new normal" in mental health care will be like in post-COVID-19 times. To what extent will the experiences gained during the pandemic influence a sustainable adoption and implementation of online mental health care treatment in the future? OBJECTIVE: In this paper, we aim to formulate expectations with regard to the sustainability of online mental health care after COVID-19. METHODS: In an interview study, 11 mental health care professionals were asked about their experiences and expectations for the future. Participants were recruited from a mental health care organization in the Netherlands. The interviews took place between April 7-30, 2020, at the peak of the COVID-19 crisis in the Netherlands. The data were analyzed using a thematic coding method. RESULTS: From the interviews, we learn that the new normal in mental health care will most likely consist of more blended treatments. Due to skill enhancement and (unexpected) positive experiences with online treatment, an increase in adoption is likely to take place. However, not all experiences promise a successful and sustainable upscaling of online treatment in the future. Mental health care professionals are learning that not all clients are able to benefit from this type of treatment. CONCLUSIONS: Sustainable upscaling of online mental health care requires customized solutions, investments in technology, and flexibility of mental health care providers. Online treatment could work for those who are open to it, but many factors influence whether it will work in specific situations. There is work to be done before online treatment is inherently part of mental health care.

Can Special Light Glasses Reduce Sleepiness and Improve Sleep of Nightshift Workers? A Placebo-Controlled Explorative Field Study.

Nightshift workers go against the natural sleep-wake rhythm. Light can shift the circadian clock but can also induce acute alertness. This placebo-controlled exploratory field study examined the effectiveness of light glasses to improve alertness while reducing the sleep complaints of hospital nurses working nightshifts. In a crossover within-subjects design, 23 nurses participated, using treatment glasses and placebo glasses. Sleepiness and sleep parameters were measured. A linear mixed model analysis on sleepiness revealed no significant main effect of the light intervention. An interaction effect was found indicating that under the placebo condition, sleepiness was significantly higher on the first nightshift than on the last night, while under the treatment condition, sleepiness remained stable across nightshift sessions. Sleepiness during the commute home also showed a significant interaction effect, demonstrating that after the first nightshift, driver sleepiness was higher for placebo than for treatment. Subjective sleep quality showed a negative main effect of treatment vs. placebo, particularly after the first nightshift. In retrospect, both types of light glasses were self-rated as effective. The use of light glasses during the nightshift may help to reduce driver sleepiness during the commute home, which is relevant, as all participants drove home by car or (motor) bike.

Mental Health Care Goes Online: Practitioners' Experiences of Providing Mental Health Care During the COVID-19 Pandemic.

The outbreak of the COVID-19 pandemic has necessitated sudden and radical changes in mental health care delivery, as strict social distancing and lockdown measures were imposed in the early phases of the pandemic. Almost overnight, practitioners were forced to transfer their face-to-face care practice to online means. To understand the implications of this drastic change for mental health care, and to improve the online care offerings, an online qualitative survey was held among mental health care professionals in Netherlands (n = 51). Our findings indicate that technological and usability problems pose a significant challenge, as do difficulties to establish rapport with clients. Moreover, not all mental health issues and treatment forms are equally amenable to online interaction. In contrast, in many instances, practitioners were positive about the effectiveness of treatment, and reported flexibility, a lower threshold for contact, and lack of travel time as advantages. Their most prominent needs concern better technological, organizational, and logistical support. It is critical that these needs are acted upon by institutions and governments. In addition, current results inform future research on the improvement of e-mental health technologies.

Active Involvement of People with Dementia: A Systematic Review of Studies Developing Supportive Technologies.

Although there are promising benefits of supportive technology in dementia care, use of these technologies is still limited. It is challenging for researchers and developers in this field to actively involve people with dementia in development. This review updates and builds on existing knowledge by including a contemporary and relevant perspective. This perspective was gained by including search words and search databases from the field of Human Computer Interaction (HCI) and Design, as these fields were expected to supply novel insights in the complex task of actively involving people with dementia in developing supportive technologies. A total of 49 out of 3456 studies were included which describe the development of a great variety of technologies. Often people with dementia were involved in the generative or evaluative phase of the development. Interviews and observations were most commonly used methods. In seven articles the people with dementia were co-designers. This literature review reflects that people with dementia can influence the development of technology in regards to content, design, and even the initial idea, although the impact on how they experience their own involvement remains largely unknown. There is a lack of specific knowledge on appropriate methods and materials for active involvement of people with dementia in supportive technology development, even when including articles from the field of HCI and Design. Future research is needed to further appreciate and improve the desired role of people with dementia in meaningful technology development.

Light, Alertness, and Alerting Effects of White Light: A Literature Overview.

Light is known to elicit non-image-forming responses, such as effects on alertness. This has been reported especially during light exposure at night. Nighttime results might not be translatable to the day. This article aims to provide an overview of (1) neural mechanisms regulating alertness, (2) ways of measuring and quantifying alertness, and (3) the current literature specifically regarding effects of different intensities of white light on various measures and correlates of alertness during the daytime. In general, the present literature provides inconclusive results on alerting effects of the intensity of white light during daytime, particularly for objective measures and correlates of alertness. However, the various research paradigms employed in earlier studies differed substantially, and most studies tested only a limited set of lighting conditions. Therefore, the alerting potential of exposure to more intense white light should be investigated in a systematic, dose-dependent manner with multiple correlates of alertness and within one experimental paradigm over the course of day.

Investigation of Dose-Response Relationships for Effects of White Light Exposure on Correlates of Alertness and Executive Control during Regular Daytime Working Hours.

To date, it is largely unknown which light settings define the optimum to steer alertness and cognitive control during regular daytime working hours. In the current article, we used a multimeasure approach combined with a relatively large sample size ( N = 60) and a large range of intensity levels (20-2000 lux at eye level) to investigate the dose-dependent relationship between light and correlates of alertness and executive control during regular working hours in the morning and afternoon. Each participant was exposed to a single-intensity light level for 1 h after a 30-min baseline phase (100 lux at the eye) in the morning and afternoon (on separate days) during their daily routine. Results revealed no clear dose-dependent relationships between 1-h daytime light exposure and correlates of alertness or executive control. Subjective correlates showed only very modest linear relationships with the log-transformed illuminance, and we found no significant effects of light intensity on the behavioral and physiological indicators. Overall, these results suggest that daytime exposure to more intense light, at least for 1 h of exposure, may not systematically benefit alertness or executive functioning. However, future research is required to investigate effects of longer exposure durations and potential moderations by prior light exposure, personal characteristics, and spectrum.

Convergent and construct validity and test-retest reliability of the Caen Chronotype Questionnaire in six languages.

Chronotype questionnaires provide a simple and time-effective approach to assessing individual differences in circadian variations. Chronotype questionnaires traditionally focused on one dimension of chronotype, namely its orientation along a continuum of morningness and eveningness. The Caen Chronotype Questionnaire (CCQ) was developed to assess an additional dimension of chronotype that captures the extent to which individual functioning varies during the day (amplitude). The aim of this study was to provide a multilanguage validation of the CCQ in six world regions (Arabic, Dutch, German, Italian, Portuguese and Spanish). At Time 1, a total of 2788 participants agreed to take part in the study (Arabic, n = 731; Dutch, n = 538; German, n = 329; Italian, n = 473; Portuguese, n = 361; Spanish, n = 356). Participants completed an assessment of the CCQ together with the Morningness-Eveningness Questionnaire (MEQ; Horne & Ostberg 1976) as well as questions related to factors theoretically related to chronotype (age, shift work, physical activity, sleep parameters and coffee consumption). One month later, participants again completed the CCQ. Results showed that the two-factor structure (morningness-eveningness and amplitude) of the CCQ could be replicated in all six languages. However, measurement invariance could not be assumed regarding the factor loadings across languages, meaning that items loaded more on their factors in some translations than in others. Test-retest reliability of the CCQ ranged from unacceptable (German version) to excellent (Dutch, Portuguese). Convergent validity was established through small-medium effect size correlations between the morningness-eveningness dimension of the CCQ and the MEQ. Taken together, our findings generally support the use of the translated versions of the CCQ. Further validation work on the CCQ is required including convergent validation against physiological markers of sleep, health and well-being.

Stopping the Train of Thought: A Pilot Study Using an Ecological Momentary Intervention with Twice-Daily Exposure to Natural versus Urban Scenes to Lower Stress and Rumination.

BACKGROUND: Stress, and specifically perseverative cognition, is considered to have considerable detrimental effects on mental and physical health. Interventions that can offer temporary stress relief could, therefore, bring considerable health benefits. Previous research has pointed to stress-reducing effects of exposure to nature after acute stressors, but has not yet investigated effects in the realm of everyday life. The present pilot study explores whether an ecological momentary intervention using exposure to natural images could be effective in lowering stress and improve mood. METHODS: Fifteen participants (12 females) scoring above threshold on stress, depression, or anxiety completed two study periods of 6 days. They watched an urban (control) or natural slideshow twice daily. Using Ecological Momentary Assessment, effects on mood, and stress-related complaints were measured in everyday life. RESULTS: Compliance to the study protocol was high, especially in the first week, with slightly more videos watched in the morning than in the evening. We found indications of improvements in mood, self-reported worrying (but not stress levels), and heart rate. CONCLUSIONS: The results suggest that twice-daily exposure to restorative visual content could be a viable Ecological Momentary Intervention, with the potential to reduce self-reported worry, lower autonomic activity, and increase positive affect.

Perceived Drivers and Barriers to the Adoption of eMental Health by Psychologists: The Construction of the Levels of Adoption of eMental Health Model.

BACKGROUND: The internet offers major opportunities in supporting mental health care, and a variety of technology-mediated mental and behavioral health services have been developed. Yet, despite growing evidence for the effectiveness of these services, their acceptance and use in clinical practice remains low. So far, the current literature still lacks a structured insight into the experienced drivers and barriers to the adoption of electronic mental health (eMental health) from the perspective of clinical psychologists. OBJECTIVE: The aim of this study was to gain an in-depth and comprehensive understanding of the drivers and barriers for psychologists in adopting eMental health tools, adding to previous work by also assessing drivers and analyzing relationships among these factors, and subsequently by developing a structured representation of the obtained findings. METHODS: The study adopted a qualitative descriptive approach consisting of in-depth semistructured interviews with clinical psychologists working in the Netherlands (N=12). On the basis of the findings, a model was constructed that was then examined through a communicative validation. RESULTS: In general, a key driver for psychologists to adopt eMental health is the belief and experience that it can be beneficial to them or their clients. Perceived advantages that are novel to literature include the acceleration of the treatment process, increased intimacy of the therapeutic relationship, and new treatment possibilities due to eMental health. More importantly, a relation was found between the extent to which psychologists have adopted eMental health and the particular drivers and barriers they experience. This differentiation is incorporated in the Levels of Adoption of eMental Health (LAMH) model that was developed during this study to provide a structured representation of the factors that influence the adoption of eMental health. CONCLUSIONS: The study identified both barriers and drivers, several of which are new to the literature and found a relationship between the nature and importance of the various drivers and barriers perceived by psychologists and the extent to which they have adopted eMental health. These findings were structured in a conceptual model to further enhance the current understanding. The LAMH model facilitates further research on the process of adopting eMental health, which will subsequently enable targeted recommendations with respect to technology, training, and clinical practice to ensure that mental health care professionals as well as their clients will benefit optimally from the current (and future) range of available eMental health options.