Internet-based cognitive behavioral therapy (iCBT) programs have the potential to improve access to mental healthcare, but they are not viewed as acceptable nor widely utilized by the general public. This study tested whether two acceptance-facilitating interventions improved acceptability and uptake-related behavior for therapist assisted and self-guided iCBT. Participants were randomly assigned to read a treatment rationale for iCBT (vs. a brief definition) and to receive a small financial incentive (or not) for seeking more information about evidence-based iCBT programs. Participants (N = 662) were a diverse group recruited from a University participant pool and the surrounding community. Participants completed standardized measures of attitudes toward and outcome expectancy for iCBT and a single question about willingness to use it and were given the opportunity to get information about accessing evidence-based iCBT programs. A series of MANCOVAs showed small, positive effects of the treatment rationale on attitudes and outcome expectancy for both self-guided and therapist-assisted iCBT, but not for willingness to use it. A hierarchical logistic regression model found no effect of the treatment rationale or financial incentive on whether participants sought additional information about how to access iCBT, although psychopathology symptoms and identifying as White or multiracial were positively associated with information-seeking. Inconsistent with past research, participants rated therapist-assisted and self-guided iCBT as equally acceptable. Participants recruited from the community reported greater willingness to use iCBT than University students. These results underscore the urgent need for further research toward improving the acceptability and uptake of iCBT so that it may better fulfill its potential to fill the gap in unmet mental health need.
Reactivation of deafferented cortex plays a key role in mediating the recovery of lost functions, although the precise mechanism is not fully understood. This study simultaneously characterized the dynamic spatiotemporal features of tactile responses in areas 3b and 1 before and 6–8 weeks after partial dorsal column lesion (DCL), and examined how the reactivation relates to the recovery of simple hand use in squirrel monkeys. A combination of high spatiotemporal resolution functional intrinsic optical imaging, microelectrode mapping, behavioral assessment, and tracer histology methods were used. Compared with the normal cortex, we found that the responses of deafferented areas 3b and 1 to 3 s of continuous 8 Hz tactile stimulation of a single digit were significantly weaker and more transient. This finding indicates a loss of response to sustained tactile stimuli. The activation area enlarged for areas 3b and 1 in both directions along digit representation (medial–lateral) and across areas (anterior–posterior). All subjects showed behavioral deficits in a food reaching-grasping-retrieving task within the first 5 weeks after DCL, but recovered at the time when optical images were acquired. Summarily, we showed that these populations of cortical neurons responded to peripheral tactile inputs, albeit in significantly altered manners in each area, several weeks after deafferentation. We propose that compromised ascending driven inputs, impaired lateral inhibition, and local integration of input signals may account for the altered spatiotemporal dynamics of the reactivated areas 3b and 1 cortices. Further investigation with large sample sizes is needed to fully characterize the effects of deafferentation on area 1 activation size.
Background Reducing the burden of depression is a global health concern. Self-guided mobile health (mHealth) apps are one approach to address this problem. However, there is little research on self-guided mHealth apps in a global sample or on how they are used in the real world. These gaps in our knowledge must be addressed to bring the promise of mHealth apps for reducing the global burden of depression closer to reality. Objective The purpose of this study is to examine the naturalistic user behavior of MoodTools, a publicly available, free-to-use, self-guided mHealth app designed to improve symptoms of depression, in a global community sample. Methods Mobile analytics data were collected from all unique downloads of the Android version of MoodTools between March 1, 2016, and February 28, 2018. Due to the deidentification and data aggregation process, no demographic or personal identifying information was tied to individual user data. All information was stored in aggregated, anonymized data files on Google Analytics’ storage database. Google’s software development kit was used to securely capture data about the number of downloads, location of downloads, number of app sessions, frequency and duration of app sessions, time between app sessions, and user retention, allowing for examination of which app’s tools were viewed and for how long, including Information (psychoeducation), Test (self-monitoring using the Patient Health Questionnaire [PHQ-9]), Thought Diary (targeting negative cognitions), Activities (behavioral activation), Videos (curated from YouTube), and Safety Plan (safety plan development and links to quickly access crisis management resources). Results MoodTools was used by 158,930 people from 198 countries, including countries where English was not the primary language and in low- and middle-income countries. After the initial download, 51.14% (n=81,277) of users returned to the app after the initial download, and retention rates decreased with each subsequent app session. The typical person used the app for 3 sessions for a total of 12 minutes over 90 days. The most frequently visited tools were Test and Thought Diary (n=393,549, 24.32%). On average, users completed and reviewed the results of the PHQ-9 for 49 seconds and 53 seconds, respectively, and spent 3 minutes and 5 seconds on Thought Diary. Conclusions Self-guided mHealth apps could be one approach (among the many needed) to reduce the burden of depression. Observational data collected in this study show a global interest in MoodTools, including in low- and middle-income countries and countries where English is not the primary language. Future research is needed to determine whether people who use self-guided apps experience improvement in depressive symptoms, and if so, what “dosage” provides a meaningful benefit.
BACKGROUND The scope and impact of depression worldwide is breathtaking. Reducing the global burden of depression will require a multi-pronged approach. OBJECTIVE The purpose of this study is to examine naturalistic user behavior of MoodTools, a publicly available, self-guided mHealth app designed to improve symptoms of depression, in a global community sample. METHODS Mobile analytics data was collected from all unique downloads of the Android version of MoodTools between March 1, 2016 and February 28, 2018. RESULTS MoodTools was used by 158,930 people from 198 countries. 51.14% of users returned to the app after initial download. The typical person used the app for 3 sessions for a total of 12 minutes over the span of 90 days. Users most often visited tools designed for self-monitoring of symptoms and for targeting a core mechanism of depressive psychopathology, negative cognitions. CONCLUSIONS Results suggest that there is global interest in a publicly available app for improving depression. Self-guided apps like MoodTools, therefore, could be a tool in the toolbox to address the global burden of depression. Future research is needed to determine whether people who use self-guided apps experience improvement in depressive symptoms. Given the low motivation and behavioral avoidance associated with the disorder, a key challenge for self-guided apps for depression is to engage and to retain users. CLINICALTRIAL none, not a trial
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