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Background Most American adolescents have access to smartphones, and recent estimates suggest that they spend considerable time on social media compared with other physical and leisure activities. A large body of literature has established that social media use is related to poor mental health, but the complicated relationship between social media and symptoms of depression and anxiety in adolescents is yet to be fully understood. Objective We aim to investigate the relationship between social media use and depression and anxiety symptoms in adolescents by exploring physical activity as a mediator. Methods A Qualtrics survey manager recruited adult panel participants between February and March 2019, who indicated that they had adolescent children who spoke English. A total of 4592 adolescent-parent dyads completed the survey that took approximately 39 minutes. The survey entailed completing web-based questionnaires assessing various aspects of social media use, psychological symptoms, and psychosocial factors. The average age of the adolescent participants was 14.62 (SD 1.68; range 12-17) years, and the majority of the adolescent sample was male (2392/4592, 52.09%). Results Total social media use was associated with more depressive symptoms (multiple R2=0.12; F3,4480=207.1; P<.001), anxiety (multiple R2=0.09; F3,4477=145.6; P<.001), and loneliness (multiple R2=0.06; F3,4512=98.06; P<.001), controlling for age and gender. Physical activity was associated with decreased depression and anxiety symptoms after controlling for other extracurricular activities and social media use (multiple R2=0.24; F5,4290=266.0; P<.001). There were significant differences in symptoms based on gender: female adolescents reported higher rates of social media use and males reported higher rates of depression. Nonbinary and transgender adolescents had higher rates of depression, anxiety, and loneliness than the female and male adolescents in the sample. Conclusions In a nationally representative sample of adolescents, more social media use was associated with more severe symptoms of depression, anxiety, and loneliness. Increased physical activity was associated with decreased depression and anxiety symptoms. Physical activity partially mediated the relationship between social media use and depression and anxiety. As this was a cross-sectional study, we cannot conclude that social media use causes internalizing symptoms or that physical activity leads to decreased internalizing symptoms—there may be additional confounding variables producing the relationships we observed. Physical activity may protect against the potentially harmful effect of social media on some adolescents. The effect sizes were small to medium, and the results should be interpreted with caution. Other limitations of this study include our reliance on self-reporting. Future work should examine social media use beyond how much time adolescents spend using social media and instead focus on the nature of social media activity.

Introduction Doing What Matters in Times of Stress (DWM) is a five-module transdiagnostic guided self-help (GSH) intervention developed by the World Health Organization, originally in a group-based format. In a sample of individuals recruited from across the United States, we conducted an open trial to study the feasibility and acceptability of an adaptation of DWM in which guidance was provided individually and remotely via phone and videoconferencing. Methods We assessed internalizing symptoms, psychological well-being, work and social functioning, usability of the intervention, and emotion regulation over the course of 6 weeks. Results A total of 263 individuals completed our screening. Of those, 75.29% ( n = 198) qualified for the intervention. We reached most participants who qualified (71.21%, n = 141) via phone to schedule a GSH session. Most of those scheduled attended a study session (84.4%, n = 119), and most of those who attended a session completed more than half the treatment (84.03%, n = 100). Retention rates were comparable to meta-analytic estimates of dropout rates in GSH. Participants showed improvement on internalizing symptoms, psychological well-being, work and social functioning, usability of the intervention, and emotion regulation. Conclusion DWM is a freely available, seemingly efficacious transdiagnostic intervention for internalizing disorder symptoms. Supplementary Information The online version contains supplementary material available at 10.1007/s10608-022-10338-5.

Cognitive-behavioral therapies (CBTs) are the most widely studied form psychotherapy for disorders like depression and anxiety. Nonetheless, there is heterogeneity in response to CBTs vs. other treatments. Researchers have become increasingly interested in using pre-treatment individual differences (i.e., moderators) to match patients to the most effective treatments for them. Several methods to combine multiple variables to create precision treatment rules (PTRs) that identify subgroups have been proposed. We review the rationale behind multivariable PTRs as well as studies that have used different PTRs. We identify conceptual and methodological issues in the literature. Multivariable treatment assignment is a promising avenue of research. Nonetheless, effect sizes appear to be small and most of the samples that have been used to study these questions have been grossly underpowered to detect small effects. We recommend researchers explore multivariable treatment selection strategies, particularly those resembling risk-stratification, in heterogeneous samples of patients undergoing low-intensity CBTs vs. realistic minimal controls.

Background Self-help interventions have the potential to increase access to evidence-based mental health care. Self-help can be delivered via different formats, including print media or digital mental health interventions (DMHIs). However, we do not know which delivery format is more likely to result in higher engagement. Objective The aims of this study were to identify if there is a preference for engaging in print media versus DMHIs and whether there are individual differences in relative preferences. Methods Participants were 423 adults between the ages of 18 and 82 years (201/423, 47.5% female) recruited on Prolific as a nationally representative sample of the US population, including non-Hispanic White (293/423, 69.2%), non-Hispanic Black (52/423, 12%), Asian (31/423, 7%), Hispanic (25/423, 6%), and other individuals (22/423, 5%). We provided individuals with psychoeducation in different self-help formats and measured their willingness to use print media versus DMHIs. We also assessed participants’ demographics, personality, and perception of each format’s availability and helpfulness and used these to predict individual differences in the relative preferences. Results Participants reported being more willing to engage with print media than with DMHIs (B=0.41, SE 0.08; t422=4.91; P<.001; d=0.24, 95% CI 0.05-0.43). This preference appeared to be influenced by education level (B=0.22, SE 0.09; t413=2.41; P=.02; d=0.13, 95% CI –0.06 to 0.32), perceived helpfulness (B=0.78, SE 0.06; t411=13.66; P<.001; d=0.46, 95% CI 0.27-0.66), and perceived availability (B=0.20, SE 0.58; t411=3.25; P=.001; d=0.12, 95% CI 0.07-0.30) of the self-help format. Conclusions This study suggests an overall preference for print media over DMHIs. Future work should investigate whether receiving mental health treatment via participants’ preferred delivery format can lead to higher engagement.

There is a growing interest in developing scalable interventions, including internet-based cognitive-behavioral therapy (iCBT), to meet the increasing demand for mental health services. Given the growth in diversity worldwide, it is essential that the clinical trials of iCBT for depression include diverse samples or, at the very least report information of the racial-ethnic composition of their samples. The field currently lacks data on how racial and ethnic diversity are represented in the iCBT literature. We conducted a systematic review to examine the overall reporting of racial and ethnic minorities in published clinical trials of iCBT for depression. We also reviewed the representation of specific racial and ethnic minority groups. We used a database of randomized controlled trials, focusing on iCBT studies. A total of 59 iCBT RCTs 16,411 participants are summarized in this study. Only 29% of the trial reported race, and only 19% reported ethnicity. Of those that reported race, 88% were conducted in the United States, while reporting outside of the United States was very poor. Within and without the United States, the most reported race was White (75%), followed by Black (8%), and Asian (6%). Furthermore, when translating this to individual participants, 12,863 (76.84%) participants had no reported race and 15,960 (97%) had no reported ethnicity. These findings suggest that reporting on race-ethnicity is very poor outside the United States. While studies in the U.S. report on racial-ethnic representation, the representation itself is quite poor.

BACKGROUND Self-help interventions have the potential to increase access to evidence-based mental health care. Self-help can be delivered via different formats, including print media or digital mental health interventions (DMHIs). However, we do not know which delivery format is more likely to result in higher engagement. OBJECTIVE The aims of this study were to identify if there is a preference for engaging in print media vs. DMHIs and whether there are individual differences in relative preferences. METHODS Participants were 423 adults between the ages of 18 and 82 years old (48% female) recruited on Prolific to be a nationally representative sample of the US population (Non-Hispanic White=69%, Non-Hispanic Black=12%, Asian 7.3%, Hispanic=5.9%, Other=5.2%). We provided individuals with psychoeducation on different self-help formats and measured their willingness to use print media vs. DMHIs. We also measured participants’ demographics, personality, and perception of each format’s availability and helpfulness and used these to predict individual differences in the relative preferences. RESULTS Participants reported being more willing to engage with print media than DMHIs (B=.41, SE=.08, t=4.91, P<.001, d=.24, 95% CI=.05–.43). This preference appeared to be influenced by education level (B=.22, SE=.09, t(422)=2.37, P=.02, d=.13, 95% CI=-.06–.32), perceived helpfulness (B=.78, SE=.06, t(12)=13.66, p < .001, d=.46, 95% CI=.27–.66), and perceived availability (B=.20, SE=.58, t(12)=3.25, P=.001, d=.12, 95% CI=.07–.30) of the self-help format. CONCLUSIONS This study suggests an overall preference for print media over DMHIs. Future work should study whether receiving mental health treatment via participants’ preferred delivery format can lead to higher engagement.

Objective: In recent years, emotion regulation strategies such as cognitive reappraisal (CR) and expressive suppression (ES) have emerged as potential transdiagnostic mechanisms of change. Functional models of emotion dysregulation hypothesize that avoidance strategies like ES maintain internalizing distress symptoms, but these models have not received close empirical scrutiny in treatment studies. The objective of this study was to test whether week-to-week within-person changes in CR and ES predicted changes in negative affect (NA) and positive affect (PA) in a guided self-help intervention. Methods: N = 141 participants were recruited for a six-week remote trial of a guided self-help transdiagnostic CBT (NCT04870099). NA was measured with the Kessler Scale Psychological Distress Scale (K6) and PA with the World Health Organization-5 Well-being Index (WHO-5). We used the Emotion Regulation Questionnaire (ERQ) to measure CR and ES and disaggregated within- versus between-person variability using a random intercept cross-lagged panel model. Results: Participants (Mage = 40.36, SDage = 13.95, nfemale = 120, nnon-Hispanic white = 110) improved in NA, PA, CR, and ES across the trial, with the smallest improvements in ES. At the between-person level, CR was associated with both NA (r = -0.22, p = .022) and PA (r = 0.40, p &lt; .001). At the within-person level, week-to-week changes in CR were associated with subsequent week-to-week decreases in NA (ranging from β = -0.28 to β = -0.55). Conclusions: Our findings support the role of cognitive restructuring as a mechanism of change in transdiagnostic CBT.