Digital Interventions to Enhance Readiness for Psychological Therapy: Scoping Review

Abstract

Background Psychological therapy is an effective treatment method for mental illness; however, many people with mental illness do not seek treatment or drop out of treatment early. Increasing client uptake and engagement in therapy is key to addressing the escalating global problem of mental illness. Attitudinal barriers, such as a lack of motivation, are a leading cause of low engagement in therapy. Digital interventions to increase motivation and readiness for change hold promise as accessible and scalable solutions; however, little is known about the range of interventions being used and their feasibility as a means to increase engagement with therapy. Objective This review aimed to define the emerging field of digital interventions to enhance readiness for psychological therapy and detect gaps in the literature. Methods A literature search was conducted in PubMed, PsycINFO, PsycARTICLES, Scopus, Embase, ACM Guide to Computing Literature, and IEEE Xplore Digital Library from January 1, 2006, to November 30, 2021. The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) methodology was applied. Publications were included when they concerned a digitally delivered intervention, a specific target of which was enhancing engagement with further psychological treatment, and when this intervention occurred before the target psychological treatment. Results A total of 45 publications met the inclusion criteria. The conditions included depression, unspecified general mental health, comorbid anxiety and depression, smoking, eating disorders, suicide, social anxiety, substance use, gambling, and psychosis. Almost half of the interventions (22/48, 46%) were web-based programs; the other formats included screening tools, videos, apps, and websites. The components of the interventions included psychoeducation, symptom assessment and feedback, information on treatment options and referrals, client testimonials, expectation management, and pro-con lists. Regarding feasibility, of the 16 controlled studies, 7 (44%) measuring actual behavior or action showed evidence of intervention effectiveness compared with controls, 7 (44%) found no differences, and 2 (12%) indicated worse behavioral outcomes. In general, the outcomes were mixed and inconclusive owing to variations in trial designs, control types, and outcome measures. Conclusions Digital interventions to enhance readiness for psychological therapy are broad and varied. Although these easily accessible digital approaches show potential as a means of preparing people for therapy, they are not without risks. The complex nature of stigma, motivation, and individual emotional responses toward engaging in treatment for mental health difficulties suggests that a careful approach is needed when developing and evaluating digital readiness interventions. Further qualitative, naturalistic, and longitudinal research is needed to deepen our knowledge in this area.

Women Empowered to Connect with Addiction Resources and Engage in Evidence-based Treatment (WE-CARE): A Usability and Feasibility Study of a Mobile Health Application for the Universal Screening of Alcohol, Substance Use, Depression and Anxiety. (Preprint)

“…With issues related to stigma and fear addressed by the anonymous status, mobile apps can encourage more women to undergo screenings, leading to early identification of at-risk individuals, improved education, and increased treatment options for healthcare providers [68]. Novel digital strategies to improve mental health screenings, patient engagement, and referral to treatment show preliminary effectiveness [69]. A recent report found that using tablets in the waiting room resulted in nearly twice as many individuals screening for depression than when interviewed by nursing staff [70].…”

Use of the Therapy App Prescinde for Increasing Adherence to Smoking Cessation Treatment

“…Smoking cessation apps offer a wide range of content options, ranging from videos and short and simple ads to more comprehensive programs encompassing mindfulness meditation, self-efficacy enhancement, motivation for change, and smoking cessation counseling (through educational, self-efficacy, and coping skills messages). Additional components include messages promoting happiness based on positive psychology principles, aimed at increasing adherence to treatment [13,26,29,[39][40][41]. These apps can also serve as adjuncts to cognitive behavioral treatments [42].…”

Co-design and evaluation of a smartphone-based mental health promotion and anti-stigma embodied conversational agent for church-affiliated Black adults

“…Given my extensive experience partnering with these church communities, I'd like to offer my perspective on an ideal intervention duration as a next step if deploying the intervention more broadly to the entire church. When reviewing the digital care-seeking encouragement intervention literature, I found that intervention durations varied widely from 15-minute sessions to four-week-plus interventions with no set best practice recommendations for intervention duration (Jardine et al, 2022). For this study, I chose a study duration of two weeks.…”