Low-effort internet intervention to reduce students' stress delivered with Meta's Messenger chatbot (Stressbot): A randomized controlled trial.
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SUBMITTER: Maciejewski J
PROVIDER: S-EPMC10413073 | biostudies-literature | 2023 Sep
REPOSITORIES: biostudies-literature
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Low-effort internet intervention to reduce students' stress delivered with Meta's Messenger chatbot (Stressbot): A randomized controlled trial.
Maciejewski Jan J Smoktunowicz Ewelina E
Internet interventions 20230725
In order to be more accessible and overcome the challenges of low adherence and high dropout, self-guided internet interventions need to seek new delivery formats. In this study, we tested whether a widely-adopted social media app - Meta's (Facebook) Messenger - would be a suitable conveyor of such an internet intervention. Specifically, we verified the efficacy of Stressbot: a Messenger chatbot-delivered intervention focused on enhancing coping self-efficacy to reduce stress and improve quality ...[more]
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Project description:BackgroundGlobally, students face increasing mental health challenges, including elevated stress levels and declining well-being, leading to academic performance issues and mental health disorders. However, due to stigma and symptom underestimation, students rarely seek effective stress management solutions. Conversational agents in the health sector have shown promise in reducing stress, depression, and anxiety. Nevertheless, research on their effectiveness for students with stress remains limited.ObjectiveThis study aims to develop a conversational agent-delivered stress management coaching intervention for students called MISHA and to evaluate its effectiveness, engagement, and acceptance.MethodsIn an unblinded randomized controlled trial, Swiss students experiencing stress were recruited on the web. Using a 1:1 randomization ratio, participants (N=140) were allocated to either the intervention or waitlist control group. Treatment effectiveness on changes in the primary outcome, that is, perceived stress, and secondary outcomes, including depression, anxiety, psychosomatic symptoms, and active coping, were self-assessed and evaluated using ANOVA for repeated measure and general estimating equations.ResultsThe per-protocol analysis revealed evidence for improvement of stress, depression, and somatic symptoms with medium effect sizes (Cohen d=-0.36 to Cohen d=-0.60), while anxiety and active coping did not change (Cohen d=-0.29 and Cohen d=0.13). In the intention-to-treat analysis, similar results were found, indicating reduced stress (β estimate=-0.13, 95% CI -0.20 to -0.05; P<.001), depressive symptoms (β estimate=-0.23, 95% CI -0.38 to -0.08; P=.003), and psychosomatic symptoms (β estimate=-0.16, 95% CI -0.27 to -0.06; P=.003), while anxiety and active coping did not change. Overall, 60% (42/70) of the participants in the intervention group completed the coaching by completing the postintervention survey. They particularly appreciated the quality, quantity, credibility, and visual representation of information. While individual customization was rated the lowest, the target group fitting was perceived as high.ConclusionsFindings indicate that MISHA is feasible, acceptable, and effective in reducing perceived stress among students in Switzerland. Future research is needed with different populations, for example, in students with high stress levels or compared to active controls.Trial registrationGerman Clinical Trials Register DRKS 00030004; https://drks.de/search/en/trial/DRKS00030004.
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Project description:BackgroundCollege environments promote high-volume or binge alcohol consumption among youth, which may be especially harmful to those with type 1 diabetes (T1D). Little is known about the acceptability and effectiveness of interventions targeting reduced alcohol use by college students with T1D, and it is unclear whether intervention framing (specifically, the narrator of intervention messages) matters with respect to affecting behavior change. Interventions promoted by peer educators may be highly relatable and socially persuasive, whereas those delivered by clinical providers may be highly credible and motivating.ObjectiveThe aim of this study is to determine the acceptability and impacts of an alcohol use psychoeducational intervention delivered asynchronously through web-based channels to college students with T1D. The secondary aim is to compare the impacts of two competing versions of the intervention that differed by narrator (peer vs clinician).MethodsWe recruited 138 college students (aged 17-25 years) with T1D through web-based channels and delivered a brief intervention to participants randomly assigned to 1 of 2 versions that differed only with respect to the audiovisually recorded narrator. We assessed the impacts of the exposure to the intervention overall and by group, comparing the levels of alcohol- and diabetes-related knowledge, perceptions, and use among baseline, immediately after the intervention, and 2 weeks after intervention delivery.ResultsOf the 138 enrolled participants, 122 (88.4%) completed all follow-up assessments; the participants were predominantly women (98/122, 80.3%), were White non-Hispanic (102/122, 83.6%), and had consumed alcohol in the past year (101/122, 82.8%). Both arms saw significant postintervention gains in the knowledge of alcohol's impacts on diabetes-related factors, health-protecting attitudes toward drinking, and concerns about drinking. All participants reported significant decreases in binge drinking 2 weeks after the intervention (21.3%; odds ratio 0.48, 95% CI 0.31-0.75) compared with the 2 weeks before the intervention (43/122, 35.2%). Changes in binge drinking after the intervention were affected by changes in concerns about alcohol use and T1D. Those who viewed the provider narrator were significantly more likely to rate their narrator as knowledgeable and trustworthy; there were no other significant differences in intervention effects by the narrator.ConclusionsThe intervention model was highly acceptable and effective at reducing self-reported binge drinking at follow-up, offering the potential for broad dissemination and reach given the web-based format and contactless, on-demand content. Both intervention narrators increased knowledge, improved health-protecting attitudes, and increased concerns regarding alcohol use. The participants' perceptions of expertise and credibility differed by narrator.Trial registrationClinicalTrials.gov NCT02883829; https://clinicaltrials.gov/ct2/show/NCT02883829.International registered report identifier (irrid)RR2-10.1177/1932296819839503.
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Project description:BackgroundFace-to-face cognitive behavioral therapy (CBT) is the most promising treatment to reduce stress, but access to CBT is limited. Internet-delivered CBT (ICBT) enables large-scale dissemination at low costs. Evidence suggests that ICBT can reduce stress in subclinical and mixed diagnostic samples, but less is known about the effect of ICBT in targeted samples suffering from elevated perceived stress or stress-related disorders.ObjectiveTo investigate the efficacy of ICBT specifically aimed at reducing stress in adults with elevated perceived stress or stress-related disorders.MethodsWe searched for randomized controlled trials comparing ICBT with a control group in PubMed, Web of Science, and PsycInfo between 2010 and 2021. A meta-analysis of 14 comparisons (total N = 1831) was performed, and Cohen's d was calculated to assess the difference between intervention and control groups at posttest for the primary outcome self-rated stress. Effects on secondary outcomes of anxiety and depression were also investigated.ResultsThe pooled mean effect size for self-rated stress at posttest was d = 0.78 [CI 95 % 0.66-0.90]. For anxiety and depression, the effects were d = 0.69 [95 % CI 0.52-0.86] and d = 0.65 [95 % CI 0.56-0.75] respectively. The heterogeneity of results between studies was overall low to moderate. Subgroup analyses were not conducted due to the limited number of studies eligible for inclusion.ConclusionsResults provide evidence of the efficacy of ICBT to reduce stress, anxiety, and depressive symptoms in adults suffering from elevated stress or stress-related disorders. Findings have important implications for the development of safe and evidence-based treatment guidelines in the face of a rapid digital expansion.This study was preregistered at Open Science Framework (osf.io) with DOI 10.17605/OSF.IO/BQAZ3.
| S-EPMC9240371 | biostudies-literature
Project description:BackgroundPsychological distress is prevalent among university students. However, the availability of evidence-based mental health treatment remains limited in many low- and middle-income countries, including Indonesia. Internet-delivered, mindfulness-based interventions that reduce distress have potential for treating university student distress at scale. Unfortunately, evidence-based, internet-delivered mindfulness treatments are not yet available in Indonesia. Cultural adaptation of established evidence-based, internet-delivered mindfulness interventions is needed.ObjectiveIn this paper, we describe the process of culturally adapting an Australian internet-delivered mindfulness program (Introduction to Mindfulness) to be relevant and appropriate for treating Indonesian university students' psychological distress.MethodsTo assist the cultural adaptation process, we used a systematic cultural adaptation framework and a mixed methods approach combining quantitative and qualitative methods. In study 1 (information gathering), we administered an internet-delivered questionnaire to Indonesian university students (n=248) to examine their preferences regarding an internet-delivered mindfulness intervention. In study 2 (preliminary design), a draft program was developed and independently reviewed by Indonesian stakeholders. Stakeholders (n=25) included local Indonesian mindfulness and mental health professionals (n=6) and university students (n=19), who were selected to maximize sample representativeness regarding personal and professional characteristics. To evaluate the initial design and cultural congruence of the internet-delivered mindfulness program in the Indonesian context, we conducted interviews and focus groups with stakeholders. Stakeholders also completed the Cultural Relevance Questionnaire.ResultsIn study 1, most Indonesian university students (240/248, 96.8%) reported openness to an internet-delivered mindfulness program. Most of interested students (127/240, 52.9%) preferred the length of the program to be 3 to 4 sessions, with 45.8% (110/240) preferring brief lessons taking only 15 to 30 minutes to complete. They (194/240, 80.8%) recommended that the program be accessible both through websites and mobile phones. In study 2, Indonesian stakeholders generally found the internet-delivered program to be highly culturally appropriate in terms of language, concepts, context, treatment goals, and depictions of students' emotional and behavioral experiences. However, stakeholders also recommended some specific adaptations regarding the program's delivery model (eg, combining visual and audio modalities when delivering psychoeducation), cultural components (eg, including more social and spiritual activities), program practicality (eg, including rewards to promote engagement), and design elements (eg, including additional culturally relevant illustrations). Following stakeholder feedback, a new culturally adapted Indonesian internet-delivered mindfulness program called Program Intervensi Mindfulness Daring Mahasiswa Indonesia was created.ConclusionsThis study highlights the process and importance of cultural adaptation of an evidence-based mindfulness treatment and demonstrates how this may be achieved for internet-delivered psychotherapy programs. We found that a culturally adapted internet-delivered mindfulness program was relevant for Indonesian students with some adjustments to the programs' content and delivery. Future research is now needed to evaluate the clinical benefit of this program.
| S-EPMC10502595 | biostudies-literature
Project description:Internet-delivered cognitive behavioral therapy (ICBT) interventions can be as effective as traditional face-to-face therapy for various mental health conditions. However, a significant challenge these online interventions face is the high rate of people who start but then stop using the program. This early discontinuation can be seen as incomplete treatment and can reduce the potential benefits for users. By exploring why people stop using ICBT programs, we can better understand how to address this problem. This study aimed to examine the experiences of healthcare workers who had stopped using a therapist-guided internet-delivered stress recovery program to gain deeper insights into usage attrition. We conducted semi-structured interviews with twelve participants who were female healthcare workers ranging in age from 24 to 68 years (M = 44.67, SD = 11.80). Telephone interviews were conducted and the data were transcribed and analyzed using thematic analysis. Qualitative data analysis revealed that most participants had multiple reasons for discontinuing the program. They identified both barriers and facilitators to using the program, which could be categorized as either personal or program related. Personal aspects included life circumstances, personal characteristics, and psychological responses to the program. Program-related aspects encompassed technical factors, program content, and the level of support provided. The findings of this study can enhance our understanding of why people stop using guided internet-delivered programs. We discuss the practical and research implications, with the ultimate aim of improving the design and efficacy of internet interventions.
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Project description:ObjectiveChatbots' rapid advancements raise the possibility that they can be used to deliver mental health support. However, public utilization of and opinions toward chatbots for mental health support are poorly understood.MethodsSurvey study of 428 U.S. university students who participated in early 2024, just over one year after the release of ChatGPT. Descriptive analyses examined utilization of and attitudes toward both traditional mental health services (i.e. psychotherapy, counseling, or medication) and chatbot-delivered mental health support.ResultsNearly half (49%) of participants reported having used a chatbot for any purpose, yet only 5% reported seeking mental health support from a chatbot (8% when only considering participants with probable depression or generalized anxiety disorder). Attitudes toward traditional mental health services were broadly positive, and attitudes toward chatbot-delivered support were neutral and significantly less positive (d = 1.18, p < .001). Participants reported lack of need and doubts about helpfulness as barriers to using chatbot-delivered support more frequently than they reported them as barriers to traditional services. Cost, time, and stigma barriers were less frequently reported for chatbot-delivered support than for traditional services. Attitudes were generally consistent as a function of mental health status.ConclusionAmong U.S. students, utilization of chatbots for mental health support is uncommon. Chatbots are perceived as less likely to be beneficial, yet also less affected by cost, time, and stigma barriers than traditional services. Rigorous outcome research may increase public trust in and utilization of chatbots for mental health support.
| S-EPMC11748072 | biostudies-literature
Project description:BackgroundSpinal fusion surgery is a common and painful musculoskeletal surgery performed in the adolescent population. Despite the known risk for developing chronic postsurgical pain, few perioperative psychosocial interventions have been evaluated in this population, and none have been delivered remotely (via the Internet) to improve accessibility.AimsThe aim of this single-arm pilot study was to evaluate the feasibility and acceptability of the first Internet-based psychological intervention delivered during the perioperative period to adolescents undergoing major spinal fusion surgery and their parents.MethodsThirteen adolescents (M age = 14.3; 69.2% female) scheduled for spine fusion surgery and their parents were provided access to the online psychosocial intervention program. The program included six lessons delivering cognitive-behavioral therapy skills targeting anxiety, sleep, and acute pain management during the month prior to and the month following surgery. Feasibility indicators included recruitment rate, intervention engagement, and measure completion. Acceptability was assessed via quantitative ratings and qualitative interviews.ResultsOur recruitment rate was 81.2% of families approached for screening. Among participating adolescent-parent dyads, high levels of engagement were demonstrated (100% completed all six lessons). All participants completed outcome measures. High treatment acceptability was demonstrated via survey ratings and qualitative feedback, with families highlighting numerous strengths of the program as well as areas for improvement.ConclusionsThese findings suggest that this online psychosocial intervention delivered during the perioperative period is feasible and acceptable to adolescents and their parents. Given favorable feasibility outcomes, an important next step is to evaluate the intervention in a full-scale randomized controlled trial.
| S-EPMC9009921 | biostudies-literature
Project description:BackgroundTransitioning to adulthood and challenges in university life can result in increased stress levels among university students. Chronic and severe stress is associated with deleterious psychological and physiological effects. Digital interventions could succeed in approaching and helping university students who might be at risk; however, the experiences of students with internet-based stress management interventions are insufficiently understood.ObjectiveThis study aims to explore the feasibility; acceptability; and changes in perceived stress, depressive symptoms, and quality of life from baseline to posttest assessment of a 5-session, internet-based stress management intervention guided by an e-coach, developed for university students experiencing high levels of stress.MethodsA single-arm study was conducted. Students were recruited from different channels, mainly from a web survey. Students were eligible if they (1) scored ≥20 on the Perceived Stress Scale-10, (2) were aged ≥18 years, and (3) were studying at one of the participating universities. Feasibility and acceptability of the intervention were investigated using several indications, including satisfaction (Client Satisfaction Questionnaire-8) and usability (System Usability Scale-10). We also investigated the indicators of intervention adherence using use metrics (eg, the number of completed sessions). Our secondary goal was to explore the changes in perceived stress (Perceived Stress Scale-10), depressive symptoms (Patient Health Questionnaire-9), and quality of life (EQ-5D-5L scale) from baseline to posttest assessment. In addition, we conducted semistructured interviews with intervention completers and noncompleters to understand user experiences in depth. For all primary outcomes, descriptive statistics were calculated. Changes from baseline to posttest assessment were examined using 2-tailed paired sample t tests or the Wilcoxon signed rank test. Qualitative data were analyzed using thematic analysis.ResultsOf 436 eligible students, 307 (70.4%) students started using the intervention. Overall, 25.7% (79/307) completed the core sessions (ie, sessions 1-3) and posttest assessment. A substantial proportion of the students (228/307, 74.3%) did not complete the core sessions or the posttest assessment. Students who completed the core sessions reported high satisfaction (mean 25.78, SD 3.30) and high usability of the intervention (mean 86.01, SD 10.25). Moreover, this group showed large reductions in perceived stress (Cohen d=0.80) and moderate improvements in depression score (Cohen d=0.47) and quality of life (Cohen d=-0.35) from baseline to posttest assessment. Qualitative findings highlight that several personal and intervention-related factors play a role in user experience.ConclusionsThe internet-based stress management intervention seems to be feasible, acceptable, and possibly effective for some university students with elevated stress levels. However, given the high dropout rate and qualitative findings, several adjustments in the content and features of the intervention are needed to maximize the user experience and the impact of the intervention.Trial registrationNetherlands Trial Register 8686; https://onderzoekmetmensen.nl/nl/trial/20889.International registered report identifier (irrid)RR2-10.1016/j.invent.2021.100369.
| S-EPMC10674149 | biostudies-literature
Project description:BACKGROUND:Patient adherence is defined as the extent to which a patient complies with medical or health advice. At present, there is a lack of reliable and valid measures specifically designed to measure adherence to internet-delivered behavioral interventions. OBJECTIVE:The objective of this study was to develop and psychometrically evaluate a novel measure of adherence to guided internet-delivered behavioral interventions. METHODS:In collaboration with experienced clinicians and researchers in the field, a 5-item, clinician-rated internet intervention Patient Adherence Scale (iiPAS) was developed. The initial scale was tested in a sample of children and adolescents (N=50) participating in internet-delivered cognitive behavioral therapy (ICBT) studies. A revised version of the iiPAS was then administered to a larger sample of children and adolescents (N=148) with various behavioral problems participating in ICBT trials. The scale was evaluated according to a classical test theory framework. RESULTS:The iiPAS demonstrated excellent internal consistency. Factor analyses revealed one underlying factor, explaining about 80% of the variance, suggesting that the scale captures a homogeneous adherence construct. The iiPAS was strongly associated with objective measures of patient activity in ICBT (number of logins, number of written characters, and completed modules). Furthermore, mid- and posttreatment ratings of the iiPAS were significantly correlated with treatment outcomes. By contrast, objective measures of patient activity in the Web-based platform did not correlate with treatment outcomes. CONCLUSIONS:The iiPAS could be a useful tool to measure adherence in a broad range of internet-delivered behavioral interventions.
| S-EPMC6774571 | biostudies-literature
Project description:IntroductionAcademic education is often associated with increased stress and adverse effects on mental health. Internet-based interventions have shown to be effective in reducing stress-related symptoms. However, college students as target group so far have not been reached appropriately with psychological interventions and little is known about college students' perception of Internet-based stress management interventions. The objective of this study was to explore the experiences of students participating in an Internet- and App-based stress management intervention originally developed for stressed employees and subsequently adapted and tailored to college students.MethodSemi-structured interviews were conducted with ten participants selected from a randomized controlled trial that evaluated the effectiveness of an Internet- and App-based stress training. The selection of participants aimed to include students with different levels of treatment success. In order to enable an in-depth examination of intervention elements causing dissatisfaction, the interviews were systematically adapted regarding participants' statements in a precedent questionnaire. The interview material was analyzed based on the grounded theory method and thematic analysis.ResultsResults suggest students perceive a necessity to adapt Internet-based interventions to their particular needs. Students' statements indicate that a scientific perspective on the intervention and instable life circumstances could be student-specific factors affecting treatment experience. General themes emerging from the data were attitudes towards individualization and authenticity as well as demands towards different functions of feedback.DiscussionParticipants' experiences hint at certain intellectual and lifestyle-related characteristics of this population. Future studies should explore whether adaptions to these characteristics lead to a higher acceptance, adherence and effectiveness in the target population.
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