Technology
Jane Shkel, M.S.
Research Assistant
University of California, Irvine
Irvine, California
Gavin Green, B.S.
Research Assistant
University of California, Irvine
Huntington Beach, California
Stacey Le, B.A.
Research Assistant
University of California, Irvine
Westminster, California
Zoe Dodge-Rice, B.A.
Research Assistant
University of California, Irvine
Irvine, California
Benjamin Kaveladze, M.A.
Graduate Student
University of California, Irvine
Irvine, California
Veronique Marcotte, M.S.
Statistician
University of California, Irvine
Irvine, California
Kevin Rushton, B.S.
Program Manager of Digital Solutions
Mental Health America
Washington, District of Columbia
Theresa Nguyen, LCSW
Chief Program Officer
Mental Health America
Alexandria, Virginia
Stephen M. Schueller, Ph.D.
Associate Professor of Psychological Science
University of California, Irvine
Irvine, California
Digital mental health interventions (DMHIs) can help bridge the gap between demand for mental health care and availability of treatment resources by mitigating barriers such as accessibility, cost, and stigma. Research suggests that DMHIs with human support may be more effective; however, most DMHIs are “self-guided.” A scalable way to provide human support is by using other platform users (i.e., “crowdsourcing” support).
To evaluate this form of support we developed “Overcoming Thoughts,” a novel online platform for depression and anxiety built in partnership with Mental Health America. “Overcoming Thoughts” consists of two exercises – cognitive restructuring and behavioral experimentation. We conducted a pilot randomized controlled trial comparing two versions of this platform: a version with crowdsourced support and a self-guided control. Participants used the platform for 8 weeks. At the end of the trial period, we invited a subset of participants to complete an exit interview using purposive sampling based on group assignment and symptom improvement. Twenty-three participants completed these interviews, which addressed issues of acceptability, usability, and impact.
We conducted thematic qualitative analysis to identify common themes in participants’ experience of the platform. Our team identified initial themes using affinity diagramming to create a codebook and two raters coded all transcripts until thematic saturation was reached. The final codebook consisted of 19 codes. Raters had 88.1% agreement in codes across all transcripts. We also compared differences in the frequency that themes occurred between conditions and those who improved and did not improve on the primary study outcome at week 8.
Five major themes were identified: 1) possible opportunities to expand the platform (100%), 2) improvement in mental health as a result of using the platform (87%); 3) increased self-reflection skills (83%); 4) platform being more helpful for certain situations or domains (83%); and 5) application of skills into users’ lives, even without direct platform use (74%). Though there were no differences in themes among groups based on improvement status (all p’s > .05), there were four themes that differed based on conditions (p’s from .012 to .046): 1) helpfulness of self-reflection supported by an exercise summary; 2) aiding in slowing thoughts and feeling calmer; 3) overcoming patterns of avoidance; and 4) repetitiveness of content.
Our findings identified different benefits users perceived from a novel DMHI including improvement in mental health, self-reflection, and coping skills. Interestingly, we did not note any differences in themes among those who improved and those who did not. We did, however, find some differences between the conditions, like control users being more likely than crowdsource users to comment on the helpfulness of the summary pages and note perceived improvement in areas like calmness and overcoming avoidance. Whereas, the crowdsource users identified repetitiveness of the platform despite crowdsource content adding more novelty. Further research is needed to better understand how novel features might support users in DMHIs and create more ways to understand users’ experience of these interventions.