Process Model of Emotion Regulation-Based Digital Intervention for Emotional Problems: A mixed methods feasibility study

The current study explored the feasibility of a newly developed self-guided digital intervention program TEA (Training for Emotional Adaptation) in alleviating depressive and anxiety symptoms, corresponding to the urgent call for remote mental health service. It is one of a few studies which adapted from theoretical models with effective intervention techniques. The first part involved 11 professional mental health practitioners giving feedback on the feasibility; while the second part involved a single-arm study with 32 participants recruited online, who went through the seven intervention sessions. The questionnaires were collected before, after, 14-days after and 30-days after the intervention. Moreover, 10 participants were invited to semi-structured interviews. Practitioners thought the TEA showed high professionalism (8.91/10) and is suitable for treating emotional symptoms (8.09/10). The Generalized estimating equation (GEE) model showed that the TEA significantly reduced their psychological symptoms, while the effects of the intervention were retained for 30-day post intervention (Cohens d >1). Thematic analysis revealed three main themes about future improvement, including content improvement, interaction improvement and bug-fixing. Taken together, current study supported the effectiveness of TEA, with the potential to address the urgent need for remote mental health service. Future randomized controlled trials to confirm the effectiveness are required.

[1]  Anonymous COVAX delivers its 1 billionth COVID-19 vaccine doseCOVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide , 2022, Saudi medical journal.

[2]  Helen Christensen,et al.  Effect of Engagement With Digital Interventions on Mental Health Outcomes: A Systematic Review and Meta-Analysis , 2021, Frontiers in Digital Health.

[3]  John J. Foxe,et al.  Demographic and mental health assessments in the adolescent brain and cognitive development study: Updates and age-related trajectories , 2021, Developmental Cognitive Neuroscience.

[4]  Reed J. D. Sorensen,et al.  Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic , 2021, The Lancet.

[5]  S. Bucci,et al.  Digital mental health in China: a systematic review , 2021, Psychological Medicine.

[6]  Richard T. Liu,et al.  Digital Technologies for Emotion-Regulation Assessment and Intervention: A Conceptual Review , 2021, Clinical psychological science : a journal of the Association for Psychological Science.

[7]  C. Bockting,et al.  Effectiveness of digital psychological interventions for mental health problems in low-income and middle-income countries: a systematic review and meta-analysis , 2020, Lancet psychiatry.

[8]  John Torous,et al.  Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow , 2020, JMIR mental health.

[9]  Jennifer H. Pfeifer,et al.  Cognitive reappraisal and expressive suppression relate differentially to longitudinal structural brain development across adolescence , 2020, Cortex.

[10]  A. Soltanian,et al.  Examining the Effectiveness of a Web-Based Intervention for Depressive Symptoms in Female Adolescents: Applying Social Cognitive Theory , 2019, Journal of research in health sciences.

[11]  D. Berle,et al.  A systematic review and meta-analysis of the Unified Protocol as a transdiagnostic emotion regulation based intervention. , 2019, Clinical psychology review.

[12]  J. Gill,et al.  The effect of mindfulness meditation on sleep quality: a systematic review and meta‐analysis of randomized controlled trials , 2019, Annals of the New York Academy of Sciences.

[13]  J. Gross,et al.  Mental illness and well‐being: an affect regulation perspective , 2019, World psychiatry : official journal of the World Psychiatric Association.

[14]  J. Sheng,et al.  Depression in sleep disturbance: A review on a bidirectional relationship, mechanisms and treatment , 2019, Journal of cellular and molecular medicine.

[15]  R. Kessler,et al.  Internet interventions for mental health in university students: A systematic review and meta‐analysis , 2018, International journal of methods in psychiatric research.

[16]  S. Hollon,et al.  Internet-based behavioural activation with lay counsellor support versus online minimal psychoeducation without support for treatment of depression: a randomised controlled trial in Indonesia. , 2018, The lancet. Psychiatry.

[17]  B. Klein,et al.  Cognitive behavior therapy for older adults with insomnia and depression: a randomized controlled trial in community mental health services , 2018, Sleep.

[18]  A. Luik,et al.  Efficacy of digital CBT for insomnia to reduce depression across demographic groups: a randomized trial , 2018, Psychological Medicine.

[19]  M. Tiburcio,et al.  Web-Based Intervention to Reduce Substance Abuse and Depression: A Three Arm Randomized Trial in Mexico , 2018, Substance use & misuse.

[20]  I. Gotlib,et al.  Investigating the nature of co-occurring depression and anxiety: Comparing diagnostic and dimensional research approaches. , 2017, Journal of affective disorders.

[21]  E. Holmes,et al.  Emotion Regulation Strategies in Depressive and Anxiety Symptoms in Youth: A Meta-Analytic Review , 2017, Journal of youth and adolescence.

[22]  J. Francis,et al.  Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework , 2017, BMC Health Services Research.

[23]  C. Hunt,et al.  Suppression and Expression of Emotion in Social and Interpersonal Outcomes: A Meta-Analysis , 2017, Emotion.

[24]  V. Patel,et al.  The Impact of Digital Technology on Psychological Treatments and Their Dissemination. , 2018, Focus.

[25]  Christopher D. Burton,et al.  Pilot randomised controlled trial of Help4Mood, an embodied virtual agent-based system to support treatment of depression , 2016, Journal of telemedicine and telecare.

[26]  P. Cuijpers,et al.  Scaling-up treatment of depression and anxiety: a global return on investment analysis. , 2016, The lancet. Psychiatry.

[27]  Laura Manea,et al.  Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis. , 2016, General hospital psychiatry.

[28]  Bogdan Tudor Tulbure,et al.  Internet-Delivered Cognitive-Behavioral Therapy for Social Anxiety Disorder in Romania: A Randomized Controlled Trial , 2015, PloS one.

[29]  C. Knaevelsrud,et al.  Web-Based Psychotherapy for Posttraumatic Stress Disorder in War-Traumatized Arab Patients: Randomized Controlled Trial , 2015, Journal of medical Internet research.

[30]  D. Cutuli,et al.  Cognitive reappraisal and expressive suppression strategies role in the emotion regulation: an overview on their modulatory effects and neural correlates , 2014, Front. Syst. Neurosci..

[31]  Min Zhao,et al.  Reliability and validity of the Chinese version of the Patient Health Questionnaire (PHQ-9) in the general population. , 2014, General hospital psychiatry.

[32]  M. Fava,et al.  RELATIONSHIP BETWEEN SLEEP DISTURBANCE AND DEPRESSION, ANXIETY, AND FUNCTIONING IN COLLEGE STUDENTS , 2013, Depression and anxiety.

[33]  Jianping Wang,et al.  Chinese My Trauma Recovery, A Web-Based Intervention for Traumatized Persons in Two Parallel Samples: Randomized Controlled Trial , 2013, Journal of medical Internet research.

[34]  R. Roberts,et al.  A Systematic Review Assessing Bidirectionality between Sleep Disturbances, Anxiety, and Depression. , 2013, Sleep.

[35]  J. Taffe,et al.  The Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA): a psychometric evaluation. , 2012, Psychological assessment.

[36]  P. Sheeran,et al.  Dealing with feeling: a meta-analysis of the effectiveness of strategies derived from the process model of emotion regulation. , 2012, Psychological bulletin.

[37]  Sisira Edirippulige,et al.  Journal round up , 2012 .

[38]  Michelle G. Craske,et al.  Computer Therapy for the Anxiety and Depressive Disorders Is Effective, Acceptable and Practical Health Care: A Meta-Analysis , 2010, PloS one.

[39]  D. Yu Insomnia Severity Index: psychometric properties with Chinese community-dwelling older people. , 2010, Journal of advanced nursing.

[40]  Qichang Shi,et al.  Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001–05: an epidemiological survey , 2009, The Lancet.

[41]  Jonathan A. Smith Qualitative Psychology: A Practical Guide to Research Methods , 2006, QMiP Bulletin.

[42]  B. Löwe,et al.  A brief measure for assessing generalized anxiety disorder: the GAD-7. , 2006, Archives of internal medicine.

[43]  Hsiu-Fang Hsieh,et al.  Three Approaches to Qualitative Content Analysis , 2005, Qualitative health research.

[44]  O. John,et al.  Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. , 2003, Journal of personality and social psychology.

[45]  James J. Gross,et al.  Emotion Regulation in Adulthood: Timing Is Everything , 2001 .

[46]  R. Spitzer,et al.  The PHQ-9 , 2001, Journal of General Internal Medicine.

[47]  C. Morin,et al.  Validation of the Insomnia Severity Index as an outcome measure for insomnia research. , 2001, Sleep medicine.

[48]  M. Tansella,et al.  The Personal Health Questionnaire: a new screening instrument for detection of ICD-10 depressive disorders in primary care , 2000, Psychological Medicine.

[49]  R. G. Clapp,et al.  Stability of Cognitive Style in Adults and Some Implications, a Longitudinal Study of the Kirton Adaption-Innovation Inventory , 1993 .

[50]  R. Price,et al.  Emotional Disorders in Development , 2020 .

[51]  Shiwen Sun,et al.  Effects of an Online Mindfulness Intervention Focusing on Attention Monitoring and Acceptance in Pregnant Women: A Randomized Controlled Trial , 2019, Journal of midwifery & women's health.

[52]  R Core Team,et al.  R: A language and environment for statistical computing. , 2014 .

[53]  James J. Gross,et al.  Emotion regulation: Conceptual and empirical foundations. , 2014 .

[54]  C. Jianxin,et al.  Reliability and validity of Chinese version of the Generalized Anxiety Disorder 7-item (GAD-7) scale in screening anxiety disorders in outpatients from traditional Chinese internal department , 2013 .

[55]  R. Spitzer,et al.  The PHQ-9: validity of a brief depression severity measure. , 2001, Journal of general internal medicine.

[56]  A. Mellers,et al.  Emotion Regulation in Adulthood: Timing Is Everything , 2001 .