Search Results (12)

Background: Alcohol use disorder (AUD) is a major public health concern frequently associated with anxiety and depressive disorders, highlighting the need for innovative and personalised mental health interventions. Virtual reality (VR) has emerged as a digital tool that may support cognitive behavioural therapy (CBT) by enabling immersive and controlled exposure to relevant stimuli. Methods: This scoping review aimed to map how VR is integrated into CBT-oriented interventions for adults with AUD, with a focus on therapeutic mechanisms and their potential relevance for precision digital mental health. The review followed Joanna Briggs Institute methodology and PRISMA-ScR guidelines. Searches were conducted in PubMed, CINAHL, and Psychology and Behavioural Sciences Collection for studies published in the last ten years in English, Portuguese, or Spanish. Two independent reviewers performed screening and data extraction. Results: Eight studies were included, encompassing approaches such as cue exposure, simulation of high-risk environments, and covert sensitisation. The studies explored mechanisms including craving induction and regulation, identification of individual triggers, emotional processing, and enhancement of self-efficacy. The evidence base was characterised by small sample sizes, heterogeneous designs, and limited longitudinal data. Conclusions: This review provides a structured mapping of current applications of VR within CBT frameworks for AUD and highlights key therapeutic mechanisms that may have transdiagnostic relevance. However, the existing evidence remains preliminary, and findings should be interpreted with caution. The results support the exploration of VR within emerging precision digital mental health approaches, while underscoring the need for further rigorous and standardised research. Full article

Dementia is a leading and growing cause of disability worldwide. Insomnia is highly prevalent in mild cognitive impairment (MCI) and dementia and is associated with impaired cognition, functional decline, and reduced quality of life (QoL). Although sleep disturbance represents a potentially modifiable risk factor within the trajectory of cognitive impairment, there have not been many studies conducted to examine the feasibility or preliminary efficacy of digital cognitive behavioural therapy for insomnia (dCBT-I) in this population. The aim of this pilot randomised controlled feasibility study is to evaluate the acceptability, adherence, and potential clinical effects of a multi-component dCBT-I programme (Sleepio) in adults with MCI or mild dementia and comorbid insomnia. Thirty community-dwelling adults aged ≥50 years with established MCI or mild dementia (Mini-Mental State Examination ≥18; Clinical Dementia Rating 0.5–1.0) and insomnia (Sleep Condition Indicator ≤16) will be randomised (1:1) to Sleepio or a wait-list control. Feasibility outcomes include recruitment and retention rates, intervention adherence (completion of ≥4/6 sessions), and acceptability measured using validated usability scales. Secondary outcomes include changes in sleep, mood, QoL, cognition, and function over 10 weeks. Adverse events will be monitored to assess safety. Findings will inform the design of a future definitive trial evaluating digital sleep interventions in cognitively impaired populations. Ethical approval has been granted. The trial is registered at ClinicalTrials.gov (NCT07363928). Full article

Individuals with cystic fibrosis (CF) face significant treatment burdens, and as life expectancy has increased, there is growing emphasis on their psychosocial well-being. Prevalence data indicate that approximately one-quarter to one-third of individuals with CF and their caregivers experience clinically significant anxiety or depression. Specifically, pooled global estimates report an anxiety prevalence of 24.9% (95% CI: 20.8–28.9%) and depression prevalence of 13–33% in adults with CF, with caregivers experiencing even higher rates (anxiety: 35–38%; depression: 20–35%). Depression is independently associated with a nearly twofold increase in mortality risk and substantially higher healthcare costs, underscoring its prognostic significance. These mental health comorbidities are consistently associated with reduced treatment adherence, diminished quality of life, increased healthcare utilisation, and decreased survival. Accordingly, psychological well-being has emerged as a key patient outcome that directly shapes engagement with care and the effectiveness of long-term CF management. International CF guidelines now recommend routine mental health screening within multidisciplinary care frameworks. Evidence-based interventions include cognitive–behavioural therapy (CBT), which is endorsed as a primary treatment, although access remains limited, and stepped-care pharmacotherapy, primarily selective serotonin reuptake inhibitors (SSRIs), for moderate to severe symptoms. Telemedicine and other digital health approaches have expanded access to psychological support, with remote CBT and online programmes demonstrating feasibility and symptom improvement during the COVID-19 pandemic and beyond. The advent of CFTR modulator therapies has significantly altered clinical outcomes, enabling many patients to achieve improved lung function and daily functioning. Nevertheless, mental health challenges persist, as individuals navigate new identity shifts and anxieties despite enhanced physical health. The implementation of mental healthcare remains inconsistent; while screening rates have increased, timely follow-up and integrated psychosocial support are frequently insufficient across care centres. This narrative review highlights the ongoing need to integrate mental health management into CF care to optimise adherence, patient outcomes, and long-term survival in the current therapeutic landscape. Full article

Background/Objectives: Insomnia disorder is highly prevalent and disabling, yet access to cognitive behavioural therapy for insomnia (CBT-I), the recommended first-line treatment, remains limited. Digital CBT-I (dCBT-I) offers scalable alternative; however, treatment outcomes vary according to intervention format and delivery context. This study evaluated whether delivering dCBT-I within a structured, medically supervised crenotherapy context improved insomnia symptom severity compared with stand-alone dCBT-I. Methods: In this multicentre proof-of-concept randomised controlled trial, 66 adults with insomnia disorder were allocated to receive either stand-alone dCBT-I (n = 38) or dCBT-I delivered within a 3-week standardised crenotherapy programme (medically supervised thermal spa treatment; n = 28). The primary outcome was change in Insomnia Severity Index (ISI) scores from pre- to post-treatment. Secondary outcomes included subjective sleep parameters (e.g., sleep efficiency and sleep onset latency), sleep-related functioning, pre-sleep arousal, anxiety and depressive symptoms. Engagement and satisfaction were assessed as additional descriptive outcomes. Results: Both groups showed significant improvements in insomnia severity, sleep parameters, and psychological symptoms. However, the primary between-group comparison did not demonstrate a statistically significant additive effect of crenotherapy on insomnia severity. ISI outcomes did not differ between the crenotherapy-delivered and stand-alone dCBT-I groups. Nevertheless, post hoc exploratory subgroup analyses suggested that, among participants younger than 60, delivery of dCBT-I within a crenotherapy care setting was associated with greater improvements in insomnia symptoms compared with stand-alone dCBT-I (mean ISI change: 10.4 vs. 5.4, p = 0.030). In a separate subgroup analysis, among participants with baseline anxiety symptoms, dCBT-I delivered within a crenotherapy care setting was associated with a greater reduction in anxiety compared with stand-alone dCBT-I (p = 0.030). Engagement and satisfaction were high in both groups, with no significant differences. Conclusions: Delivering dCBT-I within a crenotherapy context appears feasible and may offer specific benefits for specific subpopulations, particularly younger individuals and those with comorbid anxiety. These findings support further investigation of context-sensitive digital models to improve personalisation and accessibility of insomnia treatment. Full article

Shift work can have an adverse impact on sleep and wellbeing, as well as negative consequences for workplace safety and productivity. SleepShifters is a co-developed sleep management programme that aims to equip shift workers and employers with the skills needed to manage sleep from the onset of employment, thus preventing sleep problems and their associated consequences from arising. This paper describes the co-development process and resulting programme protocol of SleepShifters, designed in line with the Medical Research Council’s framework for the development and evaluation of complex interventions. Programme components were co-produced in partnership with stakeholders from four organisations across the United Kingdom, following an iterative, four-stage process based on focus groups and interviews. As well as a handbook containing guidance on shift scheduling, workplace lighting, and controlled rest periods, SleepShifters consists of five key components: (1) an annual sleep awareness event; (2) a digital sleep training induction module for new starters; (3) a monthly-themed sleep awareness campaign; (4) a website, hosting a digital Cognitive Behavioural Therapy for insomnia platform and supportive video case studies from shift-working peers; (5) a sleep scheduling app for employees. Future work will implement and assess the effectiveness of delivering SleepShifters in organisational settings. Full article

Although smart device use among children is increasing, most interventions overlook their cognitive and emotional development or rely too heavily on external control. Such approaches often overlook the developmental needs of children for emotional regulation and autonomy. Therefore, this study aims to propose a child-centred user experience (UX) framework to support digital self-regulation in preschool-aged children. The proposed system integrates multiple psychological theories—including Piaget’s concept of animistic thinking, executive function theory, Self-Determination Theory, and Acceptance and Commitment Therapy—to support cognitive and emotional regulation during screen use. Key features include persistent visual cues to enhance time awareness and behavioural anticipation, narrative-based character interactions to foster empathy and agency, and ritualised closure routines supported by multimodal and tangible interaction elements. Developed as a mobile prototype, the system was iteratively refined through two-stage consultations with child and adolescent psychiatrists and a developmental psychologist, including formative design feedback and follow-up expert review. Their feedback provided preliminary validation of the system’s developmental validity and emotional coherence. These findings suggest that affectively attuned UX design is a viable alternative to conventional control-based screen-time interventions in early childhood. Full article

Cognitive behavioural therapy (CBT) is an evidence-based intervention for managing distress associated with tinnitus, hyperacusis, and misophonia. This paper summarises key points from the 2025 Tonndorf Lecture presented at the third World Tinnitus Congress and the 14th International Tinnitus Seminar in Poland. The lecture addressed (1) the theoretical foundations of CBT for these conditions, (2) clinical evidence on CBT delivered by psychologists, audiologists, and digital self-help, and (3) the proportion of patients who may benefit from CBT. Research demonstrates that CBT can effectively reduce distress related to tinnitus, hyperacusis, and misophonia. Both psychologist- and audiologist-delivered CBT approaches have demonstrated significant improvements in reducing the impact of tinnitus, hyperacusis, and misophonia on patients’ quality of life, while guided internet-based CBT also demonstrates positive outcomes. Unguided internet-based CBT is also effective, though it faces challenges such as higher dropout rates. Despite these promising results, not all patients experience the same level of benefit. Some continue to experience distress even after completing CBT, highlighting the need for alternative or complementary interventions and ongoing support. This paper estimates that approximately 1 in 52 individuals with tinnitus require CBT, indicating that while tinnitus is relatively common, the need for intensive therapy is comparatively small. To enhance treatment outcomes, future research should compare the effectiveness of psychologist- and audiologist-delivered CBT, explore hybrid models that combine face-to-face and digital interventions, and address challenges with internet-based CBT, particularly for hyperacusis and misophonia. Furthermore, incorporating neuroimaging and physiological measures in future randomised controlled trials could provide objective insights into the neural mechanisms underlying symptom improvement, ultimately helping to refine CBT interventions. Identifying characteristics of non-responders to CBT may also guide the development of more tailored therapeutic approaches. Full article

Background: Digital psychological interventions can target deficit-oriented and asset-oriented psychological outcomes in the workplace. This review examined: (a) the effectiveness of digital interventions for psychological well-being at work, (b) associations with workplace outcomes, and (c) associations between interventions’ effectiveness and their theory-base. Methods: six electronic databases were searched for randomised controlled trials (RCT) and quasi-experimental studies. The methodological quality of studies that used randomisation was conducted with the “Cochrane Collaboration’s Risk of Bias” tool, while the “JBI Critical Appraisal Checklist” was used for non-randomised studies. Studies’ theory-base was evaluated using an adaptation of the “theory coding scheme” (TSC). Due to heterogeneity, narrative synthesis was performed. Results: 51 studies were included in a synthesis describing four clusters of digital interventions: (a) cognitive behavioural therapy, (b) stress-management interventions and workplace well-being promotion, (c) meditation training and mindfulness-based interventions, and (d) self-help interventions. Studies demonstrated a high risk of contamination effects and high attrition bias. Theory-informed interventions demonstrated greater effectiveness. Cognitive behavioural therapy demonstrated the most robust evidence for reducing depression symptoms among healthy employees. With the exception of the Headspace application, there was weak evidence for meditation training apps, while relaxation training was a key component of effective stress-management interventions. Full article

Internet-delivered cognitive behaviour therapy (ICBT) is helpful for many clients, but less is known about the challenges clients face during ICBT, such as difficulties with skill practice, development, or maintenance. Understanding client difficulties can help therapists support clients with skill development and prevent treatment drop-out, but has not been systematically studied. This study included a conventional content analysis of clients’ responses to a homework reflection question about difficulties with lessons and skills. Data was drawn from a previously published trial of 301 clients who were randomly assigned to receive homework reflection questions during ICBT. A decreasing number of clients responded to the question about skill difficulties with each lesson. Clients who answered the question about difficulties were more engaged with ICBT (i.e., more lessons completed, logins, days enrolled in ICBT, and messages sent to therapists). Clients shared skill-specific challenges (including initial challenges and more advanced challenges), generic challenges (content or skills being cognitively draining or emotionally draining, contextual challenges, forgetfulness, limited time, and lack of familiarity with the skill), or no challenges. Thought challenging (59.6%) and graded exposure (57.5%) were associated with the greatest number of skill-specific challenges. Findings can help therapists anticipate and address common client challenges during ICBT. Full article

There has been a lot of interest in digital mental health interventions but adherence to online programmes has been less than optimal. Chatbots that mimic brief conversations may be a more engaging and acceptable mode of delivery. We developed a chatbot, called 21-Day Stress Detox, to deliver stress management techniques for young adults. The purpose of the study was to explore the feasibility, acceptability, and potential efficacy of this low-intensity digital mental health intervention in a non-clinical population of young adults. The content was derived from cognitive behavioural therapy (CBT) and included evidence-informed elements such as mindfulness and gratitude journaling. It was delivered over 21 daily sessions using the Facebook Messenger platform. Each session was intended to last about 5–7 min and included text, animated GIFs, relaxation tracks and reflective exercises. We conducted an open single-arm trial collecting app usage through passive data collection as well as self-rated satisfaction and qualitative (open-ended) feedback. Efficacy was assessed via outcome measures of well-being (World Health Organisation (Five) Well-being Index; WHO-5; and Personal Well-being Measure; ONS4); stress (Perceived Stress Scale–10 item version; PSS-10); and anxiety (Generalized Anxiety Disorder 7-item scale; GAD-7). One hundred and ten of the 124 participants who completed baseline commenced the chatbot and 64 returned the post-intervention assessment. Eighty-one percent were female and 51% were first year students. Forty-five percent were NZ European and 41% were Asian. Mean engagement was 11 days out 21 days (SD = 7.8). Most (81%) found the chatbot easy to use. Sixty-three percent rated their satisfaction as 7 out of 10 or higher. Qualitative feedback revealed that convenience and relatable content were the most valued features. There was a statistically significant improvement on the WHO-5 of 7.38 (SD = 15.07; p < 0.001) and a mean reduction on the PSS-10 of 1.77 (SD = 4.69; p = 0.004) equating to effect sizes of 0.49 and 0.38, respectively. Those who were clinically anxious at baseline (n = 25) experienced a greater reduction of GAD-7 symptoms than those (n = 39) who started the study without clinical anxiety (−1.56, SD = 3.31 vs. 0.67, SD = 3.30; p = 0.011). Using a chatbot to deliver universal psychological support appears to be feasible, acceptable, have good levels of engagement, and lead to significant improvements in well-being and stress. Future iterations of the chatbot should involve a more personalised content. Full article

Insomnia is the most common sleep disorder worldwide. Its effects generate economic costs in the millions but could be effectively reduced using digitally provisioned cognitive behavioural therapy. However, traditional acquisition and maintenance of the necessary technical infrastructure requires high financial and personnel expenses. Sleep analysis is still mostly done in artificial settings in clinical environments. Nevertheless, innovative IT infrastructure, such as mHealth and cloud service solutions for home monitoring, are available and allow context-aware service provision following the Smart Cities paradigm. This paper aims to conceptualise a digital, cloud-based platform with context-aware data storage that supports diagnosis and therapy of non-organic insomnia. In a first step, requirements needed for a remote diagnosis, therapy, and monitoring system are identified. Then, the software architecture is drafted based on the above mentioned requirements. Lastly, an implementation concept of the software architecture is proposed through selecting and combining eleven cloud computing services. This paper shows how treatment and diagnosis of a common medical issue could be supported effectively and cost-efficiently by utilising state-of-the-art technology. The paper demonstrates the relevance of context-aware data collection and disease understanding as well as the requirements regarding health service provision in a Smart Cities context. In contrast to existing systems, we provide a cloud-based and requirement-driven reference architecture. The applied methodology can be used for the development, design, and evaluation of other remote and context-aware diagnosis and therapy systems. Considerations of additional aspects regarding cost, methods for data analytics as well as general data security and safety are discussed. Full article

There is a large body of research showing that psychological treatment can be effectively delivered via the internet, and Digital Mental Health Services (DMHS) are now delivering those interventions in routine care. However, not all attempts to translate these research outcomes into routine care have been successful. This paper draws on the experience of successful DMHS in Australia and Canada to describe ten lessons learned while establishing and delivering internet-delivered cognitive behavioural therapy (ICBT) and other mental health services as part of routine care. These lessons include learnings at four levels of analysis, including lessons learned working with (1) consumers, (2) therapists, (3) when operating DMHS, and (4) working within healthcare systems. Key themes include recognising that DMHS should provide not only treatment but also information and assessment services, that DMHS require robust systems for training and supervising therapists, that specialist skills are required to operate DMHS, and that the outcome data from DMHS can inform future mental health policy. We also confirm that operating such clinics is particularly challenging in the evolving funding, policy, and regulatory context, as well as increasing expectations from consumers about DMHS. Notwithstanding the difficulties of delivering DMHS, we conclude that the benefits of such services for the broader community significantly outweigh the challenges. Full article