JMIR Publications

ABSTRACT

Background:

Dual-process theories propose that the brain uses two types of thinking to influence behaviour; automatic processing and reflective processing. Automatic processing is fast, immediate, non-conscious, and unintentional whereas reflective processing focuses on logical reasoning; it is slow, step-by-step, and intentional. Most digital psychological health interventions tend to solely target the reflective system even though the automatic processing pathway can have strong influences on behaviour. Laboratory-based research has highlighted that automatic processing tasks can create behaviour change; however, there are significant gaps in the field on the design, implementation and delivery of automatic processing tasks in real-world settings. It is important to identify and summarise the existing literature in this area to inform the translation of laboratory-based research to real world settings.

Objective:

This scoping review aimed to explore the effectiveness of automatic training tasks, types of training tasks commonly used, mode of delivery and impacts of gamification on automatic processing tasks designed for digital psychological health interventions in real-world settings among adults.

Methods:

The scoping review methodology proposed by Arskey and O’Malley (2005) and Colquhoun (2016) was applied. A scoping review was chosen due to the novelty of the digital automatic processing field and to encompass a broad review of the existing evidence-base. Electronic databases and grey literature databases were searched with the search terms ‘automatic processing,’ ‘computerised technologies,’ ‘health intervention’, ‘real-world’ ‘adults’ and synonyms of these words. The search is up-to-date until September 2018. A manual search was also completed on reference lists of included studies.

Results:

Fourteen studies met all inclusion criteria. There was a wide variety of health conditions targeted with the most prevalent being alcohol abuse followed by social anxiety. Attention bias modification tasks were the most prevalent type of automatic processing task, and the majority of tasks were most commonly delivered online via a personal computer. Of the 14 studies included in the review, six studies demonstrated positive changes to automatic processes.

Conclusions:

This is the first review to synthesise the evidence on automatic processing tasks in real-world settings targeting adults. Findings were mixed, with less than half the studies reviewed showing significant improvements in automatic processing. Once primarily used in laboratory settings, automatic processing tasks are being increasingly adopted into other health fields in real-world settings and continuously being improved upon to increase engagement and effectiveness by using online mediums and drawing from the emerging field of gamification.