JMIR Publications

ABSTRACT

Background:

Digital mental health interventions (DMHIs) can help bridge the gap between the demand for mental health care and availability of treatment resources. The affordances of DMHIs have been proposed to overcome barriers to care such as accessibility, cost, and stigma. Despite these proposals, most evaluations of DMHI focus on clinical effectiveness with less consideration of users’ perspectives and experiences.

Objective:

We conducted a pilot randomized controlled trial of “Overcoming Thoughts,” a web-based platform using cognitive and behavioral principles for addressing depression and anxiety. The “Overcoming Thoughts” platform included two brief interventions – cognitive restructuring and behavioral experimentation. Users accessed either a version that included asynchronous interaction with other users (“crowdsourced” platform) or a completely self-guided version (control condition). We aimed to understand users’ perspectives and experiences by conducting a subset of interviews during the follow-up period of the trial.

Methods:

We used purposive sampling to select a subset of trial participants based on group assignment (treatment and control) and symptom improvement (those who improved and those who did not on primary outcomes). We conducted semi-structured interviews with 23 participants during the follow-up period that addressed acceptability, usability, and impact. We conducted thematic analysis of the interviews, continuing until saturation was reached.

Results:

Eight major themes were identified: 1) possible opportunities to expand the platform; 2) improvement in mental health as a result of using the platform; 3) increased self-reflection skills; 4) platform being more helpful for certain situations or domains; 5) application of skills into users’ lives, even without direct platform use; 6) increased coping skills as a result of using the platform; 7) repetitiveness of platform exercises; and 8) use pattern. Though no differences in themes were found 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 (greater in control); 2) aiding in slowing thoughts and feeling calmer (greater in control); 3) overcoming patterns of avoidance (greater in control); and 4) repetitiveness of content (greater in the intervention).

Conclusions:

We identified different benefits users perceived from a novel DMHI and opportunities to improve the platform. Interestingly, we did not note any differences in themes among those who improved and those who did not, but did find some differences between those who received the control and intervention versions of the platform. Future research should continue to investigate users’ experiences of DMHIs to better understand the complex dynamics of use and outcomes. Clinical Trial: ClinicalTrials.gov: NCT04226742