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Come Get Your Mental Health, at the Screen or on Your Phone!

21 May

Aussies love web and phone based interventions for health education and mental health, and are pre-eminent researchers and evaluators of digital services – probably because flesh and blood providers can be hard to come by in the vast, non-urban areas of this very big country that's also a continent.

This Australian study examines whether mental health self-efficacy (MHSE), a construct from Bandura's Social Learning Theory (SLT), influences the positive results of web-based interventions on such conditions as depression and anxiety.

(MHSE is the belief that we have some agency over our fate, and can master a situation and produce a positive outcome with our own efforts. Web-based interventions, of course, put the end-user in the driver's seat - they themselves execute their own results, at their own pace and on their own time.)

So it stands to reason that if you have strong feelings of self-efficacy, you might do well with an online intervention; and in the reverse, that an online intervention might enhance your feelings of self-efficacy.

In particular, the investigators looked at symptom improvement and functional outcomes of a new mobile phone and web-based psychotherapy intervention for people with mild-to-moderate depression, anxiety and stress.

Data from 49 people with symptoms of depression, anxiety and/or stress in the mild-to-moderate range were used to examine the reliability and validity of a new measure of MHSE, the Mental Health Self-efficacy Scale (MHSES).

Then they conducted a secondary analysis of data from a recently completed randomized controlled trial (N = 720) to evaluate whether MHSE effected post-intervention outcomes, as measured by the Depression, Anxiety and Stress Scales (DASS), and the Work and Social Adjustment Scale (WSAS), for people with symptoms in the mild-to-moderate range.

The data from the first study established that the MHSES comprised a unitary factor, with acceptable internal reliability (Cronbach's alpha = .89) and construct validity. In other words, it was a genuinely separate attribute to measure.

In the second study, the intervention group showed significantly greater improvement in MHSE at post-intervention relative to the control conditions (p's < = .000) and investigators determined that MHSE mediated the effects of the intervention on anxiety and stress symptoms.

Furthermore, people with low pre-treatment MHSE reported the greatest post-intervention gains in symptoms of depression, anxiety and overall distress. No effects were found for MHSE on work and social functioning.

The researchers conclude that mental health self-efficacy influences symptom outcomes of a self-guided mobile phone and web-based psychotherapeutic intervention, and may itself be a worthwhile target to increase the effectiveness and efficiency of online treatment programs.

Citation: Clarke J, Proudfoot J, Birch MR, Whitton AE, Parker G, Manicavasagar V, Harrison V, Christensen H, Hadzi-Pavlovic D. Effects of mental health self-efficacy on outcomes of a mobile phone and web intervention for mild-to-moderate depression, anxiety and stress: secondary analysis of a randomised controlled trial. BMC Psychiatry. 2014 Sep 26; 14:272. doi: 10.1186/s12888-014-0272-1.

Belleruth Naparstek

Psychotherapist, author and guided imagery pioneer Belleruth Naparstek is the creator of the popular Health Journeys guided imagery audio series. Her latest book on imagery and posttraumatic stress, Invisible Heroes: Survivors of Trauma and How They Heal (Bantam Dell), won the Spirituality & Health Top 50 Books Award.