J.A. Walburg

An Internet-Based Intervention to Promote Mental Fitness for Mildly Depressed Adults: Randomized Controlled Trial

Background Depression is a worldwide problem warranting global solutions to tackle it. Enhancing well-being has benefits in its own right and could be a good strategy for preventing depression. Providing well-being interventions via the Internet may have synergetic effects. Objective Psyfit (“mental fitness online”) is a fully automated self-help intervention to improve well-being based on positive psychology. This study examines the clinical effects of this intervention. Methods We conducted a 2-armed randomized controlled trial that compared the effects of access to Psyfit for 2 months (n=143) to a waiting-list control condition (n=141). Mild to moderately depressed adults in the general population seeking self-help were recruited. Primary outcome was well-being measured by Mental Health Continuum-Short Form (MHC-SF) and WHO Well-being Index (WHO-5); secondary outcomes were depressive symptoms, anxiety, vitality, and general health measured by Center for Epidemiological Studies Depression Scale (CES-D), Hospital Anxiety and Depression Scale Anxiety subscale (HADS-A), and Medical Outcomes Study-Short Form (MOS-SF) vitality and general health subscales, respectively. Online measurements were taken at baseline, 2 months, and 6 months after baseline. Results The dropout rate was 37.8% in the Psyfit group and 22.7% in the control group. At 2-month follow-up, Psyfit tended to be more effective in enhancing well-being (nonsignificantly for MHC-SF: Cohen’s d=0.27, P=.06; significantly for WHO-5: Cohen’s d=0.31, P=.01), compared to the waiting-list control group. For the secondary outcomes, small but significant effects were found for general health (Cohen’s d=0.14, P=.01), vitality (d=0.22, P=.02), anxiety symptoms (Cohen’s d=0.32, P=.001), and depressive symptoms (Cohen’s d=0.36, P=.02). At 6-month follow-up, there were no significant effects on well-being (MHC-SF: Cohen’s d=0.01, P=.90; WHO-5: Cohen’s d=0.26, P=.11), whereas depressive symptoms (Cohen’s d=0.35, P=.02) and anxiety symptoms (Cohen’s d=0.35, P=.001) were still significantly reduced compared to the control group. There was no clear dose–response relationship between adherence and effectiveness, although some significant differences appeared across most outcomes in favor of those completing at least 1 lesson in the intervention. Conclusions This study shows that an online well-being intervention can effectively enhance well-being (at least in the short-term and for 1 well-being measure) and can help to reduce anxiety and depression symptoms. Further research should focus on increasing adherence and motivation, reaching and serving lower-educated people, and widening the target group to include people with different levels of depressive symptoms. Trial Registration Netherlands Trial Register (NTR) number: NTR2126; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2126 (archived by WebCite at http://www.webcitation.org/6IIiVrLcO).

Cost-effectiveness of online positive psychology: Randomized controlled trial

As yet, no evidence is available about the cost-effectiveness of positive psychological interventions. When offered via the Internet, these interventions may be particularly cost-effective, because they are highly scalable and do not rely on scant resources such as therapists’ time. Alongside a randomized controlled trial of an online positive psychological intervention, a health-economic evaluation was conducted. Mild to moderately depressed adults seeking self-help and recruited in the general population were randomly assigned to the intervention group (n = 143) and a waitlisted usual care group (n = 141). Improved clinical outcomes were achieved in the intervention group (at least for depression) at higher costs. When outliers (the top 2.5%, n = 5 in intervention group, n = 2 in control group) were removed, cost-effectiveness was increased considerably. For positive psychology, economic evaluations may be a means to nudge policy decision-makers towards placing positive psychological interventions on the health agenda.

An early intervention to promote well-being and flourishing and reduce anxiety and depression: A randomized controlled trial

Background There is growing evidence that fostering mental well-being and flourishing might effectively prevent mental disorders. In this study, we examined whether a 9-week comprehensive positive self-help intervention with email support (TL-E) was effective in enhancing well-being and flourishing and decreasing anxiety and depressive symptoms in a non-clinical sample. Methods A total of 275 participants with low or moderate well-being (mean age = 48 years, 86% female) were randomly assigned to a TL-E (n = 137) or wait-list control group (WL; n = 138). Participants completed online self-reporting questionnaires at baseline and at 3, 6 and 12 months. Results Repeated measure analyses revealed significant more improvement on mental well-being (F = 42.00, p ≤ 0.001, d = 0.66, 95% CI = 0.42–0.90), anxiety (F = 21.65, p ≤ 0.001, d = 0.63, 95% CI = 0.39–0.87) and depression (F = 13.62, p ≤ 0.001, d = 0.43, 95% CI = 0.19–0.67) in the TL-E group versus the WL group. The proportion of flourishing in the TL-E group increased from 7 to 30% after 3 months (NNT = 5.46) and to 34% after 6 months (NNT = 5.25). All within group effects were maintained up to 12 months. We found no meaningful dose-response relationship for adherence, nor a clear moderator pattern. Limitations It is unknown whether results were influenced by the email support that accompanied the self-help intervention since TL-E was only compared to a wait-list condition. The generalizability of the findings is limited by the self-selected sample of mainly higher-educated women. Conclusion A guided positive self-help intervention might be considered as a new mental health promotion strategy because it has the potential to improve well-being up to the status of flourishing mental health, and to decrease anxiety and depressive symptomatology.

Validation of the Flourishing Scale in a sample of people with suboptimal levels of mental well-being

BackgroundThere is growing interest in measuring the eudaimonic perspective of mental well-being (social and psychological well-being) alongside existing measures of the hedonic perspective of mental well-being (subjective well-being). The Flourishing Scale (FS) assesses core aspects of social-psychological functioning and is now widely used in research in practice. However, the reliability and validity of eudaimonic measures such as the FS has not yet been tested in people with low or moderate levels of well-being. This group is at risk for developing mental disorders and, therefore, an important target group for public mental health.MethodsWe extensively evaluated the psychometric properties of the 8-item FS in a sample of adults with low or moderate levels of well-being in The Netherlands (N = 275) using confirmatory factor analysis (CFA), item response theory analysis and a multitrait matrix.ResultsThe unidimensional structure of the scale was confirmed with CFA and an adequate fit to the Rasch model. However, our sample showed positive skewness of the scale, but lacked measurement precision at the higher end of the social-psychological continuum. In general, the multitrait matrix demonstrated the convergent validity of the scale, with strong to weak correlations between the FS and (1) overall well-being, (2) social and psychological well-being (3) positive eudaimonic states, (4) hedonic states, (5) psychopathology and (6) personality traits. Nevertheless, relatively low correlations were found, specifically in comparison with the Mental Health Continuum-Short Form (MHC-SF).ConclusionsThe FS seems a reliable and valid instrument for measuring social-psychological functioning in adults with suboptimal well-being, but its use in intervention studies and clinical practice might be debatable. Therefore, the FS seems most suitable to include in epidemiological studies alongside existing hedonic measures to more fully capture mental well-being. Future research should examine the temporal stability of the FS and the consequences of the positive skewness and limited external validity of the scale found in the current study.

Possible mechanisms in a multicomponent email guided positive psychology intervention to improve mental well-being, anxiety and depression: A multiple mediation model

Abstract The efficacy of several multicomponent positive psychology interventions (PPIs) have been demonstrated, but little is known about its possible mechanisms of change. We examined (1) the efficacy of an email guided self-help PPI on six core well-being processes (positive emotion, use of strengths, optimism, self-compassion, resilience and positive relations) and (2) the mediating role of these processes on mental well-being, anxiety and depressive symptoms. Adults ≥ 18 years were recruited in the general population and randomized into the intervention (n = 137) or wait-list control group (n = 138). Repeated measures analyses showed that the intervention group improved significantly more than the control group on all six processes. Improvement (t0–t1) on each process statistically mediated improvement (t0–t2) on mental well-being, anxiety and depressive symptoms. Simple-mediation analyses revealed small to moderate effect sizes. Multiple-mediation analyses revealed most pronounced results for positive relations and self-compassion, suggesting that these processes might be key mechanisms in promoting well-being.

Online training voor het verbeteren van de mentale conditie

SamenvattingDe meeste mensen weten wel wat ze (zouden) moeten doen om gezond te blijven: iedere dag een half uurtje bewegen, gezond eten, niet roken en niet teveel alcohol drinken. Voor onze mentale gezondheid is dit minder duidelijk. Of niet? Psyfit.nl is een online zelfhulpcursus waarmee de mentale conditie wordt getraind. Via een zestal ‘mental fitness’ principes, zoals het richting geven aan je leven, stimuleren van positieve emoties en leven in het hier en nu, werken mensen aan hun welbevinden en veerkracht wat tezamen de mentale conditie bepaalt.1Door de oefeningen, tests en tips krijgen deelnemers inzicht in hun krachten en mogelijkheden om met het leven van alledag om te gaan (zie box 1 Onderdelen in Psyfit.nl en Figuur 1 Screenshot).AbstractOnline training to improve mental fitness - From effectiveness to impact Psyfit.nl (‘‘mental fitness online’’) is a fully automated self-help intervention aimed at improving well-being. The intervention is based on the emerging field of positive psychology in which tools aimed at flourishing and positive functioning are being developed and evaluated. The combination of positive psychology and technology offers synergetic opportunities: both intent to engage and empower large groups of people (‘positive technology’). In a randomized controlled trial, the intervention was found to be effective in the enhancement of wellbeing and reduction of depression and anxiety symptoms. Psyfit is currently being put into practice. Different ways to disseminate and implement the intervention in order to improve the uptake and adherence are being explored.