This study will explore the functioning of a mobile transdiagnostic emotion regulation intervention designed for university students to optimize the uptake and the effectiveness of the intervention.
It is estimated that globally between 12 and 50% of all university students are affected by mental health problems, the most common ones being anxiety, depression, and substance abuse. Over the past years online-based interventions have been spotlighted by researchers and clinicians as an avenue for a better outreach and provision of low threshold interventions aimed at primary and secondary prevention of mental health problems among the university students population. As part of a student wellbeing program at the Erasmus University Rotterdam (EUR), a transdiagnostic mobile intervention consisting of a suite of preventative self-guided tools is being developed. Its' goal is to help students better manage their mental health by teaching them adaptive emotional regulation strategies. The intervention includes exercises from different therapeutic approaches, and targets transdiagnostic factors such as negative self-referential thoughts, rumination, experiences of prolonged negative emotional states, and mental health literacy. The intervention is delivered via a smartphone and consists of 20 therapeutic exercises teaching students strategies like upregulation of positive affect, staying present in the moment, cognitive defusion, relaxation and breathing techniques, and self compassion skills. The main goals of the study are to evaluate whether the intervention and its components have the intended effects on student's emotional states as well as get insight into students' engagement patterns and experience with the intervention. This will be done by utilizing an explanatory sequential mixed methods approach combining novel methods of online-intervention assessment, specifically Micro Randomized Trials (MRT) with semi-structured interviews, which will provide information on the lived experiences of the participants with the intervention and provide explanation of the quantitative results. The results of this trial will support the optimization and further development of the mobile application that will later be evaluated for its full-scale effectiveness.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
PREVENTION
Masking
NONE
Enrollment
161
The intervention under study includes 5 therapeutic approaches, namely: Positive psychology \[PP\], Mindfulness, Acceptance and Commitment Therapy \[ACT\], Breathing and relaxation, and Self-compassion \[SC\]. The intervention consists of 4 core features: (i) monitoring through filling in EMAs assessing participants emotional states (ii) feedback through visualization of participant emotional states upon every completion of the EMAs (iii) exercises targeting different emotion regulation skills \[i.e., upregulation of positive affect, mindfulness, cognitive defusion, breathing and relaxation, self-compassion) and health facts (i.e., control intervention) describing health information including nutrition, exercise, sleeping habits. (iv) psychoeducative articles describing the 5 therapeutic approaches (PP, ACT, Mindfulness, Breathing and Relaxation, SC)
Erasmus University Rotterdam
Rotterdam, South Holland, Netherlands
Changes in a momentary emotional state
Participants will be asked to evaluate seven emotional states before and after engaging in the ER intervention or control intervention by answering the question: "How \[affect (e.g., happy)\] do you feel at the moment?" Each of 7 emotional states is evaluated on a scale from 1 \[Not at all\] to 5 \[Extremely\]. The emotional states are combined into 2 categories of affect: negative (stressed, frustrated, sad, fatigued) and positive (happy, energetic, relaxed). Changes in the momentary emotional states (i.e., positive and negative affect) will be evaluated by looking at the responses on the pre and post EMA in the relation to whether a participant received an ER intervention or health information.
Time frame: Day 2 - day 22
Changes in thought believability and discomfort after engaging in CD exercise
When randomized to CD exercise, participants will be asked to evaluate their self-selected unhelpful thought answering the following questions on a scale from 1 (not at all uncomfortable/believable) to 100 (extremely uncomfortable / believable) before and after the exercise: "How uncomfortable is the thought?" "How believable (true) is the thought?" The effects of CD exercises will be assessed by comparing the pre and post scores on the two thought parameters.
Time frame: Day 2 - day 22
Objective engagement patterns: Engagement metrics
Objective engagement patterns with the intervention will be assessed using descriptive statistics of engagement metrics (i.e., exercise completion rates, average time spent, and times of the day where participants completed the exercises) per exercise and exercise category. In addition, a correlational analysis will be used to evaluate whether there is a relationship between time of the day and exercise completion rates.
Time frame: Day 2 - day 22
Objective engagement patterns: Relationship between time of the day and exercise completion
A correlational analysis will be used to evaluate whether there is a relationship between the time of the day participants engaged in an exercise and exercise completion rates.
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Time frame: Day 2 - day 22
Subjective engagement patterns: Exercise likeability and helpfulness
Subjective engagement patterns will be evaluated by combining exercise likeability and helpfulness ratings with information from the semi-structured interviews. Exercise likeability and helpfulness are assessed with items rated on a scale from 1 (not at all) to 5 (very much): "How much did you like the exercise?" "How helpful did you find the exercise?"
Time frame: Day 2 - day 22
Subjective engagement patterns: User experience
Semi-structured interviews will be conducted with a subsample of participants (n=21) within three weeks upon completion of the MRT. University students will be asked to report on their general experience with intervention as well as intervention categories and separate exercises. Example questions are: "What do you think about the intervention?", "What kind of difficulties did you experience while using it?",
Time frame: Up to 3 weeks upon completion of the Micro Randomized Trial
Changes in ER skills
ER skills will be measured with the Emotion Regulation Skills Questionnaire \[ERSQ\] that evaluates seven types of ER skills: awareness, sensation, clarity, understanding, acceptance, tolerance, compassionate self-support, readiness to confront distressing situations, and modification of negative emotions. The 27 items are rated on a scale from 0 \[ not at all \] to 4 \[ almost always \]. Higher scores on the ERSQ subscales and the overall ERSQ score indicate higher ER skills.
Time frame: At the baseline and day 23
Changes in Anxiety symptoms
Symptoms of anxiety will be measured with the Generalized Anxiety Disorder questionnaire \[GAD-7\] Participants will indicate how often they have been bothered by different symptoms over the last two weeks on a scale from 0 (not at all) to 3 (nearly every day). The summed scores for GAD-7 range between 0-21, with higher scores indicating higher levels of depression and anxiety symptoms
Time frame: At the baseline and day 23
Changes in Depressive symptoms
Symptoms of depression will be measured with the Patient Health Questionnaire \[PHQ-9\]. Participants will indicate how often they have been bothered by different symptoms over the last two weeks on a scale from 0 (not at all) to 3 (nearly every day). The summed scores for PHQ range from 0-27, with higher scores indicating higher levels of depression and anxiety symptoms
Time frame: At the baseline and day 23
Changes in stress levels
Perceived Stress Scale \[PSS-10\] will be used to assess stress levels. Participants will be asked to indicate how often they felt or thought a certain way over the last month on a scale from 0 \[never\] to 5 \[very often\]. The summed score ranges from 0 - 40, with higher scores indicating higher levels of perceived stress symptoms.
Time frame: At the baseline and day 23