Eberle Jeremy William, Baee Sonia, Wolfe Emma Catherine, Boukhechba Mehdi, Funk Daniel Harold, Teachman Bethany Ann, Barnes Laura Elizabeth
Department of Psychology, University of Virginia, Charlottesville, Virginia, United States of America.
Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America.
PLOS Digit Health. 2025 Jul 24;4(7):e0000945. doi: 10.1371/journal.pdig.0000945. eCollection 2025 Jul.
Digital mental health interventions (DMHIs) have the potential to expand treatment access for anxiety but often have low user engagement. The present study analyzed differences in psychosocial outcomes for different behavioral engagement patterns in a free web-based cognitive bias modification for interpretation (CBM-I) program. CBM-I is designed to shift interpretation biases common in anxiety by providing practice thinking about emotionally ambiguous situations in less threatening ways. Using data from 697 anxious community adults undergoing five weekly sessions of CBM-I in a clinical trial, we extracted program use markers based on task completion rate and time spent on training and assessment tasks. After using an exploratory cluster analysis of these markers to create two engagement groups (whose patterns ended up reflecting generally more vs. less time spent across tasks), we used multilevel models to test for group differences in interpretation bias and anxiety outcomes. Unexpectedly, engagement group did not significantly predict differential change in positive interpretation bias or anxiety. Further, participants who generally spent less time on the program (including both training and assessment tasks) improved in negative interpretation bias (on one of two measures) significantly more during the training phase than those who spent more time (and post hoc tests found were significantly older and slightly less educated). However, participants who generally spent less time had a significant loss in training gains for negative bias (on both measures) by 2-month follow-up. Findings highlight the challenge of interpreting time spent as a marker of engagement and the need to consider cognitive and affective markers of engagement in addition to behavioral markers. Further understanding engagement patterns holds promise for improving DMHIs for anxiety.
数字心理健康干预措施(DMHIs)有潜力扩大焦虑症的治疗途径,但用户参与度往往较低。本研究分析了在一个基于网络的免费解释性认知偏差修正(CBM-I)项目中,不同行为参与模式在心理社会结果方面的差异。CBM-I旨在通过提供以威胁性较小的方式思考情绪模糊情境的练习,来改变焦虑症中常见的解释偏差。利用来自697名焦虑的社区成年人在一项临床试验中接受为期五周的CBM-I治疗的数据,我们根据任务完成率以及在训练和评估任务上花费的时间提取了项目使用指标。在对这些指标进行探索性聚类分析以创建两个参与组(其模式最终反映了在各项任务上花费的时间总体上更多与更少)之后,我们使用多层次模型来测试解释偏差和焦虑结果方面的组间差异。出乎意料的是,参与组并未显著预测积极解释偏差或焦虑的差异变化。此外,总体上在该项目上花费时间较少的参与者(包括训练和评估任务)在训练阶段,消极解释偏差(在两项测量中的一项上)的改善幅度明显大于花费时间较多的参与者(事后检验发现,前者年龄显著更大且受教育程度略低)。然而,到2个月随访时,总体上花费时间较少的参与者在消极偏差(两项测量均如此)的训练收益方面出现了显著损失。研究结果凸显了将花费的时间解释为参与度指标的挑战,以及除行为指标外还需考虑参与度的认知和情感指标的必要性。进一步了解参与模式有望改善针对焦虑症的数字心理健康干预措施。