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      Implementation of the Enhanced Moderated Online Social Therapy (MOST+) Model Within a National Youth E-Mental Health Service (eheadspace): Protocol for a Single Group Pilot Study for Help-Seeking Young People

      , BBSc, DipEd, BSc (Hons), GradDipClinEpi, MPsych (Clin), PhD 1 , 2 , 3 , , , BA (Hons), MPsych (Clin), PhD 4 , , BEd, MPsych, PhD 5 , , BA, PGDipClinPsych, MA, PhD 1 , 2 , , PhD 1 , 6 , , BA (Hons), MSc 1 , , BSc (Hons), DPsych (Clinical) 1 , 2 , , BA (Hons), MPsych (Clin), PhD 1 , 2 , 7 , , DipEd, BA, PGDipLegSt, PGDipBIT, MIS, PhD 6 , , BSc, MSc, PhD 6 , , MSc (ClinPsych), PhD 1 , 2 , 8 , , BA (Hons) 1 , 2 , , BPsychSc, MStat 1 , 2 , , MD Psychiatry 1 , 2 , , BSc (Hons), DClinPsy, MAResearchMeth, PhD 1 , 2
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      JMIR Research Protocols
      JMIR Publications
      internet, social networking, young adult, adolescent, mental heath

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          There is a substantial need for youth electronic mental health (e-mental health) services. In addressing this need, our team has developed a novel moderated online social therapy intervention called enhanced moderated online social therapy (MOST+). MOST+ integrates real-time, clinician-delivered Web chat counseling, interactive user-directed online therapy, expert and peer moderation, and private and secure peer-to-peer social networking. MOST+ has been designed to give young people immediate, 24-hour access to anonymous, evidence-based, and short-term mental health care.


          The primary aims of this pilot study were to determine the feasibility, acceptability, and safety of the intervention. Secondary aims were to assess prepost changes in key psychosocial outcomes and collect qualitative data for future intervention refinement.


          MOST+ will be embedded within eheadspace, an Australian youth e-mental health service, and will be evaluated via an uncontrolled single-group study. Approximately 250 help-seeking young people (16-25 years) will be progressively recruited to the intervention from the eheadspace home page over the first 4 weeks of an 8-week intervention period. All participants will have access to evidence-based therapeutic content and integrated Web chat counseling. Additional access to moderated peer-to-peer social networking will be granted to individuals for whom it is deemed safe and appropriate, through a three-tiered screening process. Participants will be enrolled in the MOST+ intervention for 1 week, with the option to renew their enrollment across the duration of the pilot. Participants will complete a survey at enrollment to assess psychological well-being and other mental health outcomes. Additional assessment will occur following account deactivation (ie, after participant has opted not to renew their enrollment, or at trial conclusion) and will include an online survey and telephone interview assessing psychological well-being and experience of using MOST+.


          Recruitment for the study commenced in October 2017. We expect to have initial results in March 2018, with more detailed qualitative and quantitative analyses to follow.


          This is the first Australia-wide research trial to pilot an online social media platform merging real-time clinical support, expert and peer moderation, interactive online therapy, and peer-to-peer social networking. The importance of the project stems from the need to develop innovative new models for the efficient delivery of responsive evidence-based online support to help-seeking young people. If successful, this research stands to complement and enhance e-mental health services in Australia.

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          Most cited references24

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          Positive psychotherapy.

          Positive psychotherapy (PPT) contrasts with standard interventions for depression by increasing positive emotion, engagement, and meaning rather than directly targeting depressive symptoms. The authors have tested the effects of these interventions in a variety of settings. In informal student and clinical settings, people not uncommonly reported them to be "life-changing." Delivered on the Web, positive psychology exercises relieved depressive symptoms for at least 6 months compared with placebo interventions, the effects of which lasted less than a week. In severe depression, the effects of these Web exercises were particularly striking. This address reports two preliminary studies: In the first, PPT delivered to groups significantly decreased levels of mild-to-moderate depression through 1-year follow-up. In the second, PPT delivered to individuals produced higher remission rates than did treatment as usual and treatment as usual plus medication among outpatients with major depressive disorder. Together, these studies suggest that treatments for depression may usefully be supplemented by exercises that explicitly increase positive emotion, engagement, and meaning. ((c) 2006 APA, all rights reserved).
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            Do Online Mental Health Services Improve Help-Seeking for Young People? A Systematic Review

            Background Young people regularly use online services to seek help and look for information about mental health problems. Yet little is known about the effects that online services have on mental health and whether these services facilitate help-seeking in young people. Objective This systematic review investigates the effectiveness of online services in facilitating mental health help-seeking in young people. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, literature searches were conducted in PubMed, PsycINFO, and the Cochrane library. Out of 608 publications identified, 18 studies fulfilled the inclusion criteria of investigating online mental health services and help-seeking in young people aged 14-25 years. Results Two qualitative, 12 cross-sectional, one quasi-experimental, and three randomized controlled trials (RCTs) were reviewed. There was no change in help-seeking behavior found in the RCTs, while the quasi-experimental study found a slight but significant increase in help-seeking. The cross-sectional studies reported that online services facilitated seeking help from a professional source for an average of 35% of users. The majority of the studies included small sample sizes and a high proportion of young women. Help-seeking was often a secondary outcome, with only 22% (4/18) of studies using adequate measures of help-seeking. The majority of studies identified in this review were of low quality and likely to be biased. Across all studies, young people regularly used and were generally satisfied with online mental health resources. Facilitators and barriers to help-seeking were also identified. Conclusions Few studies examine the effects of online services on mental health help-seeking. Further research is needed to determine whether online mental health services effectively facilitate help-seeking for young people.
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              The YouthMood Project: a cluster randomized controlled trial of an online cognitive behavioral program with adolescents.

              The aim in the current study was to investigate the effectiveness of an online, self-directed cognitive-behavioral therapy program (MoodGYM) in preventing and reducing the symptoms of anxiety and depression in an adolescent school-based population. A cluster randomized controlled trial was conducted with 30 schools (N = 1,477) from across Australia, with each school randomly allocated to the intervention or wait-list control condition. At postintervention and 6-month follow-up, participants in the intervention condition had significantly lower levels of anxiety than did participants in the wait-list control condition (Cohen's d = 0.15-0.25). The effects of the MoodGYM program on depressive symptoms were less strong, with only male participants in the intervention condition exhibiting significant reductions in depressive symptoms at postintervention and 6-month follow-up (Cohen's d = 0.27-0.43). Although small to moderate, the effects obtained in the current study provide support for the utility of universal prevention programs in schools. The effectiveness of booster sessions should be explored in future research.

                Author and article information

                JMIR Res Protoc
                JMIR Res Protoc
                JMIR Research Protocols
                JMIR Publications (Toronto, Canada )
                February 2018
                22 February 2018
                : 7
                : 2
                : e48
                [1] 1 Orygen, The National Centre of Excellence in Youth Mental Health Parkville Australia
                [2] 2 Centre for Youth Mental Health The University of Melbourne Melbourne Australia
                [3] 3 Orygen Youth Health Northwestern Mental Health Melbourne Australia
                [4] 4 School of Psychology Australian Catholic University Melbourne Australia
                [5] 5 headspace National Youth Mental Health Foundation Melbourne Australia
                [6] 6 School of Computing and Information Systems The University of Melbourne Melbourne Australia
                [7] 7 Institute of Sport, Exercise and Active Living Victoria University Melbourne Australia
                [8] 8 Universitat Rovira i Virgili Tarragona Spain
                Author notes
                Corresponding Author: Simon Rice simon.rice@ 123456orygen.org.au
                Author information
                ©Simon Rice, John Gleeson, Steven Leicester, Sarah Bendall, Simon D'Alfonso, Tamsyn Gilbertson, Eoin Killackey, Alexandra Parker, Reeva Lederman, Greg Wadley, Olga Santesteban-Echarri, Ingrid Pryor, Daveena Mawren, Aswin Ratheesh, Mario Alvarez-Jimenez. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 22.02.2018.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://www.researchprotocols.org, as well as this copyright and license information must be included.

                : 30 August 2017
                : 22 November 2017
                : 3 December 2017
                : 4 December 2017

                internet,social networking,young adult,adolescent,mental heath


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