Acceptance of E-Mental Health Services for Different Application Purposes Among Psychotherapists in Clinical Training in Germany and Switzerland: Secondary Analysis of a Cross-Sectional Survey.

Background: Despite solid evidence supporting the efficacy of electronic mental health (EMH) services, their acceptance among psychotherapists is limited and uptake rates remain low. However, the acceptance of different EMH services has yet barely been examined in future generations of psychotherapists in a differentiated manner. The aims of this study were (1) to elaborate the intention to use various EMH services for different application purposes and (2) to determine predictors of EMH service acceptance among psychotherapists in clinical training (PiT). Materials and Methods: Our paper is based on a secondary data analysis of a cross-sectional survey. Respondents were recruited via recognized educational institutions for psychotherapy within Germany and the German-speaking part of Switzerland between June and July of 2020. The survey contained items on the intention to use different EMH services (i.e., guided and unguided programs, virtual reality, psychotherapy by telephone and videoconference) for various application purposes (i.e., prevention, treatment addition, treatment substitute, aftercare). Potential predictors of EMH service acceptance (e.g., barriers and advantages) were examined based on an extension of the Unified Theory of Acceptance and Use of Technology (UTAUT). Results: Most of the n = 216 respondents were female (88.4%) and located in Germany (72.2%). General acceptance of EMH was moderate (M = 3.4, SD = 1.12, range 1-5), while acceptance of psychotherapy via videoconference was highest (M = 3.7, SD = 1.15) and acceptance of unguided programs was lowest (M = 2.55, SD = 1.14). There was an interaction effect of EMH service and application purpose (η2 = 0.21). Barriers and advantages both had a uniform influence on EMH service acceptance (Pr > 0.999), while impersonality, legal concerns, concerns about therapeutic alliance, simplified information provision, simplified contact maintenance, time flexibility, and geographic flexibility were significant predictors (all p < 0.05). Results showed that the extended UTAUT model was the best fitting model to predict EMH service acceptance (Pr > 0.999). Conclusions: The intention to use different EMH services varied between application purposes among PiT. To increase acceptance of EMH services and reduce misconceptions, we identified predictors that should be addressed in future acceptance-facilitating interventions when educating PiT.

Piloting an Innovative Concept of e-Mental Health and mHealth Workshops With Medical Students Using a Participatory Co-design Approach and App Prototyping: Case Study.

BACKGROUND: Medical students show low levels of e-mental health literacy. Moreover, there is a high prevalence of common mental illnesses among medical students. Mobile health (mHealth) apps can be used to maintain and promote medical students' well-being. To date, the potential of mHealth apps for promoting mental health among medical students is largely untapped because they seem to lack familiarity with mHealth. In addition, little is known about medical students' preferences regarding mHealth apps for mental health promotion. There is a need for guidance on how to promote competence-based learning on mHealth apps in medical education. OBJECTIVE: The aim of this case study is to pilot an innovative concept for an educative workshop following a participatory co-design approach and to explore medical students' preferences and ideas for mHealth apps through the design of a hypothetical prototype. METHODS: We conducted a face-to-face co-design workshop within an elective subject with 26 participants enrolled at a medical school in Germany on 5 consecutive days in early March 2020. The aim of the workshop was to apply the knowledge acquired from the lessons on e-mental health and mHealth app development. Activities during the workshop included group work, plenary discussions, storyboarding, developing personas (prototypical users), and designing prototypes of mHealth apps. The workshop was documented in written and digitalized form with the students' permission. RESULTS: The participants' feedback suggests that the co-design workshop was well-received. The medical students presented a variety of ideas for the design of mHealth apps. Among the common themes that all groups highlighted in their prototypes were personalization, data security, and the importance of scientific evaluation. CONCLUSIONS: Overall, this case study indicates the feasibility and acceptance of a participatory design workshop for medical students. The students made suggestions for improvements at future workshops (eg, use of free prototype software, shift to e-learning, and more time for group work). Our results can be (and have already been) used as a starting point for future co-design workshops to promote competence-based collaborative learning on digital health topics in medical education.

Lesion Evidence for a Causal Role of the Insula in Aversion to Social Inequity.

Humans resist unequal distributions of goods in their social interactions, even if it requires foregoing personal gains. Functional neuroimaging studies implicate the insula in this aversion to social inequity and in fairness-related decisions, but a causal contribution has not yet been established. We compared the responses of 30 patients with lesions to the insula on a multiple-trial version of the one-shot Ultimatum Game, a neuroeconomic social exchange paradigm where a sum of money is split between two players, to those of 30 matched patients with brain injuries sparing the insula. Insula lesion patients accepted offers of an unequal disadvantageous split significantly more often than comparison lesion patients. Computational modeling confirmed that this difference in choice behavior was due to decreased aversion to disadvantageous inequity following insula damage, rather than due to increased decision noise or non-consideration of inequity. Our results provide novel evidence that the insula is causally involved in aversion to inequity and in value-based choices in the context of social interactions.

Trier social stress test and food-choice: Behavioral, self-report & hormonal data.

A sample of 144 participants underwent the Trier Social Stress Test (TSST), a psychosocial stress manipulation involving a mock interview and a mental arithmetic task, or a matched control procedure. Physiological stress was estimated via a collection of 7 saliva samples over the course of the experiment analysed for cortisol and alpha-amylase, as well as via the mean heart-rate measured before and during the experimental manipulation. Subjective stress was assessed via the Positive and Negative Affect Scale as well as four Visual Analogue Scales at 6 points over the time course of the experiment. Participants solved an incentive-compatible food-choice task before, immediately after and in the aftermath of the experimental manipulation. In each trial of the food-choice task, participants had to choose one out of a set of two to seven snack bundles. Each snack bundle consisted of specific amounts of a sweet or salty snack and a fruit or vegetable. The snacks for both categories were selected to be similarly attractive according to the previously provided online ratings of the participants. The design of the food-choice task allows for the calculation of revealed preference consistency indices. The dataset further contains several self-report questionnaires administered to the participants before the experimental session, including the Trier Inventory of Chronic Stress.