The experience sampling methodology as a digital clinical tool for more person-centered mental health care: an implementation research agenda.

This position paper by the international IMMERSE consortium reviews the evidence of a digital mental health solution based on Experience Sampling Methodology (ESM) for advancing person-centered mental health care and outlines a research agenda for implementing innovative digital mental health tools into routine clinical practice. ESM is a structured diary technique recording real-time self-report data about the current mental state using a mobile application. We will review how ESM may contribute to (1) service user engagement and empowerment, (2) self-management and recovery, (3) goal direction in clinical assessment and management of care, and (4) shared decision-making. However, despite the evidence demonstrating the value of ESM-based approaches in enhancing person-centered mental health care, it is hardly integrated into clinical practice. Therefore, we propose a global research agenda for implementing ESM in routine mental health care addressing six key challenges: (1) the motivation and ability of service users to adhere to the ESM monitoring, reporting and feedback, (2) the motivation and competence of clinicians in routine healthcare delivery settings to integrate ESM in the workflow, (3) the technical requirements and (4) governance requirements for integrating these data in the clinical workflow, (5) the financial and competence related resources related to IT-infrastructure and clinician time, and (6) implementation studies that build the evidence-base. While focused on ESM, the research agenda holds broader implications for implementing digital innovations in mental health. This paper calls for a shift in focus from developing new digital interventions to overcoming implementation barriers, essential for achieving a true transformation toward person-centered care in mental health.

Experiences of a digital health intervention for young people exposed to technology assisted sexual abuse: a qualitative study.

BACKGROUND: There is growing evidence that Technology Assisted Sexual Abuse (TASA) represents a serious problem for large numbers of children. To date, there are very few evidence-based interventions available to young people (YP) after they have been exposed to this form of abuse, and access to support services remains a challenge. Digital tools such as smartphones have the potential to increase access to mental health support and may provide an opportunity for YP to both manage their distress and reduce the possibility of further victimization. The current study explores the acceptability of a digital health intervention (DHI; the i-Minds app) which is a theory-driven, co-produced, mentalization-based DHI designed for YP aged 12-18 who have experienced TASA. METHODS: Semi-structured interviews were conducted with 15 YP recruited through Child and Adolescent Mental Health Services, a Sexual Assault Referral Centre and an e-therapy provider who had access to the i-Minds app as part of a feasibility clinical trial. Interviews focused on the acceptability and usability of i-Minds and were coded to themes based on the Acceptability of Healthcare Interventions framework. RESULTS: All participants found the i-Minds app acceptable. Many aspects of the app were seen as enjoyable and useful in helping YP understand their abuse, manage feelings, and change behavior. The app was seen as usable and easy to navigate, but for some participants the level of text was problematic and aspects of the content was, at times, emotionally distressing at times. CONCLUSIONS: The i-Minds app is useful in the management of TASA and helping change some risk-related vulnerabilities. The app was designed, developed and evaluated with YP who had experienced TASA and this may account for the high levels of acceptability seen. TRIAL REGISTRATION: The trial was registered on the ISRCTN registry on the 12/04/2022 as i-Minds: a digital intervention for young people exposed to online sexual abuse (ISRCTN43130832).

The Use of a Comprehensive Concept of Capability for Wellbeing Assessment: A Best-Fit Framework Synthesis.

Developing an instrument with the capability approach can be challenging, since the capability concept of Sen is ambiguous concerning the burdens that people experience whilst achieving their capabilities. A solution is to develop instruments with a comprehensive concept of capability, such as the concept of 'option-freedom'. This study aims to develop a theoretical framework for instrument development with the concept of option-freedom. A best-fit framework synthesis was conducted with seven qualitative papers by one researcher. Two researchers supported the synthesis by discussing interim results during the synthesis. A priori concepts of option-freedom were used to deductively code against. Themes and subthemes were developed inductively when data did not match a priori themes. Seven paper were identified that fulfilled the eligibility criteria. Four themes emerged from the synthesis. (1) Option Wellbeing represents a range of options that need to be satisfied for individuals to experience wellbeing. (2) Self-Realization represents that there are experiences in an individual's life that have value beyond realizing options. (3) Perceived Access to Options represents the perceived ability of individuals to realize freedoms. (4) Perceived Control represents the experience of having control. Developing an instrument with the proposed framework has two benefits. First, it acknowledges the importance of assessing impediments in realizing capabilities for wellbeing assessment. Secondly, the themes form a broad informational base by including themes related to subjective wellbeing. Future research should study the feasibility of implementing the framework for instrument development.

Implementation of a digital health intervention for young people exposed to Technology Assisted Sexual Abuse.

BACKGROUND: The internet has become a place of increased risk of abuse, including sexual abuse, for young people (YP). One potential risk factor to online abuse and exploitation is the ability to mentalise. We developed the i-Minds app, a mentalisation-based digital health intervention (DHI) for YP who have experienced technology assisted sexual abuse (TASA), which we tested in a clinical feasibility trial. Nested within the trial was a qualitative implementation study with clinicians who referred to the trial. OBJECTIVE: To explore the barriers and enablers to the future integration of i-Minds into clinical practice. PARTICIPANTS AND SETTING: Twelve HCPs were recruited from across two trial recruitment sites (Manchester and Edinburgh). METHODS: Semi-structured interviews were informed by Normalisation Process Theory (NPT). Framework analysis was used; transcripts were coded deductively to NPT constructs. RESULTS: Practitioners were positive about the need for, and added value of, the i-Minds app over existing interventions, including other DHIs. While they felt confident with the app, concerns remained around the safety of using the app without practitioner support. i-Minds promoted changes in practitioners' work and impacted online behaviour of YP. There was an identified need for further training and organisational support. CONCLUSIONS: Practitioners are aware of TASA but have limited knowledge, skills and tools to work with TASA in clinical practice with YP. There is a need for awareness raising and education about TASA and DHI. i-Minds offers a theory-informed DHI for working with YP exposed to TASA that is acceptable to practitioners and YP.

Patient perspectives on the causes of breast cancer: a qualitative study on the relationship between stress, trauma, and breast cancer development.

Purpose: We qualitatively evaluated breast cancer survivors' perception of the relation between breast cancer development and both childhood trauma and stressful life events in adulthood.Methods: Women (N = 50) who have or had a positive breast cancer diagnosis completed a close-ended survey, a timeline of significant life events, and an in-depth interview. All interviews were transcribed and inductively coded using thematic analysis with an emphasis on patient perspectives of illness.Results: Participants reported a perceived connection between breast cancer development and stressful life events, and four themes were identified: 1) experiencing major interpersonal stress in both childhood and adulthood, 2) ideas about the relationship between emotional stress and physical disease, 3) ideas about how different types of stress contribute to developing breast cancer, 4) post-treatment post-traumatic growth and meaning-making.Conclusions: Our findings suggest that of the participants who felt something could be causally attributed to their developing breast cancer, most of them made causal attributions between social, personal, and physical stress and trauma across the lifetime to the aetiology of their breast cancer. We suggest that breast cancer patients and survivors may benefit from additional psycho-social, stress-reducing, and/or somatic-based trauma-informed therapies to address stress and trauma.

Qualitative analysis of first-person accounts of noetic experiences.

The term "noetic" comes from the Greek word noesis/noetikos that means inner wisdom, direct knowing, intuition, or implicit understanding. Strong cultural taboos exist about sharing these experiences. Thus, many may not feel comfortable transparently discussing or researching these topics, despite growing evidence that these experiences may be real. The study's objective was to qualitatively evaluate first-hand accounts of noetic experiences. 521 English-speaking adults from around the world completed an online survey that collected demographic data and four open-ended questions about noetic experiences. Thematic analysis was used to characterize the data. The ten most used codes were expressing to or sharing with others, impacting decision-making, intuition/"just knowing," meditation/hypnosis, inner visions, setting intentions/getting into the "state," healing others, writing for self, and inner voice. There were five main themes identified: 1. Ways of Engagement; 2. Ways of Knowing; 3. Types of Information; 4. Ways of Affecting; and 5. Ways of Expressing. Subthemes. Future research will include investigating the nuances of these themes and also establishing standardized methods for evaluating them. This would also then inform curricula and therapies to support people in these experiences.

A case study of extended human capacity perception during Energy Medicine treatments using mixed methods analysis.

INTRODUCTION: Some "energy medicine" modalities, such as Reiki, continue to show evidence for efficacy, but the underlying mechanisms of action are still uncertain. To help illuminate possible mechanisms, this exploratory mixed-method study using qualitative and quantitative analyses investigated: 1) How do energy medicine sessions function from the perspective of a seer, i.e., an individual trained in techniques to enable perception of purported subtle energies, and 2) Do any of these observations correlate with changes in participants' subjective pain? METHOD: One seer reported observations during 30-minute energy medicine sessions delivered by 17 practitioners to participants experiencing chronic hand or wrist pain. Data were coded using an inductive approach, followed by thematic and descriptive analyses. Content analysis was used to assign whether each code was mentioned by the seer for each participant, generating 119 binary variables, one for each code. The relationship between these binary variables and change in participant pain scores after the energy medicine session and three weeks later were explored using linear regression models. RESULTS: The qualitative thematic analysis identified six major themes from the seer's notes: "Experience of the Practitioner," "Experience of the Participant," "Space and Other Beings" (referring to the qualities of the physical space the energy medicine session occurred in and ostensible non-physical beings present during session), "Participant-Practitioner Relationship," "Healing Process," and "Attributes of Energy." The energy medicine methods used varied for each participant, according to the practitioners' perceptions of each individual's needs. The linear regression models yielded significant associations between changes in pain scores and various codes, including energy color, practitioner touch and the presence of ostensible non-physical beings supporting the session, although their significance did not persist after correction for multiple comparisons. DISCUSSION: Future studies investigating the mechanisms of energy medicine may benefit from including perceptions by seers in their outcome measures.