Ecological momentary intervention to enhance emotion regulation in healthcare workers via smartphone: a randomized controlled trial protocol

Diana Castilla, María Vicenta Navarro-Haro, Carlos Suso-Ribera, Amanda Díaz-García, Irene Zaragoza, Azucena García-Palacios, Diana Castilla, María Vicenta Navarro-Haro, Carlos Suso-Ribera, Amanda Díaz-García, Irene Zaragoza, Azucena García-Palacios

Abstract

Background: CUIDA-TE is an APP that offers transdiagnostic cognitive behavioral therapy focused on enhancing emotion regulation. As a novelty, it incorporates ecological momentary interventions (EMI), which can provide psychological support in real time, when suffering arises. The main goal of the study is to evaluate the efficacy of CUIDA-TE to improve emotion regulation in healthcare workers, a population that has been particularly emotionally impacted by the COVID-19 pandemic.

Methods: In this three-arm, randomized controlled trial (RCT) the study sample will be composed of a minimum of 174 healthcare workers. They will be randomly assigned to a 2-month EMI group (CUIDA-TE APP, n ≥ 58), a 2-month ecological momentary assessment (EMA) only group (MONITOR EMOCIONAL APP, n ≥ 58), or a wait-list control group (no daily monitoring nor intervention, n ≥ 58). CUIDA-TE will provide EMI if EMA reveals emotional problems, poor sleep quality/quantity, burnout, stress, or low perceived self-efficacy when regulating emotions. Depression will be the primary outcome. Secondary outcomes will include emotion regulation, quality of life, and resilience. Treatment acceptance and usability will also be measured. Primary and secondary outcomes will be obtained at pre- and post-intervention measurements, and at the 3-month follow-up for all groups.

Discussion: To our knowledge, this is the first RCT that evaluates the efficacy of an APP-based EMI to improve emotion regulation skills in healthcare workers. This type of intervention might ultimately help disseminate treatments and reach a larger number of individuals than traditional face-to-face individual therapies.

Trial registration: ClinicalTrial.gov : NCT04958941 Registered 7 Jun 2021.

Study status: Participant recruitment has not started.

Keywords: APP; CBT; DBT; Ecological momentary intervention; Emotion regulation; Health professional; Intervention; RCT; Smartphone; Transdiagnostic.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Design flowchart
Fig. 2
Fig. 2
Example of EMI flow app for anger construct
Fig. 3
Fig. 3
Graphical User Interface example of both applications

References

    1. WHO . Rolling Updates on Coronavirus Disease (COVID-19) 2020.
    1. INE. Información estadística para el análisis del impacto de la crisis COVID-a9. Instituto Nacional de Estadística (España) 2021. . Accessed 12 Dec 2020.
    1. Martín-Brufau R, Suso-Ribera C, Corbalán J. Emotion network analysis during COVID-19 quarantine - A longitudinal study. Front Psychol. 2020;11. 10.3389/fpsyg.2020.559572.
    1. Wind TR, Rijkeboer M, Andersson G, Riper H. The COVID-19 pandemic: The ‘black swan’ for mental health care and a turning point for e-health. Internet Interv. 2020;20:100317. doi: 10.1016/j.invent.2020.100317.
    1. De Kock JH, Latham HA, Leslie SJ, Grindle M, Munoz SA, Ellis L, et al. A rapid review of the impact of COVID-19 on the mental health of healthcare workers: implications for supporting psychological well-being. BMC Public Health. 2021;21:1–18.
    1. Mortier P, Vilagut G, Ferrer M, Serra C, Molina JD, López-Fresneña N, et al. Thirty-day suicidal thoughts and behaviors among hospital workers during the first wave of the Spain COVID-19 outbreak. Depress Anxiety. 2021;38:528–544. doi: 10.1002/DA.23129.
    1. Vieta E, Pérez V, Arango C. Psychiatry in the aftermath of COVID-19. Rev Psiquiatr Salud Ment. 2020;13:105–110. doi: 10.1016/j.rpsm.2020.04.004.
    1. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395:912–920. doi: 10.1016/S0140-6736(20)30460-8.
    1. Franza F, Basta R, Pellegrino F, Solomita B, Fasano V. The role of fatigue of compassion, burnout and hopelessness in healthcare: experience in the time of Covid-19 outbreak. Psychiatr Danub. 2020;32:S10–S14.
    1. Dosil Santamaría M, Ozamiz-Etxebarria N, Redondo Rodríguez I, Jaureguizar Alboniga-Mayor J, Picaza GM. Impacto psicológico de la COVID-19 en una muestra de profesionales sanitarios españoles. Rev Psiquiatr Salud Ment. 2020; In press.
    1. Alonso J, Vilagut G, Mortier P, Ferrer M, Alayo I, Aragón-Peña A, et al. Mental health impact of the first wave of COVID-19 pandemic on Spanish healthcare workers: A large cross-sectional survey. Rev Psiquiatr y Salud Ment. 2021;14:90–105.
    1. Li Y-F, Zhang Y-G, Niu J-T, Si X-L, Yan X-K. Analysis of TCM in prevention and treatment of post-traumatic stress disorder induced by COVID-19. Chinese Tradit herb. Drugs. 2020;51:1130–8.
    1. Lee AM, GWS Wong J, McAlonan GM, Cheung V, Cheung C, Sham PC, et al. Stress and psychological distress among SARS survivors 1 year after the outbreak. 2007.
    1. Taylor S, Landry CA, Rachor GS, Paluszek MM, Asmundson GJG. Fear and avoidance of healthcare workers: an important, under-recognized form of stigmatization during the COVID-19 pandemic. J Anxiety Disord. 2020;75:102289.
    1. Trumello C, Bramanti SM, Ballarotto G, Candelori C, Cerniglia L, Cimino S, et al. Psychological adjustment of healthcare Workers in Italy during the COVID-19 pandemic: differences in stress, anxiety, depression, burnout, secondary trauma, and compassion satisfaction between frontline and non-frontline professionals. Int J Environ Res Public Heal. 2020;17:1–13. doi: 10.3390/ijerph17228358.
    1. Talaee N, Varahram M, Jamaati H, Salimi A, Attarchi M, Kazempour dizaji M, et al. Stress and burnout in health care workers during COVID-19 pandemic: validation of a questionnaire. J Public Heal. 2020;1. 10.1007/s10389-020-01313-z.
    1. Morgantini Id LA, Naha U, Wang H, Id SF, Mer Acar O¨, Flores JM, et al. Factors contributing to healthcare professional burnout during the COVID-19 pandemic: A rapid turnaround global survey. 2020.
    1. Matsuo T, Kobayashi D, Taki F, Sakamoto F, Uehara Y, Mori N, et al. Prevalence of health care worker burnout during the coronavirus disease 2019 (COVID-19) pandemic in Japan. JAMA Netw Open. 2020;3:e2017271. doi: 10.1001/jamanetworkopen.2020.17271.
    1. McEvoy PM, Nathan P, Norton PJ. Efficacy of Transdiagnostic Treatments: A review of published outcome studies and future research directions. J Cogn Psychother. 2009;23:20–33.
    1. Barlow DH. Unified protocol for Transdiagnostic treatment of emotional disorders: therapist guide. Can Fam Physician. 2011;24:507–508.
    1. Barlow DH, Sauer-Zavala S, Carl JR, Bullis JR, Ellard KK. The nature, diagnosis, and treatment of neuroticism. Clin Psychol Sci. 2014;2:344–365.
    1. Bullis JR, Boettcher H, Sauer-Zavala S, Farchione TJ, Barlow DH. What is an emotional disorder? A transdiagnostic mechanistic definition with implications for assessment, treatment, and prevention. Clin Psychol Sci Pract. 2019;26:e12278.
    1. Linehan MM. Skills training manual for treating borderline personality disorder. New York: Guilford P; 1993.
    1. Linehan MM. DBT® skills training manual. 2. New York: Guilford Press; 2015.
    1. Hayes SStrosahl KWilson K. Acceptance and commitment therapy: an experiential approach to behaviour change. New York, NY: Guildford; 1999.
    1. Sloan E, Hall K, Moulding R, Bryce S, Mildred H, Staiger PK. Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: A systematic review. Clin Psychol Rev. 2017;57:141–163.
    1. Aldao A. Emotion regulation strategies as transdiagnostic processes: A closer look at the invariance of their form and function = Estrategias de regulación emocional como procesos transdiagnósticos: Una visión más detenida sobre la invarianza de su forma y función. Rev Psicopatología y Psicol Clín. 2012;17:261.
    1. Fernandez KC, Jazaieri H, Gross JJ. Emotion regulation: A Transdiagnostic perspective on a new RDoC domain. Cognit Ther Res. 2016;40:426–440.
    1. Norton PJ, Paulus DJ. Toward a unified treatment for emotional disorders: update on the science and practice. Behav Ther. 2016;47:854–868.
    1. Calkins SD. ORIGINS AND OUTCOMES OF INDIVIDUAL DIFFERENCES IN EMOTION REGULATION. Monogr Soc Res Child Dev. 1994;59:53–72.
    1. Thompson RA. Emotion regulation: A theme in SEARCH of definition. Monogr Soc Res Child Dev. 1994;59:25–52. doi: 10.1111/J.1540-5834.1994.TB01276.X.
    1. Martín-Brufau R, Martin-Gorgojo A, Suso-Ribera C, Estrada E, Capriles-Ovalles ME, Romero-Brufau S. Emotion regulation strategies, workload conditions, and burnout in healthcare residents. Int J Environ Res Public Health. 2020;17:1–12. doi: 10.3390/IJERPH17217816.
    1. Wang M, Saudino KJ. Emotion regulation and stress. J Adult Dev. 2011;18:95–103.
    1. Sauer-Zavala S, Gutner CA, Farchione TJ, Boettcher HT, Bullis JR, Barlow DH. Current definitions of “Transdiagnostic” in treatment development: A Search for consensus. Behav Ther. 2017;48:128–138.
    1. Neacsiu ABohus MLinehan M. Dialectical behavior therapy skills: an intervention for emotion dysregulation. In: Neacsiu ABohus MLinehan M 2014.
    1. Valentine SE, Bankoff SM, Poulin RM, Reidler EB, Pantalone DW. The use of dialectical behavior therapy skills training as stand-alone treatment: A systematic review of the treatment outcome literature. J Clin Psychol. 2015;71:1–20.
    1. Badrfam R, Zandifar A, Arbabi M. Mental health of medical workers in COVID-19 pandemic: restrictions and barriers. J Res Health Sci. 2020;20:e00481.
    1. Holmes EA, O’connor RC, Perry H, Tracey I, Wessely S, Arseneault L, et al. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet. 2020;7:560. doi: 10.1016/S2215-0366(20)30168-1.
    1. Dores AR, Geraldo A, Carvalho IP, Barbosa F. The use of new digital information and communication Technologies in Psychological Counseling during the COVID-19 pandemic. Int J Environ Res Public Health. 2020;17:7663.
    1. Andersson G. Internet-Delivered Psychological Treatments. Annu Rev Clin Psychol. 2016;12:157–179. doi: 10.1146/annurev-clinpsy-021815-093006.
    1. Karyotaki E, Ebert DD, Donkin L, Riper H, Twisk J, Burger S, et al. Do guided internet-based interventions result in clinically relevant changes for patients with depression? An individual participant data meta-analysis. Clin Psychol Rev. 2018;63:80–92.
    1. Andrews G, Williams AD. Up-scaling clinician assisted internet cognitive behavioural therapy (iCBT) for depression: A model for dissemination into primary care. Clin Psychol Rev. 2015;41:40–48.
    1. Andersson G, Carlbring P, Titov N, Lindefors N. Internet interventions for adults with anxiety and mood disorders: A narrative umbrella review of recent Meta-analyses. Can J Psychiatr. 2019;64:465–470.
    1. Miralles I, Granell C, Díaz-Sanahuja L, van Woensel W, Bretón-López J, Mira A, et al. Smartphone apps for the treatment of mental disorders: systematic review. JMIR mHealth uHealth. 2020;8:1–28.
    1. Garcia-Palacios A, Herrero R, Belmonte MA, Castilla D, Guixeres J, Molinari G, et al. Ecological momentary assessment for chronic pain in fibromyalgia using a smartphone: A randomized crossover study. Eur J Pain. 2014;18:862–872. doi: 10.1002/j.1532-2149.2013.00425.x.
    1. Kobylińska D, Kusev P. Flexible emotion regulation: How situational demands and individual differences influence the effectiveness of regulatory strategies. Front Psychol. 2019;10:1–9.
    1. Colombo D, Fernández-Álvarez J, Suso-Ribera C, Cipresso P, Valev H, Leufkens T, et al. The need for change: understanding emotion regulation antecedents and consequences using ecological momentary assessment. Emotion. 2020;20:30–36.
    1. Troy AS, Shallcross AJ, Mauss IB. A person-by-situation approach to emotion regulation. Psychol Sci. 2013;24:2505–2514.
    1. Sheppes G, Scheibe S, Suri G, Gross J. Emotion-regulation choice. Psychol Sci. 2011;22:1391–1396. doi: 10.1177/0956797611418350.
    1. Lazarus RS, Alfert E. Short-circuiting of threat by experimentally altering cognitive appraisal. J Abnorm Soc Psychol. 1964;69:195–205.
    1. Van Dillen LF, Koole SL. Clearing the mind: A working memory model of distraction from negative mood. Emotion. 2007;7:715–723.
    1. Fruzzetti AE, Shenk C. Fostering validating responses in families. In: Borderline personality disorder: meeting the challenges to successful treatment: Routledge; 2020. p. 215–28.
    1. Sheppes G, Scheibe S, Suri G, Radu P, Blechert J, Gross JJ. Emotion regulation choice: A conceptual framework and supporting evidence. J Exp Psychol Gen. 2014;143:163–181.
    1. Mirchi N, Betzel RF, Bernhardt BC, Dagher A, Mišić B. Tracking mood fluctuations with functional network patterns. Soc Cogn Affect Neurosci. 2019;14:47–57.
    1. Colombo D, Fernández-Álvarez J, Patané A, Semonella M, Kwiatkowska M, García-Palacios A, et al. Current state and future directions of technology-based ecological momentary assessment and intervention for major depressive disorder: A systematic review. J Clin Med. 2019;8:465.
    1. Trull TJ, Ebner-Priemer UW. Using experience sampling methods/ecological momentary assessment (ESM/EMA) in clinical assessment and clinical research: introduction to the special section. 2009.
    1. Stone AA, Shiffman S. Ecological momentary assessment (Ema) in behavioral medicine. Ann Behav Med. 1994;16:199–202. doi: 10.1093/abm/16.3.199.
    1. Suso-Ribera C, Castilla D, Zaragozá I, Ribera-Canudas MVMV, Botella C, García-Palacios A. Validity, reliability, feasibility, and usefulness of pain monitor. Clin J Pain. 2018;34:900–908. doi: 10.1097/AJP.0000000000000618.
    1. Marzano L, Bardill A, Fields B, Herd K, Veale D, Grey N, et al. The application of mHealth to mental health: opportunities and challenges. Lancet Psychiatry. 2015;2:942–948.
    1. Bylsma LM, Rottenberg J. Uncovering the dynamics of emotion regulation and dysfunction in daily life with ecological momentary assessment. Emot Regul Well-Being. 2011:225–44. 10.1007/978-1-4419-6953-8_14.
    1. Statista . Statista. Number of smartphone users from 2016 to 2021 (in billions) 2021.
    1. Balaskas A, Schueller SM, Cox AL, Doherty G. Ecological momentary interventions for mental health: A scoping review. PLoS One. 2021;16:e0248152. doi: 10.1371/JOURNAL.PONE.0248152.
    1. Loo Gee B, Griffiths KM, Gulliver A. Effectiveness of mobile technologies delivering ecological momentary interventions for stress and anxiety: a systematic review. J Am Med Informatics Assoc. 2016;23:221–229.
    1. Olff M. Mobile mental health: a challenging research agenda. Eur J Psychotraumatol. 2015;6:27882. 10.3402/EJPT.V6.27882.
    1. Price M, Yuen EK, Goetter EM, Herbert JD, Forman EM, Acierno R, et al. mHealth: A mechanism to deliver more accessible, more effective mental health care. Clin Psychol Psychother. 2014;21:427. doi: 10.1002/CPP.1855.
    1. Gross JJ. Hadbook of emotion regulation. Second edi. New York: Guildford; 2015.
    1. Schulz K, Altman D, Moher D. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. PLoS Med. 2010;7:e1000251.
    1. Erdfelder E, FAul F, Buchner A, Lang AG. Statistical power analyses using G*power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41:1149–1160.
    1. Doris, Eichert H-C, Riper H, Ebert DD. Blending Face-to-Face and Internet-Based Interventions for the Treatment of Mental Disorders in Adults: Systematic Review. J Med Internet Res 2017;19(9)e306 . 2017;19:e6588. doi:10.2196/JMIR.6588.
    1. Suso-Ribera C, Castilla D, Zaragozá I, Mesas Á, Server A, Medel J, et al. Telemonitoring in chronic pain management using smartphone apps: A randomized controlled trial comparing usual assessment against app-based monitoring with and without clinical alarms. Int J Environ Res Public Health. 2020;17:1–23.
    1. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–613. doi: 10.1046/j.1525-1497.2001.016009606.x.
    1. Martin A, Rief W, Klaiberg A, Braehler E. Validity of the brief patient health questionnaire mood scale (PHQ-9) in the general population. Gen Hosp Psychiatry. 2006;28:71–77.
    1. Diez-Quevedo C, Rangil T, Sanchez-Planell L, Kroenke K, Spitzer RL. Validation and utility of the patient health questionnaire in diagnosing mental disorders in 1003 general hospital Spanish inpatients. Psychosom Med. 2001;63:679–686.
    1. Gross JJ, John O. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J Pers Soc Psychol. 2003;85:348–362.
    1. Preece DA, Becerra R, Robinson K, Gross JJ. The emotion regulation questionnaire: psychometric properties in general community samples. J Pers Assess. 2020;102:348–356. doi: 10.1080/00223891.2018.1564319.
    1. Cabello R, Salguero JM, Fernández-Berrocal P, Gross JJ. A Spanish adaptation of the emotion regulation questionnaire. Eur J Psychol Assess. 2013;29:234–240. doi: 10.1027/1015-5759/a000150.
    1. Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and Dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess. 2004;26:41–54. doi: 10.1023/B:JOBA.0000007455.08539.94.
    1. Hervás G, Jódar R. Adaptación al castellano de la Escala de Dificultades en la Regulación Emocional. Clín y Salud. 2008;19 . Accessed 27 Feb 2021.
    1. Smith BW, Dalen J, Wiggins K, Tooley E, Christopher P, Bernard J. The brief resilience scale: assessing the ability to bounce back. Int J Behav Med. 2008;15:194–200.
    1. Galiana L, Oliver A, Arena F, De Simone G, Tomás JM, Vidal-Blanco G, et al. Development and validation of the short professional quality of life scale based on versions IV and V of the professional quality of life scale. Health Qual Life Outcomes. 2020;18:1–12. doi: 10.1186/s12955-020-01618-3.
    1. Samaniego A, Urzúa A, Buenahora M, Vera-Villarroel P. Symptomatology associated with mental health disorders in health workers in Paraguay: COVID-19 effect. Rev Interam Psicol J Psychol. 2020;54:e1298. doi: 10.30849/RIPIJP.V54I1.1298.
    1. Buselli R, Corsi M, Baldanzi S, Chiumiento M, Del LE, Dell’Oste V, et al. Professional quality of life and mental health outcomes among health care workers exposed to Sars-Cov-2 (Covid-19) Int J Environ Res Public Heal. 2020;17:6180. doi: 10.3390/IJERPH17176180.
    1. Pocatello . The Concise ProQOL Manual. 2010.
    1. Brooke JSUS. A quick and dirty usability scale. Usability Eval Ind. 1996:189–94.
    1. Lewis JR. The system usability scale: past, present, and future. Int J Hum Comput Interact. 2018;34:577–590. doi: 10.1080/10447318.2018.1455307.
    1. Bangor A, Kortum PT, Miller JT. An empirical evaluation of the system usability scale. Int J Hum Comput Interact 2008;24 June 2015:574–594.
    1. Castilla D, Garcia-Palacios A, Miralles I, Breton-Lopez J, Parra E, Rodriguez-Berges S, et al. Effect of web navigation style in elderly users. Comput Human Behav. 2016;55:909–920. doi: 10.1016/j.chb.2015.10.034.
    1. Hermes EDA, Lyon AR, Schueller SM, Glass JE. Measuring the implementation of behavioral intervention technologies: Recharacterization of established outcomes. J Med Internet Res. 2019;21:e11752. doi: 10.2196/11752.
    1. Stats G. Mobile operating system market share Spain. Statcounter. 2020; . Accessed 14 Dec 2020.
    1. Miró J, de la Vega R, Solé E, Racine M, Jensen MP, Gálan S, et al. Defining mild, moderate, and severe pain in young people WITHPHYSICAL disabilities. Disabil Rehabil. 2017;39:1131. doi: 10.1080/09638288.2016.1185469.
    1. Díaz-García A, González-Robles A, García-Palacios A, Fernández-Álvarez J, Castilla D, Bretón JM, et al. Negative and positive affect regulation in a transdiagnostic internet-based protocol for emotional disorders: randomized controlled trial. J Med Internet Res. 2021;23:1–23.
    1. Heiy JE, Cheavens JS. Back to basics: A naturalistic assessment of the experience and regulation of emotion. Emotion. 2014;14:878–891.
    1. Garruba M, Joseph C. The impact of fatigue in the healthcare setting: A scoping review. Monash Heal. 2019:1–13 . Accessed 17 Oct 2021.
    1. Killingsworth MA, Gilbert DT. A wandering mind is an unhappy mind. Science (80- ) 2010;330:932.
    1. Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. J Consult Clin Psychol. 2010;78:169–183.
    1. Webb TL, Miles E, Sheeran P. Dealing with feeling: A meta-analysis of the effectiveness of strategies derived from the process model of emotion regulation. Psychol Bull. 2012;138:775–808.
    1. Peña-Sarrionandia A, Mikolajczak M, Gross JJ. Integrating emotion regulation and emotional intelligence traditions: A meta-analysis. Front Psychol. 2015;6(160):1–27.
    1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385.
    1. Teshome A, Shegaze M, Glagn M, Getie A, Tekabe B, Getahun D, et al. Perceived stress and associated factors among health care professionals working in the context of COVID-19 pandemic in public health institutions of southern Ethiopia 2020. PLoS One. 2021;16:e0252809.
    1. Sreeramareddy CT, Shankar PR, Binu V, Mukhopadhyay C, Ray B, Menezes RG. Psychological morbidity, sources of stress and coping strategies among undergraduate medical students of Nepal. BMC Med Educ. 2007;7:26.
    1. Saghaei M. Random allocation software for parallel group randomized trials. BMC Med Res Methodol. 2004;4:1–6.
    1. European Commission . Regulation (EU) 2016/679 (RGPD). Eur-Lex, Access to european Union Law. Directive 95/46/EC (General Data Protection Regulation) 2020.
    1. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed: IEA Lawrence Erlbaum Associates, Publishers; 1988.
    1. Harvey AG, Gumport NB. Evidence-based psychological treatments for mental disorders: modifiable barriers to access and possible solutions. Behav Res Ther. 2015;68:1–12.
    1. Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ, et al. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet. 2007;370:841–850.
    1. Gabilondo A, Rojas-Farreras S, Rodríguez A, Fernández A, Pinto-Meza A, Vilagut G, et al. Use of primary and specialized mental health care for a major depressive episode in Spain by ESEMeD respondents. Psychiatr Serv. 2011;62:152–161.
    1. Mateo JJ. Esperar un año para ver al psicólogo: EL PAÍS; 2019. . Accessed 10 Dec 2021
    1. Remacha B. La asistencia a la salud mental se perpetúa como lujo en España ante los escasos recursos del sistema público: (National newspaper); 2019. . Accessed 10 Dec 2021
    1. Andrews G, Basu A, Cuijpers P, Craske MG, McEvoy P, English CL, et al. Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: an updated meta-analysis. J Anxiety Disord. 2018;55:70–78.
    1. Massoudi B, Holvast F, Bockting CLH, Burger H, Blanker MH. The effectiveness and cost-effectiveness of e-health interventions for depression and anxiety in primary care: A systematic review and meta-analysis. J Affect Disord. 2019;245:728–743.
    1. Richards D, Enrique A, Eilert N, Franklin M, Palacios J, Duffy D, et al. A pragmatic randomized waitlist-controlled effectiveness and cost-effectiveness trial of digital interventions for depression and anxiety. npj Digit Med. 2020;3:1–10. doi: 10.1038/s41746-020-0293-8.
    1. Torous J, Myrick KJ, Rauseo-Ricupero N, Firth J. Digital mental health and COVID-19: using technology today to accelerate the curve on access and quality tomorrow. JMIR Ment Heal. 2020;7:1–6.
    1. Colombo D, Fernández-álvarez J, Palacios AG, Cipresso P, Botella C, Riva G. New technologies for the understanding, assessment, and intervention of emotion regulation. Front Psychol. 2019;10:1–10. doi: 10.3389/fpsyg.2019.01261.
    1. Thoits PA. Stress and health: major findings and policy implications. J Health Soc Behav. 2010;51(S):S41–S53.
    1. Sheppes G, Suri G, Gross JJ. Emotion regulation and psychopathology. Annu Rev Clin Psychol. 2015;11:379–405. doi: 10.1146/annurev-clinpsy-032814-112739.
    1. Berking M, Wupperman P. Emotion regulation and mental health: recent findings, current challenges, and future directions. Curr Opin Psychiatry. 2012;25:128–134.

Source: PubMed

3
Subscribe