Conclusions
depression, Anxiety, anxiety
DISORDER, DISORDER
This study adds to the existing body of literature on stepped-care models and advances the research field of adaptive intervention designs and therapist assistance delivered via video chat technology. Significant improvements in the primary outcomes of anxiety and depression were observed across all 3 treatment conditions, with high levels of treatment acceptability and program completion reported. Adaptive research designs that aim to improve the efficiency and efficacy of DMH interventions while considering participant characteristics of nonengagement and symptom severity present both opportunities and challenges. Although these findings indicate that therapist assistance was no more effective than the DMH intervention program alone for reducing symptoms of anxiety or depression, the data highlight the potential influence of participant selection bias and participant preferences within stepped-care treatment models. Under the caveat that all participants had therapist contact for the diagnostic assessments, the findings present evidence that transdiagnostic DMH interventions can be effective with or without therapist assistance; however, further research is needed to consolidate conclusions.The authors thank and acknowledge the Australian Government Research Training Program for supporting the first author. They wish to thank the participants and therapists who took part in this trial and all the consumer and content expert reviewers. The authors would also like to acknowledge the programming work of Asher Leslie and Lewis Lakerink in the creation of the digital platform.Conflicts of Interest: BK was one of the primary creators of the Life Flex digital mental health program. BK receives no personal income from the Life Flex program.CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) checklist.Life Flex program modules.Participant preferences.Descriptive of outcome at baseline by conditions.Change in intervention outcomes over time.Reliable and clinically significant change in 7-item Generalized Anxiety Disorder Scale (GAD-7) score among digital mental health intervention–only program participants.Reliable and clinically significant change in 7-item Generalized Anxiety Disorder Scale (GAD-7) score among low-intensity therapist-assistance participants.Reliable and clinically significant change in 7-item Generalized Anxiety Disorder Scale (GAD-7) score among high-intensity therapist-assistance participants.Reliable and clinically significant change in 9-item Patient Health Questionnaire (PHQ-9) score among digital mental health intervention–only program participants.Reliable and clinically significant change in 9-item Patient Health Questionnaire (PHQ-9) score among low-intensity therapist-assistance participants.Reliable and clinically significant change in 9-item Patient Health Questionnaire (PHQ-9) score among high-intensity therapist-assistance participants.Correlations among outcomes and repeated measures.Remainder of the sociodemographic and clinical characteristics of the sample at baseline by intervention conditions.Reliable and clinically significant change in intervention primary outcomes over times across intervention conditions.Distribution of the individual 7-item Generalized Anxiety Disorder (GAD-7) change by reliable change status in different time points.Distribution of the individual 9-item Patient Health Questionnaire (PHQ-9) change by reliable change status in different time points.Frequency of each disorder at preintervention, postintervention, and follow-up time points.Treatment satisfaction ratings.