Background
depression, anxiety
DISORDERS
Digital health interventions have a well-established evidence base for the effective delivery of mental health care for various psychological disorders, including anxiety and depression [DMH intervention programs have been disseminated in a variety of formats, from purely self-help (ie, no therapist assistance or other form of human involvement) to guided (ie, therapist assistance) delivery methods in which the mode and amount of therapist involvement can vary substantially among studies [Research on DMH intervention programs incorporating adaptive treatment elements has the potential to further our understanding of the optimal intensity of therapist assistance. Adaptive intervention designs incorporate criteria that influence how and whether treatment is maintained or augmented based on participant responses, such as engagement levels or symptom severity [Therapist assistance within DMH intervention programs has been delivered synchronously and asynchronously. Synchronous interactions include telephone calls, instant messaging, and video chat interactions between a therapist and participant in real time; asynchronous communication can also include messaging and email support [There is currently a lack of research on the use of video chat as a modality of therapist assistance within a DMH intervention. To our knowledge, there is no identified adaptive randomized clinical trial that has investigated the efficacy of a 2-stage adaptive design whereby a transdiagnostic biopsychosocial DMH intervention program is augmented with either low- or high-intensity video chat–based therapist assistance should a participant not engage with the program or their symptoms not improve. In stepped-care research, little is known about the intensity of therapist assistance required at the next level of care. To further understand the efficacy of stepped-care models and adaptive intervention designs within DMH interventions, this clinical trial sought to evaluate and compare no therapist assistance with participants randomized to receive either 10 minutes (low intensity) or 50 minutes (high intensity) of therapist assistance per week. In this study, both low- and high-intensity therapist assistance were delivered via video chat technology. This further contributes to the body of literature as higher-intensity therapist assistance is typically delivered in person within stepped-care models.