A Solution-Focused Research Approach to Achieve an Implementable Revolution in Digital Mental Health
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There are few reports of iCBT outcomes sustained over longer periods after initial implementation efforts conclude.
“Examining trends also adds to evidence regarding iCBT in routine care as there are few reports of iCBT outcomes sustained over longer periods after initial implementation efforts conclude. 35”
From Utilization, Patient Characteristics, and Longitudinal Improvements among Patients from a Provincially Funded Transdiagnostic Internet-delivered Cognitive Behavioural Therapy Program: Observational Study of Trends over 6 Years (2022) · cites this paper as [35]
The Sustainable Implementation section (page not available) says funded research often ends with publication of an efficacy trial and argues for sustaining digital mental health interventions after research support is withdrawn. It does not say that reports of long-term iCBT outcomes after initial implementation efforts are few. (LLM, conf=0.78)
Experimental — accuracy not yet measuredDespite evidence from 15 years of research for the effectiveness of digital mental health interventions, a historical and global research translation gap has hindered clinical implementation, and very few digital interventions have been successfully integrated into mental services.
“Yet, despite evidence from 15 years of research for the effectiveness of digital mental health interventions, a historical and global research translation gap has hindered clinical implementation, and very few digital interventions have been successfully integrated into mental services.”
From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [364]
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“Examining trends also adds to evidence regarding iCBT in routine care as there are few reports of iCBT outcomes sustained over longer periods after initial implementation efforts conclude.(35) Research questions explored in this study were as follows: What growth will be observed in iCBT over time? Will users of iCBT…”
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“Moreover, it is particularly relevant for technology-based interventions by examining the contextual and implementation factors concerning how any intervention is performed and why [8].”
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“Instead, we have proposed elsewhere, that phases of create, trial, and sustain, might be more appropriate when it comes to digital health (8).”
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“) (40, 41) to support and improve mental health conditions and provide mental healthcare including screening, health promotion, prevention, early intervention, treatment, or relapse prevention (42).”
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“Human-centered design is increasingly employed in health care innovation to enhance user experience, thereby promoting engagement [13-17].”
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“10,60,62 This study uniquely features an integrated digital platform implemented across a large number of services, across a large swathe of Australia, and across varied states that have distinct health bureaucracies.”
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“Therefore, we propose a multi-phase, user-centered study design (Lyon and Koerner, 2016; Mohr et al., 2018) to develop an mHealth app intervention for community-based individuals with acquired brain injuries (stroke and TBI) and their care partners.”
MethodPokémon GO Within the Context of Family Health: Retrospective Study
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“Research is needed to advance the real-world implementation of digital health interventions [22,100].”
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“However, the approach to date of simply translating an evidence-based face-to-face intervention to a digital format has not worked; the process relies on what clinicians think users need, the way in which in-person services are delivered does not align with how people engage with their phones [16,17], and it fails to…”
BackgroundSelf-citationDesigning Digital Interventions for Eating Disorders
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“ED e at in g di so rd er , B N b ul im ia n er vo sa , B ED b in ge e at in g di so rd er , A N a no re xi a ne rv os a 131 Current Psychiatry Reports (2023) 25:125–138”
BackgroundEfficacy of Gamified Digital Mental Health Interventions for Pediatric Mental Health Conditions
Bryant, B. R., Sisk, M. R., & Mcguire, J. F. (2024) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2024.3139 · Cited by 30 · see citing works
Towards A Framework for Mobile Behavior Change Research
Okeke, F., Sobolev, M., & Estrin, D. L. (2018) · Technology, Mind, and Society Conference (TechMindSociety) · doi:10.1145/3183654.3183706 · Cited by 27 · see citing works
“We design the framework as a solution-focused research approach [20, 33] that explores behavior change in real-world settings in a standardized, extensible, and replicable way.”
MethodRiboldi, I., Calabrese, A., Piacenti, S., Capogrosso, C. A., Paioni, S. L., Bartoli, F., Carrà, G., Armes, J., Taylor, C., & Crocamo, C. (2024) · Clinical Practice and Epidemiology in Mental Health · doi:10.2174/0117450179271467231231060255 · Cited by 29 · see citing works
van Kessel, K., Babbage, D. R., Kersten, P., Drown, J., Sezier, A., Thomas, P., & Thomas, S. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100371 · Cited by 25 · see citing works
“Mohr et al. (2018), and Wilson et al. (2018) suggest we need to consider more agile and efficient approaches to mHealth development and evaluation lifecycles.”
BackgroundScott, J. L., Hockey, S. J., Ospina‐Pinillos, L., Doraiswamy, P. M., Álvarez‐Jiménez, M., & Hickie, I. B. (2021) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13390 · Cited by 30 · see citing works
Cross, S. P. M., Nicholas, J., Mangelsdorf, S. N., Valentine, L., Baker, S. T. E., McGorry, P. D., Gleeson, J., & Álvarez‐Jiménez, M. (2023) · JMIR Formative Research · doi:10.2196/49846 · Cited by 24 · see citing works
“Additionally, there has been a historical, global failure to integrate digital interventions into real-world mental health services [19].”
BackgroundUse of Technology in the Assessment and Treatment of Eating Disorders in Youth
Sadeh‐Sharvit, S. (2019) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2019.05.011 · Cited by 24 · see citing works
Moderated Online Social Therapy for Young People With Active Suicidal Ideation: Qualitative Study
Bailey, E., Robinson, J., Álvarez‐Jiménez, M., Nedeljkovic, M., Valentine, L., Bendall, S., D’Alfonso, S., Gilbertson, T., McKechnie, B., & Rice, S. (2021) · Journal of Medical Internet Research · doi:10.2196/24260 · Cited by 23 · see citing works
“In addition, although the integration of digital interventions with existing mental health services may have several benefits, including improved treatment engagement and outcomes [20,21], to date there have been limited efforts to integrate web-based and face-to-face treatments for young people with suicidal thoughts…”
BackgroundDigital Technology to Enhance Clinical Care of Early Psychosis
Bell, I. H., & Álvarez‐Jiménez, M. (2019) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-019-00182-y · Cited by 23 · see citing works
Beahm, J. D., McCall, H. C., Carleton, R. N., Titov, N., Dear, B., & Hadjistavropoulos, H. D. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100481 · Cited by 23 · see citing works
Xie, E. B., Jung, J. W., Kaur, J., Benzies, K., Tomfohr‐Madsen, L. M., & Keys, E. (2023) · Journal of Medical Internet Research · doi:10.2196/43219 · Cited by 23 · see citing works
“Extending eHealth to intervention delivery (referred to as digital interventions hereafter) helps address some of the common barriers associated with engaging with traditional health care services, such as accessibility, costs, availability, and time [1,27,28].”
Lyngs, U., Lukoff, K., Slovák, P., Inzlicht, M., Freed, M., Andrews, H., Tinsman, C., Csuka, L., Alberts, L., de Mello, V. O., et al. (2024) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3613904.3642946 · Cited by 22 · see citing works
“…evidence on the potential of specific interventions [49], but the practical challenge of how to scaffold a process by which people can browse multiple DSCTs and apply the options most relevant to their personal goals across their device ecosystem, has so far received limited attention [55, 80].”
BackgroundInfluentialEngdahl, P., Svedberg, P., Lexén, A., & Bejerholm, U. (2020) · JMIR Formative Research · doi:10.2196/15625 · Cited by 22 · see citing works
“Service user empowerment is emerging as a focal point in mental health research and reforms, but the understanding of how to implement such a paradigm shift is still underdeveloped [74]. mWorks may have a role to play in such a paradigm shift.”
Scholl, J., Kohls, E., Görges, F., Steinbrecher, M., Baldofski, S., Moessner, M., & Rummel-Kluge, C. (2021) · JMIR Formative Research · doi:10.2196/27865 · Cited by 22 · see citing works
“E-mental health and web-based interventions, as in, the provision of psychosocial or psychotherapeutic support through information and communication technologies, have emerged as an important area in psychotherapy service and research over the past decade [1-3].”
BackgroundInfluencing factors associated with mental workload among nurses: A latent profile analysis
Jin, M., Qian, R., Wang, J., Long, J., Yuan, Z., Zeng, L., Liao, D., Liu, X., Tang, S., & Huang, S. (2024) · International Journal of Nursing Sciences · doi:10.1016/j.ijnss.2024.04.002 · Cited by 20 · see citing works
“…who adopt negative coping strategies tend to focus more on the negative aspects of events, negate the sense of achievement from work and self-worth, and increase MWL. Mohr et al. [51] also showed that groups with higher MWL were more inclined to yield and avoid when faced with work pressure.”
BackgroundGraham, A. K., Neubert, S. W., Chang, A., Liu, J., Fu, E., Green, E. A., Kornfield, R., & Nicholas, J. (2021) · Frontiers in Digital Health · doi:10.3389/fdgth.2021.651749 · Cited by 21 · see citing works
“Too often, digital health interventions have been designed based on what clinicians think intervention consumers need without sufficiently accounting for what they want (8, 9).”
BackgroundHao, X., Dai, Y., Jia, S., Liu, S., Zhao, C., & Liu, X. (2025) · BMC Nursing · doi:10.1186/s12912-025-02976-3 · Cited by 19 · see citing works
“Groups with higher mental workload are more likely to show avoidance or surren-der when facing work pressures [39].”
McAlister, K. L., Baez, L. M., Huberty, J., & Kerppola, M. (2025) · JMIR Formative Research · doi:10.2196/72469 · Cited by 31 · see citing works
“First, Moment for Parents was developed using HCD, which is thought to enhance engagement with digital mental health interventions [40].”
Garety, P. A., Ward, T., Emsley, R., Greenwood, K., Freeman, D. H., Fowler, D. G., Kuipers, E., Bebbington, P., Dunn, G., & Hardy, A. (2021) · Efficacy and Mechanism Evaluation · doi:10.3310/eme08110 · Cited by 18 · see citing works
Digital and remote behavioral therapies for treating tic disorders: Recent advances and next steps
Khan, K., Hollis, C. P., Murphy, T. L., & Hall, C. L. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.928487 · Cited by 20 · see citing works
“Optimizing user experience, which is defined as the extent to which an intervention is perceived by a person as useful, enjoyable and user friendly, has great potential to address barriers to successful future implementation (39).”
BackgroundStalujanis, E., Neufeld, J., Stalder, M. G., Belardi, A., Tegethoff, M., & Meinlschmidt, G. (2020) · JMIR mhealth and uhealth · doi:10.2196/20329 · Cited by 19 · see citing works
“In addition, it is well known that, after initial involvement, users of digital mental health interventions tend to put those away [50].”
Simon, N. A., Ploszajski, M., Lewis, C., Smallman, K., Roberts, N. P., Kitchiner, N., Brookes‐Howell, L., & Bisson, J. I. (2021) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12341 · Cited by 19 · see citing works
“…use of Internet-based therapies for stress, anxiety, and depression in England found inconsistency in their use and their recommendation across the country (Bennion, Hardy, Moore, & Millings, 2017), and LI treatment adoption in clinical practice remains limited (Mohr, Riper, & Schueller, 2017).”
BackgroundClough, B. A., Rowland, D. P., & Casey, L. M. (2019) · Internet Interventions · doi:10.1016/j.invent.2019.100288 · Cited by 20 · see citing works
“Despite the efficacy and advantages of e-interventions, substantial barriers exist that often limit MHPs' referral, implementation and dissemination of e-interventions (Carper et al., 2013; Mohr et al., 2017; Mohr et al., 2015; Reynolds et al., 2015).”
BackgroundLuther, L., Buck, B., Fischer, M. W., Johnson-Kwochka, A. V., Coffin, G., & Salyers, M. P. (2020) · Journal of Technology in Behavioral Science · doi:10.1007/s41347-020-00162-7 · Cited by 18 · see citing works
“Few studies have taken a solution-focused approach to understanding and addressing the practical barriers to mHealth implementation (Mohr et al. 2018), including understanding the availability of digital technologies and services and addressing clinician attitudes.”
BackgroundIJzerman, R. V. H., van der Vaart, R., & Evers, A. W. M. (2019) · Journal of Medical Internet Research · doi:10.2196/13432 · Cited by 17 · see citing works
“However, implementation of iCBT in clinical practice remains a challenge [23,24], and different health care settings show different usages of iCBT.”
Békés, V., Bőthe, B., & Doorn, K. A. (2025) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70085 · Cited by 16 · see citing works
Bechtel, J. M., LePoire, E., Bauer, A. M., Bowen, D. J., & Fortney, J. C. (2020) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2020.10.004 · Cited by 16 · see citing works
Videokonsultationen durch Psychotherapeuten in Zeiten der COVID-19-Pandemie
Haun, M. W., Hoffmann, M., Tönnies, J., Dinger, U., Hartmann, M., & Friederich, H.-C. (2020) · Psychotherapeut · doi:10.1007/s00278-020-00438-6 · Cited by 14 · see citing works
Buck, B., Kopelovich, S. L., Tauscher, J. S., Chwastiak, L., & Ben‐Zeev, D. (2022) · Journal of Technology in Behavioral Science · doi:10.1007/s41347-022-00270-6 · Cited by 15 · see citing works
“Digital health interventions pre-sent a promising means of addressing population mental health needs (Arevian et al., 2020; Friis-Healy et al., 2021; Rauschenberg et al., 2021); however, several barriers prevent this promise from being actualized in real-world settings (Mohr et al., 2018).”
BackgroundWilliams, A. J., Freed, M., Theofanopoulou, N., Roquet, C. D., Klasnja, P., Gross, J. J., Schleider, J. L., & Slovák, P. (2023) · JMIR Mental Health · doi:10.2196/46826 · Cited by 19 · see citing works
“This supports emerging arguments about the benefits of interventions that draw on extensive user-centered design approaches and focus on addressing the day-to-day needs of target populations [18,57,58].”
BackgroundTrusting the bot: Addressing the ethical challenges of consumer digital mental health therapy
Martinez‐Martin, N. (2020) · Developments in neuroethics and bioethics · doi:10.1016/bs.dnb.2020.03.003 · Cited by 14 · see citing works
Preliminary effects of a digital mental health intervention for depression and anxiety
van Orden, M. L., Kraaijeveld, J. C., Spijker, A. T., Silven, A. V., Bonten, T. N., Chavannes, N. H., & van Dijke, A. (2022) · Clinical eHealth · doi:10.1016/j.ceh.2022.06.002 · Cited by 13 · see citing works
O’Sullivan, S., McEnery, C., Cagliarini, D., Hinton, J. D. X., Valentine, L., Nicholas, J., Chen, N. A., Castagnini, E., Lester, J., Kanellopoulos, E., et al. (2024) · JMIR Mental Health · doi:10.2196/49217 · Cited by 13 · see citing works
“However, despite young people’s preferences and calls for the integration of face-to-face and web-based services [16,41], current mental health services rarely provide this type of integrated web-based support [42].”
BackgroundWells, K. B., Thames, A. D., Young, A. S., Zhang, L., Heilemann, M. V., Romero, D. F., Oliva, A., Jones, F., Tang, L., Brymer, M. J., et al. (2022) · JMIR Formative Research · doi:10.2196/42031 · Cited by 13 · see citing works
“Commentaries emphasize “solution-focused” approaches to digital mental health, with attention to user experience and an intervention target of engagement (usefulness, usability, satisfaction, use, contacts with others), consistent with community-engaged approaches [19-21].”
Background
- Authors
- Mohr, D. C., Riper, H., & Schueller, S. M.
- Affiliations
- Northwestern University (US)
- Vrije Universiteit Amsterdam (NL)
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2018-02-01
- Volume
- 75
- Issue
- 2
- Pages
- 113
- ISSN
- 2168-622X (ISSN-L)
- OpenAlex
- W2772874515
- Cited by
- 204
- References
- 7
- Citations by year
- 2026: 21 · 2025: 28 · 2024: 27 · 2023: 19 · 2022: 26 · 2021: 29 · 2020: 25 · 2019: 20 · 2018: 9
- FWCI
- 16.89
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion)
- VU Research Portal (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- digital mental health, implementation, digital health interventions, mental health technology
- MeSH terms
- Mental Disorders, Computers, Forecasting, Health Plan Implementation, Humans, Mental Health Services, Motivation, Patient Acceptance of Health Care, Therapy, Computer-Assisted, Randomized Controlled Trials as Topic, Treatment Outcome, Biomedical Research, Mobile Applications
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