(PS12-81) Pilot Feasibility and Acceptability of a Cognitive Bias Modification for Interpretation Digital Program for Anxiety Offered in a Large Healthcare System

Anxiety disorders are highly prevalent in the U.S., but many barriers prevent easy access to evidence-based treatments, including mental health provider shortages, high treatment costs, and lack of transportation. Digital mental health interventions (DMHIs) may help overcome these barriers by offering remote, scalable, cost-effective, and evidence-based mental health interventions via websites and smartphone apps. By inviting patients to DMHIs using healthcare systems’ electronic health record (EHR) portals, patients can be better connected with research-supported DMHIs without requiring provider time.

MindTrails is a publicly available online cognitive bias modification for interpretation (CBM-I) DMHI to reduce anxiety with preliminary efficacy data. This open trial evaluated the feasibility and acceptability of MindTrails when offered via EHR portal in the Kaiser Permanente Colorado healthcare system to patients with elevated anxiety symptoms (N=1600). Individuals who began the intervention (n=66) were asked to complete five online CBM-I sessions, report their anxiety symptoms pre-intervention and post-training sessions (using two separate measures), and provide post-intervention feedback on their perceptions of MindTrails. Results were compared to a priori benchmarks established based on prior studies of DMHIs.

Participants (mean age = 44.6 years, SD = 12.4) were predominantly female (60.6%), White (90.9%), non-Hispanic (96.9%), and highly educated (51.5% with an advanced degree) and reported moderate anxiety symptom severity at pre-intervention (OASIS: M = 8.42, SD = 3.17; DASS-AS: M = 10.94, SD = 7.78) . One of four benchmarks for feasibility (based on clinical deterioration, adherence, and credibility) was met —74% finished the first session, suggesting good initial engagement. However, 18% (hypothesized > 20%) completed all five sessions, 7.6% (hypothesized < 5%) reported an anxiety symptom increase of > 50% from baseline while using MindTrails, and participants were only slightly confident in MindTrail’s ability to reduce anxiety symptoms at pre-intervention (M = 1.80, SD = 0.76; hypothesized > 2.0). Two of four primary benchmarks for acceptability were met (all rated on a scale from 1 to 5 and hypothesized > 3.5), with participants generally liking MindTrails (M = 3.58, SD = 0.90) and finding the program easy to use (M = 4.42, SD = 0.67). Benchmarks were not met for helpfulness (M = 3.0, SD = 0.9) or likelihood of recommending the program to others (M = 3.17, SD = 1.19). Three of four secondary benchmarks for acceptability were met – participants were only slightly concerned about privacy while using MindTrails (M = 1.83, SD = 1.40), did not experience technical troubles (M = 1.33, SD = 0.49), and found the program’s content very trustworthy (M = 4.33, SD = 0.65). The fourth benchmark was not met, with 33% reporting they would “probably” or “definitely” use a similar program in the future (hypothesized > 50%).

Findings are mixed regarding the feasibility and acceptability of MindTrails when deployed through a healthcare system’s EHR portal. Qualitative feedback from participants may help determine areas for improvement to better meet the needs of this patient population.