Moderated Online Social Therapy (MOST) in Help-Seeking Young People: Pilot Randomized Controlled Study.

Background: In the context of a sharp rise in help-seeking in youth mental health, digital mental health interventions offer enormous potential to improve outcomes, facilitate access, and meet the increasing demand for mental health services. For example, for young adults attending third-level education, digital mental health interventions may support help-seeking students while either waiting to attend student counseling or to sustain gains once a brief course of face-to-face counseling sessions has been completed. Moderated Online Social Therapy (MOST) is an online intervention that combines tailored psychotherapeutic content with one-to-one therapist and peer support worker support, and an online community. MOST has an emerging evidence base in multiple mental health contexts, but it has not yet been implemented in the university context. Objective: This trial investigated the feasibility of using MOST to support the mental health of third-level students who recently attended a student counseling service. Methods: We conducted a pilot randomized controlled study of third-level students who had recently completed ~4 sessions of counseling in their university counseling service. Students were randomly assigned to the intervention or control arm at a rate of 2:1. In the intervention arm, students had access to MOST for 26 weeks, and both groups were assessed at baseline, 12 weeks, and 26 weeks. Outcomes assessed at each time point included social and occupational functioning, cognitive functioning, depression, anxiety, and loneliness. To examine the feasibility of the trial, we examined data on recruitment, trial retention, and engagement with the MOST platform. We calculated effect sizes for outcome variables to explore the preliminary efficacy of the MOST intervention. Results: A total of 74 participants were recruited, meeting the recruitment target of ~3.1 participants per semester month. Retention in the trial was 70% (52/74) at 12 weeks, reducing to 66% (49/74) at 26 weeks. For the intervention group, when engagement was measured in terms of participation in at least one component of the intervention, 81% (38/47) of the intervention group engaged for 5 or more weeks of the trial (~20% of the maximum 26 weeks). Based on the effect sizes observed, the intervention arm was associated with modest gains in social function and cognitive function and reduced clinical symptom severity at 12 weeks. Conclusions: Based on the recruitment, retention, and engagement rates observed, a full randomized controlled trial of MOST with young adults at the university is feasible. Moreover, the effect sizes favoring the intervention arm are consistent with previous studies and support a full trial of MOST as a potentially beneficial support for youth mental health in further education settings.