Acceptability/Feasibility of COVID-19 Intervention

There is a coming mental health crisis in response to the COVID-19 pandemic. Already,
rates of depression, anxiety, and suicide are elevated in response to the pandemic. A
recent study of more than 5,400 people in the US found prevalence rates of anxiety and
depression in June of 2020 were 3-4 times higher than these rates in June of 2019. In
this same study, 41% of respondents in June 2020 reported experiencing an adverse mental
or behavioral health condition, including 13% who endorsed using substances to cope with
stress or emotions and 11% who reported seriously contemplating suicide in the prior 30
days. Thus, heightened anxiety, stress, and depression will likely continue to lead to
increases in self-harm and maladaptive substance use if left unchecked.

It is crucial that empirically validated psychotherapies be developed to meet these
needs. These treatments must address how common barriers to treatment, including time,
cost, transportation, and stigma about mental health may be exacerbated by the pandemic.
The investigators developed a brief, virtual group-based intervention, framed as
educational, Coping with Coronavirus-Related Emotions and Worries (COPING CREW), to
address these barriers. This intervention was developed over the summer by Drs. Allan,
Suhr, and Austin, working with two graduate student research assistants for
administration by clinical psychology graduate student therapists as part of their
practicum experience at the Ohio University Psychology and Social Work Clinic (PSWC). A
benefit of this approach, therefore, is that this intervention is highly scalable.

Theoretical models posit the short- and long-term stressors experienced during the
pandemic exacerbate the experience of negative emotions an individual is already
predisposed to experience. That is, people who are already experiencing mental health
issues are going to experience more severe issues and people who may not already be
experiencing mental health issues are more likely to develop mental health issues during
the pandemic. Cognitive risk factors (i.e., amplifying cognitions) such as anxiety
sensitivity (fear of anxiety sensations), intolerance of uncertainty (fear of the
unknown), and loneliness (the subjective feeling of isolation) increase the experience of
negative emotions as well as the likelihood of unhealthy coping behavior such as
increased alcohol consumption or self-harm.

Anxiety sensitivity, intolerance of uncertainty, and loneliness can be reduced through
brief interventions applying cognitive-behavioral therapy principles. Reductions in these
constructs lead to later reductions in anxiety, depression, and suicide. Targeting these
risk factors appears critical to address distress due to COVID-19. In 317 Ohio University
faculty, staff, and students, anxiety sensitivity, intolerance of uncertainty, and
loneliness accounted for 63%-75% of the variance in ratings of anxiety, depression, and
suicidality as well as 49% of COVID-related disability. These findings highlight the
prominent role these risk factors play in the distress many individuals are experiencing
due to COVID-19. The investigators have developed a virtual group-based intervention
targeting risk factors that amplify the experience of emotional distress; the next steps
in developing a scientifically rigorous intervention that can be disseminated broadly is
to develop and pilot test this intervention.

The goals specific to this project are to 1) engage stakeholders in the design of a brief
group-based treatment to improve COPING CREW and 2) to conduct a Stage I pilot trial
through evaluating the acceptability and feasibility of COPING CREW.

Aim 1: Refine a prototype for COPING CREW by working virtually with a community partner
stakeholder advisory group (SAG) as well as participants receiving the intervention. The
investigators will develop a SAG comprising one participant from each community partner.
The investigators will meet with the SAG at least three times during the 1-year project.
Meetings will occur prior to starting COPING CREW groups, after running the first two
groups, and after all four groups have been completed. The investigators anticipate that
building a strong relationship with this SAG will increase treatment relevance to
clientele, treatment engagement, and treatment dissemination. In turn, this will enhance
the durable impacts and sustainability of COPING CREW. In addition to SAGs, the
investigators will also utilize a systematic approach to engage with participant
stakeholders by asking for feedback about the intervention (the Exit Interview). The
investigators have used these intervention modules separately a number of times but have
yet to examine these modules as part of the same intervention. Thus, participants will
provide important information on how to tailor the intervention, including the order of
the components, the amount of homework specific to each component, and the length of time
before the booster session to best meet their needs. Although the investigators are
confident that COPING CREW will largely be viewed as acceptable, it can be modified to
increase acceptability by effective engagement with community partners. Solicitation of
feedback will occur via two mechanisms. First, information related to adaptation will be
obtained from quantitative and qualitative feedback during the intervention. Second,
information related to adaptation and engagement will also be collected in separate,
focused feedback sessions with COPING CREW participants.

Aim 2: Examine acceptability and feasibility of COPING CREW, delivered virtually. A pilot
one arm trial will be conducted, delivering the intervention to 24 participants across 4
groups.

H1: It is hypothesized that the intervention will demonstrate high acceptability and
feasibility (as measured by completion rates and favorable ratings of satisfaction)
across intervention modules and components within sessions. Components will include
psychoeducation, challenging cognitive biases or mythbusting, behavioral exposure,
behavioral experiments, and ecological momentary intervention (EMI) for treatment
monitoring and homework tracking.