A person-based approach to planning and developing "EmOcean": A transdiagnostic digital intervention for stress and...

This paper constitutes an intervention development paper, illustrating the application of the person-based approach to planning and developing a digital transdiagnostic intervention to support Portuguese adults in managing their stress and emotions, thereby enhancing their mental health.

A multi-method intervention development study following the person-based approach (Phase I: collating and analysing evidence; Phase II: creating the intervention plan). Evidence from three quantitative studies, examining emotional schemas, psychological flexibility, and mental health in the context of stress, a qualitative study, exploring stress-coping experiences, and a scoping review of digital interventions designed for stress, were combined with experts' consultation to facilitate the creation of the guiding principles and the logic model. This guided the development of prototype intervention.

Community-based recruitment across Portugal, collected online and at hospitals, senior universities and patient organisations.

Quantitative studies used a convenience sample (Study 1, n=666; Study 2, n=583; Study 3, n=276). 29 adults purposively sampled from the Study 3' highest and lowest stress quartiles took part in semi-structured interviews. In the scoping review, 5867 articles were identified, and 131 studies of digital psychological interventions for stress were included. Six experts in stress, cognitive behavioural therapy, acceptance and commitment therapy, emotional schema therapy, digital interventions, intervention development and public health reviewed the draft intervention plan.

Stress responses, more than stressor type, were the strongest predictor of both positive and negative mental health, with emotional schemas (negative evaluation of emotions, difficulties in reappraisal) and psychological flexibility (behavioural awareness, valued action, openness to experience) acting as mediators. Qualitative interviews highlighted maladaptive thoughts as the main barrier and emotional management as the main facilitator to coping, alongside preferences for intervention content and delivery. The scoping review found common components in existing digital interventions for stress, but none integrated the emotional schemas model. Together with expert consultation, these findings led to the development of EmOcean prototype, a guided self-help digital intervention comprising eight integrated and five optional modules, tailored to users' needs, characteristics and preferences, which are completed sequentially on a weekly basis. Modules include psychoeducation and exercises on topics such as stress, emotions, cognitive reframing, mindfulness, acceptance, values, activities, problem-solving, time management, physical exercise, sleep, social support, assertiveness and emotional management.

Combining empirical, theoretical and person-based evidence supported the development of EmOcean, an intervention hypothesised to support stress and emotion management and enhance mental health. Its acceptability, feasibility and efficacy will be evaluated in future studies.