Background: Chatbots have the potential to provide cost-effective mental health prevention programs at scale and increase interactivity, ease of use, and accessibility of intervention programs. Objective: The development of chatbot prevention for eating disorders (EDs) is still in its infancy. Our aim is to present examples of and solutions to challenges in designing and refining a rule-based prevention chatbot program for EDs, targeted at adult women at risk for developing an ED. Methods: Participants were 2409 individuals who at least began to use an EDs prevention chatbot in response to social media advertising. Over 6 months, the research team reviewed up to 52,129 comments from these users to identify inappropriate responses that negatively impacted users’ experience and technical glitches. Problems identified by reviewers were then presented to the entire research team, who then generated possible solutions and implemented new responses. Results: The most common problem with the chatbot was a general limitation in understanding and responding appropriately to unanticipated user responses. We developed several workarounds to limit these problems while retaining some interactivity. Conclusions: Rule-based chatbots have the potential to reach large populations at low cost but are limited in understanding and responding appropriately to unanticipated user responses. They can be most effective in providing information and simple conversations. Workarounds can reduce conversation errors.

Mental health phone applications (apps) provide cost-effective, easily accessible support for college students, yet long-term engagement is often low. Digital overload, defined as information burden from technological devices, may contribute to disengagement from mental health apps. This study aimed to explore the influence of digital overload and phone use preferences on mental health app use among college students, with the goal of informing how notifications could be designed to improve engagement in mental health apps for this population. A semi-structured interview guide was developed to collect quantitative data on phone use and notifications as well as qualitative data on digital overload and preferences for notifications and phone use. Interview transcripts from 12 college students were analyzed using thematic analysis. Participants had high daily phone use and received large quantities of notifications. They employed organization and management strategies to filter information and mitigate the negative effects of digital overload. Digital overload was not cited as a primary barrier to mental health app engagement, but participants ignored notifications for other reasons. Findings suggest that adding notifications to mental health apps may not substantially improve engagement unless additional factors are considered, such as users’ motivation and preferences.

Evidence-based single session interventions (SSI) that promote growth mindset have been shown to be associated with improved mental health, particularly in adolescents. Youth in Lebanon suffer from alarmingly high rates of mental illness combined with lack of availability of mental health services and a stigma for seeking help. The present study investigated the effects of a growth mindset of personality SSI on mental health of children and adolescents in Lebanon with most identifying as Syrian refugees. We hypothesized that participation in the growth mindset SSI would lead to a decrease in hopelessness and self-hate and an increase in hope, agency, and perceived control, from pre- to postintervention using a within-subject research design. The intervention was translated into formal Arabic, adapted to the culture, and administered online at a school and a youth center. Within group effect sizes calculations show that the intervention was associated with a decrease in hopelessness (dav = 0.36, 95% CI [0.11, 0.61]; dz = 0.48, 95% CI [0.22, 0.73]) and self-hate (dav = 0.37, 95% CI [0.09, 0.64]; dz = 0.57, 95% CI [0.28, 0.85]) and an increase in perceived control (dav = 0.36, 95% CI [0.10, 0.61]; dz = 0.50, 95% CI [0.24, 0.76]). These changes from pre- to postintervention were significant with small to moderate effect sizes. This study provided the first evidence in the Arab world of the cultural acceptability and feasibility as well as the mental health benefits of a cost-free, Arabic growth mindset SSI.