Attention Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder historically considered to be a condition of childhood, characterized by deficits in sustained attention abilities. However, more recent literature has not only begun to reveal it as a lifespan disorder persisting well into adulthood but has also increasingly focused on enhanced distractibility (as opposed to an attention deficit per se) as a core feature. Despite this proposed framework, unbiased physiological markers of enhanced distractibility do not exist, and relevant symptoms continue to be evaluated by subjective behavioral and cognitive assessments. More specifically, measuring underlying neural correlates of enhanced distractibility (such as difficulty ignoring irrelevant external stimuli or difficulty disengaging from task irrelevant internal thought) remains a key goal to better understand ADHD. Preliminary studies have begun to investigate these processes in children. Yet given current understanding of the maturational changes associated with attentional control across development, investigation into how this presentation differs in adults is warranted. As such, I aimed in this dissertation to examine neural differences in processing of external and internal distraction (internal distraction characterized here as mind wandering) between adults with and without ADHD, using EEG/event-related potentials (ERPs). To this end, 26 adult men and women with and without ADHD completed one 30-minute long three-stimulus auditory oddball task, and one 30-minute long two-stimulus auditory oddball task, while their behavioral and EEG data were recorded. Study participants also completed several questionnaires probing mood and attention in daily life. Adults with ADHD showed increased reaction time variability in response to distractor tones as well as a tendency for decreased MMN latency, compared to controls. Additionally, in adults with ADHD, the ERP P3a response to distracting tones was significantly larger in amplitude and significantly shortened in latency than to target tones, a pattern that did not exist for adults without ADHD. Although no neural differences were found during periods of on task versus internally distracted thought, adults with ADHD showed a trend to slowing in response time during periods of mind wandering. Additionally adults with ADHD reported more frequent engagement in unintentional mind wandering and reported being significantly more impaired by mind wandering in daily life than adults without ADHD. Overall, these findings contribute to a growing literature examining enhanced distractibility as a key feature of ADHD, providing initial insight into external and internal distraction processes in adults with ADHD. These preliminary results suggest that adults with ADHD may indeed be more “captured” than adults without ADHD by both external and internal distraction. Future work should consider examining the utility of measures of enhanced distractibility, in addition to impaired sustained attention, in the diagnosis of this condition.

Background: Although psychotherapy is one of the most efficacious and effective treatments for depression, limited accessibility to trained providers markedly limits access to care. In an attempt to overcome this obstacle, several platforms seeking to provide these services using digital modalities (eg, video, text, and chat) have been developed. However, the use of these modalities individually poses barriers to intervention access and acceptability. Multimodal platforms, comprising those that allow users to select from a number of available modalities, may be able to provide a solution to these concerns.

Objective: We aimed to investigate the preliminary effectiveness of providing psychotherapy through a multimodal digital psychotherapy platform. In addition, we aimed to examine differential responses to intervention by gender, self-reported physical health status, and self-reported financial status, as well as how prior exposure to traditional face-to-face psychotherapy affected the effectiveness of a multimodal digital psychotherapy intervention. Finally, we aimed to examine the dose-response effect.

Methods: Data were collected from a total of 318 active users of BetterHelp, a multimodal digital psychotherapy platform. Data on physical health status, financial status, and prior exposure to psychotherapy were obtained using self-report measures. Effectiveness was determined by the extent of symptom severity change, which was measured using the Patient Health Questionnaire at Time 1 (time of enrollment) and Time 2 (3 months after enrollment). Intervention dosage was measured as the sum of individual therapist-user interactions across modalities.

Results: Depression symptom severity was significantly reduced after the use of the multimodal digital psychotherapy intervention (P<.001). Individuals without prior traditional psychotherapy experience revealed increased improvement after intervention (P=.006). We found no significant dose-response effect of therapy, nor significant differences in outcomes across gender, self-reported financial status, and self-reported physical health status.

Conclusions: Users of BetterHelp experienced significantly reduced depression symptom severity after engaging with the platform. Study findings suggest that this intervention is equally effective across gender, self-reported financial status, and self-reported physical health status and particularly effective for individuals without a history of psychotherapy. Overall, study results suggest that multimodal digital psychotherapy is a potentially effective treatment for adult depression; nevertheless, experimental trials are needed. We discuss directions for future research.

Although psychotherapy is one of the most efficacious and effective treatments for depression, limited accessibility to trained providers markedly limits access to care. In an attempt to overcome this obstacle, several platforms seeking to provide these services using digital modalities (eg, video, text, and chat) have been developed. However, the use of these modalities individually poses barriers to intervention access and acceptability. Multimodal platforms, comprising those that allow users to select from a number of available modalities, may be able to provide a solution to these concerns.

We aimed to investigate the preliminary effectiveness of providing psychotherapy through a multimodal digital psychotherapy platform. In addition, we aimed to examine differential responses to intervention by gender, self-reported physical health status, and self-reported financial status, as well as how prior exposure to traditional face-to-face psychotherapy affected the effectiveness of a multimodal digital psychotherapy intervention. Finally, we aimed to examine the dose-response effect.

Data were collected from a total of 318 active users of BetterHelp, a multimodal digital psychotherapy platform. Data on physical health status, financial status, and prior exposure to psychotherapy were obtained using self-report measures. Effectiveness was determined by the extent of symptom severity change, which was measured using the Patient Health Questionnaire at Time 1 (time of enrollment) and Time 2 (3 months after enrollment). Intervention dosage was measured as the sum of individual therapist-user interactions across modalities.

Depression symptom severity was significantly reduced after the use of the multimodal digital psychotherapy intervention (P<.001). Individuals without prior traditional psychotherapy experience revealed increased improvement after intervention (P=.006). We found no significant dose-response effect of therapy, nor significant differences in outcomes across gender, self-reported financial status, and self-reported physical health status.

Users of BetterHelp experienced significantly reduced depression symptom severity after engaging with the platform. Study findings suggest that this intervention is equally effective across gender, self-reported financial status, and self-reported physical health status and particularly effective for individuals without a history of psychotherapy. Overall, study results suggest that multimodal digital psychotherapy is a potentially effective treatment for adult depression; nevertheless, experimental trials are needed. We discuss directions for future research.