Psychiatry · Medical Literature
A person-based approach to planning and developing "EmOcean": A transdiagnostic digital intervention for stress and emotion management
Abstract
Objectives 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. Design 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. Setting Community-based recruitment across Portugal, collected online and at hospitals, senior universities and patient organisations. Participants 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. Results 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
Clinical relevance
EmOcean addresses a critical gap in the availability of theory-driven, culturally adapted digital mental health tools for Portuguese-speaking adults managing stress and emotional dysregulation — a population largely underserved by existing evidence-based digital interventions. By targeting transdiagnostic mechanisms (emotional schemas and psychological flexibility) rather than disorder-specific symptoms, the intervention has potential relevance across a broad spectrum of anxiety, depressive, and stress-related presentations. The systematic, person-based development methodology — integrating multi-method quantitative evidence, qualitative lived-experience data, expert consultation, and a 131-study scoping review — positions EmOcean as a rigorous prototype warranting prospective efficacy evaluation.
Key findings
1. Stress response style, rather than stressor type, was identified as the strongest predictor of both positive and negative mental health outcomes across the quantitative studies (Studies 1–3; n=666, 583, and 276, respectively). 2. Emotional schemas — specifically negative evaluation of emotions and difficulties with cognitive reappraisal — functioned as significant mediators in the relationship between stress and mental health (exact effect sizes not reported in the abstract). 3. Psychological flexibility dimensions — behavioural awareness, valued action, and openness to experience — also acted as mediators between stress responses and mental health outcomes (effect sizes not reported in the abstract). 4. A scoping review of 5,867 screened articles identified 131 eligible studies of digital psychological interventions for stress, forming the evidence base for intervention content and design decisions. 5. Qualitative semi-structured interviews with 29 purposively sampled adults (drawn from the highest and lowest stress quartiles of Study 3) enriched understanding of real-world stress-coping experiences and informed the guiding principles and logic model. 6. Six domain experts (spanning stress, CBT, ACT, emotional schema therapy, digital intervention development, and public health) reviewed and refined the draft intervention plan, supporting content validity and theoretical coherence. NOTE: No inferential statistics, confidence intervals, p-values, or effect sizes were extractable from the provided abstract; findings above reflect the directional conclusions stated by the authors.
Practice implications
Clinicians treating adults with stress-related or emotional disorders should recognize that targeting how patients respond to stress — particularly maladaptive emotional schemas (e.g., negative appraisal of one's own emotions, suppression of reappraisal) and psychological inflexibility — may be more therapeutically meaningful than cataloguing stressor type, and these constructs should inform case formulation and treatment target selection. The EmOcean prototype, grounded in CBT, ACT, and emotional schema therapy principles and co-developed with end-users, represents a potentially scalable community-based digital adjunct for stress and emotion management, though clinicians should await forthcoming efficacy trial data before routine recommendation. Future deployment should consider culturally specific adaptation processes and person-based co-design as a replicable model for developing digital mental health tools in under-resourced or non-English-speaking populations.