Aha! Moments During Brief Digital Mental Health Interventions: A Mixed Methods Study of Randomized Controlled Trials

Background: The demand for scalable interventions to address loneliness and other mental health challenges is high. Digital single-session interventions (SSIs) have shown promise to radically increase access to evidence-based mental health support. However, the average effects of existing SSIs on mental health problems are small. One approach to improving SSI design is to understand users’ experiences—specifically, their reports of which parts of SSIs elicit “Aha! moments.” Although Aha! moments are frequently posited to be an important mechanism for change in psychotherapy, their potential to spark lasting change has not been empirically tested. Accordingly, this mixed-methods investigation includes 1) a qualitative thematic analysis of participant-reported Aha! moments and 2) a quantitative analysis of Aha! moments’ importance as predictors of intervention satisfaction and lasting change in loneliness. Method: This pre-registered mixed-methods study leveraged data from two randomized controlled trials (total n = 693) testing a digital, self-guided SSI focused on decreasing loneliness. 261 of these participants reported experiencing an Aha! moment during the SSI, and 188 (ages 18-73) provided qualitative responses describing what part of the intervention caused their Aha! moment. Qualitative responses were extracted for three coders to complete a thematic analysis. Results: Participants who received an SSI were more likely to endorse Aha! moments than participants in a control condition (p < .01). 11 themes emerged from participants’ self-identified Aha! moments during SSIs which were subcategorized. Of the intervention content codes, cognitive restructuring (N = 60, 31.91%) was the most frequently endorsed. Of the personal user experience codes, validation (N = 17; 9.04%) and self-reflection (N = 17; 9.04%) were most frequently endorsed. In both trials, Aha! moments were strongly associated with intervention satisfaction (ps < 0.01). In one trial, but not the other, participants who endorsed Aha! moments showed larger 8-week reductions in loneliness than those who did not (p[trial 1] = .23, p[trial 2] < .01). Conclusions: Participant-reported Aha! moments may be valuable for informing brief intervention design. Future work developing SSIs for loneliness may benefit from focusing on cognitive restructuring, exposure, and social skills training.