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Fernández-Buendía S, Cuijpers P, Grimaldos J, Díaz-García A, Palau-Batet M, Quero S. A blended intervention for adjustment disorder: Study protocol for a feasibility trial. Internet Interv 2024; 35:100715. [PMID: 38313142 PMCID: PMC10837064 DOI: 10.1016/j.invent.2024.100715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 02/06/2024] Open
Abstract
Introduction Adjustment disorder (AjD) is a maladaptive response to one or more psychosocial stressors. In many cases, the symptomatology of this disorder disappears once the stressor or its consequences are no longer present. However, in some cases, if left untreated, the symptoms may worsen and develop into a more severe mental disorder. In this regard, different authors propose that a low-intensity intervention may be suitable for this disorder. Previous studies with other mental disorders and with patients with AjD found that blended interventions can be a viable and effective option. The aim of this study is to analyze the feasibility (the participants' expectations and preferences, the satisfaction and acceptance, the appropriateness of different methods of recruitment and data collection, and the reasons for dropping out) of a blended cognitive-behavioral intervention (CBT) for AjD that combines the use of a self-applied Internet-based program with videoconference sessions with a therapist. As a secondary objective, the potential efficacy of this intervention will be tested. Method and analysis A feasibility trial with a single-group and open-trial design will be conducted. A total of 41 participants will be assigned to the single treatment group. All the participants will be assessed for eligibility and respond at four measurement points: pre-treatment, post-treatment, and 3- and 12-month follow-ups. The treatment combines the use of an Internet-based intervention through a web platform with videoconference sessions with a therapist every 10-12 days. The intervention contains seven modules and is based on CBT. The main outcome measures are related to the feasibility of the intervention (adherence, treatment satisfaction and expectations, participants' opinions, preferences, therapeutic alliance, and usability). Clinical measures will also be assessed. Discussion To the best of our knowledge, this is the first study to test a blended intervention for AjD in the Spanish language. We expect this intervention to be feasible, and that a future Randomized Controlled Trial will be able to show its efficacy. Potential limitations include difficulties in recruiting the sample, failures in the computer systems, or a high dropout rate. Measures have been taken to try to reduce the impact of these limitations. This study received the approval of the Ethics committee of Universitat Jaume I in March 2022 (CD/42/2022). Trial registration ClinicalTrials.gov Identifier: NCT05464121. Registered 19 July 2022, https://clinicaltrials.gov/ct2/show/NCT05464121.
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Affiliation(s)
- Sara Fernández-Buendía
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Jorge Grimaldos
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Amanda Díaz-García
- Department of Psychology and Sociology, Universidad de Zaragoza (Campus de Teruel), Teruel, Spain
| | - María Palau-Batet
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Soledad Quero
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Madrid, Spain
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Fernández-Buendía S, Miguel C, Dumarkaite A, Kazlauskas E, Cuijpers P, Quero S. Technology-supported treatments for adjustment disorder: A systematic review and preliminary meta-analysis. J Affect Disord 2024; 347:29-38. [PMID: 37992766 DOI: 10.1016/j.jad.2023.11.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 10/21/2023] [Accepted: 11/17/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND The use of technology in psychological treatments can bring evidence-based interventions closer to more people using fewer resources. The aim of this systematic review and preliminary meta-analysis was to summarize all the available information about technology-supported psychological treatments for Adjustment Disorder (AjD) patients of all ages. METHOD Eligibility criteria included studies that tested a technology-supported treatment in patients with AjD and reported data on a mental health outcome. Case studies and case series were excluded. Searches were conducted in the PubMed, Web of Science, Scopus, and PsycINFO databases. Study quality was assessed using the Cochrane RoB 2.0. tool for Randomized Controlled Trials (RCTs) and the NHLBI tool for pre-post studies. RESULTS Nine articles (8 RCTs and 1 pre-post study) were included, eight that tested computerised interventions and two that used virtual reality. The meta-analysis showed the superior efficacy of the intervention groups compared to control conditions in reducing mental health symptomatology and a significant improvement between pre- and post-treatment. LIMITATIONS The small number of studies included and the high heterogeneity among them were two of the main limitations. CONCLUSIONS These results are similar to those observed in previous systematic reviews on technology-supported treatments for other mental disorders and suggest that these interventions could be effective for patients with AjD. However, further research is needed to determine the advantages and disadvantages of these interventions for the treatment of AjD in different age populations such as children, adolescents or older adults, as well as effective means for improving treatment retention.
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Affiliation(s)
- Sara Fernández-Buendía
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain.
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands.
| | - Austeja Dumarkaite
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Evaldas Kazlauskas
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania.
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands.
| | - Soledad Quero
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain.
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Valla L, Haga SM, Garthus-Niegel S, Drozd F. Dropout or Drop-In Experiences in an Internet-Delivered Intervention to Prevent Depression and Enhance Subjective Well-Being During the Perinatal Period: Qualitative Study. JMIR Pediatr Parent 2023; 6:e46982. [PMID: 38153796 PMCID: PMC10766164 DOI: 10.2196/46982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 10/24/2023] [Accepted: 11/06/2023] [Indexed: 12/30/2023] Open
Abstract
Background The perinatal period is a vulnerable time when women are at increased risk of depression. "Mamma Mia" is a universal preventive internet-delivered intervention offered to pregnant women, with the primary goals of preventing the onset or worsening of depression and enhancing subjective well-being during the perinatal period. However, treatment dropout from internet-delivered interventions is often reported. Objective The study aim was to acquire an understanding of the different experiences among participants who dropped out of the Mamma Mia intervention during pregnancy, compared to participants who dropped out during the postpartum follow-up phase. Methods A total of 16 women from a larger randomized controlled trial (Mamma Mia) participated in individual semistructured interviews following a strengths, weaknesses, opportunities, and threats format. Of the 16 participants included, 8 (50%) women dropped out early from the intervention during pregnancy (pregnancy group), whereas 8 (50%) women dropped out later, after giving birth (postpartum follow-up group). Data were analyzed using the framework approach. Results The results showed that there were differences between the groups. In general, more participants in the postpartum follow-up group reported that the program was user-friendly. They became more aware of their own thoughts and feelings and perceived that the program had provided them with more new knowledge and practical information than participants in the pregnancy group. Participants in both groups suggested several opportunities for improving the program. Conclusions There were differences between women who dropped out of the intervention during pregnancy and the postpartum follow-up phase. The reported differences between groups should be further examined.
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Affiliation(s)
- Lisbeth Valla
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Silje Marie Haga
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Susan Garthus-Niegel
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
- Institute for Systems Medicine and Faculty of Medicine, Medical School Hamburg, Hamburg, Germany
| | - Filip Drozd
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
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Fowler JA, Buckley L, Muir M, Viskovich S, Paradisis C, Zanganeh P, Dean JA. Digital mental health interventions: A narrative review of what is important from the perspective of LGBTQIA+ people. J Clin Psychol 2023; 79:2685-2713. [PMID: 37528773 DOI: 10.1002/jclp.23571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/19/2023] [Accepted: 07/15/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVES Digital mental health interventions are a promising therapeutic modality to provide psychological support to LGBTQIA+ (lesbian, gay, bisexual, trans, Queer, intersex, asexual, plus other gender, sexual, and romantic minority identities) people. The aim of this narrative review is to explore how the LGBTQIA+ community has been engaged in the design of digital mental health interventions, how content has been tailored to the LGBTQIA+ community, and features identified as important by LGBTQIA+ participants. METHODS A total of 33 studies were included in this review from a larger yield of 1933 identified from systematic searches of five databases (PsycINFO, PubMed, Scopus, CINAHAL, and Medline). Data were analyzed narratively and using content analysis. RESULTS Only half of the studies reported engaging the LGBTQIA+ community in intervention designs. Interventions have been tailored in a variety of ways to support LGBTQIA+ individuals-such as through affirming imagery, recruitment through LGBTQIA+ networks, and designing content to focus specifically on LGBTQIA+ issues. A range of features were identified as important for participants, namely how content was tailored to LGBTQIA+ experiences, providing connection to community, and links to other relevant LGBTQIA+ resources. While not a primary aim, results also showed that a wide range of digital modalities can significantly improve a range of mental health problems. CONCLUSION Digital interventions are an acceptable and effective form of therapeutic intervention, but future research needs to focus on meaningful engagement of community members to inform design and implementation.
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Affiliation(s)
- James A Fowler
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lisa Buckley
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Miranda Muir
- Faculty of Health and Behavioral Sciences, School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Shelley Viskovich
- Faculty of Health and Behavioral Sciences, School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Chris Paradisis
- Faculty of Health and Behavioral Sciences, School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Parnian Zanganeh
- Faculty of Health and Behavioral Sciences, School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Judith A Dean
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Queensland, Australia
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de la Rosa-Gómez A, Hernández Posadas A, Valencia PD, Flores-Plata LA, Serrano Zárate B, Flores Elvira AI, Dominguez-Rodriguez A, Vázquez Sánchez MF, González Santiago E. Online transdiagnostic intervention for emotional, trauma- and stressor-related disorders in the Mexican population: A randomized pilot and feasibility trial. Contemp Clin Trials Commun 2023; 35:101204. [PMID: 37691848 PMCID: PMC10482736 DOI: 10.1016/j.conctc.2023.101204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/14/2023] [Accepted: 08/20/2023] [Indexed: 09/12/2023] Open
Abstract
•Mexican individuals received via telehealth the unified protocol for anxiety, depression, and trauma related disorders.•Online unified protocol reduced depression, anxiety, emotional issues, uncertainty intolerance, and psychological distress.•The transdiagnostic unified protocol is well-suited to train therapists for emotional, trauma, and stressor-related disorders.
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Affiliation(s)
| | | | - Pablo D. Valencia
- Faculty of Higher Studies Iztacala, National Autonomous University of Mexico, Mexico
| | | | - Berenice Serrano Zárate
- Faculty of Health Sciences, Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Spain
| | | | - Alejandro Dominguez-Rodriguez
- Faculty of Behavioural, Management, and Social Sciences, Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands
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Sørensen CW, Sonne C, Sacha M, Kristiansen M, Hannemose SZ, Stein DJ, Carlsson J. Potential advantages of combining randomized controlled trials with qualitative research in mood and anxiety disorders - A systematic review. J Affect Disord 2023; 325:701-712. [PMID: 36642313 DOI: 10.1016/j.jad.2023.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Most randomized controlled trials (RCTs) of mood and anxiety disorders employ solely quantitative methods. Supplementing quantitative data with qualitative methods, a so-called mixed-method approach, would seem useful, however this area has not been rigorously reviewed. We undertook a systematic review of RCTs of mood and anxiety disorders that employed concurrent quantitative data collection and qualitative methods exploring the participants' perspective, with the aim of 1. determining the number of such studies, 2. describing study characteristics, and 3. identifying potential advantages of a mixed-method approach. METHODS Following PRISMA guidelines, a systematic literature search for RCTs of mood and anxiety disorders, concurrently applying quantitative and qualitative methods, was conducted using EMBASE, PsycINFO and Pubmed, from their inception to February 2021. Categories of potential advantages of this mixed method approach were developed. RESULTS A total of 45 RCTs were included. The qualitative components typically included 10-40 participants, mostly consisting of interviews after the intervention. The majority of papers did not state a specific rationale for using a mixed method approach. Four categories of advantages emerged: 1. determine acceptability/feasibility, 2. investigate efficacy, 3. inform implementation in clinical practice and 4. generate new hypotheses based on the combination of quantitative and qualitative data. LIMITATIONS Lack of cross-referencing and consistent terminology challenged identification of relevant publications. CONCLUSION There are a number of potential advantages of applying mixed method approaches in RCTs within psychiatric research. Intentional consideration of such advantages early in trial design may increase the likelihood of gaining added value.
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Affiliation(s)
- Carina Winkler Sørensen
- The Mental Health Services of the Capital Region of Denmark, Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Copenhagen, Denmark; Mental Health Centre Copenhagen, Denmark.
| | - Charlotte Sonne
- The Mental Health Services of the Capital Region of Denmark, Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Copenhagen, Denmark
| | - Maria Sacha
- The Mental Health Services of the Capital Region of Denmark, Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Copenhagen, Denmark
| | - Maria Kristiansen
- Department of Public Health & Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sigrid Zeuthen Hannemose
- The Mental Health Services of the Capital Region of Denmark, Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Copenhagen, Denmark
| | - Dan J Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry, South Africa; Neuroscience Institute, University of Cape Town, South Africa
| | - Jessica Carlsson
- The Mental Health Services of the Capital Region of Denmark, Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Dominguez-Rodriguez A, Martínez-Arriaga RJ, Herdoiza-Arroyo PE, Bautista-Valerio E, de la Rosa-Gómez A, Castellanos Vargas RO, Lacomba-Trejo L, Mateu-Mollá J, Lupercio Ramírez MDJ, Figueroa González JA, Ramírez Martínez FR. E-Health Psychological Intervention for COVID-19 Healthcare Workers: Protocol for its Implementation and Evaluation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912749. [PMID: 36232049 PMCID: PMC9566813 DOI: 10.3390/ijerph191912749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/24/2022] [Accepted: 09/30/2022] [Indexed: 05/13/2023]
Abstract
(1) Background: Healthcare workers have been affected by the COVID-19 pandemic. Digital interventions have been carried out that have been effective with this population; however, few have been reported in Latin America. Our aim is to describe the components and methods to evaluate the feasibility and utility of an online multi-component psychological intervention for healthcare workers in Mexico during COVID-19. (2) Methods: This study is a randomized clinical trial with two arms: (1) self-applied intervention and (2) intervention delivered online by therapists. The participants are randomly assigned to one arm, receiving the same treatment contents in both groups. The "Personal COVID" intervention consists of an internet platform containing 9 nuclear and 3 complementary modules. The objectives of the intervention are: (1) to reduce anxiety, depressive symptoms, burnout, and compassion fatigue, and (2) to increase the quality of life, sleep quality, self-care, and their skills to give bad news. The protocol has been registered on ClinicalTrials.gov (identifier: NCT04890665). (3) Discussion: This protocol is designed according to the highest scientific standards following the SPIRIT guidelines. The "Personal COVID" intervention is expected to be of high efficacy in treating the emotional distress of healthcare workers and promoting their health during the COVID-19 pandemic.
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Affiliation(s)
| | - Reyna Jazmín Martínez-Arriaga
- Departamento de Clínicas de Salud Mental, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
- Correspondence: ; Tel.: +52-3310585200
| | | | - Eduardo Bautista-Valerio
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Mexico City 54090, Mexico
| | - Anabel de la Rosa-Gómez
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Mexico City 54090, Mexico
| | | | - Laura Lacomba-Trejo
- Department of Personality, Evaluation and Psychological Treatment, Universitat de València, 46010 Valencia, Spain
| | - Joaquín Mateu-Mollá
- Health Sciences Area, Valencian International University, 46002 Valencia, Spain
| | - Miriam de Jesús Lupercio Ramírez
- Maestría en Psicología de la Salud, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco 44340, Mexico
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Gatto AJ, Elliott TJ, Briganti JS, Stamper MJ, Porter ND, Brown AM, Harden SM, Cooper LD, Dunsmore JC. Development and Feasibility of an Online Brief Emotion Regulation Training (BERT) Program for Emerging Adults. Front Public Health 2022; 10:858370. [PMID: 35757621 PMCID: PMC9226550 DOI: 10.3389/fpubh.2022.858370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Mental wellness is a critical component of healthy development in emerging adulthood and serves to protect against stress and promote resilience against psychopathology. Emotion regulation is a key mechanism for effective prevention because of its role in socio-emotional competence and its transdiagnostic significance for psychopathology. In this feasibility study, a brief, time and cost-effective emotion regulation training program for emerging adults (BERT) was developed and tested using the RE-AIM framework. Importantly, building interventions within the context of an implementation framework, such as the RE-AIM framework, enhances the chances that an intervention will be able to scale out and scale up. First, the brainwriting premortem method was utilized to refine program content, conducting focus groups a priori to identify potential program failures prior to program implementation. Undergraduate students (n = 12) attended four focus groups presenting initial program content. Four clinicians were also interviewed to determine program barriers. Qualitative analyses aggregated participant feedback to identify compliments, changes, and concerns about BERT and critical feedback was immediately implemented prior to initial testing. BERT was rooted in cognitive-behavioral practices and informed by the Gross model of emotion regulation. The 5-week program was then examined in a college sample (N = 42) to evaluate implementation (low attrition, high content engagement, favorable attitudes, low incidence of technical errors, costs), reach (enrollment and completion demographics comparable to the population in which recruitment took place), and efficacy (positive change in emotion regulation pre- to post-program). Of the recruited participants, 36 remained in the study where 27 completed at least 80% of program content. Repeated-measures ANOVAs exhibited significant improvements in emotion regulation, psychological distress, and negative affectivity, suggesting promising initial efficacy. Initial data provide support for feasibility and a future randomized control trial. BERT has potential significance for promoting healthy development as its brief electronic format reduced barriers and the program development process incorporated stakeholder feedback at multiple levels to inform better implementation and dissemination.
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Affiliation(s)
- Alyssa Jo Gatto
- Department of Psychology, Virginia Tech, Blacksburg, VA, United States
| | | | | | | | - Nathaniel D. Porter
- University Libraries, Virginia Tech, Blacksburg, VA, United States
- Department of Sociology, Virginia Tech, Blacksburg, VA, United States
| | - Anne M. Brown
- University Libraries, Virginia Tech, Blacksburg, VA, United States
| | - Samantha M. Harden
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, United States
| | - Lee D. Cooper
- Department of Psychology, Virginia Tech, Blacksburg, VA, United States
| | - Julie C. Dunsmore
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX, United States
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Huynh AT, Gaboury I, Provencher MD, Norton PJ, Roberge P. Patient acceptability of group transdiagnostic cognitive behavior therapy for the treatment of anxiety disorders in community-based care: a qualitative study. CLIN PSYCHOL-UK 2022. [DOI: 10.1080/13284207.2022.2041363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Ai-Thuy Huynh
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Canada
| | - Isabelle Gaboury
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Canada
| | | | | | - Pasquale Roberge
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Canada
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Khetarpal SK, Auster LS, Miller E, Goldstein TR. Transition age youth mental health: addressing the gap with telemedicine. Child Adolesc Psychiatry Ment Health 2022; 16:8. [PMID: 35109881 PMCID: PMC8809232 DOI: 10.1186/s13034-022-00444-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/24/2022] [Indexed: 02/02/2023] Open
Abstract
Transition age youth (TAY), a demographic spanning ages 15-26, navigate a myriad of developmental transitions, ranging from identity formation and intimate relationships to substance use. Unfortunately, many young adults continue to have a dearth of mental health services and programing tailored to their unique developmental needs. Moreover, the systems of care in place are generally designed for treating traditional pediatric and adult patients but not ideally suited to meet the needs of TAY. Given the additional stressors from the COVID-19 pandemic, TAY are now, more than ever, in need of routine mental health care. We posit that the rapid expansion of telemedicine programming developed in response to the pandemic could be beneficial in mitigating this historic gap in care. In this commentary, we call on mental health providers and researchers to expand and invest in the growing number of telemedicine interventions and programming for this population so that TAY can begin to receive the care they so desperately need.
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Affiliation(s)
- Susheel K. Khetarpal
- grid.21925.3d0000 0004 1936 9000University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15213 USA
| | - Lauren S. Auster
- grid.266102.10000 0001 2297 6811Department of Psychiatry, University of California San Francisco, San Francisco, CA USA
| | - Elizabeth Miller
- grid.21925.3d0000 0004 1936 9000University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15213 USA ,grid.239553.b0000 0000 9753 0008Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA USA
| | - Tina R. Goldstein
- grid.21925.3d0000 0004 1936 9000University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15213 USA ,Department of Psychiatry, Western Psychiatric Hospital, Pittsburgh, PA USA
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Westerberg B, Bäärnhielm S, Giles C, Hylén U, Holländare F, Bejerot S. An Internet Based Intervention for Adults With Autism Spectrum Disorder-A Qualitative Study of Participants Experiences. Front Psychiatry 2021; 12:789663. [PMID: 35002808 PMCID: PMC8729877 DOI: 10.3389/fpsyt.2021.789663] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/02/2021] [Indexed: 12/01/2022] Open
Abstract
Background: Adults with autism spectrum disorder face several barriers to accessing evidence-based care, including difficulties in communicating needs, social anxiety or in traveling to a health care unit. In recent years, several forms of internet-based treatments have shown to be effective for a variety of psychiatric conditions. Internet-based treatment alternatives allow convenient and flexible formats, and therefore have the potential to increase access to health care for individuals with autism spectrum disorder. However, knowledge about how internet-based treatment features may suit the needs of individuals with autism is limited. The aim of this study was to explore the participant experiences of an internet-based intervention for adults with autism spectrum disorder. The primary focus of the investigation was on autism-specific needs in relation to the features unique to the online format. Methods: In this qualitative study, semi-structured telephone interviews were conducted with 14 participants who had completed a text-based internet-based intervention for adults with autism spectrum disorder. We used an inductive approach and analyzed the data using qualitative content analysis. Results: Five main categories were identified: (1) implications of the online format, (2) the fixed non-individualized model, (3) therapist interaction, (4) interacting with other participants, and (5) making use of the treatment content. Overall, participants appreciated the availability and that they could work on their treatment independent of time or location. Among those participating in group-based chat-sessions with the other participants, it was considered a generally positive experience. Furthermore, most participants felt safe and relaxed in relation to the therapist and appreciated the text-based format. However, several participants felt that the format and content of the treatment was not sufficiently adapted to their individual life situation. Conclusion: In conclusion, this internet-based treatment constitutes an accessible and energy-saving treatment alternative for adults with autism. Further, integrating group-based components seems feasible in an otherwise individual internet-based treatment for individuals with autism. However, group-based components do require a clear purpose and rationale. Future studies should develop and evaluate treatment adaptations tailored to individual needs.
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Affiliation(s)
- Britta Westerberg
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Sofie Bäärnhielm
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden
| | - Clover Giles
- Center for Lifespan Developmental Research, Örebro University, Örebro, Sweden
| | - Ulrika Hylén
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Fredrik Holländare
- Department of Psychiatry, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Susanne Bejerot
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Irish M, Zeiler M, Kuso S, Musiat P, Potterton R, Wagner G, Karwautz A, Waldherr K, Schmidt U. Students' perceptions of an online mental health intervention: a qualitative interview study. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2021; 35:177-186. [PMID: 33369715 DOI: 10.1007/s40211-020-00383-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/26/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND University students are at a heightened risk of developing mental health disorders. Online interventions are becoming increasingly popular in this target group, both to prevent the development of mental health disorders and to treat existing ones. The PLUS (Personality and Living of University Students) programme is a web-based targeted prevention intervention which has been tested across two European countries. Completion of this programme has been relatively poor. Understanding university students' opinions, experiences and perceptions of the PLUS programme can lead to future improvements in intervention design, engagement and dissemination. METHODS Semistructured interviews were conducted with university students from the UK (n = 10) and Austria (n = 14) who had previously had access to PLUS. Students were asked about their perception and experiences of the programme, and how it could be improved. Results were analysed using thematic analysis. RESULTS Experience of online prevention programmes in general were limited and as a result of this, few had specific expectations of the PLUS programme before signing up. The lack of guidance and accountability due to the online nature of the programme made engagement challenging for many, however, frequent reminder emails helped mitigate this. In terms of positives of the programme, participants found the flexibility suitable for students and many noticed that the programme created change in how they thought or behaved. CONCLUSION Overall, the PLUS programme was well received by students, despite study retention being poor. Although PLUS was viewed as a useful tool to integrate into the university setting, several improvements were suggested to increase engagement. By considering this feedback, uptake and intervention completion can be improved for future preventative interventions.
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Affiliation(s)
- Madeleine Irish
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Box P059, SE5 8AF, London, UK.
| | - Michael Zeiler
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Stefanie Kuso
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Ferdinand Porsche Ring 3, 2700, Wiener Neustadt, Austria
| | - Peter Musiat
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Box P059, SE5 8AF, London, UK
| | - Rachel Potterton
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Box P059, SE5 8AF, London, UK
| | - Gudrun Wagner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Andreas Karwautz
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Karin Waldherr
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Ferdinand Porsche Ring 3, 2700, Wiener Neustadt, Austria
| | - Ulrike Schmidt
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Box P059, SE5 8AF, London, UK
- South London and Maudsley NHS Foundation Trust, SE5 8AZ, Camberwell, London, UK
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13
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Lawler K, Earley C, Timulak L, Enrique A, Richards D. Dropout From an Internet-Delivered Cognitive Behavioral Therapy Intervention for Adults With Depression and Anxiety: Qualitative Study. JMIR Form Res 2021; 5:e26221. [PMID: 34766909 PMCID: PMC8663602 DOI: 10.2196/26221] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/16/2021] [Accepted: 08/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Treatment dropout continues to be reported from internet-delivered cognitive behavioral therapy (iCBT) interventions, and lower completion rates are generally associated with lower treatment effect sizes. However, evidence is emerging to suggest that completion of a predefined number of modules is not always necessary for clinical benefit or consideration of the needs of each individual patient. OBJECTIVE The aim of this study is to perform a qualitative analysis of patients' experiences with an iCBT intervention in a routine care setting to achieve a deeper insight into the phenomenon of dropout. METHODS A total of 15 purposively sampled participants (female: 8/15, 53%) from a larger parent randomized controlled trial were interviewed via telephone using a semistructured interview schedule that was developed based on the existing literature and research on dropout in iCBT. Data were analyzed using a descriptive-interpretive approach. RESULTS The experience of treatment leading to dropout can be understood in terms of 10 domains: relationship to technology, motivation to start, background knowledge and attitudes toward iCBT, perceived change in motivation, usage of the program, changes due to the intervention, engagement with content, experience interacting with the supporter, experience of web-based communication, and termination of the supported period. CONCLUSIONS Patients who drop out of treatment can be distinguished in terms of their change in motivation: those who felt ready to leave treatment early and those who had negative reasons for dropping out. These 2 groups of participants have different treatment experiences, revealing the potential attributes and nonattributes of dropout. The reported between-group differences should be examined further to consider those attributes that are strongly descriptive of the experience and regarded less important than those that have become loosely affiliated.
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Affiliation(s)
- Kate Lawler
- E-Mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland.,Clinical Research and Innovation, SilverCloud Health, Dublin, Ireland
| | - Caroline Earley
- E-Mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland.,Clinical Research and Innovation, SilverCloud Health, Dublin, Ireland
| | - Ladislav Timulak
- E-Mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Angel Enrique
- E-Mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland.,Clinical Research and Innovation, SilverCloud Health, Dublin, Ireland
| | - Derek Richards
- E-Mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland.,Clinical Research and Innovation, SilverCloud Health, Dublin, Ireland
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Balaskas A, Schueller SM, Cox AL, Doherty G. The Functionality of Mobile Apps for Anxiety: Systematic Search and Analysis of Engagement and Tailoring Features. JMIR Mhealth Uhealth 2021; 9:e26712. [PMID: 34612833 PMCID: PMC8529472 DOI: 10.2196/26712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/02/2021] [Accepted: 07/15/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND A range of mobile apps for anxiety have been developed in response to the high prevalence of anxiety disorders. Although the number of publicly available apps for anxiety is increasing, attrition rates among mobile apps are high. These apps must be engaging and relevant to end users to be effective; thus, engagement features and the ability to tailor delivery to the needs of individual users are key. However, our understanding of the functionality of these apps concerning engagement and tailoring features is limited. OBJECTIVE The aim of this study is to review how cognitive behavioral elements are delivered by anxiety apps and their functionalities to support user engagement and tailoring based on user needs. METHODS A systematic search for anxiety apps described as being based on cognitive behavioral therapy (CBT) was conducted on Android and iPhone marketplaces. Apps were included if they mentioned the use of CBT for anxiety-related disorders. We identified 597 apps, of which 36 met the inclusion criteria and were reviewed through direct use. RESULTS Cognitive behavioral apps for anxiety incorporate a variety of functionalities, offer several engagement features, and integrate low-intensity CBT exercises. However, the provision of features to support engagement is highly uneven, and support is provided only for low-intensity CBT treatment. Cognitive behavioral elements combine various modalities to deliver intervention content and support the interactive delivery of these elements. Options for personalization are limited and restricted to goal selection upon beginning use or based on self-monitoring entries. Apps do not appear to provide individualized content to users based on their input. CONCLUSIONS Engagement and tailoring features can be significantly expanded in existing apps, which make limited use of social features and clinical support and do not use sophisticated features such as personalization based on sensor data. To guide the evolution of these interventions, further research is needed to explore the effectiveness of different types of engagement features and approaches to tailoring therapeutic content.
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Affiliation(s)
- Andreas Balaskas
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Stephen M Schueller
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States.,Department of Informatics, University of California, Irvine, Irvine, CA, United States
| | - Anna L Cox
- UCL Interaction Centre, University College London, London, United Kingdom
| | - Gavin Doherty
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
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15
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Nordby ES, Kenter RM, Lundervold AJ, Nordgreen T. A self-guided Internet-delivered intervention for adults with ADHD: A feasibility study. Internet Interv 2021; 25:100416. [PMID: 34401375 PMCID: PMC8350603 DOI: 10.1016/j.invent.2021.100416] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 06/03/2021] [Accepted: 06/11/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder that tends to persist into adulthood. Many adults with ADHD seek non-pharmacological treatment in addition to pharmacological treatment. Still, there are few non-pharmacological treatment options available. The aim of the current study was to explore the feasibility of a self-guided Internet-delivered intervention for adults with ADHD. METHODS The study has an uncontrolled, within-group, pre-post design. Thirteen participants with an ADHD diagnosis were included and given access to the first three modules of a seven-module intervention. To explore the feasibility of the intervention, the adherence, credibility, and treatment satisfaction were examined. Preliminary efficacy of the intervention was examined through self-report measures of inattention, hyperactivity, depression, anxiety, stress, and quality of life. RESULTS In terms of adherence, seven participants (54%) completed all three intervention modules (M = 1.85, SD = 1.3). The participants reported both good credibility and treatment satisfaction with the intervention. The participants also reported challenges related to usability and technical issues. Although the clinical outcomes must be interpreted with caution due to the study design and the small sample size, a statistically significant reduction in severity of inattention was reported by the participants following the intervention (p = .006, d = 1.57). The reduction was non-significant for hyperactivity (p = .326, d = 0.33). The participants who completed all three modules in the intervention (n = 7) also reported a significant decrease in stress (p = .042, d = 0.67) and a significant increase in quality of life (p = .016, d = 0.99). No significant changes were found on measures of anxiety and depression. CONCLUSION The adherence to the intervention was relatively low, but the participants who completed the study reported good credibility and satisfaction with the intervention. These results indicate that there is a need to improve the intervention to make it more engaging before conducting a randomized-controlled trial investigating the clinical effects of the full seven-module intervention.
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Affiliation(s)
- Emilie S. Nordby
- Division of Psychiatry, Haukeland University Hospital, Haukelandsbakken 15, 5009 Bergen, Norway
| | - Robin M.F. Kenter
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Christies gate 12, 5015 Bergen, Norway
| | - Astri J. Lundervold
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Jonas Lies vei 91, 5009 Bergen, Norway
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Haukelandsbakken 15, 5009 Bergen, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Årstadveien 17, Block D, 5009 Bergen
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16
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Behandlungsschwierigkeiten bei geleiteter Online-Therapie. PSYCHOTHERAPEUT 2021. [DOI: 10.1007/s00278-021-00522-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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González-Robles A, Suso-Ribera C, Díaz-García A, García-Palacios A, Castilla D, Botella C. Predicting response to transdiagnostic iCBT for emotional disorders from patient and therapist involvement. Internet Interv 2021; 25:100420. [PMID: 34401379 PMCID: PMC8350608 DOI: 10.1016/j.invent.2021.100420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Transdiagnostic iCBT has been shown to be effective for the treatment of emotional disorders. Less is known about the optimal level of therapist and patient involvement in these interventions. Specific characteristics of Internet-delivered interventions include treatment adherence (e.g., amount of review of the materials) and guidance (e.g., amount of therapist support). Exploring the importance of these elements in treatment outcome may help to maximize the efficiency of Internet-delivered psychological interventions. AIM In this study, we aimed to analyze the relationship between patient and therapist involvement (i.e., platform usage and amount of therapist guidance) in a sample of patients with emotional disorders who received transdiagnostic iCBT in Spanish public specialized mental healthcare services. METHOD This is a secondary analysis of a randomized controlled trial. The sample included 63 patients who completed transdiagnostic iCBT for emotional disorders. Platform usage metrics included number of logins into the platform and number of times the participants reviewed the modules. Therapist guidance was measured as the number of support phone calls with a therapist and their total duration (minutes). Logistic regressions and ROC analyses were performed to explore the predictive value of platform usage and therapist guidance in symptom reduction. Clinical outcomes included depressive and anxiety symptoms assessed at baseline and post-intervention. The bivariate relationship between the platform usage and therapist guidance variables was also explored. RESULTS Overall, platform usage and therapist guidance were not associated with symptom improvement. However, the patient and therapist involvement parameters were intercorrelated. Specifically, the number of calls and their duration were associated with a greater number of logins (r = 0.61; p < .001) and more frequent reviews of the modules (0.46 ≤ r ≤ 0.60; p < .001). Higher baseline depression and anxiety were, respectively, associated with greater improvements in depression (r = -0.37, p = .003) and anxiety after treatment completion (r = -0.48, p < .001). DISCUSSION The results suggest that there is no reliable cut-off point for platform usage and therapist guidance in predicting optimal symptom reduction. However, significant associations were found between platform usage and guidance variables that warrant additional research. More research on this topic is necessary to further clarify the role of these and other platform usage and guidance variables in Internet-delivered iCBT outcomes.
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Affiliation(s)
- Alberto González-Robles
- Department of Psychology and Sociology, Universidad de Zaragoza (Campus de Teruel), Teruel, Spain
- Corresponding author at: C/ Ciudad Escolar, s/n, 44001 Teruel, Spain.
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
| | - Amanda Díaz-García
- Department of Psychology and Sociology, Universidad de Zaragoza (Campus de Teruel), Teruel, Spain
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Diana Castilla
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Cristina Botella
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
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Biliunaite I, Dumarkaite A, Kazlauskas E, Sanderman R, Andersson G. ICBT program for improving informal caregiver well-being: A qualitative study. Internet Interv 2021; 23:100361. [PMID: 33489781 PMCID: PMC7811118 DOI: 10.1016/j.invent.2021.100361] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Informal caregivers represent an important and vulnerable part of the society. They can experience negative psychological symptoms, such as depression and anxiety. Internet-based cognitive behavioural therapy (ICBT) is a promising psychological support option that could be effective in reducing informal caregiver burden as well as improving psychological well-being. Qualitative studies are valuable for gaining insights into participant experiences of using ICBT. OBJECTIVE The main aim of this study was to explore informal caregiver experiences and hence acceptability and feasibility of the transdiagnostic ICBT program aimed at reducing informal caregiver burden and increasing the quality of life. METHODS Following a strategic sampling procedure, 23 informal caregivers were recruited from previous randomized controlled trial for informal caregivers in Lithuania. Participants were interviewed over phone, using semi-structured interview questions. Interviews were analysed using a thematic analysis approach. RESULTS Four themes and a total of 10 sub-themes were generated: I A program as a means of change (Convenience and applicability of the format and materials; Ability to focus on own needs; Opportunity for communication), II Suggestions for the program (Including live support; Tailoring materials and format; Providing with more time and resources), III Driving personal and situational forces (Developing acceptance and adjustment over time; Being proactive and/or receiving support) and Hindering situational factors (Deterioration and unpredictability of the care-receivers health; Lacking external support and opportunities for respite). CONCLUSIONS Most of the informal caregivers were found to be satisfied with the program's format and materials as well as the communication with the therapist via a message function in the program. Some suggestions were made regarding implementation of the live support option. Also, suggestions regarding possibility for tailoring the program's content. Lastly, several personal and situational factors were identified as important in affecting informal caregiver well-being. We conclude that ICBT has potential in reducing informal caregiver burden and improving psychological health. Further research trials are warranted for evaluating both, the effectiveness and the feasibility of the program.
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Affiliation(s)
- Ieva Biliunaite
- Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Campus Valla, SE-581 83 Linköping, Sweden
| | - Austeja Dumarkaite
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, 03100 Vilnius, Lithuania
| | - Evaldas Kazlauskas
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, 03100 Vilnius, Lithuania
| | - Robbert Sanderman
- Faculty of Behavioural and Social Sciences, University of Groningen, 9700 AB Groningen, the Netherlands
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Campus Valla, SE-581 83 Linköping, Sweden
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Díaz-García A, González-Robles A, García-Palacios A, Fernández-Felipe I, Tur C, Castilla D, Botella C. Blended transdiagnostic group CBT for emotional disorders: A feasibility trial protocol. Internet Interv 2021; 23:100363. [PMID: 33520670 PMCID: PMC7820549 DOI: 10.1016/j.invent.2021.100363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/21/2020] [Accepted: 12/29/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Emotional disorders (anxiety and depressive disorders) are a relevant public health concern associated with high prevalence, high costs, and important disability. Therefore, research priorities include designing and testing cost-effective interventions to reach everyone in need. Internet-delivered interventions for emotional disorders are effective and can help to disseminate and implement evidence-based treatments. However, although these treatments are generally effective, not all patients benefit from this treatment format equally. Blended treatments are a new form of intervention that combines the strengths of face-to-face and Internet approaches. Nevertheless, research on blended interventions has focused primarily on individual therapy, and less attention has been paid to the potential of using this format in group psychotherapy. This study aims to analyze the feasibility of blended transdiagnostic group CBT for emotional disorders. The current article describes the study protocol for this trial. METHOD AND ANALYSIS A one-armed pilot trial will be conducted. Participants will be 30 adults suffering from DSM-5 anxiety and/or depressive disorders. The treatment consists of a blended transdiagnostic group intervention delivered during a period of 24 weeks. Groups of 6 to 10 patients will attend a total of eight 2-hour, face-to-face sessions, alternated with the use of an online platform where they will find the contents of the treatment protocol. The intervention has four core components: present-focused awareness, cognitive flexibility, identification and modification of behavioral and cognitive patterns of emotional avoidance, and interoceptive and situational exposure. These components are delivered in 16 modules. Assessments will be performed at baseline, during the treatment, at post-treatment, and at 3-month follow-up. Clinical and treatment acceptability outcomes will be included. Quantitative and qualitative data (participants' views about blended group psychotherapy) will be analyzed. ETHICS AND DISSEMINATION The trial has received ethical approval from the Ethics Committee of Universitat Jaume I (September 2019) and will be conducted in accordance with the study protocol, the Declaration of Helsinki, and good clinical practice. The results of this study will be disseminated by presentation at conferences and will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04008576. Registered 05 July 2019, https://clinicaltrials.gov/ct2/show/NCT04008576.
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Affiliation(s)
- Amanda Díaz-García
- Department of Psychology and Sociology, Universidad de Zaragoza (Campus de Teruel), Teruel, Spain
| | - Alberto González-Robles
- Department of Psychology and Sociology, Universidad de Zaragoza (Campus de Teruel), Teruel, Spain
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Isabel Fernández-Felipe
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
| | - Cintia Tur
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
| | - Diana Castilla
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Cristina Botella
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
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Di Consiglio M, Fabrizi G, Conversi D, La Torre G, Pascucci T, Lombardo C, Violani C, Couyoumdjian A. Effectiveness of NoiBene: A Web-based programme to promote psychological well-being and prevent psychological distress in university students. Appl Psychol Health Well Being 2021; 13:317-340. [PMID: 33595198 DOI: 10.1111/aphw.12251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022]
Abstract
Mental health problems are very common among university students. NoiBene is an evidence-based intervention for the promotion of well-being and the prevention of psychological distress among university students. NoiBene was tested in two studies. In study 1, a randomized controlled pilot trial was conducted to investigate the efficacy of NoiBene on students' well-being, emotional awareness, emotion regulation and assertiveness. The degree of satisfaction with the intervention was also investigated. Students (n = 24) were assigned to either the NoiBene programme or a control condition. In study 2, to confirm the usefulness of NoiBene, we analysed data from the current use of NoiBene (n = 178). The effectiveness of NoiBene on transdiagnostic mechanisms (perfectionism, repetitive thinking and experiential avoidance) was also investigated. In study 1, NoiBene improved self-acceptance and increased the ability to identify feelings. Students reported a good level of perceived usefulness. In study 2, the results confirmed findings from the first study and suggested that NoiBene can improve emotional awareness and decrease transdiagnostic mechanisms. NoiBene is a promising tool that can improve students' psychological well-being. More control studies are mandatory.
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Affiliation(s)
| | - Gloria Fabrizi
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - David Conversi
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Tiziana Pascucci
- Department of Psychology, Sapienza University of Rome, Rome, Italy
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Karin E, Crane MF, Dear BF, Nielssen O, Heller GZ, Kayrouz R, Titov N. Predictors, Outcomes, and Statistical Solutions of Missing Cases in Web-Based Psychotherapy: Methodological Replication and Elaboration Study. JMIR Ment Health 2021; 8:e22700. [PMID: 33544080 PMCID: PMC7895640 DOI: 10.2196/22700] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/09/2020] [Accepted: 12/13/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Missing cases present a challenge to our ability to evaluate the effects of web-based psychotherapy trials. As missing cases are often lost to follow-up, less is known about their characteristics, their likely clinical outcomes, or the likely effect of the treatment being trialed. OBJECTIVE The aim of this study is to explore the characteristics of missing cases, their likely treatment outcomes, and the ability of different statistical models to approximate missing posttreatment data. METHODS A sample of internet-delivered cognitive behavioral therapy participants in routine care (n=6701, with 36.26% missing cases at posttreatment) was used to identify predictors of dropping out of treatment and predictors that moderated clinical outcomes, such as symptoms of psychological distress, anxiety, and depression. These variables were then incorporated into a range of statistical models that approximated replacement outcomes for missing cases, and the results were compared using sensitivity and cross-validation analyses. RESULTS Treatment adherence, as measured by the rate of progress of an individual through the treatment modules, and higher pretreatment symptom scores were identified as the dominant predictors of missing cases probability (Nagelkerke R2=60.8%) and the rate of symptom change. Low treatment adherence, in particular, was associated with increased odds of presenting as missing cases during posttreatment assessment (eg, odds ratio 161.1:1) and, at the same time, attenuated the rate of symptom change across anxiety (up to 28% of the total symptom with 48% reduction effect), depression (up to 41% of the total with 48% symptom reduction effect), and psychological distress symptom outcomes (up to 52% of the total with 37% symptom reduction effect) at the end of the 8-week window. Reflecting this pattern of results, statistical replacement methods that overlooked the features of treatment adherence and baseline severity underestimated missing case symptom outcomes by as much as 39% at posttreatment. CONCLUSIONS The treatment outcomes of the cases that were missing at posttreatment were distinct from those of the remaining observed sample. Thus, overlooking the features of missing cases is likely to result in an inaccurate estimate of the effect of treatment.
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Affiliation(s)
- Eyal Karin
- Department of Psychology, Macquarie University, MindSpot Clinic, Macquarie Park, Australia
| | - Monique Frances Crane
- Department of Psychology, Macquarie University, MindSpot Clinic, Macquarie Park, Australia
| | - Blake Farran Dear
- Department of Psychology, Macquarie University, eCentreClinic, Sydney, Australia
| | - Olav Nielssen
- Department of Psychology, Macquarie University, MindSpot Clinic, Sydney, Australia
| | | | - Rony Kayrouz
- Department of Psychology, Macquarie University, MindSpot Clinic, Macquarie Park, Australia
| | - Nickolai Titov
- Department of Psychology, Macquarie University, MindSpot Clinic, Macquarie Park, Australia
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Díaz-García A, González-Robles A, García-Palacios A, Fernández-Álvarez J, Castilla D, Bretón JM, Baños RM, Quero S, Botella C. Negative and Positive Affect Regulation in a Transdiagnostic Internet-Based Protocol for Emotional Disorders: Randomized Controlled Trial. J Med Internet Res 2021; 23:e21335. [PMID: 33522977 PMCID: PMC7884218 DOI: 10.2196/21335] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/10/2020] [Accepted: 12/01/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Emotional disorders (EDs) are among the most prevalent mental disorders. Existing evidence-based psychological treatments are not sufficient to reduce the disease burden of mental disorders. It is therefore essential to implement innovative solutions to achieve a successful dissemination of psychological treatment protocols, and in this regard, the use of information and communication technologies such as the internet can be very useful. Furthermore, the literature suggests that not everyone with an ED receives the appropriate treatment. This situation has led to the development of new intervention proposals based on the transdiagnostic perspective, which attempts to address the underlying processes common to EDs. Most of these transdiagnostic interventions focus primarily on downregulating negative affectivity (NA), and less attention has been paid to strengths and the upregulation of positive affectivity, despite its importance for well-being and mental health. OBJECTIVE This study aims to evaluate the efficacy of a transdiagnostic internet-based treatment for EDs in a community sample. METHODS A 3-armed randomized controlled trial was conducted. A total of 216 participants were randomly assigned to a transdiagnostic internet-based protocol (TIBP), a TIBP+ positive affect (PA) component, or a waiting list (WL) control group. The treatment protocol contained core components mainly addressed to downregulate NA (ie, present-focused emotional awareness and acceptance, cognitive flexibility, behavioral and emotional avoidance patterns, and interoceptive and situational exposure) as well as a PA regulation component to promote psychological strengths and enhance well-being. Data on depression, anxiety, quality of life, neuroticism and extraversion, and PA/NA before and after treatment were analyzed. Expectations and opinions of treatment were also analyzed. RESULTS Within-group comparisons indicated significant pre-post reductions in the two experimental conditions. In the TIBP+PA condition, the effect sizes were large for all primary outcomes (d=1.42, Beck Depression Inventory [BDI-II]; d=0.91, Beck Anxiety Inventory [BAI]; d=1.27, Positive and Negative Affect Schedule-Positive [PANAS-P]; d=1.26, Positive and Negative Affect Schedule-Negative [PANAS-N]), whereas the TIBP condition yielded large effect sizes for BDI-II (d=1.19) and PANAS-N (d=1.28) and medium effect sizes for BAI (d=0.63) and PANAS-P (d=0.69). Between-group comparisons revealed that participants who received one of the two active treatments scored better at posttreatment than WL participants. Although there were no statistically significant differences between the two intervention groups on the PA measure, effect sizes were consistently larger in the TIBP+PA condition than in the standard transdiagnostic protocol. CONCLUSIONS Overall, the findings indicate that EDs can be effectively treated with a transdiagnostic intervention via the internet, as significant improvements in depression, anxiety, and quality of life measures were observed. Regarding PA measures, promising effects were found, but more research is needed to study the role of PA as a therapeutic component. TRIAL REGISTRATION ClinicalTrials.gov NCT02578758; https://clinicaltrials.gov/ct2/show/NCT02578758. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12888-017-1297-z.
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Affiliation(s)
- Amanda Díaz-García
- Department of Psychology and Sociology, Universidad de Zaragoza, Teruel, Spain
| | | | - Azucena García-Palacios
- Universitat Jaume I, Castellón de la Plana, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Carlos III, Madrid, Spain
| | | | - Diana Castilla
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Carlos III, Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | | | - Rosa María Baños
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Carlos III, Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | | | - Cristina Botella
- Universitat Jaume I, Castellón de la Plana, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Carlos III, Madrid, Spain
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23
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Smink WAC, Sools AM, Postel MG, Tjong Kim Sang E, Elfrink A, Libbertz-Mohr LB, Veldkamp BP, Westerhof GJ. Analysis of the Emails From the Dutch Web-Based Intervention "Alcohol de Baas": Assessment of Early Indications of Drop-Out in an Online Alcohol Abuse Intervention. Front Psychiatry 2021; 12:575931. [PMID: 34975551 PMCID: PMC8714780 DOI: 10.3389/fpsyt.2021.575931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/18/2021] [Indexed: 12/02/2022] Open
Abstract
Nowadays, traditional forms of psychotherapy are increasingly complemented by online interactions between client and counselor. In (some) web-based psychotherapeutic interventions, meetings are exclusively online through asynchronous messages. As the active ingredients of therapy are included in the exchange of several emails, this verbal exchange contains a wealth of information about the psychotherapeutic change process. Unfortunately, drop-out-related issues are exacerbated online. We employed several machine learning models to find (early) signs of drop-out in the email data from the "Alcohol de Baas" intervention by Tactus. Our analyses indicate that the email texts contain information about drop-out, but as drop-out is a multidimensional construct, it remains a complex task to accurately predict who will drop out. Nevertheless, by taking this approach, we present insight into the possibilities of working with email data and present some preliminary findings (which stress the importance of a good working alliance between client and counselor, distinguish between formal and informal language, and highlight the importance of Tactus' internet forum).
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Affiliation(s)
- Wouter A C Smink
- Department of Psychology, Health Technology, University of Twente, Enschede, Netherlands.,Department of Research Methodology, Measurement Data Analysis, University of Twente, Enschede, Netherlands
| | - Anneke M Sools
- Department of Psychology, Health Technology, University of Twente, Enschede, Netherlands
| | - Marloes G Postel
- Department of Psychology, Health Technology, University of Twente, Enschede, Netherlands.,Tactus Addiction Treatment, Enschede, Netherlands
| | | | - Auke Elfrink
- Department of Psychology, Health Technology, University of Twente, Enschede, Netherlands
| | - Lukas B Libbertz-Mohr
- Department of Psychology, Health Technology, University of Twente, Enschede, Netherlands
| | - Bernard P Veldkamp
- Department of Research Methodology, Measurement Data Analysis, University of Twente, Enschede, Netherlands
| | - Gerben J Westerhof
- Department of Psychology, Health Technology, University of Twente, Enschede, Netherlands
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24
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Bremer V, Chow PI, Funk B, Thorndike FP, Ritterband LM. Developing a Process for the Analysis of User Journeys and the Prediction of Dropout in Digital Health Interventions: Machine Learning Approach. J Med Internet Res 2020; 22:e17738. [PMID: 33112241 PMCID: PMC7657718 DOI: 10.2196/17738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 09/03/2020] [Accepted: 09/20/2020] [Indexed: 12/29/2022] Open
Abstract
Background User dropout is a widespread concern in the delivery and evaluation of digital (ie, web and mobile apps) health interventions. Researchers have yet to fully realize the potential of the large amount of data generated by these technology-based programs. Of particular interest is the ability to predict who will drop out of an intervention. This may be possible through the analysis of user journey data—self-reported as well as system-generated data—produced by the path (or journey) an individual takes to navigate through a digital health intervention. Objective The purpose of this study is to provide a step-by-step process for the analysis of user journey data and eventually to predict dropout in the context of digital health interventions. The process is applied to data from an internet-based intervention for insomnia as a way to illustrate its use. The completion of the program is contingent upon completing 7 sequential cores, which include an initial tutorial core. Dropout is defined as not completing the seventh core. Methods Steps of user journey analysis, including data transformation, feature engineering, and statistical model analysis and evaluation, are presented. Dropouts were predicted based on data from 151 participants from a fully automated web-based program (Sleep Healthy Using the Internet) that delivers cognitive behavioral therapy for insomnia. Logistic regression with L1 and L2 regularization, support vector machines, and boosted decision trees were used and evaluated based on their predictive performance. Relevant features from the data are reported that predict user dropout. Results Accuracy of predicting dropout (area under the curve [AUC] values) varied depending on the program core and the machine learning technique. After model evaluation, boosted decision trees achieved AUC values ranging between 0.6 and 0.9. Additional handcrafted features, including time to complete certain steps of the intervention, time to get out of bed, and days since the last interaction with the system, contributed to the prediction performance. Conclusions The results support the feasibility and potential of analyzing user journey data to predict dropout. Theory-driven handcrafted features increased the prediction performance. The ability to predict dropout at an individual level could be used to enhance decision making for researchers and clinicians as well as inform dynamic intervention regimens.
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Affiliation(s)
- Vincent Bremer
- Institute of Information Systems, Leuphana University Lüneburg, Lüneburg, Germany
| | - Philip I Chow
- Center for Behavioral Health & Technology, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Burkhardt Funk
- Institute of Information Systems, Leuphana University Lüneburg, Lüneburg, Germany
| | - Frances P Thorndike
- Center for Behavioral Health & Technology, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Lee M Ritterband
- Center for Behavioral Health & Technology, University of Virginia School of Medicine, Charlottesville, VA, United States
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25
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Davies F, Shepherd HL, Beatty L, Clark B, Butow P, Shaw J. Implementing Web-Based Therapy in Routine Mental Health Care: Systematic Review of Health Professionals' Perspectives. J Med Internet Res 2020; 22:e17362. [PMID: 32706713 PMCID: PMC7413287 DOI: 10.2196/17362] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 06/05/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Web-based therapies hold great promise to increase accessibility and reduce costs of delivering mental health care; however, uptake in routine settings has been low. OBJECTIVE Our objective in this review was to summarize what is known about health care professionals' perceptions of the barriers to and facilitators of the implementation of web-based psychological treatments in routine care of adults in health care settings. METHODS We searched 5 major databases (MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library) for qualitative, quantitative, or mixed-methods studies exploring health professionals' views on computer- or internet-based psychological treatment programs. We coded included articles for risk of bias and extracted data using a prepiloted extraction sheet. RESULTS We identified 29 eligible articles: 14 qualitative, 11 quantitative, and 4 mixed methods. We identified the following themes: patient factors, health professional factors, the therapeutic relationship, therapy factors, organizational and system factors, and models of care. Health professionals supported web-based therapies only for patients with relatively straightforward, low-risk diagnoses, strong motivation and engagement, high computer literacy and access, and low need for tailored content. They perceived flexibility with timing and location as advantages of web-based therapy, but preferred blended therapy to facilitate rapport and allow active monitoring and follow-up of patients. They emphasized the need for targeted training and organizational support to manage changed workflows. Health professionals were concerned about the confidentiality and security of client data for web-based programs, suggesting that clear and transparent protocols need to be in place to reassure health professionals before they will be willing to refer. CONCLUSIONS Without health professionals' support, many people will not access web-based therapies. To increase uptake, it is important to ensure that health professionals receive education, familiarization, and training to support them in incorporating web-based therapies into their practice, and to design systems that support health professionals in this new way of working with patients and addressing their concerns. TRIAL REGISTRATION PROSPERO CRD42018100869; https://tinyurl.com/y5vaoqsk.
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Affiliation(s)
- Fiona Davies
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
| | - Heather L Shepherd
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
| | - Lisa Beatty
- Flinders Centre for Innovation in Cancer, College of Medicine & Public Health, Flinders University South Australia, Adelaide, Australia
| | - Brodie Clark
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
| | - Joanne Shaw
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
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26
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Patel S, Akhtar A, Malins S, Wright N, Rowley E, Young E, Sampson S, Morriss R. The Acceptability and Usability of Digital Health Interventions for Adults With Depression, Anxiety, and Somatoform Disorders: Qualitative Systematic Review and Meta-Synthesis. J Med Internet Res 2020; 22:e16228. [PMID: 32628116 PMCID: PMC7381032 DOI: 10.2196/16228] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/20/2020] [Accepted: 03/23/2020] [Indexed: 12/20/2022] Open
Abstract
Background The prevalence of mental health disorders continues to rise, with almost 4% of the world population having an anxiety disorder and almost 3.5% having depression in 2017. Despite the high prevalence, only one-third of people with depression or anxiety receive treatment. Over the last decade, the use of digital health interventions (DHIs) has risen rapidly as a means of accessing mental health care and continues to increase. Although there is evidence supporting the effectiveness of DHIs for the treatment of mental health conditions, little is known about what aspects are valued by users and how they might be improved. Objective This systematic review aimed to identify, appraise, and synthesize the qualitative literature available on service users’ views and experiences regarding the acceptability and usability of DHIs for depression, anxiety, and somatoform disorders. Methods A systematic search strategy was developed, and searches were run in 7 electronic databases. Qualitative and mixed methods studies published in English were included. A meta-synthesis was used to interpret and synthesize the findings from the included studies. Results A total of 24 studies were included in the meta-synthesis, and 3 key themes emerged with descriptive subthemes. The 3 key themes were initial motivations and approaches to DHIs, personalization of treatment, and the value of receiving personal support in DHIs. The meta-synthesis suggests that participants’ initial beliefs about DHIs can have an important effect on their engagement with these types of interventions. Personal support was valued very highly as a major component of the success of DHIs. The main reason for this was the way it enabled individual personalization of care. Conclusions Findings from the systematic review have implications for the design of future DHIs to improve uptake, retention, and outcomes in DHIs for depression, anxiety, and somatoform disorders. DHIs need to be personalized to the specific needs of the individual. Future research should explore whether the findings could be generalized to other health conditions.
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Affiliation(s)
- Shireen Patel
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Athfah Akhtar
- School of Social Sciences, Birmingham City University, Birmingham, United Kingdom
| | - Sam Malins
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Nicola Wright
- Faculty of Medicine, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Emma Rowley
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Emma Young
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
| | - Stephanie Sampson
- NIHR MindTech MedTech Co-operative, University of Nottingham, Nottingham, United Kingdom
| | - Richard Morriss
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom.,NIHR MindTech MedTech Co-operative, University of Nottingham, Nottingham, United Kingdom
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27
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Ghawadra SF, Lim Abdullah K, Choo WY, Danaee M, Phang CK. The effect of mindfulness‐based training on stress, anxiety, depression and job satisfaction among ward nurses: A randomized control trial. J Nurs Manag 2020; 28:1088-1097. [DOI: 10.1111/jonm.13049] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 04/19/2020] [Accepted: 05/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Sajed Faisal Ghawadra
- Department of Nursing Science Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
- Faculty of Nursing Arab American University ‐ Palestine (AAUP) Jenin Palestine
| | - Khatijah Lim Abdullah
- Department of Nursing Science Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
- Fakultas Keperawatan Universitas Airlangga Surabaya Indonesia
| | - Wan Yuen Choo
- Department of Social & Preventive Medicine Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Mahmoud Danaee
- Department of Social & Preventive Medicine Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Cheng Kar Phang
- Behavioral Health Centre Sunway Medical Centre Selangor Malaysia
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28
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Cardi V, Albano G, Salerno L, Lo Coco G, Ambwani S, Schmidt U, Macdonald P, Treasure J. The Feasibility of Using Guided Self-Help in Anorexia Nervosa: An Analysis of Drop-Out From the Study Protocol and Intervention Adherence. Front Psychol 2020; 11:707. [PMID: 32373032 PMCID: PMC7178255 DOI: 10.3389/fpsyg.2020.00707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/24/2020] [Indexed: 01/12/2023] Open
Abstract
The implementation of online technologies to promote wellbeing is increasingly becoming a worldwide priority. This study includes secondary analyses of data and examined drop-out rates in an online guided self-help intervention for patients with anorexia nervosa. Specifically, rates of drop-out at end of treatment (i.e., 6 weeks assessment), as well as intervention adherence (minimum of four of six online guided sessions) and differences between completers and drop-outs were examined. Motivation to change and associated patient variables were assessed as predictors of drop-out using structural equation modeling. Ninety-nine patients were randomized to the intervention arm of the trial. Data were available for 82 individuals, 67 of whom completed the 6 weeks assessment and attended a minimum of four online sessions. No significant differences were found between completers and drop-outs at baseline. At the end of the first week of participation, drop-outs from the 6 weeks assessment or the intervention reported less satisfaction with their work with the mentor delivering online guidance. Greater confidence in own ability to change and higher controlled motivation (willingness to change due to pressure from others) predicted lower drop-out rates from the 6 weeks assessment. Stronger alliance with the therapist at the treatment center and lower psychological distress were associated with greater autonomous motivation (self-directed motivation) and importance and ability to change. Data demonstrate that a novel online guided self-help intervention for patients with anorexia nervosa is feasible. Early satisfaction with the program and external pressure to change have a protective role against drop-out rates. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT02336841.
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Affiliation(s)
- Valentina Cardi
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Gaia Albano
- Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
| | - Laura Salerno
- Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
| | - Gianluca Lo Coco
- Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
| | | | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Pamela Macdonald
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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29
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Reconsidering perfect: a qualitative study of the experiences of internet-based cognitive behaviour therapy for perfectionism. Behav Cogn Psychother 2020; 48:432-441. [DOI: 10.1017/s1352465820000090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Internet-based cognitive behaviour therapy (ICBT) is a promising format for treating different psychiatric disorders. In addition, several clinical trials have found positive results when using it to target transdiagnostic processes, such as perfectionism. However, few qualitative investigations have been conducted on the experiences of clients undergoing such treatments.Method:In the current study, clients completing 12-week guided ICBT for perfectionism responded to open-ended questions at post-treatment. In total, 30 out of 62 (48.4%) described their impressions of its content and the support provided by their guide.Results:The results were analysed qualitatively using thematic analysis. Five themes were found in the responses: Learning how to do things differently, Noticing the positives, Feeling safe to be honest, A comfortable treatment format and Barriers to treatment.Conclusions:The results suggest that many clients were able to achieve a change in perspective in relation to their perfectionism and started facing their fears. They were also able to report the benefits of doing things differently as part of treatment, such as an improvement in their interpersonal relationships. Most clients were also positive about the treatment format, enjoying its flexibility and the encouragement offered by their therapist. However, obstacles such as conflicting commitments, personal difficulties, time-consuming and comprehensive treatment modules, and a desire for more support were brought up by some, suggesting that there are aspects that could be considered in the future.
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30
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Predictors of treatment outcomes and adherence in internet-based cognitive behavioral therapy for social anxiety in China. Behav Cogn Psychother 2020; 48:291-303. [PMID: 31928568 DOI: 10.1017/s1352465819000730] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although internet-based cognitive behaviour therapy (ICBT) is an effective treatment for social anxiety disorder (SAD), a substantial proportion of patients do not achieve clinically significant improvement. More research is needed to identify which factors predict treatment adherence and outcomes. AIMS The aims of this study were to (1) identify demographic and clinical factors associated with treatment adherence and outcomes in ICBT for social anxiety in China, and (2) explore whether low-intensity therapist support results in improved treatment adherence or outcomes. METHOD Participants were assigned to either therapist-guided (N = 183) or self-guided ICBT (N = 72). Level of social anxiety was measured at both pre- and post-treatment. Treatment adherence and outcomes were analysed using a two-step linear and logistic regression approach. Clinical and demographic characteristics were examined. RESULTS No significant group differences were found for treatment adherence or outcomes between the therapist-guided and self-guided conditions. Participants diagnosed with SAD were significantly less likely to drop out (OR 0.531, p = .03) compared with subclinical participants with social anxiety symptoms. Older participants (B = 0.17, SE = 0.04, p = .008) and participants with a diagnosis of SAD (B = 0.16, SE = 0.44, p = .01) tended to complete more modules. Participants who completed more modules (B = 0.24, SE = 0.03, p = .01) and participants who identified as female (B = -0.20, SE = 0.18, p = .04) reported greater reductions in SAD symptoms. CONCLUSIONS Understanding of factors related to adherence and outcome is necessary to prevent drop-out and optimize outcome.
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Gullickson KM, Hadjistavropoulos HD, Dear BF, Titov N. Negative effects associated with internet-delivered cognitive behaviour therapy: An analysis of client emails. Internet Interv 2019; 18:100278. [PMID: 31890627 PMCID: PMC6926340 DOI: 10.1016/j.invent.2019.100278] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/25/2019] [Accepted: 09/02/2019] [Indexed: 01/15/2023] Open
Abstract
Internet-delivered cognitive behaviour therapy (ICBT) is an efficacious form of treatment for anxiety and depression, yet it is still possible for clients to experience negative effects associated with treatment. In the ICBT literature, the term negative effects is broadly used to refer to all potentially adverse or unwanted events or experiences that are perceived as undesirable by the client and may or may not be associated with long-term symptoms or distress. Previous ICBT studies have asked clients to retrospectively describe negative effects at post-treatment; however, no research has examined the content of clients' emails to their therapist to see whether clients are reporting negative effects as they arise. In the current study, 96 clients (80 completers; 16 non-completers) were randomly selected from a published ICBT trial and directed content analysis was used to examine client emails for mention of negative effects. In addition, correlational analyses were used to examine the relationship between negative effects and: 1) demographic characteristics; 2) treatment engagement; 3) treatment satisfaction; 4) working alliance; and 5) symptom outcomes among completers. The results indicated that 61.5% of clients experienced at least one negative effect during treatment, although total number of negative effects was not significantly correlated with client demographic characteristics, lessons completed, working alliance, treatment satisfaction, or symptom outcomes. Among completers, technical difficulties, implementation problems, and negative emotional states were the most commonly reported negative effects, whereas dropout was the most commonly reported negative effect by non-completers. Negative effects that have been identified in previous research, such as symptom deterioration, novel symptoms, and severe adverse events, were not identified in client emails. The high incidence of negative effects in the current study suggests there may be value in systematically monitoring client emails for negative effects throughout treatment as a supplement to retrospective post-treatment reports. This will give therapists the opportunity to intervene as negative effects occur and potentially mitigate any impact they have on treatment outcomes. Future research, both qualitative and quantitative, is needed to gain a more nuanced understanding of negative effects associated with ICBT.
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Affiliation(s)
- Kirsten M. Gullickson
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - Heather D. Hadjistavropoulos
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada,Corresponding author.
| | - Blake F. Dear
- eCentreClinic, Department of Psychology, Macquarie University, Balaclava Road, North Ryde, NSW, Australia
| | - Nickolai Titov
- MindSpot Clinic and eCentreClinic, Department of Psychology, Macquarie University, Balaclava Road, North Ryde, NSW, Australia
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Skea ZC, Newlands R, Gillies K. Exploring non-retention in clinical trials: a meta-ethnographic synthesis of studies reporting participant reasons for drop out. BMJ Open 2019; 9:e021959. [PMID: 31164359 PMCID: PMC6561611 DOI: 10.1136/bmjopen-2018-021959] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To undertake a meta-ethnographic synthesis of findings from primary studies reporting qualitative data that have explored participant-reported factors influencing non-retention within a clinical trial context. DESIGN A systematic search and meta-ethnography was conducted for published papers (from 1946 to July 2018) that contained qualitative data from trial non-retainers. PARTICIPANTS We identified 11 studies reporting qualitative data from 13 trials. The studies were undertaken between 2008 and 2018. Each study included between 3 and 40 people who had dropped out from a trial, with findings from 168 people in total reported across the papers. RESULTS Emergent from our synthesis was the significance of trial non-retainers' perceptions around the personal 'fit' of key aspects of the trial with their personal beliefs, preferences, capabilities or life circumstances. These related to their own health state; preferences for receiving trial 'care'; individual capabilities; beliefs about or experiences of trial medication and considerations whether trial participation could be accommodated into their broader lives. All these factors raise important issues around the extent to which initial decisions to participate were fully informed. CONCLUSIONS To improve retention in clinical trials, researchers should work to reduce the burden on trial participants both through the design of the intervention itself as well as through simplified data collection processes. Providing more detail on the nature of the trial interventions and what can be expected by 'participation' at the consenting stage may prove helpful in order to manage expectations.
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Affiliation(s)
- Zoë C Skea
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Görlich D, Faldum A. Implementing online interventions in ICare: A biostatistical perspective. Internet Interv 2019; 16:5-11. [PMID: 30775259 PMCID: PMC6364454 DOI: 10.1016/j.invent.2018.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 11/30/2018] [Accepted: 12/12/2018] [Indexed: 11/22/2022] Open
Abstract
The implementation of research studies is a highly complex process. All decisions with respect to the study design impact the statistical analyses and interpretation of the results. Within the ICare research project (EU H2020 Grant agreement 634757) seven research trials are conducted to generate evidence on efficacy, effectiveness and the dissemination potential of online interventions targeting eating disorders, common mental health problems and resilience. Within the project a central biometrical unit was established to manage and coordinate data collection, processing and statistical data analysis. This allows for harmonized trial planning, conduct, data management processes and analysis strategies. The purpose of this article is to describe the common concepts underlying all seven ICare trials. This includes development of (adaptive sequential) study designs, handling of missing values, general data management and processing as well as data protection aspects.
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Affiliation(s)
- Dennis Görlich
- Westfälische Wilhelms-Universität Münster, Institute of Biostatistics and Clinical Research, Schmeddingstraße 56, D-48149 Münster, Germany
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Deterioration rates in Virtual Reality Therapy: An individual patient data level meta-analysis. J Anxiety Disord 2019; 61:3-17. [PMID: 30057346 DOI: 10.1016/j.janxdis.2018.06.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/23/2018] [Accepted: 06/18/2018] [Indexed: 12/15/2022]
Abstract
Ample evidence supports the use of Virtual Reality (VR) for anxiety disorders. Nonetheless, currently there is no evidence about moderators or potential negative effects of VR treatment strategies. An Individual Patient Data (IPD) approach was employed with 15 retrieved datasets. The current study sample was composed of 810 patients. Randomized control trials (RCTs) for each primary outcome measure were performed, in addition to moderator analyses of the socio-demographic variables. Deterioration rates were 14 patients (4.0%) in VR, 8 (2.8%) in active control conditions, and 27 (15%) in the WL condition. With regard to receiving treatment, patients in a waiting list control condition had greater odds of deteriorating than in the two active conditions, odds ratios (ORs) 4.87, 95% confidence interval (CI) [0.05, 0.67]. In the case of the socio-demographic variables, none of them were associated with higher or lower odds of deterioration, with the exception of marital status in the WL condition; married people presented a significantly lower probability of deterioration, OR 0.19, 95% CI [0.05, 0.67]. Finally, when comparing pooled effects of VR versus all control conditions, the OR was 0.61 (95% CI 0.31-1.23) in favor of VR, although this result was not statistically significant. This study provides evidence about the deterioration rates of a therapeutic VR approach, showing that the number of deteriorated patients coincides with other therapeutic approaches, and that deterioration is less likely to occur, compared to patients in WL control groups.
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Mira A, Soler C, Alda M, Baños R, Castilla D, Castro A, García-Campayo J, García-Palacios A, Gili M, Hurtado M, Mayoral F, Montero-Marín J, Botella C. Exploring the Relationship Between the Acceptability of an Internet-Based Intervention for Depression in Primary Care and Clinical Outcomes: Secondary Analysis of a Randomized Controlled Trial. Front Psychiatry 2019; 10:325. [PMID: 31133899 PMCID: PMC6523778 DOI: 10.3389/fpsyt.2019.00325] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 04/26/2019] [Indexed: 12/03/2022] Open
Abstract
Background: Depression is one of the most prevalent psychological disorders worldwide. Although psychotherapy for depression is effective, there are barriers to its implementation in primary care in Spain. The use of the Internet has been shown to be a feasible solution. However, the acceptability of Internet-based interventions has not been studied sufficiently. Objective: To assess the acceptability of an Internet-based intervention (IBI) for depression in primary care, and explore the relationship between expectations and satisfaction and the improvement in the clinical variables in primary care patients receiving this intervention. Furthermore, it offers data about the effects of some sociodemographic characteristics on these acceptability variables and analyzes whether the expectations are related to finalizing the intervention. Methods: Data were based on depressive patients who were participants in a randomized controlled trial. In the present study, we present the data from all the participants in the Internet intervention groups (N = 198). All the participants filled out the expectation and satisfaction scales (six-item scales regarding treatment logic, satisfaction, recommending, usefulness for other disorders, usefulness for the patient, and unpleasantness), the Beck Depression Inventory-II, and the secondary outcome measures: depression and anxiety impairment, and positive and negative affect. Results: Results showed that participants' expectations and satisfaction with the program were both high and differences in expectations and satisfaction depended on some sociodemographic variables (age: older people have higher expectations; sex: women have greater satisfaction). A positive relationship between these variables and intervention efficacy was found: expectations related to "usefulness for the patient" were a statistically related predictor to the results on the BDI-II (Beta = 0.364), and the perception of how logical the treatment is (Beta = 0.528) was associated with change in the clinical variable. Furthermore, the higher the expectations, the higher the improvements exhibited by the patients in all measures evaluated during the ten intervention modules. High expectations were also directly related to finalizing the intervention. Conclusions: This is the first study in Spain to address this issue in the field of IBIs for depression in primary care. The IBI showed high acceptance related to the intervention's efficacy and completion. Research on IBI acceptability could help to implement the treatment offered. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT01611818.
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Affiliation(s)
- Adriana Mira
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón, Spain.,Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
| | - Carla Soler
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Marta Alda
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain.,Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain.,University Hospital Miguel Servet, Zaragoza, Spain
| | - Rosa Baños
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain.,Department of Personality, Evaluation and Psychological Treatment, Universitat de València, Valencia, Spain
| | - Diana Castilla
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón, Spain.,Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain.,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Adoración Castro
- Department of Psychology, Universitat de les Illes Balears, Palma de Mallorca, Spain.,Primary Care Prevention and Health Promotion Research Network, RedIAPP, ISCIII, Madrid, Spain
| | - Javier García-Campayo
- Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain.,University Hospital Miguel Servet, Zaragoza, Spain.,Primary Care Prevention and Health Promotion Research Network, RedIAPP, ISCIII, Madrid, Spain
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón, Spain.,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Margalida Gili
- Department of Psychology, Universitat de les Illes Balears, Palma de Mallorca, Spain.,Primary Care Prevention and Health Promotion Research Network, RedIAPP, ISCIII, Madrid, Spain
| | - Mariena Hurtado
- Mental Health Clinical Management Unit, Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital Carlos Haya, University of Malaga, Málaga, Spain
| | - Fermín Mayoral
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, ISCIII, Madrid, Spain.,Mental Health Clinical Management Unit, Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital Carlos Haya, University of Malaga, Málaga, Spain
| | - Jesús Montero-Marín
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain.,Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain.,Primary Care Prevention and Health Promotion Research Network, RedIAPP, ISCIII, Madrid, Spain
| | - Crisitina Botella
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón, Spain.,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
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Fernández-Álvarez J, Díaz-García A, Vara MD, Molinari G, Colombo D, Riva G, Baños RM, Botella C. Clients' Experiences With Internet-Based Psychological Treatments for Mental Disorders: Protocol for a Metasynthesis of Qualitative Studies. JMIR Res Protoc 2018; 7:e183. [PMID: 30463837 PMCID: PMC6282014 DOI: 10.2196/resprot.9722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/02/2018] [Accepted: 05/29/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Given the rise of internet-based treatments as an effective therapeutic tool for psychological disorders, it is necessary to carry out research that examines clients' experiences with this type of intervention. The qualitative methodology has been found to be useful for analyzing clients' perceptions in terms of facilitators and barriers, acceptability, and negative effects of internet-based treatments. However, a lack of integration of these primary studies has prevented their findings from being applied to new research and in clinical practice. OBJECTIVE The objective of this paper is to describe the protocol for a metasynthesis of qualitative studies exploring the experiences of clients who underwent an internet-based treatment. METHODS Elliot and Timulak's metasynthesis approach will be used to review and synthesize qualitative studies related to client experiences in terms of the barriers and facilitators they perceived when undergoing internet-based treatment. For each search string, the features in the Sample, Phenomenon of Interest, Design, Evaluation, Research type (SPIDER) tool will be considered. Electronic databases (PubMed, PsycINFO, and Web of Science) will be searched. Two independent reviewers will analyze the material in order to determine whether the eligibility criteria are fulfilled. Findings will make it possible to create a hierarchy of domains in terms of their relevance across all the primary studies. The data obtained from primary studies will be cross-analyzed using descriptive and interpretative procedures. RESULTS The search strategy is currently being conducted. First results are expected to be submitted for publication in 2019. CONCLUSIONS We will develop conceptual framework of the barriers and facilitators perceived by clients and propose their implications and recommendations for clinical practice, research, and training. TRIAL REGISTRATION PROSPERO CRD42018079894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=79894 (Archived by WebCite at http://www.webcitation.org/73C6OtlS7). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/9722.
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Affiliation(s)
| | | | | | | | | | - Giuseppe Riva
- Università Cattolica del Sacro Cuore, Milan, Italy.,Applied Technology for Neuro-Psychology Laboratory, Instituto Auxologico Italiano, Milan, Italy
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Schröder J, Berger T, Meyer B, Lutz W, Späth C, Michel P, Rose M, Hautzinger M, Hohagen F, Klein JP, Moritz S. Impact and change of attitudes toward Internet interventions within a randomized controlled trial on individuals with depression symptoms. Depress Anxiety 2018; 35:421-430. [PMID: 29489038 DOI: 10.1002/da.22727] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 12/21/2017] [Accepted: 12/28/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Most individuals with depression do not receive adequate treatment. Internet interventions may help to bridge this gap. Research on attitudes toward Internet interventions might facilitate the dissemination of such interventions by identifying factors that help or hinder uptake and implementation, and by clarifying who is likely to benefit. This study examined whether attitudes toward Internet interventions moderate the effects of a depression-focused Internet intervention, and how attitudes change over the course of treatment among those who do or do not benefit. METHODS We recruited 1,004 adults with mild-to-moderate depression symptoms and investigated how attitudes toward Internet interventions are associated with the efficacy of the program deprexis, and how attitudes in the intervention group change from pre to post over a 3 months intervention period, compared to a control group (care as usual). This study consists of a subgroup analysis of the randomized controlled EVIDENT trial. RESULTS Positive initial attitudes toward Internet interventions were associated with greater efficacy (η2p = .014) independent of usage time, whereas a negative attitude (perceived lack of personal contact) was associated with reduced efficacy (η2p = .012). Users' attitudes changed during the trial, and both the magnitude and direction of attitude change were associated with the efficacy of the program over time (η2p = .030). CONCLUSIONS Internet interventions may be the most beneficial for individuals with positive attitudes toward them. Informing potential users about evidence-based Internet interventions might instill positive attitudes and thereby optimize the benefits such interventions can provide. Assessing attitudes prior to treatment might help identify suitable users.
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Affiliation(s)
- Johanna Schröder
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Björn Meyer
- Research Department, Gaia, Hamburg, Germany, and Department of Psychology, City University, London, United Kingdom
| | - Wolfgang Lutz
- Department of Psychology, University of Trier, Trier, Germany
| | - Christina Späth
- Department of Psychosomatic Medicine, Charité University Medical Center, Berlin, Germany
| | - Pia Michel
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Rose
- Department of Psychosomatic Medicine, Charité University Medical Center, Berlin, Germany
| | - Martin Hautzinger
- Department of Psychology, Clinical Psychology and Psychotherapy, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Fritz Hohagen
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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