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Miqdadi AI, Chong MC, Yoong TL, Koh OH, Alhadidi M. Internet-Based Cognitive-Behavioral Therapy for Individuals Experiencing Panic Attacks: A Scoping Literature Review. J Psychosoc Nurs Ment Health Serv 2024; 62:9-15. [PMID: 37751578 DOI: 10.3928/02793695-20230919-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Panic attacks (PAs) are prevalent and highly comorbid with various physical and psychological disorders. Cognitive-behavioral therapy (CBT) is a well-established psychosocial intervention. Internet-delivered CBT (ICBT) presents a promising avenue to overcome barriers and provide evidence-based support to those in need. The current scoping review aimed to systematically map the existing literature and identify knowledge gaps regarding the impact of ICBT on outcome measures for individuals experiencing PAs. The PRISMA guidelines for scoping reviews were used. A total of 3,044 records were retrieved, and 18 studies from 2013 to 2023 were ultimately included in the analysis. ICBT demonstrated effectiveness as a psychosocial intervention for improving panic symptoms and anxiety in individuals with PAs. However, the impact of ICBT on quality of life (QOL) remains inconclusive. All studies included in this review focused on assessing the severity of panic symptoms, with limited emphasis on measuring QOL. This scoping review holds significant implications for research and practice. However, further addressing the research needs identified in this review will enhance our understanding and improve treatment outcomes for PAs. [Journal of Psychosocial Nursing and Mental Health Services, 62(4), 9-15.].
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Jelinek L, Schröder J, Bücker L, Miegel F, Baumeister A, Moritz S, Sibilis A, Schultz J. Improving adherence to unguided Internet-based therapy for obsessive-compulsive disorder: A randomized controlled trial. J Affect Disord 2023; 338:472-481. [PMID: 37348657 DOI: 10.1016/j.jad.2023.06.038] [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: 01/17/2023] [Revised: 06/11/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Adherence to internet-based cognitive-behavioral therapy (iCBT) is often low, possibly reducing its potential. The current study set out to test whether adherence and effects of unguided iCBT for obsessive-compulsive disorder (OCD) could be improved by varying the degree of autonomy in which modules are completed (free choice vs. fixed order). METHODS We randomized 151 individuals with OCD to either an unguided iCBT with a fixed (iCBTfixed) or a free-choice (iCBTfree+) order of the modules. We assessed participants at baseline (t0), eight weeks (t1), and 16 weeks (t2). Primary outcomes were adherence (utilization time, modules completed) and change in OCD severity (Y-BOCS). Secondary outcomes included depression, self-esteem, and treatment satisfaction. We calculated intent-to-treat (ITT) and complete case (CC) analyses. RESULTS Analyses showed that both iCBT programs significantly reduced OCD severity. While groups did not differ on the ITT analyses, for the CC analyses, a greater improvement was found in the iCBTfixed in comparison to the iCBTfree+ group regarding OCD severity and quality of life, with medium effect sizes from t0 to t1 (ηp2 = 0.067-0.077). Time of utilization and number of modules completed did not differ between groups. LIMITATIONS No placebo control group, short follow-up period, self-report assessment. CONCLUSIONS iCBT is effective in improving OCD. Despite similar adherence in the fixed versus the free-choice module order, the study offers tentative evidence that a fixed order of content is associated with better effects. More research on the effects of adherence on outcome is necessary.
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Affiliation(s)
- Lena Jelinek
- Department of Psychotherapy and Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Johanna Schröder
- Department of Psychotherapy and Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute for Clinical Psychology and Psychotherapy, Department of Psychology, Medical School Hamburg, Hamburg, Germany
| | - Lara Bücker
- Department of Psychotherapy and Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Miegel
- Department of Psychotherapy and Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Baumeister
- Department of Psychotherapy and Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychotherapy and Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arne Sibilis
- Department of Psychotherapy and Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Josephine Schultz
- Department of Psychotherapy and Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Rubel J, Quest J, Pruessner L, Timm C, Hartmann S, Barnow S, Rittmeyer L, Rosenbaum D, Lalk C. Evaluation of a Web-Based Self-Help Intervention for Patients With Generalized Anxiety Disorder: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e41440. [PMID: 37494105 PMCID: PMC10413245 DOI: 10.2196/41440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 06/01/2023] [Accepted: 06/19/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Generalized anxiety disorder (GAD) is a highly prevalent and severely distressing condition that can lead to functional impairments and is considered one of the most difficult anxiety disorders to treat. Following new technological developments, a highly structured cognitive behavioral therapy (CBT) approach that has already shown success in face-to-face psychotherapy can be implemented: internet-delivered CBT (iCBT). There is now evidence for the efficacy of both guided and unguided iCBT interventions for GAD regarding symptom reduction. OBJECTIVE To establish the usefulness of such interventions, we plan to evaluate the efficacy of a web-based self-help program (Selfapy) for GAD in a relatively large sample. We aim to assess effects beyond symptom reduction, including effects on well-being, functioning, and mental health literacy, as well as the effect on health care burden, while testing the intervention in conditions comparable to routine care. METHODS Patients (n=156) who have been diagnosed with GAD, are aged between 18 and 65 years, have internet access, and have sufficient German language skills will be recruited for this study. The intervention group (n=78) will receive access to the 12-week self-help web-based program Selfapy. The waitlist control group (n=78) will receive no intervention in the context of the study. However, both groups will be allowed to access further health care services (eg, psychotherapy, medication), reflecting current routine care in Germany. Outcome measures will be assessed at baseline (T1) and 6 weeks (T2) and 12 weeks (T3) after the start of the intervention. The primary outcome will be generalized anxiety symptoms and quality of life at T3. Additional outcomes include depression, work capacity, therapy-related expenses and burdens, health literacy, and negative effects. RESULTS By May 2023, all participants had finished the trial and the report was being prepared for publication. CONCLUSIONS Web-based interventions may be an important addition to the German health care system to reduce barriers to treatment access. Further, they may prove cost-effective for the treatment of GAD. TRIAL REGISTRATION Deutsches Register Klinischer Studien DRKS00023799; https://tinyurl.com/22bds38x. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/41440.
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Affiliation(s)
- Julian Rubel
- Faculty of Psychology and Sport Science, Justus-Liebig-University Giessen, Gießen, Germany
| | - Jannis Quest
- Faculty of Psychology and Sport Science, Justus-Liebig-University Giessen, Gießen, Germany
| | - Luise Pruessner
- Faculty of Behavioral and Empirical Cultural Studies, Heidelberg University, Heidelberg, Germany
| | - Christina Timm
- Faculty of Behavioral and Empirical Cultural Studies, Heidelberg University, Heidelberg, Germany
| | - Steffen Hartmann
- Faculty of Behavioral and Empirical Cultural Studies, Heidelberg University, Heidelberg, Germany
| | - Sven Barnow
- Faculty of Behavioral and Empirical Cultural Studies, Heidelberg University, Heidelberg, Germany
| | - Lisa Rittmeyer
- Faculty of Psychology and Sport Science, Justus-Liebig-University Giessen, Gießen, Germany
| | - David Rosenbaum
- Clinic and Polyclinic for Psychiatry and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Christopher Lalk
- Faculty of Psychology and Sport Science, Justus-Liebig-University Giessen, Gießen, Germany
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Leung T, Großgarten K, Wolff JK, Nolting HD, Graf C, Bergmann F, Nelles G. A Stepped Health Services Intervention to Improve Care for Mental and Neurological Diseases: Protocol for a Prospective Cohort Trial. JMIR Res Protoc 2023; 12:e37569. [PMID: 36649065 PMCID: PMC9890347 DOI: 10.2196/37569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 11/25/2022] [Accepted: 11/25/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Mental and neurological disorders cause a large proportion of morbidity burden and require adequate health care structures. However, deficits in the German health care system like long waiting times for access to specialized care and a lack of coordination between health care providers lead to suboptimal quality of care and elevated health care costs. OBJECTIVE To overcome these deficits, we implement and evaluate a unique stepped and coordinated model of care (the Neurologisch-psychiatrische und psychotherapeutische Versorgung [NPPV] program) for patients with mental and neurological diseases. METHODS Patients included in the program receive an appropriate treatment according to medical needs in a multiprofessional network of ambulatory health care providers. The therapy is coordinated by a managing physician and complemented by additional therapy modules, such as group therapy, internet-based cognitive behavioral therapy, and a case management. Statutory health insurance (SHI) routine data and data from a longitudinal patient survey will be used to compare the program with regular care and evaluate SHI expenditures and patient-related outcomes. A health care provider survey will evaluate the quality of structure and processes and provider satisfaction. Finally, an analysis of ambulatory claims data and drug prescription data will be used to evaluate if health care providers follow a needs-led approach in therapy. Ethics approval for this trial was obtained from the ethics committee of the chamber of physicians in North Rhine (September 13, 2017, reference No. 2017287). RESULTS Patient enrollment of NPPV ended in September 2021. Data analysis has been completed in 2022. The results of this study will be disseminated through scientific publications, academic conferences, and a publicly available report to the German Federal Joint Committee, which is expected to be available in the first half of 2023. CONCLUSIONS The NPPV program is the first intervention to implement a stepped model of care for both mental and neurological diseases in Germany. The analysis of several data sources and a large sample size (more than 14,000 patients) enable a comprehensive evaluation of the NPPV program. TRIAL REGISTRATION German Clinical Trials Register DRKS00022754; https://tinyurl.com/3mx9pz5z. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/37569.
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Affiliation(s)
| | - Karlheinz Großgarten
- Association of Statutory Health Insurance Physicians in North Rhine, Düsseldorf, Germany
| | | | | | - Clarissa Graf
- Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
| | - Frank Bergmann
- Association of Statutory Health Insurance Physicians in North Rhine, Düsseldorf, Germany
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Pauley D, Cuijpers P, Papola D, Miguel C, Karyotaki E. Two decades of digital interventions for anxiety disorders: a systematic review and meta-analysis of treatment effectiveness. Psychol Med 2023; 53:567-579. [PMID: 34047264 PMCID: PMC9899576 DOI: 10.1017/s0033291721001999] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/24/2021] [Accepted: 04/28/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Digital interventions for anxiety disorders are a promising solution to address barriers to evidence-based treatment access. Precise and powerful estimates of digital intervention effectiveness for anxiety disorders are necessary for further adoption in practice. The present systematic review and meta-analysis examined the effectiveness of digital interventions across all anxiety disorders and specific to each disorder v. wait-list and care-as-usual controls. METHODS A systematic search of bibliographic databases identified 15 030 abstracts from inception to 1 January 2020. Forty-seven randomized controlled trials (53 comparisons; 4958 participants) contributed to the meta-analysis. Subgroup analyses were conducted by an anxiety disorder, risk of bias, treatment support, recruitment, location and treatment adherence. RESULTS A large, pooled effect size of g = 0.80 [95% Confidence Interval: 0.68-0.93] was found in favor of digital interventions. Moderate to large pooled effect sizes favoring digital interventions were found for generalized anxiety disorder (g = 0.62), mixed anxiety samples (g = 0.68), panic disorder with or without agoraphobia (g = 1.08) and social anxiety disorder (g = 0.76) subgroups. No subgroups were significantly different or related to the pooled effect size. Notably, the effects of guided interventions (g = 0.84) and unguided interventions (g = 0.64) were not significantly different. Supplemental analysis comparing digital and face-to-face interventions (9 comparisons; 683 participants) found no significant difference in effect [g = 0.14 favoring digital interventions; Confidence Interval: -0.01 to 0.30]. CONCLUSION The precise and powerful estimates found further justify the application of digital interventions for anxiety disorders in place of wait-list or usual care.
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Affiliation(s)
- Darin Pauley
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam, The Netherlands
| | - Davide Papola
- Department of Neuroscience, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam, The Netherlands
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Rubel J, Quest J, Pruessner L, Timm C, Hartmann S, Barnow S, Rittmeyer L, Rosenbaum D, Lalk C. Evaluation of an online-based self-help intervention for patients with panic disorder - Study protocol for a randomized controlled trial. Internet Interv 2022; 30:100584. [PMID: 36573072 PMCID: PMC9789353 DOI: 10.1016/j.invent.2022.100584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- J. Rubel
- Professorship for Psychotherapy Research, Department 06 - Psychology and Sport, Justus Liebig University Giessen, Germany,Corresponding author at: Professorship for Psychotherapy Research, Department of Psychology, Justus Liebig University Giessen, Otto-Behaghel-Strasse 10, House F, 35394 Giessen, Germany.
| | - J. Quest
- Professorship for Psychotherapy Research, Department 06 - Psychology and Sport, Justus Liebig University Giessen, Germany
| | - L. Pruessner
- Department of Psychology, Heidelberg University, Germany
| | - C. Timm
- Department of Psychology, Heidelberg University, Germany
| | - S. Hartmann
- Department of Psychology, Heidelberg University, Germany
| | - S. Barnow
- Department of Psychology, Heidelberg University, Germany
| | - L. Rittmeyer
- Professorship for Psychotherapy Research, Department 06 - Psychology and Sport, Justus Liebig University Giessen, Germany
| | - D. Rosenbaum
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany
| | - C. Lalk
- Professorship for Psychotherapy Research, Department 06 - Psychology and Sport, Justus Liebig University Giessen, Germany
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Nieder TO, Renner J, Zapf A, Sehner S, Hot A, König HH, Dams J, Grochtdreis T, Briken P, Dekker A. Interdisciplinary, internet-based trans health care (i²TransHealth): study protocol for a randomised controlled trial. BMJ Open 2022; 12:e045980. [PMID: 35105559 PMCID: PMC8808412 DOI: 10.1136/bmjopen-2020-045980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/04/2022] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Living in an area with no or deficient structures for trans health care is disadvantageous for trans people. By providing an internet-based health care programme, i²TransHealth aims at reducing structural disadvantages for trans people living in areas lacking specialised care. The e-health intervention consists of video consultations and a 1:1 chat with a study therapist. Additionally, the i²TransHealth network cooperates with physicians, who especially offer crisis intervention close to the participants' place of residence. The aim of this study is to evaluate the (cost-)effectiveness of the internet-based health care programme for trans people compared with a control (waiting) group. The following research questions will be examined with a sample of 163 trans people: Does a 4-month treatment with the i²TransHealth internet-based health care programme improve patient-reported health-outcomes? Is i²TransHealth cost-effective compared with standard care from a societal or health care payers' perspective? Does the participation in and support by i²TransHealth lead to an increase of trans-related expertise in the physician network? METHODS AND ANALYSIS In a randomised controlled trial, the outcomes of an internet-based health care programme for trans people will be investigated. In the intervention group, participants are invited to use i²TransHealth for 4 months. Participants allocated to the control group will be able to start with their transition-related care after 4 months of study participation. The primary outcome measure is defined as the reduction of psychosomatic symptoms, as assessed by the Brief Symptom Inventory-18, 4 months after using the i²TransHealth programme. Participants in both groups will undergo an assessment at baseline and 4 months after using i²TransHealth. ETHICS AND DISSEMINATION Positive ethical approval was obtained from the Hamburg Medical Association (PV7131). The results will be disseminated to service users and their families via media, to health care professionals via professional training and meetings and to researchers via conferences and publications. TRIAL REGISTRATION NUMBER NCT04290286. PROTOCOL VERSION 22 December 2021 (V.1.0).
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Affiliation(s)
- Timo O Nieder
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Interdisciplinary Transgender Health Care Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Janis Renner
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Interdisciplinary Transgender Health Care Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Sehner
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Amra Hot
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Grochtdreis
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Interdisciplinary Transgender Health Care Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arne Dekker
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Interdisciplinary Transgender Health Care Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Romero D, Johansson M, Hermansson U, Lindner P. Impact of Users' Attitudes Toward Anonymous Internet Interventions for Cannabis vs. Alcohol Use: A Secondary Analysis of Data From Two Clinical Trials. Front Psychiatry 2021; 12:730153. [PMID: 34646175 PMCID: PMC8502932 DOI: 10.3389/fpsyt.2021.730153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/27/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Numerous trials have demonstrated the efficacy of internet interventions targeting alcohol or cannabis use, yet a substantial proportion of users do not benefit from the format, warranting further research to identify moderators of treatment effects. Users' initial attitudes toward treatment is a potential moderator, yet no previous study has investigated users' attitudes in the context of internet interventions for addictive disorders. Method: In this secondary analysis on two internet-based trials targeting harmful alcohol use (n = 1,169) and regular cannabis use (n = 303), respectively, we compared user groups' attitudes at the item level; explored within-group heterogeneity by submitting attitude scores to a k-means cluster analysis; and investigated whether latent subgroups in each user group moderated the treatment effects. Outcome models were run using generalized linear models with 10,000 bias-corrected bootstraps accounting for subject-level clustering. Results: While substance groups and latent subgroups converged in enjoying the anonymity provided by the format, their interest toward treatment differed. Outcome analyses revealed a significant and negative time by subgroup effect on grams of cannabis consumed and screening test score (CAST), favoring the subgroup with positive treatment attitudes. There were not any significant effects of subgroup on alcohol consumption. Despite initial treatment reluctance, participants in the neutral subgroup decreased their cannabis use (gram) significantly when receiving the intervention vs. control. Conclusions: This first, exploratory study revealed key differences between substance groups' attitudes, but more importantly that within-group heterogeneity appear to affect cannabis outcomes. Assessing attitudes could be key in patient-treatment matching, yet more research is needed.
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Affiliation(s)
- Danilo Romero
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Region Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Dependency Disorders, Region Stockholm, Stockholm, Sweden
| | - Magnus Johansson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Region Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Dependency Disorders, Region Stockholm, Stockholm, Sweden
| | - Ulric Hermansson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Region Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Dependency Disorders, Region Stockholm, Stockholm, Sweden
| | - Philip Lindner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Region Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Dependency Disorders, Region Stockholm, Stockholm, Sweden
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Mor S, Botella C, Campos D, Tur C, Castilla D, Soler C, Quero S. An Internet-based treatment for Flying Phobia using 360° images: Study protocol for a feasibility pilot study. Internet Interv 2021; 24:100387. [PMID: 33936953 PMCID: PMC8076687 DOI: 10.1016/j.invent.2021.100387] [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: 07/24/2020] [Revised: 03/15/2021] [Accepted: 03/24/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Flying Phobia (FP) is a prevalent disorder that can cause serious interference in a person's life. ICBT interventions have already shown their efficacy in several studies, but studies in the field of specific phobias are still scarce. Moreover, few studies have investigated the feasibility of using different types of images in exposure scenarios in ICBTs and no studies have been carried out on the role of sense of presence and reality judgement. The aim of the present study is to explore the feasibility of an ICBT for FP (NO-FEAR Airlines) using two types of images with different levels of immersion (still and navigable images). A secondary aim is to explore the potential effectiveness of the two experimental conditions using two types of images compared to a waiting list control group. Finally, the role of navigable images compared to the still images in the level of anxiety, sense of presence, and reality judgement will also be explored. This paper presents the study protocol. METHODS This study is a three-armed feasibility pilot study with the following conditions: NO-FEAR Airlines with navigable images, NO-FEAR Airlines with still images, and a waiting list group. A minimum of 60 participants will be recruited. The intervention will have a maximum duration of 6 weeks. Measurements will be taken at four different moments: baseline, post-intervention, and two follow-ups (3- and 12-month). Participants' opinions, preference, satisfaction and acceptance regarding the images used in the exposure scenarios will be assessed. FP symptomatology outcomes will also be considered for secondary analyses. The anxiety, sense of presence, and reality judgement in the exposure scenarios will also be analysed. DISCUSSION This study will conduct a pilot study on the feasibility of an ICBT for FP and it is the first one to explore the evaluation of patients of the two type of images (still and navigable) and the role of presence and reality judgement in exposure scenarios delivered through the Internet. Research in this field can have an impact on the way these scenarios are designed and developed, as well as helping to explore whether they have any effect on adherence. TRIAL REGISTRATION NCT03900559. Trial Registration date 3 April 2019, retrospectively registered.
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Affiliation(s)
- Sonia Mor
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Cristina Botella
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, Madrid, Spain
| | - Daniel Campos
- Department of Psychology and Sociology, University of Zaragoza, Huesca, Spain
- Instituto de Investigación Sanitaria Aragón (IISAragon), Zaragoza, Spain
| | - Cintia Tur
- 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), Carlos III Institute of Health, Madrid, Spain
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10
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Schröder J, Werkle N, Cludius B, Jelinek L, Moritz S, Westermann S. Unguided Internet-based cognitive-behavioral therapy for obsessive-compulsive disorder: A randomized controlled trial. Depress Anxiety 2020; 37:1208-1220. [PMID: 33169490 DOI: 10.1002/da.23105] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Many individuals with obsessive-compulsive disorder (OCD) do not receive professional treatment due to various idiosyncratic barriers. Internet-based cognitive-behavioral therapy (iCBT) is increasingly used to narrow treatment gaps, but the efficacy of such interventions without guidance of therapists has not been well studied. This study evaluated the efficacy of an unguided iCBT that includes third-wave approaches for the treatment of OCD symptoms. METHODS A total of 128 individuals with self-reported OCD symptoms were randomly allocated to either an intervention group (unguided iCBT) or to a care-as-usual (CAU) control group following an anonymous baseline assessment via an online survey. Eight weeks after inclusion, a reassessment was carried out online. The Yale-Brown Obsessive-Compulsive Scale served as the primary outcome parameter for detecting symptom changes in the per-protocol sample with at least 60 minutes utilization. RESULTS The iCBT group showed a significantly stronger reduction of OCD symptoms with a medium effect size (η²p = 0.06) compared with the control condition. This effect was moderated by the general frequency of Internet usage (η²p = 0.08); the more time per day users spent online, the less they benefited from the intervention. Secondary outcomes revealed (1) a medium effect size on self-esteem (η²p = 0.06); (2) no statistically significant effects on quality of life, depression symptoms, impulsivity, or social insecurity; and (3) good acceptability of the intervention. CONCLUSIONS The current study provides evidence that unguided iCBT for OCD may be a viable option for individuals who experience treatment barriers. As non-compliance remains a challenge, this topic needs further research.
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Affiliation(s)
- Johanna Schröder
- Department of Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Nathalie Werkle
- Department of Psychotherapy and Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Barbara Cludius
- Department of Psychology, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Lena Jelinek
- Department of Psychotherapy and Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychotherapy and Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Westermann
- Department of Psychotherapy and Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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11
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Weisel KK, Zarski AC, Berger T, Krieger T, Moser CT, Schaub MP, Görlich D, Berking M, Ebert DD. User Experience and Effects of an Individually Tailored Transdiagnostic Internet-Based and Mobile-Supported Intervention for Anxiety Disorders: Mixed-Methods Study. J Med Internet Res 2020; 22:e16450. [PMID: 32936085 PMCID: PMC7527916 DOI: 10.2196/16450] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/20/2020] [Accepted: 06/22/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Internet interventions have been shown to be effective in treating anxiety disorders. Most interventions to date focus on single disorders and disregard potential comorbidities. OBJECTIVE The aim of this mixed-methods study was to investigate feasibility, user experience, and effects of a newly developed individually tailored transdiagnostic guided internet intervention for anxiety disorders. METHODS This study is an uncontrolled, within-group, baseline, postintervention pilot trial with an embedded qualitative and quantitative process and effect evaluation. In total, 49 adults with anxiety disorders (generalized anxiety disorder n=20, social phobia n=19, agoraphobia without panic n=12, panic with agoraphobia n=6, panic without agoraphobia n=4, subclinical depression n=41) received access to the 7-session intervention. We examined motivation and expectations, intervention use, user experience, impact, and modification requests. Qualitative data were assessed using semistructured interviews and analyzed by qualitative content analysis. Quantitative outcomes included symptom severity of anxiety and depression (Hamilton Anxiety Rating Scale [HAM-A], Quick Item Inventory of Depressive Symptomatology clinician rating [QIDS-C]), diagnostic status in clinical interviews (Mini International Neuropsychiatric Interview [MINI]), and web-based self-reports (Generalized Anxiety Disorder-7 [GAD-7], Center for Epidemiological Studies Depression Scale [CES-D], Beck Anxiety Inventory [BAI], Panic and Agoraphobia Scale [PAS], Social Phobia Scale [SPS], Patient Health Questionnaire-9 [PHQ-9]) at baseline and postassessment. Quantitative data was analyzed by comparing within-group means expressed as Cohen d. RESULTS Anxiety symptom severity (HAM-A d=1.19) and depressive symptoms (QIDS-C d=0.42) improved significantly, and 54% (21/39) no longer were diagnosed as having any anxiety disorder. The main positive effects were the general improvement of disease burden and attentiveness to feelings and risk situations while the main negative effects experienced were lack of change in disease burden and symptom deterioration. The most prevalent reasons for participation were the advantages of online treatment, symptom burden, and openness toward online treatment. Helpful factors included support, psychoeducation and practicing strategies in daily life; the main hindering factors were too little individualization and being overwhelmed by the content and pace. CONCLUSIONS The intervention was found to be feasible and results show preliminary data indicating potential efficacy for improving anxiety and depression. The next step should be the evaluation within a randomized controlled trial. Concerning intervention development, it was found that future interventions should emphasize individualization even more in order to further improve the fit to individual characteristics, preferences, and needs.
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Affiliation(s)
- Kiona K Weisel
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Anna-Carlotta Zarski
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Tobias Krieger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christian T Moser
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael P Schaub
- Swiss Research Institute of Public Health and Addiction ISGF, Associated to the University of Zurich, Zurich, Switzerland
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - David D Ebert
- Clinical, Neuro- & Development Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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12
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Intensive one-week internet-delivered cognitive behavioral therapy for panic disorder and agoraphobia: A pilot study. Internet Interv 2020; 20:100315. [PMID: 32257825 PMCID: PMC7103776 DOI: 10.1016/j.invent.2020.100315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/10/2020] [Accepted: 03/16/2020] [Indexed: 12/25/2022] Open
Abstract
This is the first pilot study to explore the feasibility, acceptability and preliminary efficacy of intensive cognitive behavioral therapy (CBT) for panic disorder and/or agoraphobia delivered via the internet. Ten participants who met DSM-5 criteria for panic disorder and/or agoraphobia (6 males; mean age = 43.40, SD = 15.25) completed The Intensive Panic Program: a six-lesson exposure-based CBT program, delivered online over seven days. Clinician support was provided via phone and email. All 10 participants completed the program (100% adherence) and high levels of satisfaction were reported. We found large and significant reductions in panic symptom severity at post-treatment (d = 1.40), which were maintained at two-month follow-up. We also found large reductions in agoraphobic avoidance (d = 0.92) and functional impairment (d = 1.04) at follow-up, and days out of role were halved. On average, 132 min (SD = 42, range: 47-183) of clinician time was spent per participant during the treatment week. The results provide promising preliminary evidence for the feasibility and acceptability of internet-delivered intensive CBT for panic disorder and/or agoraphobia. A larger, randomized control trial is now needed to evaluate the efficacy of this program compared to a control group and to explore long-term outcomes. Clinical trial registration number ACTRN12618001501235.
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13
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Fusar‐Poli P, Solmi M, Brondino N, Davies C, Chae C, Politi P, Borgwardt S, Lawrie SM, Parnas J, McGuire P. Transdiagnostic psychiatry: a systematic review. World Psychiatry 2019; 18:192-207. [PMID: 31059629 PMCID: PMC6502428 DOI: 10.1002/wps.20631] [Citation(s) in RCA: 185] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The usefulness of current psychiatric classification, which is based on ICD/DSM categorical diagnoses, remains questionable. A promising alternative has been put forward as the "transdiagnostic" approach. This is expected to cut across existing categorical diagnoses and go beyond them, to improve the way we classify and treat mental disorders. This systematic review explores whether self-defining transdiagnostic research meets such high expectations. A multi-step Web of Science literature search was performed according to an a priori protocol, to identify all studies that used the word "transdiagnostic" in their title, up to May 5, 2018. Empirical variables which indexed core characteristics were extracted, complemented by a bibliometric and conceptual analysis. A total of 111 studies were included. Most studies were investigating interventions, followed by cognition and psychological processes, and neuroscientific topics. Their samples ranged from 15 to 91,199 (median 148) participants, with a mean age from 10 to more than 60 (median 33) years. There were several methodological inconsistencies relating to the definition of the gold standard (DSM/ICD diagnoses), of the outcome measures and of the transdiagnostic approach. The quality of the studies was generally low and only a few findings were externally replicated. The majority of studies tested transdiagnostic features cutting across different diagnoses, and only a few tested new classification systems beyond the existing diagnoses. About one fifth of the studies were not transdiagnostic at all, because they investigated symptoms and not disorders, a single disorder, or because there was no diagnostic information. The bibliometric analysis revealed that transdiagnostic research largely restricted its focus to anxiety and depressive disorders. The conceptual analysis showed that transdiagnostic research is grounded more on rediscoveries than on true innovations, and that it is affected by some conceptual biases. To date, transdiagnostic approaches have not delivered a credible paradigm shift that can impact classification and clinical care. Practical "TRANSD"iagnostic recommendations are proposed here to guide future research in this field.
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Affiliation(s)
- Paolo Fusar‐Poli
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,OASIS Service, South London and Maudsley NHS Foundation TrustLondonUK,Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | - Marco Solmi
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Neuroscience Department, Psychiatry UnitUniversity of PaduaPaduaItaly
| | - Natascia Brondino
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | - Cathy Davies
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Chungil Chae
- Applied Cognitive Science Lab, Department of Information Science and TechnologyPennsylvania State University, University ParkPAUSA
| | - Pierluigi Politi
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | | | | | - Josef Parnas
- Center for Subjectivity ResearchUniversity of CopenhagenCopenhagenDenmark
| | - Philip McGuire
- OASIS Service, South London and Maudsley NHS Foundation TrustLondonUK,Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,National Institute for Health Research Maudsley Biomedical Research CentreSouth London and Maudsley NHS Foundation TrustLondonUK
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14
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Campos D, Bretón-López J, Botella C, Mira A, Castilla D, Mor S, Baños R, Quero S. Efficacy of an internet-based exposure treatment for flying phobia (NO-FEAR Airlines) with and without therapist guidance: a randomized controlled trial. BMC Psychiatry 2019; 19:86. [PMID: 30841930 PMCID: PMC6404352 DOI: 10.1186/s12888-019-2060-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Internet-based treatments appear to be a promising way to enhance the in vivo exposure approach, specifically in terms of acceptability and access to treatment. However, the literature on specific phobias is scarce, and, as far as we know, there are no studies on Flying Phobia (FP). This study aims to investigate the effectiveness of an Internet-based exposure treatment for FP (NO-FEAR Airlines) that includes exposure scenarios composed of images and sounds, versus a waiting-list control group. A secondary aim is to explore two ways of delivering NO-FEAR Airlines, with and without therapist guidance. METHODS A randomized controlled trial (RCT) was conducted in which 69 participants were allocated to: 1) NO-FEAR Airlines totally self-applied, 2) NO-FEAR Airlines with therapist guidance, 3) a waiting-list control group. Primary outcome measures were the Fear of Flying Questionnaire-II and the Fear of Flying Scale. Secondary outcomes included the Fear and Avoidance Scales, Clinician Severity Scale, and Patient's Improvement scale. Behavioral outcomes (post-treatment flights and safety behaviors) were also included. Mixed-model analyses with no ad hoc imputations were conducted for primary and secondary outcome measures. RESULTS NO-FEAR Airlines (with and without therapist guidance) was significantly effective, compared to the waiting list control group, on all primary and secondary outcomes (all ps < .05), and no significant differences were found between the two ways of delivering the intervention. Significant improvements on diagnostic status and reliable change indexes were also found in both treatment groups at post-treatment. Regarding behavioral outcomes, significant differences in safety behaviors were found at post-treatment, compared to the waiting list. Treatment gains were maintained at 3- and 12-month follow-ups. CONCLUSION FP can be treated effectively via the Internet. NO-FEAR Airlines helps to enhance the exposure technique and provide access to evidence-based psychological treatment to more people in need. These data are congruent with previous studies highlighting the usefulness of computer-assisted exposure programs for FP, and they contribute to the literature on Internet-based interventions. To the best of our knowledge, this is the first RCT to investigate the effectiveness of an Internet-based treatment for FP and explore two ways of delivering the intervention (with and without therapist guidance). TRIAL REGISTRATION Clinicaltrials.gov: NCT02298478 ( https://clinicaltrials.gov/ct2/show/NCT02298478 ). Trial registration date 3 November 2014.
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Affiliation(s)
- Daniel Campos
- 0000 0001 1957 9153grid.9612.cUniversitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain
| | - Juana Bretón-López
- 0000 0001 1957 9153grid.9612.cUniversitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain ,0000 0000 9314 1427grid.413448.eCIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Cristina Botella
- 0000 0001 1957 9153grid.9612.cUniversitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain ,0000 0000 9314 1427grid.413448.eCIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Adriana Mira
- 0000 0001 1957 9153grid.9612.cUniversitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain ,0000 0001 2152 8769grid.11205.37Department of Psychology and Sociology, Area of Psychobiology, University of Zaragoza, IIS Aragón, Teruel, Spain
| | - Diana Castilla
- 0000 0001 1957 9153grid.9612.cUniversitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain ,0000 0000 9314 1427grid.413448.eCIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain ,0000 0001 2152 8769grid.11205.37Department of Psychology and Sociology, Area of Psychobiology, University of Zaragoza, IIS Aragón, Teruel, Spain
| | - Sonia Mor
- 0000 0001 1957 9153grid.9612.cUniversitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain
| | - Rosa Baños
- 0000 0000 9314 1427grid.413448.eCIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain ,0000 0001 2173 938Xgrid.5338.dUniversitat de València, Valencia, Spain
| | - Soledad Quero
- Universitat Jaume I, Av. Vicente Sos Baynat s/n, 12006, Castellón, Spain. .,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain.
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15
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Apolinário-Hagen J. Internet-Delivered Psychological Treatment Options for Panic Disorder: A Review on Their Efficacy and Acceptability. Psychiatry Investig 2019; 16:37-49. [PMID: 30122031 PMCID: PMC6354039 DOI: 10.30773/pi.2018.06.26] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/26/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Internet-delivered psychological treatments have been suggested as a chance to expand the access to professional help. However, little is known about the usefulness of different support formats and approaches of digital treatments for panic disorder among clinicians. OBJECTIVE This narrative review aimed to explore the recent evidence base on the efficacy and acceptability of different internet-delivered treatments for adults with panic disorder. METHODS A systematic search in electronic databases (Pubmed/Medline, PSYNDEX) and a hand search were performed to identify articles on randomized controlled trials published within the past five years (2012/12/10-2017/12/12) in English peer-reviewed journals. RESULTS Eight studies (1,013 participants) involving 10 interventions met the inclusion criteria. Nine interventions were primarly based on Cognitive Behavioral Therapy principles. Most interventions were effective, when compared to a control condition (6 of 8 comparisons). Minimal guidance was associated with improved outcomes in one study and adherence in two studies (3 comparisons). Furthermore, no differences were found based on treatment approach (2 comparisons). Regarding acceptability, the attrition rates were moderate to high, ranging from 9.8% to 42.1% of randomized participants. Adherence rates also varied largely (7.8-75%), whereas participant satisfaction of program completers was assessed overall high (5 studies). CONCLUSION Diverse effective internet-delivered treatments are available for the self-management of panic symptoms. Especially selfguided and transdiagnostic Cognitive Behavioral Therapy approaches appear being efficient options for the dissemination in routine care. However, due to the limited evidence base, further efforts are required to improve the actual uptake of internet-delivered treatments and identify moderators of outcomes.
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16
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González-Robles A, Díaz-García A, Miguel C, García-Palacios A, Botella C. Comorbidity and diagnosis distribution in transdiagnostic treatments for emotional disorders: A systematic review of randomized controlled trials. PLoS One 2018; 13:e0207396. [PMID: 30440020 PMCID: PMC6237379 DOI: 10.1371/journal.pone.0207396] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 10/30/2018] [Indexed: 12/17/2022] Open
Abstract
The advantages of transdiagnostic protocols for emotional disorders (ED) (anxiety and depression) include the ability to treat multiple psychological disorders using the same treatment protocol, and the capacity to better address comorbidity. Comorbidity in ED has been associated with higher rates of severity, functional impairment, and chronicity. However, no attempts have been made in the literature to systematically review whether these studies include assessments to evaluate the treatment response in comorbid diagnoses, in addition to the principal diagnosis. Moreover, transdiagnostic treatments have been developed for a range of ED, but to date no study has analyzed the real distribution of diagnoses in these studies. The current study aimed to analyze: a) whether treatment response in comorbidity is evaluated in transdiagnostic treatments for ED; b) what diagnoses are targeted in transdiagnostic treatments for ED; and c) the real distribution of the diagnoses at baseline in these studies. A systematic search of the literature was conducted in PsycINFO, PubMed, EMBASE, and the Cochrane Library. Fifty-two randomized controlled trials were identified, with a total of 7007 adult participants. The results showed that, although most of the studies reported data on comorbidity at baseline, only 40% of them examined the effects of the intervention on the comorbid disorders. The most commonly targeted diagnoses in transdiagnostic protocols were panic/agoraphobia, generalized anxiety, social anxiety, and depression. Other disorders, such as obsessive-compulsive disorder, posttraumatic stress disorder, and anxiety/depression not otherwise specified, were marginally included in these studies. Regarding the distribution of diagnoses at baseline, generalized anxiety, panic/agoraphobia, social anxiety, and depression were the most frequently observed, whereas depression not otherwise specified was the least represented. The results highlight the importance of assessing comorbidity in addition to the principal diagnoses in transdiagnostic treatments, in order to draw conclusions about the true potential of these interventions to improve comorbid symptoms. Implications of the current study and directions for future research are discussed.
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Affiliation(s)
- Alberto González-Robles
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
| | - Amanda Díaz-García
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
| | - Clara Miguel
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, 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
| | - 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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17
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Effects of a Brief Transdiagnostic Cognitive Behavioural Group Therapy on Disorder Specific Symptoms. Behav Cogn Psychother 2018; 47:1-15. [DOI: 10.1017/s1352465818000450] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background:In recent years, cognitive behavioural group therapies (CBGT) have been increasingly deployed as a strategy to increase the efficiency and cost-effectiveness in treatment of common mental health problems. The vast majority of these therapies are disorder specific, but in the last few years there has been growing interest in transdiagnostic CBGT.Aims:The aim of this study was twofold: to evaluate the treatment effects of transdiagnostic CBGT on disorder specific symptoms and what (if any) differences would be observed in the treatment effects with regard to general as opposed to disorder specific symptoms measured pre- and post-treatment.Method:The participants were 233 adult patients diagnosed with depression and/or anxiety disorders. They underwent a 6-week transdiagnostic CBGT. To compare treatment effects on general and disorder specific symptoms, raw scores on all measures were converted to standardized scores.Results:Pre–post differences were significant and there was no evidence that treatment was differentially effective for general and disorder specific symptoms. Effect sizes ranged from medium to large.Conclusion:The 6-week transdiagnostic CBGT is feasible for a wide range of mood and anxiety disorders. The results indicate that low-intensity transdiagnostic group therapies may have similar effects on both general and disorder specific symptoms.
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18
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Campos D, Mira A, Bretón-López J, Castilla D, Botella C, Baños RM, Quero S. The acceptability of an Internet-based exposure treatment for flying phobia with and without therapist guidance: patients' expectations, satisfaction, treatment preferences, and usability. Neuropsychiatr Dis Treat 2018; 14:879-892. [PMID: 29636613 PMCID: PMC5880416 DOI: 10.2147/ndt.s153041] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Internet-based treatments have been tested for several psychological disorders. However, few studies have directly assessed the acceptability of these self-applied interventions in terms of expectations, satisfaction, treatment preferences, and usability. Moreover, no studies provide this type of data on Internet-based treatment for flying phobia (FP), with or without therapist guidance. The aim of this study was to analyze the acceptability of an Internet-based treatment for FP (NO-FEAR Airlines) that includes exposure scenarios composed of images and real sounds. A secondary aim was to compare patients' acceptance of two ways of delivering this treatment (with or without therapist guidance). PATIENTS AND METHODS The sample included 46 participants from a randomized controlled trial who had received the self-applied intervention with (n = 23) or without (n = 23) therapist guidance. All participants completed an assessment protocol conducted online and by telephone at both pre- and posttreatment. RESULTS Results showed good expectations, satisfaction, opinion, and usability, regardless of the presence of therapist guidance, including low aversiveness levels from before to after the intervention. However, participants generally preferred the therapist-supported condition. CONCLUSION NO-FEAR Airlines is a well-accepted Internet-based treatment that can help enhance the application of the exposure technique, improving patient acceptance and access to FP treatment.
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Affiliation(s)
- Daniel Campos
- Department of Basic Psychology, Universitat Jaume I, Castellón, Spain
| | - Adriana Mira
- Department of Basic Psychology, Universitat Jaume I, Castellón, Spain.,Department of Psychology and Sociology, Facultad de Ciencias Sociales y Humanas, Universidad de Zaragoza, Campus Universitario de Teruel, Teruel, Spain
| | - Juana Bretón-López
- Department of Basic Psychology, Universitat Jaume I, Castellón, Spain.,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Barcelona, Spain
| | - Diana Castilla
- Department of Basic Psychology, Universitat Jaume I, Castellón, Spain.,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Barcelona, Spain
| | - Cristina Botella
- Department of Basic Psychology, Universitat Jaume I, Castellón, Spain.,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Barcelona, Spain
| | - Rosa Maria Baños
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Barcelona, Spain.,Department of Personality, Evaluation and Psychological Treatment, Universitat de València, Valencia, Spain
| | - Soledad Quero
- Department of Basic Psychology, Universitat Jaume I, Castellón, Spain.,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Barcelona, Spain
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Păsărelu CR, Andersson G, Bergman Nordgren L, Dobrean A. Internet-delivered transdiagnostic and tailored cognitive behavioral therapy for anxiety and depression: a systematic review and meta-analysis of randomized controlled trials. Cogn Behav Ther 2016; 46:1-28. [PMID: 27712544 DOI: 10.1080/16506073.2016.1231219] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Anxiety and depressive disorders are often comorbid. Transdiagnostic and tailored treatments seem to be promising approaches in dealing with comorbidity. Although several primary studies have examined the effects of Internet-delivered cognitive behavior therapy (iCBT) for anxiety and depression, no meta-analysis including different types of iCBT that address comorbidity has been conducted so far. We conducted systematic searches in databases up to 1 July 2016. Only randomized trials comparing transdiagnostic/tailored iCBT for adult anxiety and/or depression with control groups were included. Nineteen randomized trials with a total of 2952 participants that met inclusion criteria were analyzed. The quality of the studies was high, however the blinding criteria were not fulfilled. The uncontrolled effect size (Hedges' g) of transdiagnostic/tailored iCBT on anxiety and depression outcomes was large and medium for quality of life. The controlled effect size for iCBT on anxiety and depression outcomes was medium to large (anxiety: g = .82, 95% CI: .58-1.05, depression: g = .79, 95% CI: .59-1.00) and medium on quality of life (g = .56, 95% CI: .37-.73). Heterogeneity was small (quality of life) to moderate (anxiety, depression). There was a large effect on generic outcome measures and a moderate effect on comorbidities. When compared to disorder-specific treatments there were no differences on anxiety and quality of life outcomes, however there were differences in depression outcomes. Transdiagnostic and tailored iCBT are effective interventions for anxiety disorders and depression. Future studies should investigate mechanisms of change and develop outcome measures for these interventions.
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Affiliation(s)
- Costina Ruxandra Păsărelu
- a Doctoral School Evidence-Based Assessment and Psychological Interventions , Babeș-Bolyai University , Cluj-Napoca , Romania
| | - Gerhard Andersson
- b Department of Behavioural Sciences and Learning , Linköping University , Linkoping , Sweden.,c Psychiatry Section, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Lise Bergman Nordgren
- b Department of Behavioural Sciences and Learning , Linköping University , Linkoping , Sweden
| | - Anca Dobrean
- d Department of Clinical Psychology and Psychotherapy , Babeș-Bolyai University , Cluj-Napoca , Romania
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