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Monteith S, Glenn T, Geddes JR, Whybrow PC, Achtyes ED, Bauer M. Implications of Online Self-Diagnosis in Psychiatry. PHARMACOPSYCHIATRY 2024; 57:45-52. [PMID: 38471511 DOI: 10.1055/a-2268-5441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Online self-diagnosis of psychiatric disorders by the general public is increasing. The reasons for the increase include the expansion of Internet technologies and the use of social media, the rapid growth of direct-to-consumer e-commerce in healthcare, and the increased emphasis on patient involvement in decision making. The publicity given to artificial intelligence (AI) has also contributed to the increased use of online screening tools by the general public. This paper aims to review factors contributing to the expansion of online self-diagnosis by the general public, and discuss both the risks and benefits of online self-diagnosis of psychiatric disorders. A narrative review was performed with examples obtained from the scientific literature and commercial articles written for the general public. Online self-diagnosis of psychiatric disorders is growing rapidly. Some people with a positive result on a screening tool will seek professional help. However, there are many potential risks for patients who self-diagnose, including an incorrect or dangerous diagnosis, increased patient anxiety about the diagnosis, obtaining unfiltered advice on social media, using the self-diagnosis to self-treat, including online purchase of medications without a prescription, and technical issues including the loss of privacy. Physicians need to be aware of the increase in self-diagnosis by the general public and the potential risks, both medical and technical. Psychiatrists must recognize that the general public is often unaware of the challenging medical and technical issues involved in the diagnosis of a mental disorder, and be ready to treat patients who have already obtained an online self-diagnosis.
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Affiliation(s)
- Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, Michigan, USA
| | - Tasha Glenn
- ChronoRecord Association, Fullerton, California, USA
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Peter C Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, California, USA
| | - Eric D Achtyes
- Department of Psychiatry, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Medical Faculty, Technische Universität Dresden, Dresden, Germany
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Pietrabissa G, Semonella M, Marchesi G, Mannarini S, Castelnuovo G, Andersson G, Rossi AA. Validation of the Italian Version of the Web Screening Questionnaire for Common Mental Disorders. J Clin Med 2024; 13:1170. [PMID: 38398481 PMCID: PMC10889998 DOI: 10.3390/jcm13041170] [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: 01/03/2024] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The ever-increasing spread of Internet-based systems for common mental disorders has generated the need for brief online screening methods. This study aims to test the psychometric properties of the Web Screening Questionnaire (WSQ) to examine its suitability for screening for common mental health problems among a community sample of Italian adults. METHODS A total of 1282 subjects (F = 819; mean age = 42.05) answered the WSQ. Its discriminant characteristics were examined with other validated selected scales for measuring mental health widely used in the Italian population using sensitivity, specificity, and area under the curve (AUC), as well as positive (PPV) and negative predictive values (NPV). RESULTS Most of the WSQ subscales exhibited moderate to high specificity values. Specifically, the scales of 'agoraphobia' (0.947; 95%CI [0.934, 0.960]), 'anxiety' (0.959; 95%CI [0.946, 0.970]), and 'panic disorder' (0.973; 95%CI [0.964, 0.981]) showed the highest values whilst the 'obsessive-compulsive' dimension had the lowest value at 0.838, 95%CI [0.815, 0.861]. With exceptions observed for 'depression' (0.716; 95%CI [642, 798]) and 'alcohol abuse' (0.760; 95%CI [560, 920]), instead, the WSQ demonstrated critical sensitivity values (<0.6) in all dimensions. CONCLUSIONS The WSQ was appropriate for discriminating between people with and without a psychiatric condition, as it helps to confirm the absence of disorders. However, further diagnostic procedures are required, in case of a positive WSQ screening result.
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Affiliation(s)
- Giada Pietrabissa
- Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, 20123 Milano, Italy; (G.M.); (G.C.)
- Clinical Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, 20149 Milano, Italy
| | | | - Gloria Marchesi
- Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, 20123 Milano, Italy; (G.M.); (G.C.)
| | - Stefania Mannarini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35131 Padova, Italy; (S.M.); (A.A.R.)
- Center for Intervention and Research Studies on the Family, University of Padova, 35131 Padova, Italy
| | - Gianluca Castelnuovo
- Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, 20123 Milano, Italy; (G.M.); (G.C.)
- Clinical Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, 20149 Milano, Italy
| | - Gerhard Andersson
- Department of Behavioural Science and Learning, Linköping University, 58183 Linköping, Sweden;
- Department of Clinical Neuroscience, Karolinska Institute, 17177 Solna, Sweden
| | - Alessandro Alberto Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35131 Padova, Italy; (S.M.); (A.A.R.)
- Center for Intervention and Research Studies on the Family, University of Padova, 35131 Padova, Italy
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Elison-Davies S, Pittard L, Myton T, Jones A, Ward J, Davies G. Examining outcomes for service users accessing the Breaking Free Online computer-assisted therapy program for substance use disorders via a 'telehealth' approach: protocol for a two arm, parallel group randomized controlled trial. Addict Sci Clin Pract 2023; 18:39. [PMID: 37269012 DOI: 10.1186/s13722-023-00391-0] [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: 09/30/2022] [Accepted: 05/19/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Breaking Free Online (BFO), a computer-assisted therapy (CAT) program for substance use disorders (SUD), has been available across UK treatment services for the past decade and has demonstrated efficacy. The Covid-19 pandemic has contributed to digital and 'telehealth' approaches to healthcare delivery becoming more common and accepted, and has in parallel, increased numbers of referrals to SUD services because of the impact pandemic-related stress has had on substance using habits in the general population. Digital and telehealth approaches, such as BFO, have the potential to support the treatment system to meet this increased demand for SUD services. METHODS Parallel-group randomized controlled trial of eight-week BFO as an adjunct to standard treatment for SUD, in comparison to standard treatment only, at a National Health Service (NHS) Mental Health Trust in North-West England. Participants will be service users aged 18 years and over with demonstrable SUD for at least 12-months. Interventional and control groups will be compared on multiple measures from baseline to post-treatment assessment at eight-weeks, and then three and six-months follow-up. Primary outcome will be self-reported substance use, with secondary outcomes being standardized assessments of substance dependence, mental health, biopsychosocial functioning and quality of life. DISCUSSION This study will examine whether BFO and telehealth support, when delivered as an adjunct to standard SUD interventions, improves outcomes for services users receiving NHS SUD treatment. Findings from the study will be used to inform both developments to the BFO program and guidance around augmenting the delivery of CAT programs via telehealth. Trial registration registered with ISRCTN on 25th May 2021-registration number: 13694016. PROTOCOL VERSION 3.0 05th April 2022. TRIAL STATUS This trial is currently open to recruitment-estimated to be completed in May 2023.
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Affiliation(s)
- Sarah Elison-Davies
- TELUS Health, Williams House, Manchester Science Park, Lloyd Street North, Manchester, M15 6SE, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Achieve Bolton, 69-73 Manchester Road, Bolton, BL2 1ES, UK.
| | - Lauren Pittard
- TELUS Health, Williams House, Manchester Science Park, Lloyd Street North, Manchester, M15 6SE, UK
- Greater Manchester Mental Health NHS Foundation Trust, Achieve Bolton, 69-73 Manchester Road, Bolton, BL2 1ES, UK
| | - Tracey Myton
- Greater Manchester Mental Health NHS Foundation Trust, Achieve Bolton, 69-73 Manchester Road, Bolton, BL2 1ES, UK
| | - Andrew Jones
- Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M15 6JA, UK
| | - Jonathan Ward
- TELUS Health, Williams House, Manchester Science Park, Lloyd Street North, Manchester, M15 6SE, UK
| | - Glyn Davies
- TELUS Health, Williams House, Manchester Science Park, Lloyd Street North, Manchester, M15 6SE, UK
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Obasa AJ, Akinradewo OF, Olanipekun AO. Impact of technologies towards addressing stress-related problems among practicing quantity surveyors in Lagos, Nigeria. INTERNATIONAL JOURNAL OF CONSTRUCTION MANAGEMENT 2022. [DOI: 10.1080/15623599.2022.2135943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Ayotomide James Obasa
- Department of Quantity Surveying, Federal University of Technology Akure, Akure, Nigeria
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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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Dewitte M, Bettocchi C, Carvalho J, Corona G, Flink I, Limoncin E, Pascoal P, Reisman Y, Van Lankveld J. A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM). Sex Med 2021; 9:100434. [PMID: 34626919 PMCID: PMC8766276 DOI: 10.1016/j.esxm.2021.100434] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/16/2021] [Accepted: 08/10/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Although erectile dysfunction (ED) involves an interaction between physiological and psychological pathways, the psychosocial aspects of ED have received considerably less attention so far. AIM To review the available evidence on the psychosocial aspects of ED in order to develop a position statement and clinical practice recommendations on behalf of the European Society of Sexual Medicine (ESSM). METHOD A comprehensive, narrative review of the literature was performed. MAIN OUTCOME MEASURES Specific statements and recommendations according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence criteria were provided. RESULTS A multidisciplinary treatment, in which medical treatment is combined with a psychological approach, is preferred over unimodal treatment. There is increasing evidence that psychological treatments of ED can improve medical treatments, the patient's adherence to treatment, and the quality of the sexual relationship. The main components of psychological treatment of ED involve cognitive and behavioral techniques aimed at reducing anxiety, challenging dysfunctional beliefs, increasing sexual stimulation, disrupting sexual avoidance, and increasing intimacy and communication skills in a relational context. When applicable and possible, it is strongly recommended to include the partner in the assessment and treatment of ED and to actively work on interpartner agreement and shared decision-making regarding possible treatment options. To ensure a better integration of the biopsychosocial model into clinical practice, developing concrete treatment protocols and training programs are desirable. CONCLUSION Because the psychosocial approach to ED has been underexposed so far, this position statement provides valuable information for clinicians treating ED. Psychological interventions on ED are based on existing theoretical models that are grounded in empirical evidence. However, the quality of available studies is low, which calls for further research. The sexual medicine field would benefit from pursuing more diversity, inclusivity, and integration when setting up treatments and evaluating their effect. Dewitte M, Bettocchi C, Carvalho J, et al. A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM). Sex Med 2021;9:100434.
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Affiliation(s)
- Marieke Dewitte
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
| | - Carlo Bettocchi
- Policlinic, Urology Unit, University of Aldo Moro, Bari, Italy
| | - Joanna Carvalho
- Escola de Psicologia e Ciências da Vida, Universidade Lusófona de Humanidades e Tecnologias, Lisbon, Portugal
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda USL, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Ida Flink
- Center for Health and Medical Psychology, Örebro University, Örebro, Sweden
| | - Erika Limoncin
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Patricia Pascoal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal; Universidade Lusófona de Humanidades e Tecnologias, Lisbon, Portugal; Faculdade de Psicologia e Ciências da Educação & CPUP, Universidade do Porto, Portugal
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Fischer VJ, Andersson G, Billieux J, Vögele C. A randomized controlled trial of an Internet-based emotion regulation intervention for sexual health: study protocol. Trials 2021; 22:706. [PMID: 34654460 PMCID: PMC8518194 DOI: 10.1186/s13063-021-05586-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction Emotion regulation difficulties have been associated with mental disorders and sexual dysfunctions. Traditional face-to-face transdiagnostic emotion regulation interventions have shown positive results for emotional and personality disorders. Only recently have the effects of these interventions on sexual health started to be investigated. Internet-delivered psychological interventions have several advantages over face-to-face interventions, such as cost-effectiveness, accessibility, and suitability for people who experience shame because of their stigmatized problematic behaviors and those who avoid seeking help. The aims of the SHER 2—TREpS (Portuguese acronym for Emotion Regulation training for sexual health) project are as follows: (a) determine the efficacy of an Internet-based emotion regulation intervention for sexual health and sexual satisfaction and (b) explore the effects of the intervention on (1) emotion regulation skills, (2) mental health, and (3) sexual self-perception. Methods and analysis The study will use a randomized controlled trial design. Eligible participants will be randomly allocated to one of two groups: intervention (Internet-based emotion regulation training) or waitlist control. Assessments will take place before the start of the trial, at the end of the trial, and at 6-month follow up, after which participants assigned to the waitlist control condition will receive the same intervention. Primary outcomes include sexual function and satisfaction and secondary outcomes self-report measures of depression, anxiety, difficulties in emotion regulation, and sexual self-perception. This intervention study is financed by the Luxembourg National Research Fund (FNS). Ethics and dissemination Ethics approval was obtained from the Ethics Review Panel of the University of Luxembourg. Findings will be disseminated via peer-reviewed publications and conference presentations.
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Affiliation(s)
- Vinicius Jobim Fischer
- Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg - Campus Belval, 11, Porte des Sciences, L-4366 Esch-sur-Alzette, Luxembourg, Sweden.
| | - Gerhard Andersson
- Department of Behavioural Science and Learning, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 83, Linköping, Sweden
| | - Joël Billieux
- Cognitive and Affective Regulation Lab (CARLA), Institute of Psychology, University of Lausanne, uartier UNIL-Mouline - Bâtiment Géopolis - Bureau 4240, CH-1015, Lausanne, Switzerland
| | - Claus Vögele
- Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg - Campus Belval, 11, Porte des Sciences, L-4366 Esch-sur-Alzette, Luxembourg, Sweden
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Machado NM, Gomide HP, Bernardino HS, Ronzani TM. Internet-based intervention compared to brief intervention for smoking cessation in Brazil: a pilot study (Preprint). JMIR Form Res 2021; 6:e30327. [PMID: 36326817 PMCID: PMC9673002 DOI: 10.2196/30327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/03/2021] [Accepted: 05/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Smoking is still the leading cause of preventable death. Governments and health care providers should make available more accessible resources to help tobacco users stop. Objective This study describes a pilot longitudinal study that evaluated the efficacy of an internet-based intervention compared to the brief intervention for smoking cessation among Brazilians. Methods Eligible participants were recruited and randomly allocated to one of the two interventions. Measures were drawn by comparing cessation rates, motivation scores, and sought treatment between groups, assessed 1 and 3 months after the intervention. Inferential analysis was performed to compare the participants’ characteristics, and the intention to treat was calculated. Results A total of 49 smokers were enrolled in this study (n=25, 51% in the brief intervention group; n=24, 49% in the internet-based intervention group). Mean age was 44.5 (SD 13.3) years; most were male (n=29, 59.2%), had elementary school (n=22, 44.9%), smoked 14.5 cigarettes per day on average (SD 8.6), and had a mean score of 4.65 for nicotine dependence and 5.7 for motivation to quit. Moreover, 35 (71%) participants answered follow-up 1, and 19 (39%) answered follow-up 2. The results showed similar rates of cessation and reduction for both intervention groups. Conclusions The internet-based intervention was slightly more effective for smoking cessation, while the brief intervention was more effective in reducing the number of cigarettes smoked per day. This difference was small and had no statistical significance even after adjusting for intention-to-treat analysis. These results should be interpreted with caution, especially due to the small sample size.
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Affiliation(s)
- Nathalia Munck Machado
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
- Department of Psychology, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | | | | | - Telmo Mota Ronzani
- Department of Psychology, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
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Mukhiya SK, Wake JD, Inal Y, Pun KI, Lamo Y. Adaptive Elements in Internet-Delivered Psychological Treatment Systems: Systematic Review. J Med Internet Res 2020; 22:e21066. [PMID: 33245285 PMCID: PMC7732710 DOI: 10.2196/21066] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/19/2020] [Accepted: 10/26/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Internet-delivered psychological treatments (IDPTs) are built on evidence-based psychological treatment models, such as cognitive behavioral therapy, and are adjusted for internet use. The use of internet technologies has the potential to increase access to evidence-based mental health services for a larger proportion of the population with the use of fewer resources. However, despite extensive evidence that internet interventions can be effective in the treatment of mental health disorders, user adherence to such internet intervention is suboptimal. OBJECTIVE This review aimed to (1) inspect and identify the adaptive elements of IDPT for mental health disorders, (2) examine how system adaptation influences the efficacy of IDPT on mental health treatments, (3) identify the information architecture, adaptive dimensions, and strategies for implementing these interventions for mental illness, and (4) use the findings to create a conceptual framework that provides better user adherence and adaptiveness in IDPT for mental health issues. METHODS The review followed the guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The research databases Medline (PubMed), ACM Digital Library, PsycINFO, CINAHL, and Cochrane were searched for studies dating from January 2000 to January 2020. Based on predetermined selection criteria, data from eligible studies were analyzed. RESULTS A total of 3341 studies were initially identified based on the inclusion criteria. Following a review of the title, abstract, and full text, 31 studies that fulfilled the inclusion criteria were selected, most of which described attempts to tailor interventions for mental health disorders. The most common adaptive elements were feedback messages to patients from therapists and intervention content. However, how these elements contribute to the efficacy of IDPT in mental health were not reported. The most common information architecture used by studies was tunnel-based, although a number of studies did not report the choice of information architecture used. Rule-based strategies were the most common adaptive strategies used by these studies. All of the studies were broadly grouped into two adaptive dimensions based on user preferences or using performance measures, such as psychometric tests. CONCLUSIONS Several studies suggest that adaptive IDPT has the potential to enhance intervention outcomes and increase user adherence. There is a lack of studies reporting design elements, adaptive elements, and adaptive strategies in IDPT systems. Hence, focused research on adaptive IDPT systems and clinical trials to assess their effectiveness are needed.
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Affiliation(s)
| | | | | | - Ka I Pun
- Western Norway University of Applied Sciences, Bergen, Norway
| | - Yngve Lamo
- Western Norway University of Applied Sciences, Bergen, Norway
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Chichetto NE, Polanka BM, So-Armah KA, Sung M, Stewart JC, Koethe JR, Edelman EJ, Tindle HA, Freiberg MS. Contribution of Behavioral Health Factors to Non-AIDS-Related Comorbidities: an Updated Review. Curr HIV/AIDS Rep 2020; 17:354-372. [PMID: 32314325 PMCID: PMC7363585 DOI: 10.1007/s11904-020-00498-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW We summarize recent literature on the contribution of substance use and depression to non-AIDS-related comorbidities. Discussion of recent randomized clinical trials and implementation research to curtail risk attributed to each behavioral health issue is provided. RECENT FINDINGS Smoking, unhealthy alcohol use, opioid use, and depression are common among PWH and individually contribute to increased risk for non-AIDS-related comorbidities. The concurrence of these conditions is notable, yet understudied, and provides opportunity for linked-screening and potential treatment of more than one behavioral health factor. Current results from randomized clinical trials are inconsistent. Investigating interventions to reduce the impact of these behavioral health conditions with a focus on implementation into clinical care is important. Non-AIDS-defining cancers, cardiovascular disease, liver disease, and diabetes are leading causes of morbidity in people with HIV. Behavioral health factors including substance use and mental health issues, often co-occurring, likely contribute to the excess risk of non-AIDS-related comorbidities.
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Affiliation(s)
- Natalie E Chichetto
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Brittanny M Polanka
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| | - Kaku A So-Armah
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Minhee Sung
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| | - John R Koethe
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Centers, Nashville, TN, USA
| | - Matthew S Freiberg
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Centers, Nashville, TN, USA
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Donker T, van Klaveren C, Cornelisz I, Kok RN, van Gelder JL. Analysis of Usage Data from a Self-Guided App-Based Virtual Reality Cognitive Behavior Therapy for Acrophobia: A Randomized Controlled Trial. J Clin Med 2020; 9:jcm9061614. [PMID: 32466528 PMCID: PMC7357041 DOI: 10.3390/jcm9061614] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/14/2020] [Accepted: 05/22/2020] [Indexed: 11/21/2022] Open
Abstract
This study examined user engagement with ZeroPhobia, a self-guided app-based virtual reality (VR) Cognitive Behavior Therapy for acrophobia symptoms using cardboard VR viewers. Dutch acrophobic adults (n = 96) completed assessments at baseline and immediately following treatment. Primary outcome measures were the Acrophobia Questionnaire (AQ) and the Igroup Presence Questionnaire (IPQ). Usage data consisted of number of VR sessions practiced, practice time, and fear ratings directly after practicing. Results show that of the 66 participants who played at least one level, the majority continued to finish all levels, spending on average 24.4 min in VR. Self-reported fear consistently decreased between the start and finish of levels. Post-test AQ scores depended quadratically on time spent in VR. Higher pre-test AQ scores were significantly associated with subjective anxiety after the first level and a reduction of post-test AQ scores, but not with number of sessions, suggesting it might be more beneficial to play one level for a longer time period instead of practicing many VR levels. Results also show an optimum exposure level at which increasing practice time does not result in increased benefit. Self-guided VR acrophobia treatment is effective and leads to consistent reductions in self-reported anxiety both between levels and after treatment. Most participants progressed effectively to the highest self-exposure level, despite the absence of a therapist.
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Affiliation(s)
- Tara Donker
- Department of Clinical, Neuro and Developmental Psychology, Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Psychology, Laboratory of Biological and Personality Psychology, Albert Ludwigs-University of Freiburg, Peter-Kaplan Meierstrasse 8, 79104 Freiburg im Breisgau, Germany
- Correspondence: ; Tel.: +31-20-5988959; Fax: +31-20-5988758
| | - Chris van Klaveren
- Department of Education Sciences, Section Methods and Statistics and Amsterdam Center for Learning Analytics, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands; (C.v.K.); (I.C.)
| | - Ilja Cornelisz
- Department of Education Sciences, Section Methods and Statistics and Amsterdam Center for Learning Analytics, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands; (C.v.K.); (I.C.)
| | - Robin N. Kok
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark;
- Centre for Innovative Medical Technology, Odense University Hospital, Indgang 101, 5000 Odense, Denmark
| | - Jean-Louis van Gelder
- Institute of Education and Child Studies, Leiden University, Pieter de la Court building, 4th floor, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands;
- Max Planck Institute for the Study of Crime, Security and Law, Department of Criminology, Günterstalstraße 73, 79100 Freiburg, Germany
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Smartteen- a computer assisted cognitive behavior therapy for Indian adolescents with depression- a pilot study. Asian J Psychiatr 2020; 50:101970. [PMID: 32114331 DOI: 10.1016/j.ajp.2020.101970] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 01/02/2020] [Accepted: 02/09/2020] [Indexed: 11/23/2022]
Abstract
The prevalence of unipolar depression among adolescents in India is high. Cognitive behavior therapies (CBTs) are considered the current gold standard treatment for depression in adolescents; however, their access is limited in India. Given the ubiquity of technology including smartphones and computers, technology can be leveraged to improve access of CBT treatment in India. Our team developed smartteen- a computer application designed to augment in-person CBT for treatment of depression in adolescents. This paper will present results of the pilot evaluation of smartteen (a cCBT) for its feasibility, acceptability and effectiveness in reducing depressive symptoms. Twenty-one adolescents with unipolar depression seeking treatment at a tertiary care hospital were randomly assigned to smartteen (n = 11) and TAU (n = 10). Both groups received twelve weeks of treatment and were assessed at baseline, mid-treatment (6 weeks) and post-treatment (12 weeks) using four clinical measures including BDI-II, CDRS-R, CGI-S and CGAS. smartteen was shown to be feasible and acceptable treatment to adolescents. At 6 weeks, both treatments were effective in reducing depression. At 12 weeks, smartteen was significantly more effective than TAU in reducing depression symptoms and improving functioning on CGAS. Treatment compliance was better in smartteen group. smartten was shown to reduce the time spent by therapist to deliver 12 sessions of CBT treatment for depression. Results indicate that smartteen may be subjected to more rigorous evaluations with larger samples and considered for wider implementation if found effective.
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Machado NM, Gomide HP, Bernardino HS, Ronzani TM. Facebook recruitment of smokers: comparing gain- and loss-framed ads for the purposes of an Internet-based smoking cessation intervention. CAD SAUDE PUBLICA 2019; 35:e00151318. [DOI: 10.1590/0102-311x00151318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 04/30/2019] [Indexed: 11/21/2022] Open
Abstract
Abstract: Gain- and loss-framed messages about smoking behavior have commonly been used to promote cessation. However, there are still no clear conclusions as to what kind of message is more effective for motivating smokers to quit. This study compared the effectiveness of loss- and gain-framed messages in the online recruitment of smokers via Facebook Advertising. Loss- and gain-framed messages about smoking were created and released as Facebook ads. Users who clicked on the ads were automatically redirected to the “Live Without Tobacco” intervention (http://www.vivasemtabaco.com.br). The amount spent on the ads was BRL 647.64. Data were collected from the Facebook Ads platform and from a relational database. Analyses were performed on the 6,350 users who clicked on one of the ads and 1,731 who were successfully redirected to the intervention. Gain-framed ads reached 174,029 people and loss-framed ads reached 180,527. The former received 2,688 clicks, while the latter received 3,662. The cost of the click was BRL 0.12 per gain-framed ad and BRL 0.09 per loss-framed ad. Loss-framed ads reached more users, got more clicks (and website accesses), and led to more accounts and quit plans being created. Loss-framed messages about smoking appear to be more cost-effective for both initial recruitment and intervention engagement. Facebook has proven to be a good outreach and recruitment tool and can be a solution for the difficulty in reaching smokers for cessation interventions.
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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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15
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Davies SR, Caldwell DM, Dawson S, Sampson SJ, Welton NJ, Wiles N, Kessler D, Miljanović M, Milunovic V, Peters T, Lewis G, Lopez-Lopez JA, Churchill R. Multimedia-delivered cognitive behavioural therapy versus face-to-face cognitive behavioural therapy for depression in adults. Hippokratia 2018. [DOI: 10.1002/14651858.cd013184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Sarah R Davies
- University of Bristol; Population Health Sciences, Bristol Medical School; Canynge Hall 39 Whatley Road Bristol UK BS8 2PS
| | - Deborah M Caldwell
- University of Bristol; Population Health Sciences, Bristol Medical School; Canynge Hall 39 Whatley Road Bristol UK BS8 2PS
| | - Sarah Dawson
- University of Bristol; Population Health Sciences, Bristol Medical School; Canynge Hall 39 Whatley Road Bristol UK BS8 2PS
| | | | - Nicky J Welton
- University of Bristol; Population Health Sciences, Bristol Medical School; Canynge Hall 39 Whatley Road Bristol UK BS8 2PS
| | - Nicola Wiles
- University of Bristol; Population Health Sciences, Bristol Medical School; Canynge Hall 39 Whatley Road Bristol UK BS8 2PS
| | - David Kessler
- University of Bristol; Population Health Sciences, Bristol Medical School; Canynge Hall 39 Whatley Road Bristol UK BS8 2PS
| | - Maja Miljanović
- Agency for Quality and Accreditation in Health Care and Social Welfare; Zagreb Croatia
| | - Vibor Milunovic
- Clinical Hospital Merkur; Division of Hematology; Zagreb Croatia 10000
| | - Tim Peters
- University of Bristol; Academic Unit of Primary Health Care, Department of Community Based Medicine; Cotham Hill Bristol UK BS6 6JL
| | - Glyn Lewis
- UCL; UCL Division of Psychiatry; 67-73 Riding House St London UK W1W 7EJ
| | - Jose A Lopez-Lopez
- University of Bristol; Population Health Sciences, Bristol Medical School; Canynge Hall 39 Whatley Road Bristol UK BS8 2PS
| | - Rachel Churchill
- University of York; Centre for Reviews and Dissemination; York UK Y010 5DD
- University of York; Cochrane Common Mental Disorders Group; York - None - UK Y010 5DD
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Tang WX, Zhang LF, Ai YQ, Li ZS. Efficacy of Internet-delivered cognitive-behavioral therapy for the management of chronic pain in children and adolescents: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e12061. [PMID: 30200086 PMCID: PMC6133396 DOI: 10.1097/md.0000000000012061] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Pediatric chronic pain is relatively common in the world. Although cognitive behavior therapy (CBT) has been shown to be efficacious in children and adolescents, it is generally recognized that availability and accessibility of CBT are limited. While Internet-delivered cognitive-behavioral therapy (ICBT) performs better in these areas. OBJECTIVES This systematic review aims to evaluate the clinical effects of ICBT for chronic pain in youth when compared with the control treatments. METHODS We searched electronic databases to identify randomized controlled trials that compared ICBT with the control therapy for pediatric chronic pain. The primary outcomes were 95% confidence intervals and mean difference or standardized mean difference in change of pain intensity and activity limitations. RESULTS Four trials met the inclusion criteria with a total of 404 participants of whom 208 received ICBT. Compared with pretreatment, children reported significant, medium to large benefits on pain intensity, activity limitations, and parental protective behaviors after receiving ICBT immediately. Significant small to medium effects were found for outcomes of depressive symptoms, anxiety, and sleep quality from baseline to post-treatment in the ICBT group. But most measures of ICBT did not show statistically significant superiority to those of the control conditions, except parental protective behaviors. Generally children and their parents were highly acceptable and satisfied with ICBT. CONCLUSION ICBT for physical and psychological conditions in youth with chronic pain is a full potential therapy; it can be successful on clinically effects and socioeconomic benefits. However, only limited data supported the conclusion, we require further methodologically robust trials. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017069811.
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17
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Weisel KK, Lehr D, Heber E, Zarski AC, Berking M, Riper H, Ebert DD. Severely Burdened Individuals Do Not Need to Be Excluded From Internet-Based and Mobile-Based Stress Management: Effect Modifiers of Treatment Outcomes From Three Randomized Controlled Trials. J Med Internet Res 2018; 20:e211. [PMID: 29921562 PMCID: PMC6030574 DOI: 10.2196/jmir.9387] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 02/11/2018] [Accepted: 03/25/2018] [Indexed: 11/13/2022] Open
Abstract
Background Although internet-based and mobile-based stress management interventions (iSMIs) may be a promising strategy to reach employees suffering from high chronic stress, it remains unknown whether participants with high symptom severity of depression or anxiety also benefit from iSMIs or should be excluded. Objective This study aimed to evaluate the efficacy of iSMIs in subgroups with high symptom severity and to test whether baseline symptom severity moderates treatment outcome. Methods Data from three randomized controlled trials (N=791) were pooled to identify effect modifiers and to evaluate efficacy in subgroups with different levels of initial symptom severity. The outcomes perceived stress (Perceived Stress Scale, PSS), depression severity (Center for Epidemiological Depression Scale, CES-D), and anxiety (Hospital Anxiety and Depression Scale, HADS) symptom severity were assessed at baseline, 7-week postassessment, and 6-month follow-up. Potential moderators were tested in predicting differences in the change of outcome in multiple moderation analyses. Simple slope analyses evaluated efficacy of the iSMI comparing the intervention group with the waitlist control group in subgroups with low, moderate, and severe initial symptomology based on means and SDs of the study population. In addition, subgroups with clinical values of depression (CES-D≥16) and anxiety (HADS≥8) at baseline were explored, and response rates (RRs; 50% symptom reduction) and symptom-free (SF) status (CES-D<16, HADS<8) were reported. Results Individuals with high stress (PSS≥30), depression (CES-D≥33), anxiety (HADS≥15), and emotional exhaustion (MBI≥5.6) benefited significantly from the intervention with great reductions of stress (dpost=0.86-1.16, dFU=0.93-1.35), depression (dpost=0.69-1.08, dFU=0.91-1.19), and anxiety (dpost=0.79-1.19, dFU=1.06-1.21), and effects were sustained at 6-month follow-up. Symptom severity moderated treatment outcomes, as individuals with higher symptom severity at baseline benefited significantly more from the intervention than individuals with lower symptom severity. Furthermore, 82.9% (656/791) of individuals had clinical depression values at baseline, of which significantly more individuals in the intervention group reached at least 50% symptom reduction or fell under clinical cut-off (RR: 29.2%, 93/318; SF: 39.6%, 126/318) compared with the waitlist control group (RR: 8.0%, 27/338; SF: 18.6%, 63/338) at postassessment. Significantly more individuals with clinical anxiety values at baseline (HADS≥8, 85.3%, 675/791) in the intervention group achieved at least 50% symptom reduction or fell under clinical cut-off (RR: 27.7%, 94/339; SF: 39.8%, 135/339) compared with the WLC (RR: 4.8%, 16/336; SF: 15.5%, 52/336). Conclusions Highly burdened individuals benefit greatly from iSMIs and therefore should not be excluded from participation. Stress management may be a valid entry point to reach highly burdened individuals who otherwise may not seek treatment. Trial Registration 1) German Clinical Trials Register DRKS00005112; https://www.drks.de/DRKS00005112 (Archived by WebCite at http://www.webcitation.org/6zmIZwvdA); 2) German Clinical Trials Register DRKS00005384; https://www.drks.de/ DRKS00005384 (Archived by WebCite at http://www.webcitation.org/6zmIerdtr); and 3) German Clinical Trials Register DRKS00004749; https://www.drks.de/DRKS00004749 (Archived by WebCite at http://www.webcitation.org/6zmIjDQPx).
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Affiliation(s)
- Kiona Krueger Weisel
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University Erlangen-Nuernberg, Erlangen, Germany
| | - Dirk Lehr
- Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany.,Department of Health Psychology and Applied Biological Psychology, Institute for Psychology, Leuphana University Lueneburg, Lueneburg, Germany
| | - Elena Heber
- Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany.,GET.ON Institute for Online Health Trainings, Hamburg, Germany
| | - Anna-Carlotta Zarski
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University Erlangen-Nuernberg, Erlangen, Germany.,Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University Erlangen-Nuernberg, Erlangen, Germany.,Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany
| | - Heleen Riper
- Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany.,Department of Clinical, Neuro and Developmental Psychology, Faculty of Behaviour and Movement Sciences, VU University Amsterdam, Amsterdam, Netherlands
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University Erlangen-Nuernberg, Erlangen, Germany.,Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany
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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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19
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An Online Mental Health and Wellness Intervention Supplementing Standard Care of Depression and Anxiety. Arch Psychiatr Nurs 2016; 30:666-670. [PMID: 27888957 DOI: 10.1016/j.apnu.2016.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 03/02/2016] [Accepted: 03/06/2016] [Indexed: 01/25/2023]
Abstract
Online interventions offer benefits, but often have not been tested in studies. The aim was to study feasibility, acceptability, and preliminary effectiveness of an online intervention supplementing standard care of depression and anxiety. The study was conducted within a large healthcare system. Three primary care and four behavioral health providers recruited 96 participants. Overall, 91% (n=87) agreed to participate, while 43% (n=41) completed registration and 27% (n=26) logged into the intervention multiple times. Participants referred by behavioral health demonstrated greater involvement. Reductions in depression and anxiety were observed. Most providers were satisfied with the intervention. This study supports future research.
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20
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Vigerland S, Lenhard F, Bonnert M, Lalouni M, Hedman E, Ahlen J, Olén O, Serlachius E, Ljótsson B. Internet-delivered cognitive behavior therapy for children and adolescents: A systematic review and meta-analysis. Clin Psychol Rev 2016; 50:1-10. [DOI: 10.1016/j.cpr.2016.09.005] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 09/16/2016] [Accepted: 09/18/2016] [Indexed: 11/29/2022]
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21
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Montero-Marín J, Araya R, Pérez-Yus MC, Mayoral F, Gili M, Botella C, Baños R, Castro A, Romero-Sanchiz P, López-Del-Hoyo Y, Nogueira-Arjona R, Vives M, Riera A, García-Campayo J. An Internet-Based Intervention for Depression in Primary Care in Spain: A Randomized Controlled Trial. J Med Internet Res 2016; 18:e231. [PMID: 27565118 PMCID: PMC5018101 DOI: 10.2196/jmir.5695] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/26/2016] [Accepted: 06/23/2016] [Indexed: 12/31/2022] Open
Abstract
Background Depression is the most prevalent cause of illness-induced disability worldwide. Face-to-face psychotherapeutic interventions for depression can be challenging, so there is a need for other alternatives that allow these interventions to be offered. One feasible alternative is Internet-based psychological interventions. This is the first randomized controlled trial (RCT) on the effectiveness of an Internet-based intervention on depression in primary health care in Spain. Objective Our aim was to compare the effectiveness of a low-intensity therapist-guided (LITG) Internet-based program and a completely self-guided (CSG) Internet-based program with improved treatment as usual (iTAU) care for depression. Methods Multicenter, three-arm, parallel, RCT design, carried out between November 2012 and January 2014, with a follow-up of 15 months. In total, 296 adults from primary care settings in four Spanish regions, with mild or moderate major depression, were randomized to LITG (n=96), CSG (n=98), or iTAU (n=102). Research completers at follow-up were 63.5%. The intervention was Smiling is Fun, an Internet program based on cognitive behavioral therapy. All patients received iTAU by their general practitioners. Moreover, LITG received Smiling is Fun and the possibility of psychotherapeutic support on request by email, whereas CSG received only Smiling is Fun. The main outcome was the Beck Depression Inventory-II at 3 months from baseline. Mixed-effects multilevel analysis for repeated measures were undertaken. Results There was no benefit for either CSG [(B coefficient=-1.15; P=.444)] or LITG [(B=-0.71; P=.634)] compared to iTAU, at 3 months. There were differences at 6 months [iTAU vs CSG (B=-4.22; P=.007); iTAU vs LITG (B=-4.34; P=.005)] and 15 months [iTAU vs CSG (B=-5.10; P=.001); iTAU vs LITG (B=-4.62; P=.002)]. There were no differences between CSG and LITG at any time. Adjusted and intention-to-treat models confirmed these findings. Conclusions An Internet-based intervention for depression combined with iTAU conferred a benefit over iTAU alone in the Spanish primary health care system. Trial Registration Clinicaltrials.gov NCT01611818; https://register.clinicaltrials.gov/prs/app/action/SelectProtocol? selectaction=Edit&uid=U0001NPQ&ts=2&cx=gctdh2&sid=S0003KJ6 (Archived by WebCite at http://www.webcitation.org/6jbsUvUDz)
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Affiliation(s)
- Jesús Montero-Marín
- Faculty of Health Sciences and Sports, University of Zaragoza, Zaragoza, Spain
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Wallin EEK, Mattsson S, Olsson EMG. The Preference for Internet-Based Psychological Interventions by Individuals Without Past or Current Use of Mental Health Treatment Delivered Online: A Survey Study With Mixed-Methods Analysis. JMIR Ment Health 2016; 3:e25. [PMID: 27302200 PMCID: PMC4925931 DOI: 10.2196/mental.5324] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 03/24/2016] [Accepted: 04/10/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of the Internet has the potential to increase access to evidence-based mental health services for a far-reaching population at a low cost. However, low take-up rates in routine care indicate that barriers for implementing Internet-based interventions have not yet been fully identified. OBJECTIVE The aim of this study was to evaluate the preference for Internet-based psychological interventions as compared to treatment delivered face to face among individuals without past or current use of mental health treatment delivered online. A further aim was to investigate predictors of treatment preference and to complement the quantitative analyses with qualitative data about the perceived advantages and disadvantages of Internet-based interventions. METHODS Two convenience samples were used. Sample 1 was recruited in an occupational setting (n=231) and Sample 2 consisted of individuals previously treated for cancer (n=208). Data were collected using a paper-and-pencil survey and analyzed using mixed methods. RESULTS The preference for Internet-based psychological interventions was low in both Sample 1 (6.5%) and Sample 2 (2.6%). Most participants preferred psychological interventions delivered face to face. Use of the Internet to search for and read health-related information was a significant predictor of treatment preference in both Sample 1 (odds ratio [OR] 2.82, 95% CI 1.18-6.75) and Sample 2 (OR 3.52, 95% CI 1.33-9.29). Being born outside of Sweden was a significant predictor of preference for Internet-based interventions, but only in Sample 2 (OR 6.24, 95% CI 1.29-30.16). Similar advantages and disadvantages were mentioned in both samples. Perceived advantages of Internet-based interventions included flexibility regarding time and location, low effort, accessibility, anonymity, credibility, user empowerment, and improved communication between therapist and client. Perceived disadvantages included anonymity, low credibility, impoverished communication between therapist and client, fear of negative side effects, requirements of computer literacy, and concerns about confidentiality. CONCLUSIONS Internet-based interventions were reported as the preferred choice by a minority of participants. The results suggest that Internet-based interventions have specific advantages that may facilitate help-seeking among some individuals and some disadvantages that may restrict its use. Initiatives to increase treatment acceptability may benefit from addressing the advantages and disadvantages reported in this study.
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Oromendia P, Orrego J, Bonillo A, Molinuevo B. Internet-based self-help treatment for panic disorder: a randomized controlled trial comparing mandatory versus optional complementary psychological support. Cogn Behav Ther 2016; 45:270-86. [DOI: 10.1080/16506073.2016.1163615] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Beatty L, Binnion C. A Systematic Review of Predictors of, and Reasons for, Adherence to Online Psychological Interventions. Int J Behav Med 2016; 23:776-794. [PMID: 26957109 DOI: 10.1007/s12529-016-9556-9] [Citation(s) in RCA: 177] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Lisa Beatty
- School of Psychology, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Claire Binnion
- School of Psychology, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
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Elison S, Davies G, Ward J. An Outcomes Evaluation of Computerized Treatment for Problem Drinking using Breaking Free Online. ALCOHOLISM TREATMENT QUARTERLY 2015. [DOI: 10.1080/07347324.2015.1023057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Elison S, Davies G, Ward J. Effectiveness of Computer-Assisted Therapy for Substance Dependence Using Breaking Free Online: Subgroup Analyses of a Heterogeneous Sample of Service Users. JMIR Ment Health 2015; 2:e13. [PMID: 26543918 PMCID: PMC4607383 DOI: 10.2196/mental.4355] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 03/11/2015] [Accepted: 03/14/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Substance misuse services within the United Kingdom have traditionally been oriented to opiate and crack users, and attended predominantly by male service users. Groups who do not fit this demographic, such as women or those whose primary drug of choice is neither heroin nor crack, have tended to be underrepresented in services. In addition, there can be stigma associated with traditional opiate and crack-centric services. Therefore, the computerized treatment and recovery program, Breaking Free Online (BFO), was developed to enable service users to access confidential support for dependence on a wide range of substances. BFO is delivered as computer-assisted therapy (CAT), or, where appropriate, used as self-help. OBJECTIVE The aim of this study was to report psychometric outcomes data from 393 service users accessing online support for substance misuse via BFO. METHODS Following initial referral to substance misuse services, all participants were supported in setting up a BFO login by a practitioner or peer mentor, and, where required, assisted as they completed an online baseline assessment battery contained within the BFO program. Following a period of engagement with BFO, all participants completed the same battery of assessments, and changes in the scores on these assessments were examined. RESULTS Significant improvements were found across the 393 service users in several areas of psychosocial functioning, including quality of life, severity of alcohol and drug dependence, depression, and anxiety (P=<.001 across all aspects of functioning). Additionally, significant improvements were found within specific subgroups of participants, including females (P=.001-<.001), males (P=.004-<.001), service users reporting alcohol dependence (P=.002-<.001), opiate and crack dependence (P=.014-<.001), and those seeking support for other substances that may be less well represented in the substance misuse sector (P=.001-<.001). CONCLUSIONS Data from this study indicates that BFO is an effective clinical treatment for a wide range of individuals requiring support for substance misuse. Further work is currently underway to examine more closely the clinical effectiveness of the program.
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Affiliation(s)
| | - Glyn Davies
- Breaking Free Online Manchester United Kingdom
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Schlegl S, Bürger C, Schmidt L, Herbst N, Voderholzer U. The potential of technology-based psychological interventions for anorexia and bulimia nervosa: a systematic review and recommendations for future research. J Med Internet Res 2015; 17:e85. [PMID: 25840591 PMCID: PMC4397416 DOI: 10.2196/jmir.3554] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 09/28/2014] [Accepted: 10/20/2014] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Previous studies have shown an unmet need in the treatment of eating disorders. In the last decade, interest in technology-based interventions (TBIs) (including computer- and Internet-based interventions [CBIs] or mobile interventions) for providing evidence-based therapies to individuals with different mental disorders has increased. OBJECTIVE The aim of this review was to systematically evaluate the potential of TBIs in the field of eating disorders, namely for anorexia nervosa (AN) and bulimia nervosa (BN), for both prevention and treatment, and also for carers of eating disorder patients. METHODS A systematic literature search was conducted using Medline and PsycINFO. Bibliographies of retrieved articles were also reviewed without date or study type restrictions. RESULTS Forty studies resulting in 45 publications reporting outcomes fulfilled the inclusion criteria: 22 randomized controlled trials, 2 controlled studies, and 16 uncontrolled studies. In total, 3646 patients were included. Overall, the studies provided evidence for the efficacy of guided CBIs, especially for BN patients and for compliant patients. Furthermore, videoconferencing also appeared to be a promising approach. Evaluation results of Internet-based prevention of eating disorders and Internet-based programs for carers of eating disorder patients were also encouraging. Finally, there was preliminary evidence for the efficacy of mobile interventions. CONCLUSIONS TBIs may be an additional way of delivering evidence-based treatments to eating disorder patients and their use is likely to increase in the near future. TBIs may also be considered for the prevention of eating disorders and to support carers of eating disorder patients. Areas of future research and important issues such as guidance, therapeutic alliance, and dissemination are discussed.
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Affiliation(s)
- Sandra Schlegl
- Department of Psychiatry and Psychotherapy, University of Munich, München, Germany.
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Computerised Cognitive Behavioural Therapy for Psychological Distress in Patients with Physical Illnesses: A Systematic Review. J Clin Psychol Med Settings 2015; 22:20-44. [DOI: 10.1007/s10880-015-9420-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Kobak KA, Greist R, Jacobi DM, Levy-Mack H, Greist JH. Computer-assisted cognitive behavior therapy for obsessive-compulsive disorder: a randomized trial on the impact of lay vs. professional coaching. Ann Gen Psychiatry 2015; 14:10. [PMID: 25722737 PMCID: PMC4341882 DOI: 10.1186/s12991-015-0048-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 02/04/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The purpose of the study was to examine the impact of computerized cognitive behavior therapy (CBT) self-help treatment for obsessive-compulsive disorder (OCD) (BT Steps) both alone and when supported by coaching from either a lay non-therapist coach or an experienced CBT therapist. METHODS Eighty-seven subjects with clinically significant OCD were recruited through newspaper ads and randomly assigned to receive 12 weeks of treatment with either BT Steps alone (n = 28), BT Steps with non-therapist coaching (n = 28), or BT Steps with CBT therapist coaching (n = 31). Subjects worked on BT Steps at their own pace. Subjects receiving BT Steps alone received a welcome call from the project manager. Subjects randomized to either of the coaching arms received regularly scheduled weekly phone calls for coaching, encouragement, and support. No formal therapy was provided by the coaches; thus, both lay and CBT coaches completed the same tasks. RESULTS All three treatment arms showed a significant reduction in Yale-Brown Obsessive Compulsive Scale (YBOCS) scores, with mean (SD) changes of 6.5 (5.7), 7.1 (6.1), and 6.5 (6.1) for the no coaching, lay coaching, and therapist coaching arms, respectively (all p's < .001). These represent effect sizes of 1.16, 1.41, and 1.12, respectively. No significant differences were found between treatment arms on YBOCS change scores, F(2) = 0.10, p = .904, or number of exposures sessions done (F(2) = 0.033, p = .967). When asked which method of therapy (computer vs. clinician) they preferred, 48% said computer, 33% said face-to-face therapy, and 19% had no preference. CONCLUSIONS Results support the use of online self-help for the treatment of moderate OCD. The addition of coaching by either a lay coach or a CBT therapist coach did not significantly improve outcomes.
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Affiliation(s)
- Kenneth A Kobak
- Center for Telepsychology, 7601 Ganser Way, Madison, WI 53719 USA
| | - Revere Greist
- Waypoint Health Innovations, 137 E. Wilson Street, Suite 812, Madison, WI 53703 USA
| | - David M Jacobi
- Rogers Memorial Hospital, 34700 Valley Rd, Oconomowoc, WI 53066 USA
| | | | - John H Greist
- Healthcare Technology Systems, 6515 Grand Teton Plaza, Suite 100, Madison, WI 53719 USA
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Kues JN, Janda C, Kleinstäuber M, Weise C. Internet-based cognitive behavioural self-help for premenstrual syndrome: study protocol for a randomised controlled trial. Trials 2014; 15:472. [PMID: 25467540 PMCID: PMC4265499 DOI: 10.1186/1745-6215-15-472] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 11/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With a prevalence of 3 to 8% among women of reproductive age, severe premenstrual symptoms are very common. Symptoms range from emotional and cognitive to physical changes. Severe symptoms (that is, premenstrual syndrome) can have a strong impact on everyday functioning and quality of life. Impairment can be as serious as that of dysthymic disorders. Many affected women receive either no treatment at all or are unsatisfied with their treatment. Although there is some evidence for the reduction of distress through cognitive behavioural therapy, there are only a small number of randomised controlled trials carefully investigating the efficacy of this psychotherapeutic approach. Thus, this study aims to evaluate the efficacy of a cognitive behavioural self-help treatment for women suffering from premenstrual syndrome. METHODS/DESIGN The study is conducted as a randomised controlled trial. The complex diagnostic assessment includes the completion of a symptom diary over two consecutive cycles and a telephone interview. Eligible women are randomly assigned to either a treatment or a wait-list control group. The intervention is based on cognitive behavioural therapy principles and is provided via the internet. It consists of 14 different modules on which participants work over 8 consecutive weeks. In addition to written information, participants receive email feedback from a clinical psychologist on a weekly basis. Participants assigned to the wait-list receive the treatment after the end of the waiting period (8 weeks). The primary outcome measure is the Premenstrual Syndrome Impairment Measure. Secondary outcomes include the Premenstrual Syndrome Coping Measure, the Short-Form Social Support Questionnaire, the Questionnaire for the Assessment of Relationship Quality, and the Perceived Stress Scale. Data is collected during the premenstrual (luteal) phase at pre-treatment, post-treatment, and 6-month follow-up. DISCUSSION So far, there is no study investigating internet-based cognitive behavioural therapy for premenstrual syndrome. The programme approaches the problem of high prevalence in combination with severe impairment and insufficient treatment options. TRIAL REGISTRATION ClinicalTrials.gov: NCT01961479, 9 October 2013.
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Affiliation(s)
- Johanna N Kues
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstr, 18, 35032 Marburg, Germany.
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Computer-delivered cognitive-behavioural treatments for obsessive compulsive disorder: preliminary meta-analysis of randomized and non-randomized effectiveness trials. COGNITIVE BEHAVIOUR THERAPIST 2014. [DOI: 10.1017/s1754470x1400021x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractCognitive behavioural treatments (CBTs) are well-established for obsessive compulsive disorder (OCD). However, few patients receive CBT, due to factors like geographical limitations, perceived stigmatization, and lack of CBT services. Some evidence suggests that computer-delivered cognitive-behavioural treatments (CCBTs) could be an effective strategy to improve patients’ access to CBT. To date a meta-analysis on effectiveness of CCBTs for OCD has not been conducted. The present study used meta-analytical techniques to summarize evidence on CCBTs for OCD on OCD and depression symptom outcomes at post-treatment and follow-up. A meta-analysis was conducted according to PRISMA guidelines. Treatments were classified as CCBTs if including evidence-based cognitive-behavioural components for OCD (psychoeducation, exposure and response prevention, cognitive restructuring), delivered through devices like computers, palmtops, telephone-interactive voice-response systems, CD-ROMS, and cell phones. Studies were included if they used validated outcomes for OCD. Eight studies met inclusion criteria (n= 392). A large effect favouring CCBTs over control conditions was found for OCD symptoms at post-treatment (d= 0.82,p= 0.001), but not for depression symptom outcomes (d= 0.15,p= 0.20). Theoretical implications and directions for research are discussed. A larger number of randomized controlled trials is required.
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Elison S, Ward J, Davies G, Lidbetter N, Hulme D, Dagley M. An outcomes study of eTherapy for dual diagnosis using Breaking Free Online. ADVANCES IN DUAL DIAGNOSIS 2014. [DOI: 10.1108/add-11-2013-0025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– In recent years there has been a proliferation of computer-based psychotherapeutic interventions for common mental health difficulties. Building on this, a small number of such interventions have now been developed to address substance dependence, one of which is Breaking Free Online (BFO). A new “eTherapy” self-help service, which was set up by the UK mental health charity Self-Help Services, has provided access to BFO to service users presenting with comorbid mental health and substance misuse difficulties. The purpose of this paper is to evaluate a range of clinical outcomes in the first cohort of service users accessing this dual diagnosis service.
Design/methodology/approach
– A number of standardised psychometric assessments were conducted with service users at baseline and post-treatment at discharge from the service. Outcome data were available for 47 service users out of an original cohort of 74.
Findings
– Statistically significant improvements were found in terms of measures of social functioning, depression, anxiety, alcohol and drug use and social anxiety. Clinically relevant gains were also identified, with fewer service users reaching threshold scores for depression and anxiety at post-treatment compared to baseline. Effect sizes also indicated that the identified improvements across the psychometric measures were robust and significant.
Research limitations/implications
– These findings provide further support for the clinical effectiveness of BFO, and also provide evidence that an eTherapy self-help service may be appropriate for some individuals presenting with dual diagnosis. Further research is underway with larger and alternative clinical populations to examine the effectiveness of BFO and also this novel eTherapy self-help approach.
Originality/value
– This paper has provided initial data to support effectiveness of a novel eTherapy service for dual diagnosis.
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Murphy H, Perera-Delcourt R. 'Learning to live with OCD is a little mantra I often repeat': understanding the lived experience of obsessive-compulsive disorder (OCD) in the contemporary therapeutic context. Psychol Psychother 2014; 87:111-25. [PMID: 24497400 DOI: 10.1111/j.2044-8341.2012.02076.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 07/10/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES While there has been an abundance of quantitative studies that examine the clinical features and treatment modalities of obsessive-compulsive disorder (OCD), only a few qualitative research studies examining the experience of OCD have been documented. Our objectives were to explore and understand psychosocial aspects of OCD and to provide qualitative accounts of the condition and its treatment rather than concentrating on its psychopathology. We also wanted to locate the role cognitive behavioural therapy (CBT) played in the condition for our participants. DESIGN Data for the study came from a series of nine semi-structured interviews carried out with individuals who self-identified as having OCD. Participants were recruited through two leading UK-based OCD charities. METHODS We used interpretative phenomenological analysis (IPA) to analyse the accounts and participants gave feedback as to the validity of the themes in early stages of analysis. RESULTS We report two superordinate themes--Having OCD (with subordinate themes 'wanting to be normal and fit it', 'failing at life' and 'loving and hating OCD') and The Impact of Therapy (with subordinate themes of 'wanting therapy', 'finding the roots' and 'a better self'). CONCLUSIONS Having OCD as a condition meant that individuals experienced a sense of overwhelming personal failure matched against age appropriate life cycle goals. This crisis of the self was bolstered by public and self-stigma about the condition. While clinical diagnosis and therapeutic interventions were significant, participants reported dialectical tensions experienced with OCD, pointing to the complexity of psychological functioning in the condition.
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Affiliation(s)
- Helen Murphy
- School of Psychology, University of East London, UK
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Computerised Cognitive Behavioural Therapy for Common Mental Health Disorders, What Works, for Whom Under What Circumstances? A Systematic Review and Meta-analysis. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2013. [DOI: 10.1007/s10879-013-9243-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Overholser JC. Technology-Assisted Psychotherapy (TAP): Adapting Computerized Treatments into Traditional Psychotherapy for Depression. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2013. [DOI: 10.1007/s10879-013-9241-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Brown J, Michie S, Raupach T, West R. Prevalence and characteristics of smokers interested in internet-based smoking cessation interventions: cross-sectional findings from a national household survey. J Med Internet Res 2013; 15:e50. [PMID: 23506944 PMCID: PMC3636298 DOI: 10.2196/jmir.2342] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 11/16/2012] [Accepted: 11/22/2012] [Indexed: 11/23/2022] Open
Abstract
Background An accurate and up-to-date estimate of the potential reach of Internet-based smoking cessation interventions (ISCIs) would improve calculations of impact while an understanding of the characteristics of potential users would facilitate the design of interventions. Objective This study reports the prevalence and the sociodemographic, smoking, and Internet-use characteristics of smokers interested in using ISCIs in a nationally representative sample. Methods Data were collected using cross-sectional household surveys of representative samples of adults in England. Interest in trying an Internet site or “app” that was proven to help with stopping smoking was assessed in 1128 adult smokers in addition to sociodemographic characteristics, dependence, motivation to quit, previous attempts to quit smoking, Internet and handheld computer access, and recent types of information searched online. Results Of a representative sample of current smokers, 46.6% (95% CI 43.5%-49.6%) were interested in using an Internet-based smoking cessation intervention. In contrast, only 0.3% (95% CI 0%-0.7%) of smokers reported having used such an intervention to support their most recent quit attempt within the past year. After adjusting for all other background characteristics, interested smokers were younger (OR=0.98, 95% CI 0.97-0.99), reported stronger urges (OR=1.29, 95% CI 1.10-1.51), were more motivated to quit within 3 months (OR=2.16, 95% CI 1.54-3.02), and were more likely to have made a quit attempt in the past year (OR=1.76, 95% CI 1.30-2.37), access the Internet at least weekly (OR=2.17, 95% CI 1.40-3.36), have handheld computer access (OR=1.65, 95% CI 1.22-2.24), and have used the Internet to search for online smoking cessation information or support in past 3 months (OR=2.82, 95% CI 1.20-6.62). There was no association with social grade. Conclusions Almost half of all smokers in England are interested in using online smoking cessation interventions, yet fewer than 1% have used them to support a quit attempt in the past year. Interest is not associated with social grade but is associated with being younger, more highly motivated, more cigarette dependent, having attempted to quit recently, having regular Internet and handheld computer access, and having recently searched for online smoking cessation information and support.
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Affiliation(s)
- Jamie Brown
- Cancer Research UK Health Behaviour Research Centre, Department of Public Health and Epidemiology, University College London, London, United Kingdom.
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Montero-Marín J, Carrasco JM, Roca M, Serrano-Blanco A, Gili M, Mayoral F, Luciano JV, Lopez-del-Hoyo Y, Olivan B, Collazo F, Araya R, Baños R, Botella C, García-Campayo J. Expectations, experiences and attitudes of patients and primary care health professionals regarding online psychotherapeutic interventions for depression: protocol for a qualitative study. BMC Psychiatry 2013; 13:64. [PMID: 23425435 PMCID: PMC3599900 DOI: 10.1186/1471-244x-13-64] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 02/13/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In the year 2020, depression will cause the second highest amount of disability worldwide. One quarter of the population will suffer from depression symptoms at some point in their lives. Mental health services in Western countries are overburdened. Therefore, cost-effective interventions that do not involve mental health services, such as online psychotherapy programs, have been proposed. These programs demonstrate satisfactory outcomes, but the completion rate for patients is low. Health professionals' attitudes towards this type of psychotherapy are more negative than the attitudes of depressed patients themselves. The aim of this study is to describe the profile of depressed patients who would benefit most from online psychotherapy and to identify expectations, experiences, and attitudes about online psychotherapy among both patients and health professionals that can facilitate or hinder its effects. METHODS A parallel qualitative design will be used in a randomised controlled trial on the efficiency of online psychotherapeutic treatment for depression. Through interviews and focus groups, the experiences of treated patients, their reasons for abandoning the program, the expectations of untreated patients, and the attitudes of health professionals will be examined. Questions will be asked about training in new technologies, opinions of online psychotherapy, adjustment to therapy within the daily routine, the virtual and anonymous relationship with the therapist, the process of online communication, information necessary to make progress in therapy, process of working with the program, motivations and attitudes about treatment, expected consequences, normalisation of this type of therapy in primary care, changes in the physician-patient relationship, and resources and risks. A thematic content analysis from the grounded theory for interviews and an analysis of the discursive positions of participants based on the sociological model for focus groups will be performed. DISCUSSION Knowledge of the expectations, experiences, and attitudes of both patients and medical personnel regarding online interventions for depression can facilitate the implementation of this new psychotherapeutic tool. This qualitative investigation will provide thorough knowledge of the perceptions, beliefs, and values of patients and clinicians, which will be very useful for understanding how to implement this intervention method for depression.
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Affiliation(s)
- Jesús Montero-Marín
- Department of Psychiatry, University of Zaragoza, Zaragoza, Spain,Faculty of Health and Sports, University of Zaragoza, Huesca, Spain
| | | | - Miquel Roca
- Institut Universitari d’Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, Palma de Mallorca, Spain
| | - Antoni Serrano-Blanco
- Parc Sanitari Sant Joan de Déu, and Fundación Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Margalida Gili
- Institut Universitari d’Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, Palma de Mallorca, Spain
| | - Fermin Mayoral
- Psychiatric Service, University Hospital Carlos Haya, Malaga, Spain
| | - Juan V Luciano
- Parc Sanitari Sant Joan de Déu, and Fundación Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | | | - Barbara Olivan
- Departamento de Psicología y Sociología, Universidad de Zaragoza, Zaragoza, Spain
| | - Francisco Collazo
- Servei de Psiquiatria, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Ricardo Araya
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rosa Baños
- University of Valencia, Valencia, Spain,CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain
| | - Cristina Botella
- Jaume I University, Castellón, Spain,CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain
| | - Javier García-Campayo
- Department of Psychiatry, University of Zaragoza, Zaragoza, Spain,Psychiatry Service, Miguel Servet Hospital, Avda Gomez Laguna 52, 4D 50.009, Zaragoza, Spain
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Farrand P, Woodford J. Impact of support on the effectiveness of written cognitive behavioural self-help: A systematic review and meta-analysis of randomised controlled trials. Clin Psychol Rev 2013; 33:182-95. [DOI: 10.1016/j.cpr.2012.11.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 11/12/2012] [Accepted: 11/13/2012] [Indexed: 12/11/2022]
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Lintvedt OK, Griffiths KM, Eisemann M, Waterloo K. Evaluating the translation process of an Internet-based self-help intervention for prevention of depression: a cost-effectiveness analysis. J Med Internet Res 2013; 15:e18. [PMID: 23343481 PMCID: PMC3636015 DOI: 10.2196/jmir.2422] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 12/03/2012] [Accepted: 12/20/2012] [Indexed: 11/13/2022] Open
Abstract
Background Depression is common and treatable with cognitive behavior therapy (CBT), for example. However, access to this therapy is limited. Internet-based interventions have been found to be effective in reducing symptoms of depression. The International Society for Research on Internet Interventions has highlighted the importance of translating effective Internet programs into multiple languages to enable worldwide dissemination. Objective The aim of the current study was to determine if it would be cost effective to translate an existing English-language Internet-based intervention for use in a non-English-speaking country. Methods This paper reports an evaluation of a trial in which a research group in Norway translated two English-language Internet-based interventions into Norwegian (MoodGYM and BluePages) that had previously been shown to reduce symptoms of depression. The translation process and estimates of the cost-effectiveness of such a translation process is described. Estimated health effect was found by using quality-adjusted life years (QALY). Results Conservative estimates indicate that for every 1000 persons treated, 16 QALYs are gained. The investment is returned 9 times and the cost-effectiveness ratio (CER) is 3432. The costs of the translation project totaled to approximately 27% of the estimated original English-language version development costs. Conclusions The economic analysis shows that the cost-effectiveness of the translation project was substantial. Hopefully, these results will encourage others to do similar analyses and report cost-effectiveness data in their research reports.
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Affiliation(s)
- Ove K Lintvedt
- Faculty of Health Sciences, Department of Psychology, University of Tromsø, Huginbakken 32, Tromsø, Norway
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Low intensity vs. self-guided internet-delivered psychotherapy for major depression: a multicenter, controlled, randomized study. BMC Psychiatry 2013; 13:21. [PMID: 23312003 PMCID: PMC3626601 DOI: 10.1186/1471-244x-13-21] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 01/04/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Major depression will become the second most important cause of disability in 2020. Computerized cognitive-behaviour therapy could be an efficacious and cost-effective option for its treatment. No studies on cost-effectiveness of low intensity vs self-guided psychotherapy has been carried out. The aim of this study is to assess the efficacy of low intensity vs self-guided psychotherapy for major depression in the Spanish health system. METHODS The study is made up of 3 phases: 1.- Development of a computerized cognitive-behaviour therapy for depression tailored to Spanish health system. 2.- Multicenter controlled, randomized study: A sample (N=450 patients) with mild/moderate depression recruited in primary care. They should have internet availability at home, not receive any previous psychological treatment, and not suffer from any other severe somatic or psychological disorder. They will be allocated to one of 3 treatments: a) Low intensity Internet-delivered psychotherapy + improved treatment as usual (ITAU) by GP, b) Self-guided Internet-delivered psychotherapy + ITAU or c) ITAU. Patients will be diagnosed with MINI psychiatric interview. Main outcome variable will be Beck Depression Inventory. It will be also administered EuroQol 5D (quality of life) and Client Service Receipt Inventory (consume of health and social services). Patients will be assessed at baseline, 3 and 12 months. An intention to treat and a per protocol analysis will be performed. DISCUSSION The comparisons between low intensity and self-guided are infrequent, and also a comparative economic evaluation between them and compared with usual treatment in primary. The strength of the study is that it is a multicenter, randomized, controlled trial of low intensity and self-guided Internet-delivered psychotherapy for depression in primary care, being the treatment completely integrated in primary care setting. TRIAL REGISTRATION Clinical Trials NCT01611818.
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Malik A, Goodwin GM, Holmes EA. Contemporary Approaches to Frequent Mood Monitoring in Bipolar Disorder. J Exp Psychopathol 2012; 3:572-581. [PMID: 26457175 PMCID: PMC4599136 DOI: 10.5127/jep.014311] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Mood fluctuations are problematic in bipolar disorder. Current approaches to frequent monitoring of mood in bipolar disorder are paper diaries and electronic handheld devices. These approaches are limited in several ways, notably in the reliability of the data being collected which is often retrospectively reported. The experience sampling method offers a research paradigm which could be modified for use in clinical settings, to real time frequent mood monitoring. Mobile phone technology has also recently been developed to monitor weekly mood in a bipolar sample, demonstrating successful compliance rates. We propose the use of mobile phone technology as a novel method for frequently monitoring mood in bipolar disorder.
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Affiliation(s)
- Aiysha Malik
- Department of Psychiatry, University of Oxford UK
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Spates CR, Kalata AH, Ozeki S, Stanton CE, Peters S. Initial open trial of a computerized behavioral activation treatment for depression. Behav Modif 2012; 37:259-97. [PMID: 22987916 DOI: 10.1177/0145445512455051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article presents preliminary findings from use of a novel computer program that implements an evidence-based psychological intervention to treat depression based on behavioral activation (BA) therapy. The program is titled "Building a Meaningful Life Through Behavioral Activation". The findings derive from an open trial with moderate to severely depressed individuals (N = 15) in an Intention to Treat sample. Hierarchical linear modeling (HLM) analyses revealed significant change over time on Beck Depression Inventory-Second Edition (BDI-II) scores, Revised Hamilton Depression Rating Scale scores, and significant contribution to BDI-II score variance by participant age over time, change over time in negative automatic thoughts, and change over time in BA scores. Piecewise HLM analyses revealed that significant change over time was associated uniquely with active treatment and not during 3 weeks of baseline measurement. In addition to treatment-associated significant change on all dependent measures over time, effect sizes were in the moderate to large range. Limitations are small sample size, nonrandomized control, research-recruited patients instead of purely treatment-seeking patients, possible rating bias by independent assessors who had knowledge that participants had received active treatment in this open trial, and the influence of additional services received in the post acute-treatment phase by some participants could have contributed to maintenance of gains reported for that period.
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Callahan A, Inckle K. Cybertherapy or psychobabble? A mixed methods study of online emotional support. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2012. [DOI: 10.1080/03069885.2012.681768] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Youth Work Service Providers' Attitudes Towards Computerized CBT for Adolescents. Behav Cogn Psychother 2012; 41:265-79. [DOI: 10.1017/s1352465812000306] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background:Attitudes of social service providers towards computerized CBT (cCBT) might affect use of cCBT by their clients and may provide important insights that should be considered in dissemination. There is no literature exploring the attitudes of providers of youth work services towards cCBT despite the likelihood of them having close relationships with young people at high risk of mental ill-health.Method:Focus groups and semi-structured interviews were undertaken with a total of 40 providers (21 youth workers and social service staff providing alternative schooling, justice or other intensive youth work programmes to adolescents, 6 youth service managers, 2 trainers, 5 peer leaders and 6 trainees).Results:Participants considered supporting young people who were distressed to be an important part of their role. They were generally interested in cCBT, especially those who were more mental health oriented and those who saw a cCBT programme in action. Their greatest concerns regarding cCBT related to it possibly displacing human contact, while advantages were seen as its appeal to young people and its potential therapeutic power. They would utilize cCBT in a range of ways, with many wishing to offer it in group settings. Training and resources would be required for them to use cCBT.Conclusions:Many providers of youth work services would like to be involved in the use of cCBT; this might extend the reach of cCBT to vulnerable young people. They would wish to utilize cCBT in ways that fit their current approaches. Providers’ opinions need to be considered in the dissemination of cCBT.
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Barazzone N, Cavanagh K, Richards DA. Computerized cognitive behavioural therapy and the therapeutic alliance: A qualitative enquiry. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2012; 51:396-417. [DOI: 10.1111/j.2044-8260.2012.02035.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Absalom-Hornby V, Hare DJ, Gooding P, Tarrier N. Attitudes of relatives and staff towards family intervention in forensic services using Q methodology. J Psychiatr Ment Health Nurs 2012; 19:162-73. [PMID: 22070759 DOI: 10.1111/j.1365-2850.2011.01770.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Attitudes about family interventions have been identified as a possible reason for the poor implementation of such treatments. The current study used Q methodology to investigate the attitudes of relatives of forensic service users and clinical staff towards family interventions in medium secure forensic units, particularly when facilitated by a web camera. Eighteen relatives and twenty-nine staff completed a sixty-one item Q sort to obtain their idiosyncratic views about family intervention. The results indicated that relatives and staff mostly held positive attitudes towards family intervention. Relatives showed some uncertainty towards family intervention that may reflect the lack of involvement they receive from the forensic service. Staff highlighted key barriers to successful implementation such as lack of dedicated staff time for family work and few staff adequately trained in family intervention. Despite agreement with the web-based forensic family intervention technique and its benefits, both staff and relatives predicted problems in the technique.
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Affiliation(s)
- V Absalom-Hornby
- Division of Clinical Psychology, University of Manchester, Manchester, UK.
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Andersson E, Walén C, Hallberg J, Paxling B, Dahlin M, Almlöv J, Källström R, Wijma K, Carlbring P, Andersson G. A randomized controlled trial of guided Internet-delivered cognitive behavioral therapy for erectile dysfunction. J Sex Med 2011; 8:2800-9. [PMID: 21797983 DOI: 10.1111/j.1743-6109.2011.02391.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Men with erectile dysfunction are often worried about their condition, have interpersonal difficulties, and have a reduced quality of life. Internet-delivered cognitive behavior therapy (ICBT) has been shown effective for a number of health problems but evidence is limited concerning the treatment of erectile dysfunction. AIM The study investigated the effects of ICBT for erectile dysfunction. METHODS Seventy-eight men were included in the study and randomized to either ICBT or to a control group, which was an online discussion group. Treatment consisted of a 7-week Web-based program with e-mail-based therapist support. Each therapist spent an average of 55 minutes per participant. MAIN OUTCOME MEASURE The International Index of Erectile Functioning five-item version was administered via the telephone at pretreatment, post-treatment, and 6 months after receiving ICBT. RESULTS At post-treatment, the treatment group had significantly greater improvements with regard to erectile performance compared with the control group. Between-group differences at post-treatment were small (d = 0.1), but increased at the 6-month follow-up (d = 0.88). CONCLUSIONS This study provides support for the use of ICBT as a possible treatment format for erectile dysfunction.
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Affiliation(s)
- Erik Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Sweden.
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Tortella-Feliu M, Botella C, Llabrés J, Bretón-López JM, del Amo AR, Baños RM, Gelabert JM. Virtual reality versus computer-aided exposure treatments for fear of flying. Behav Modif 2011; 35:3-30. [PMID: 21177516 DOI: 10.1177/0145445510390801] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Evidence is growing that two modalities of computer-based exposure therapies--virtual reality and computer-aided psychotherapy--are effective in treating anxiety disorders, including fear of flying. However, they have not yet been directly compared. The aim of this study was to analyze the efficacy of three computer-based exposure treatments for fear of flying: virtual reality exposure therapy (VRET), computer-aided exposure with a therapist's (CAE-T) assistance throughout exposure sessions, and self-administered computer-aided exposure (CAE-SA). A total of 60 participants with flying phobia were randomly assigned to VRET, CAE-T, or CAE-SA. Results indicate that the three interventions were effective in reducing fear of flying at posttreatment and at 1-year follow-up; furthermore, there were no significant differences between them in any of the outcome measure. Large within-group effect sizes were found for all three treatment conditions at both posttreatment and at follow-up. The results suggest that therapist involvement might be minimized during computer-based treatments and that CAE can be as effective as VRET in reducing fear of flying.
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Affiliation(s)
- Miquel Tortella-Feliu
- Department ofPsychology, University of the Balearic Islands, Palma de Mallorca, Spain.
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Moderne Informations- und Kommunikationstechnologie in der Rehabilitation. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2011; 54:458-64. [DOI: 10.1007/s00103-011-1248-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fortney JC, Harman JS, Xu S, Dong F. The association between rural residence and the use, type, and quality of depression care. J Rural Health 2011; 26:205-13. [PMID: 20633088 DOI: 10.1111/j.1748-0361.2010.00290.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To assess the association between rurality and depression care. METHODS Data were extracted for 10,319 individuals with self-reported depression in the Medical Expenditure Panel Survey. Pharmacotherapy was defined as an antidepressant prescription fill, and minimally adequate pharmacotherapy was defined as receipt of at least 4 antidepressant fills. Psychotherapy was defined as an outpatient counseling visit, and minimally adequate psychotherapy was defined as > or = 8 visits. Rurality was defined using Metropolitan Statistical Areas (MSAs) and Rural Urban Continuum Codes (RUCCs). RESULTS Over the year, 65.1% received depression treatment, including 58.8% with at least 1 antidepressant prescription fill and 24.5% with at least 1 psychotherapy visit. Among those in treatment, 56.2% had minimally adequate pharmacotherapy treatment and 36.3% had minimally adequate psychotherapy treatment. Overall, there were no significant rural-urban differences in receipt of any type of formal depression treatment. However, rural residence was associated with significantly higher odds of receiving pharmacotherapy (MSA: OR 1.16 [95% CI, 1.01-1.34; P= .04] and RUCC: OR 1.04 [95% CI, 1.00-1.08; P= .05]), and significantly lower odds of receiving psychotherapy (MSA: OR 0.62 [95% CI, 0.53-0.74; P < .01] and RUCC: OR 0.91 [95% CI, 0.88-0.94; P < .001]). Rural residence was not significantly associated with the adequacy of pharmacotherapy, but it was significantly associated with the adequacy of psychotherapy (MSA: OR 0.53 [95% CI, 0.41-0.69; P < .01] and RUCC: OR 0.92 [95% CI, 0.86-0.99; P= .02]). Psychiatrists per capita were a mediator in the psychotherapy analyses. CONCLUSIONS Rural individuals are more reliant on pharmacotherapy than psychotherapy. This may be a concern if individuals in rural areas turn to pharmacotherapy because psychotherapists are unavailable rather than because they have a preference for pharmacotherapy.
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Affiliation(s)
- John C Fortney
- South Central Mental Illness Education and Clinical Center (MIRECC) and Health Services Research and Development (HSR&D), Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA.
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