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Barakat S, Burton AL, Cunich M, Hay P, Hazelton JL, Kim M, Lymer S, Madden S, Maloney D, Miskovic-Wheatley J, Rogers D, Russell J, Sidari M, Touyz S, Maguire S. A randomised controlled trial of clinician supported vs self-help delivery of online cognitive behaviour therapy for Bulimia Nervosa. Psychiatry Res 2023; 329:115534. [PMID: 37844353 DOI: 10.1016/j.psychres.2023.115534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023]
Abstract
High dropout rates and poor adherence associated with digital interventions have prompted research into modifications of these treatments to improve engagement and completion rates. This trial aimed to investigate the added benefit of clinician support when paired alongside a ten-session, online cognitive behaviour therapy (CBT) self-help intervention for bulimia nervosa (BN). As part of a three-arm, phase II randomised controlled trial, 114 participants (16 years or over) with full or subthreshold BN were randomly assigned to complete the intervention in a self-help mode (with administrative researcher contact; n = 38), with adjunct clinician support (weekly 30-minute videoconferencing sessions; n = 37), or a no-treatment waitlist control (WLC; n = 39). Baseline to post-treatment (12-weeks) decreases in objective binge episode frequency were significantly greater for clinician-supported participants as compared to WLC, but not for self-help when compared to WLC. However, due to continued improvements for self-help across follow-up (24-weeks), both arms outperformed WLC when analysed as an overall rate of change across three timepoints. Clinician-supported participants outperformed self-help in regards to laxative use and dietary restraint. Our results demonstrate that good clinical outcomes can be achieved with a relatively brief online CBT-based program even in the absence of structured clinical support, indicating a possible overreliance upon clinician support as a primary adherence-facilitating mechanism.
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Affiliation(s)
- Sarah Barakat
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW 2006, Australia; School of Psychology, University of Sydney, Sydney, NSW, Australia.
| | - Amy L Burton
- School of Psychology, University of Sydney, Sydney, NSW, Australia; Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; Graduate School of Health, University of Technology Sydney, Sydney NSW, Australia
| | - Michelle Cunich
- Sydney Health Economics Collaborative, Sydney Local Health District, Camperdown, NSW, Australia; Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia; Co-Lead, Implementation and Policy, Cardiovascular Initiative, University of Sydney, Camperdown, NSW, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia; Mental Health Services South Western Sydney Local Health District, Campbelltown, NSW, Australia
| | - Jessica L Hazelton
- School of Psychology, University of Sydney, Sydney, NSW, Australia; Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Marcellinus Kim
- Sydney Local Health District Mental Health Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Sharyn Lymer
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia
| | - Sloane Madden
- Department of Psychological Medicine, Sydney Children's Hospital Network, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Danielle Maloney
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW 2006, Australia
| | - Jane Miskovic-Wheatley
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW 2006, Australia
| | - Daniel Rogers
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW 2006, Australia
| | - Janice Russell
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW 2006, Australia; Sydney Local Health District Mental Health Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Morgan Sidari
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW 2006, Australia; Queensland Eating Disorder Service, Metro North Hospital and Health, Brisbane, QLD, Australia
| | - Stephen Touyz
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW 2006, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW 2006, Australia
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2
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Emerson JA, Schumacher LM, Bond DS, Thomas JG, Lillis J. Physical activity changes during an automated online weight loss program. J Behav Med 2023; 46:680-688. [PMID: 36602619 DOI: 10.1007/s10865-022-00383-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 11/06/2022] [Indexed: 01/06/2023]
Abstract
Evidence-based online behavioral weight loss (BWL) treatment targets a combination of diet, physical activity, and behavioral skills training. While weight loss outcomes are well documented, little is known about changes in physical activity. This study examined changes in objectively measured physical activity across the energy expenditure spectrum during a fully automated, online BWL program. Adults with overweight or obesity (n = 63) completed a 12-week, online BWL program. Participants wore an accelerometer for 7 days and body weight was measured in-clinic at pre- and post-treatment. At post-treatment, mean daily moderate-to-vigorous physical activity increased by about 4 min (SE = 1.59, p = 0.01). There were no statistically significant changes in light physical activity or time spent sedentary (p's > 0.05). Despite only minimal changes in moderate-to-vigorous physical activity overall, larger increases correlated with greater weight loss (r = - 0.28, p = 0.02), which averaged 6.1% of baseline weight at post-treatment. Though achieving important weight loss outcomes, online programs may fail to produce clinically relevant improvements in physical activity, which can put weight loss maintenance at risk.
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Affiliation(s)
- Jessica A Emerson
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI, 02903, USA
| | - Leah M Schumacher
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond St., Providence, RI, 02903, USA
| | - Dale S Bond
- Hartford Hospital/Hartford HealthCare, 80 Seymour Street, Hartford, CT, 06106, USA
| | - J Graham Thomas
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI, 02903, USA.
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond St., Providence, RI, 02903, USA.
| | - Jason Lillis
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond St., Providence, RI, 02903, USA
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3
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Reitsma L, Boelen PA, de Keijser J, Lenferink LIM. Self-guided online treatment of disturbed grief, posttraumatic stress, and depression in adults bereaved during the COVID-19 pandemic: A randomized controlled trial. Behav Res Ther 2023; 163:104286. [PMID: 36906949 PMCID: PMC9985540 DOI: 10.1016/j.brat.2023.104286] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 02/17/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE This randomized-waitlist controlled trial is the first study examining short-term effects of a self-guided online grief-specific cognitive behavioral therapy (CBT) in reducing early persistent complex bereavement disorder (PCBD), posttraumatic stress disorder (PTSD), and depression symptoms in adults bereaved during the COVID-19 pandemic. METHOD Sixty-five Dutch adults, bereaved at least three months earlier during the pandemic, with clinically-relevant PCBD, PTSD, and/or depression symptoms, were allocated to a treatment (n = 32) or waitlist condition (n = 33). Telephone interviews were conducted to assess PCBD, PTSD, and depression symptoms (using validated instruments) at baseline, post-treatment, and post-waiting period. Participants received an eight-week self-guided online grief-specific CBT including exposure, cognitive restructuring, and behavioral activation assignments. Analyses of covariance were performed. RESULTS Intention-to-treat analyses indicated that people in the intervention condition showed significantly lower PCBD (d = 0.90), PTSD (d = 0.71), and depression (d = 0.57) symptom-levels post-treatment relative to waitlist controls post-waiting, while taking baseline symptom-levels and use of professional psychological co-intervention into account. CONCLUSIONS The online CBT proved to be an effective intervention, reducing PCBD, PTSD, and depression symptoms. Pending replication of these findings, early online interventions may be widely implemented in practice to improve treatments for distressed bereaved people.
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Affiliation(s)
- L Reitsma
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, P.O. Box 80140, 3508 TC, Utrecht, the Netherlands.
| | - P A Boelen
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, P.O. Box 80140, 3508 TC, Utrecht, the Netherlands; ARQ National Psychotrauma Centre, Nienoord 5, 3508 TC, Diemen, the Netherlands
| | - J de Keijser
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands
| | - L I M Lenferink
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, P.O. Box 80140, 3508 TC, Utrecht, the Netherlands; Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands; Department of Psychology, Health & Technology, Faculty of Behavioural Management and Social Sciences, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands
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4
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Rohrer-Baumgartner N, Holthe IL, Svendsen EJ, Røe C, Egeland J, Borgen IMH, Hauger SL, Forslund MV, Brunborg C, Øra HP, Dahl HM, Bragstad LK, Killi EM, Sandhaug M, Kleffelgård I, Strand-Saugnes AP, Dahl-Hilstad I, Ponsford J, Winter L, Wade S, Løvstad M. Rehabilitation for children with chronic acquired brain injury in the Child in Context Intervention (CICI) study: study protocol for a randomized controlled trial. Trials 2022; 23:169. [PMID: 35193666 PMCID: PMC8861614 DOI: 10.1186/s13063-022-06048-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/21/2022] [Indexed: 01/10/2023] Open
Abstract
Background Pediatric acquired brain injury (pABI) is associated with long-term cognitive, behavioral, social, and emotional problems, which may affect the quality of life, school, and family functioning. Yet, there is a lack of evidence-based community-centered rehabilitation programs for chronic pABI and these children do not systematically receive comprehensive rehabilitation. The Child In Context Intervention (CICI) study is a pragmatic randomized controlled trial (RCT) for children with chronic pABI, which aims to evaluate the effectiveness of an individualized and goal-oriented intervention targeting everyday functioning of the child and family. Methods Children aged 6–16 years with MRI/CT-verified intracranial abnormalities will be included in the CICI study if they have persistent self- or parent-reported cognitive, emotional, and/or behavioral challenges 1 year or more after insult and attend school regularly. A total of 70 families will be randomized 1:1 to an intervention or a control group. The intervention consists of seven family sessions, one parent seminar, and four school sessions delivered over approximately 6 months. The parent seminar will be held in person, and the other sessions will mainly be video based. The children’s and families’ self-reported major challenges in everyday life will be targeted using SMART goals. Evidence-based strategies, when available, will be applied to achieve the goals, combined with psychoeducation. Goal attainment scaling (GAS) will be used to evaluate goal attainment. Data is collected at baseline and after approximately 6 and 9 months. External assessors are blinded to group allocation. Primary outcomes are parent-reported brain injury symptoms in children and parenting self-efficacy at 9 months of follow-up. Secondary outcomes include child-reported brain injury symptoms, quality of life, executive functioning in daily life, parent emotional symptoms, family functioning, and unmet family health care needs. A process evaluation will be conducted. Discussion The current study provides an innovative approach to rehabilitation for children in the chronic phase of ABI and their families. This complex intervention may contribute to the development of evidence-based, high-quality rehabilitation for a large patient group, which is underrepresented in clinical research. It may also improve collaboration between specialized rehabilitation facilities, schools, and local health care services. Inclusion for the trial started in April 2021. Trial registration ClinicalTrials.govNCT04798859. Registered on March 15, 2021 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06048-8.
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Affiliation(s)
| | - Ingvil Laberg Holthe
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway.,Institute of Psychology, University of Oslo, Oslo, Norway
| | - Edel Jannecke Svendsen
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway.,Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway.,Research Center for Habilitation and Rehabilitation Services and Models (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Cecilie Røe
- Research Center for Habilitation and Rehabilitation Services and Models (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jens Egeland
- Institute of Psychology, University of Oslo, Oslo, Norway.,Vestfold Hospital Trust, Tønsberg, Norway
| | - Ida M H Borgen
- Institute of Psychology, University of Oslo, Oslo, Norway.,Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Solveig L Hauger
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway.,Institute of Psychology, University of Oslo, Oslo, Norway
| | - Marit V Forslund
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Hege Prag Øra
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Hilde Margrete Dahl
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | - Line Kildal Bragstad
- Research Center for Habilitation and Rehabilitation Services and Models (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Occupational Therapy, Prosthetics and Orthotics Oslo Metropolitan University, Oslo, Norway
| | - Eli Marie Killi
- Statped: Norwegian Service for Special Needs Education, Oslo, Norway
| | - Maria Sandhaug
- Statped: Norwegian Service for Special Needs Education, Oslo, Norway
| | - Ingerid Kleffelgård
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | | | | | - Jennie Ponsford
- School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Laraine Winter
- Philadelphia Research and Education Foundation, Philadelphia, PA, USA.,Nursing Service, Department of Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Shari Wade
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway.,Institute of Psychology, University of Oslo, Oslo, Norway
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5
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Ford ME, Geurtsen GJ, Groet E, Van Bennekom CAM, Van Someren EJW. A blended eHealth intervention for insomnia following acquired brain injury: study protocol for a randomized controlled trial. Trials 2020; 21:861. [PMID: 33066812 PMCID: PMC7566121 DOI: 10.1186/s13063-020-04789-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background Up to a third of stroke patients and patients with traumatic brain injury suffer from insomnia, including problems to fall asleep or stay asleep at night. Insomnia may exacerbate other brain damage-related problems, for example regarding cognitive functioning and emotional well-being; may lead to poorer quality of life; and may complicate recovery processes. Cognitive behavioral therapy for insomnia, delivered face-to-face or online, is found to be effective in the general population. However, despite the high prevalence and serious consequences of insomnia following acquired brain injury, studies on the efficacy of face-to-face cognitive behavioral treatment in this population are scarce, and this applies even more for studies on online cognitive behavioral therapy. Therefore, this study aims to evaluate the efficacy of a newly developed guided online cognitive behavioral therapy for insomnia following acquired brain injury. Methods A multicenter, prospective, randomized, open-label, blinded end point study (PROBE) will be conducted, in which 48 patients diagnosed with stroke or traumatic brain injury and insomnia will be randomly allocated to the online cognitive behavioral therapy for insomnia treatment group or the treatment as usual group. The treatment consists of 6 online cognitive behavioral therapy sessions given on a weekly basis and personalized feedback after each session, combined with 2 face-to-face sessions. Outcomes will be assessed at baseline, immediately after the intervention period and at 6-week follow-up. The primary outcome is the insomnia severity assessed with the Insomnia Severity Index. Secondary outcome measures include sleep quality, sleep features derived from the sleep diary, fatigue, anxiety and depression, subjective cognitive functioning, and societal participation. Discussion This study will provide insight on the efficacy of online cognitive behavioral therapy for insomnia following stroke and traumatic brain injury. Trial registration Netherlands Trial Register NTR7082. Registered on 12 March 2018.
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Affiliation(s)
- Marthe E Ford
- Department of Psychology, Heliomare Rehabilitation, Wijk aan Zee, The Netherlands.
| | - Gert J Geurtsen
- Department of Medical Psychology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Erny Groet
- Department of Psychology, Heliomare Rehabilitation, Wijk aan Zee, The Netherlands.,Research and Development, Heliomare Rehabilitation, Wijk aan Zee, The Netherlands
| | - Coen A M Van Bennekom
- Department of Medical Psychology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.,Coronel Institute for Labor and Health /Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Eus J W Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands.,Departments of Integrative Neurophysiology and Psychiatry, Amsterdam UMC, VU University, Amsterdam Neuroscience, Amsterdam, The Netherlands
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Kayrouz R, Karin E, Staples LG, Nielssen O, Dear BF, Titov N. A comparison of the characteristics and treatment outcomes of migrant and Australian-born users of a national digital mental health service. BMC Psychiatry 2020; 20:111. [PMID: 32160913 PMCID: PMC7065305 DOI: 10.1186/s12888-020-02486-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/07/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND To explore the characteristics and compare clinical outcomes of non-Australian born (migrant) and Australian-born users of an Australian national digital mental health service. METHODS The characteristics and treatment outcomes of patients who completed online treatment at the MindSpot Clinic between January 2014 and December 2016 and reported a country of birth other than Australia were compared to Australian-born users. Data about the main language spoken at home were used to create distinct groups. Changes in symptoms of depression and anxiety were measured using the Patient Health Questionnaire-9 Item (PHQ-9), and Generalized Anxiety Disorder Scale - 7 Item (GAD-7), respectively. RESULTS Of 52,020 people who started assessment at MindSpot between 1st January 2014 and 22nd December 2016, 45,082 reported a country of birth, of whom 78.6% (n = 35,240) were Australian-born, and 21.4% (n = 9842) were born overseas. Of 6782 people who completed the online treatment and reported country of birth and main language spoken at home, 1631 (24%) were migrants, 960 (59%) were from English-speaking countries, and 671 (41%) were from non-English speaking countries. Treatment-seeking migrant users reported higher rates of tertiary education than Australian-born users. The baseline symptom severity, and rates of symptom reduction and remission following online treatment were similar across groups. CONCLUSIONS Online treatment was associated with significant reductions in anxiety and depression in migrants of both English speaking and non-English speaking backgrounds, with outcomes similar to those obtained by Australian-born patients. DMHS have considerable potential to help reduce barriers to mental health care for migrants.
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Affiliation(s)
- Rony Kayrouz
- MindSpot Clinic, Macquarie University, Sydney, Australia. .,eCentreClinic, Department of Psychology, Macquarie University, Sydney, New South Wales, 2109, Australia.
| | - Eyal Karin
- MindSpot Clinic, Macquarie University, Sydney, Australia.,eCentreClinic, Department of Psychology, Macquarie University, Sydney, New South Wales, 2109, Australia
| | - Lauren G Staples
- MindSpot Clinic, Macquarie University, Sydney, Australia.,eCentreClinic, Department of Psychology, Macquarie University, Sydney, New South Wales, 2109, Australia
| | - Olav Nielssen
- MindSpot Clinic, Macquarie University, Sydney, Australia
| | - Blake F Dear
- MindSpot Clinic, Macquarie University, Sydney, Australia.,eCentreClinic, Department of Psychology, Macquarie University, Sydney, New South Wales, 2109, Australia
| | - Nickolai Titov
- MindSpot Clinic, Macquarie University, Sydney, Australia.,eCentreClinic, Department of Psychology, Macquarie University, Sydney, New South Wales, 2109, Australia
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7
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Barbeito S, Sánchez-Gutiérrez T, Becerra-García JA, González Pinto A, Caletti E, Calvo A. A systematic review of online interventions for families of patients with severe mental disorders. J Affect Disord 2020; 263:147-154. [PMID: 31818771 DOI: 10.1016/j.jad.2019.11.106] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 10/29/2019] [Accepted: 11/21/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several studies show the effectiveness of face-to-face interventions with families in improving the prognosis of patients with severe psychiatric disorders and their relatives; however, the effectiveness of online interventions is poorly understood. The current study aims to provide an overview of evidence for the effectiveness of online treatments (web/app) for patients with severe psychiatric disorders and their families. METHOD We performed a systematic review of online treatments for informal family caregivers of patients with a severe psychiatric disorder. The study psychological interventions had to have been administered in an exclusively online format (app, internet) and aimed at families of patients with severe mental disorder (at least one of first episode psychosis, schizophrenia, schizoaffective, bipolar disorder, and psychotic disorder). RESULTS Of a total of 1331 articles, we identified 9 viable studies; 4 randomized clinical trials, and 5 nonrandomized clinical studies. The present study is the first systematic review in this area. Online interventions were well accepted, with good adherence and satisfaction among the caregivers and patients and improved the symptoms of both caregivers and patients. LIMITATIONS Clinical and methodological diversity of the studies. CONCLUSIONS Burden improved, and perceived stress decreased in families. Moreover, the severity of positive symptoms decreased and fewer hospitalizations were recorded in patients than in the control group. Therefore, online interventions are a promising therapeutic approach for patients with severe mental disorder and their families. However, more studies-particularly randomized clinical trials-are needed in this area.
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Affiliation(s)
- Sara Barbeito
- Faculty of Health Sciences, Universidad Internacional de la Rioja (UNIR), Spain.
| | | | | | - Ana González Pinto
- University of the Basque Country, Biomedical Research Center in Mental HealthNet (CIBERSAM), Department of Neurosciences, University of the Basque Country, Vitoria, Spain.
| | - Elisabetta Caletti
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Department of Neurosciences and Mental Health, Milan, Italy.
| | - Ana Calvo
- Faculty of Health Sciences, Universidad Internacional de la Rioja (UNIR), Spain.
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Affiliation(s)
- Nannan Hu
- Hangzhou Seventh People's Hospital, Zhejiang University School of Medcine Mental Health Center, Hangzhou, China
| | - Shengming Pan
- Hangzhou Seventh People's Hospital, Zhejiang University School of Medcine Mental Health Center, Hangzhou, China
| | - Jijun Sun
- Hangzhou Seventh People's Hospital, Zhejiang University School of Medcine Mental Health Center, Hangzhou, China
| | - Zhuo Wang
- Hangzhou Seventh People's Hospital, Zhejiang University School of Medcine Mental Health Center, Hangzhou, China
| | - Hongjing Mao
- Hangzhou Seventh People's Hospital, Zhejiang University School of Medcine Mental Health Center, Hangzhou, China.
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9
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Abstract
For countless young people, technology plays an essential role in their lives. However, its many advantages have not yet been widely applied to the treatment of youth with eating disorders. This article looks at how smartphone applications, Web conferencing, and other developments could widen the range of care available in a field where suitable support can be hard to find. Various barriers to treatment exist, such as cost, access, and the stigma attached to eating disorders, but existing and new technologies could overcome those obstacles, if clinicians are willing and able to meet the requirements associated with digitally enhanced treatment.
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Affiliation(s)
- Shiri Sadeh-Sharvit
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Kanfei Nesharim 1, Herzliya 4610101, Israel; Center for m(2)Health, Palo Alto University, Palo Alto, CA, USA.
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10
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Green MA, Kroska A, Herrick A, Bryant B, Sage E, Miles L, Ravet M, Powers M, Whitegoat W, Linkhart R, King B. A preliminary trial of an online dissonance-based eating disorder intervention. Eat Behav 2018; 31:88-98. [PMID: 30199771 DOI: 10.1016/j.eatbeh.2018.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 08/24/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE We conducted a controlled randomized preliminary trial of an expanded online version of the Body Project (n = 46) compared to an assessment-only control condition (n = 36) via a longitudinal design (baseline, postintervention, 2-month follow-up) in a community sample of women (N = 82) with clinical (n = 53) and subclinical (n = 29) eating disorder symptoms. METHOD The traditional content of the Body Project was modified to include verbal, written, and behavioral exercises designed to dissuade objectification and maladaptive social comparison and adapted to an online format. Body dissatisfaction, self-esteem, self-objectification, thin-ideal internalization, maladaptive social comparison, trait anxiety, positive affect, negative affect, and eating disorder symptomatology were evaluated in the control and the online expanded Body Project condition at baseline, postintervention, and 2-month follow-up. RESULTS A 2 (condition: online expanded Body Project, control) × 3 (time: baseline, postintervention, 2-month follow-up) mixed factorial multivariate analysis of variance (MANOVA) was conducted to examine statistically significant group differences. As predicted, results indicated a statistically significant condition × time interaction. CONCLUSIONS Participants in the expanded online Body Project condition showed significant reductions in eating disorder symptoms and several associated psychological risk correlates from baseline to postintervention and follow-up; contrary to predictions, eating disorder symptoms and risk correlates were not significantly lower in the online expanded Body Project condition compared to the waitlist control condition at postintervention or 2-month follow-up.
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Affiliation(s)
- M A Green
- Department of Psychology, Cornell College, United States of America.
| | - A Kroska
- Department of Psychological and Brain Sciences, University of Iowa, United States of America
| | - A Herrick
- Department of Psychology, Cornell College, United States of America
| | - B Bryant
- Department of Psychology, Cornell College, United States of America
| | - E Sage
- Department of Psychology, Cornell College, United States of America
| | - L Miles
- Department of Psychology, Cornell College, United States of America
| | - M Ravet
- Department of Psychology, Cornell College, United States of America
| | - M Powers
- Department of Psychology, Cornell College, United States of America
| | - W Whitegoat
- Department of Psychology, Cornell College, United States of America
| | - R Linkhart
- Department of Psychology, Cornell College, United States of America
| | - B King
- Department of Psychology, Cornell College, United States of America
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Bjureberg J, Sahlin H, Hedman-Lagerlöf E, Gratz KL, Tull MT, Jokinen J, Hellner C, Ljótsson B. Extending research on Emotion Regulation Individual Therapy for Adolescents (ERITA) with nonsuicidal self-injury disorder: open pilot trial and mediation analysis of a novel online version. BMC Psychiatry 2018; 18:326. [PMID: 30305103 PMCID: PMC6180600 DOI: 10.1186/s12888-018-1885-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 09/13/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is common among adolescents and associated with negative outcomes. However, treatments developed specifically for NSSI and the proposed NSSI disorder (NSSID) are scarce, and access to empirically supported treatments for NSSI in many areas is limited. Online treatments carry the potential to increase the availability of evidence-based treatments. Emotion regulation individual therapy for adolescents (ERITA) has shown promise in the treatment of adolescents with NSSID. METHOD The present study examined the feasibility, acceptability, and utility of an online version of ERITA. Twenty-five adolescents (aged 13-17) with NSSID and their parents were included in an uncontrolled open trial. Self-report and clinician-rated assessments of outcomes such as NSSI, self-destructive behaviors, emotion dysregulation, and global functioning were administered at pre-treatment, post-treatment, 3- and 6- month follow-up. Measures of NSSI, self-destructive behaviors, and emotion dysregulation were also assessed weekly during treatment. RESULTS Ratings of treatment credibility, expectancy, and satisfaction were acceptable, and the therapeutic alliance and treatment completion rate (96%) were high. Adolescent participation in the treatment was associated with a statistically significant increase in past-month NSSI abstinence (p = .007), large-sized improvements in past-month NSSI frequency (55% reduction, 95% confidence interval [CI]: 29, 72; Cohen's d = 0.88, 95% CI: 0.73, 1.06) and global functioning (d = 1.01, 95% CI: 0.77, 1.32), and medium-sized improvements in emotion dysregulation (d = 0.75, 95% CI: 0.59, 0.90) and NSSI versatility (d = 0.63, 95% CI: 0.54, 0.77) from pre- to post-treatment. These improvements were further strengthened at 3-month follow-up and maintained at 6-month follow-up. The online therapist-guided parent program was associated with small- to large-sized (ds = 0.47-1.22) improvements in adaptive parent behaviors, and these improvements were maintained or further improved upon at 6-month follow-up. Moreover, in line with the theoretical model underlying ERITA, change in emotion dysregulation mediated changes in both NSSI frequency and self-destructive behaviors over the course of treatment. CONCLUSIONS Together, results suggest that online ERITA is an acceptable, feasible, and promising low-intensity treatment for adolescents with NSSID. The results of this open trial must be replicated in controlled studies. TRIAL REGISTRATION ClinicalTrials.gov ( NCT02697019 ). Registered 2 March 2016.
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Affiliation(s)
- Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Norra stationsgatan 69, SE-11364, Stockholm, Sweden.
| | - Hanna Sahlin
- 0000 0004 1937 0626grid.4714.6Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Norra stationsgatan 69, SE-11364 Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- 0000 0004 1937 0626grid.4714.6Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, SE-171 65 Stockholm, Sweden
| | - Kim L. Gratz
- 0000 0001 2184 944Xgrid.267337.4Department of Psychology, University of Toledo, 2801 W. Bancroft Street, Toledo, OH 43606 USA
| | - Matthew T. Tull
- 0000 0001 2184 944Xgrid.267337.4Department of Psychology, University of Toledo, 2801 W. Bancroft Street, Toledo, OH 43606 USA
| | - Jussi Jokinen
- 0000 0004 1937 0626grid.4714.6Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Norra stationsgatan 69, SE-11364 Stockholm, Sweden ,0000 0001 1034 3451grid.12650.30Department of Clinical Sciences/Psychiatry, Umeå University, By 23, Enheten för psykiatri, 901 85 Umeå, Sweden
| | - Clara Hellner
- 0000 0004 1937 0626grid.4714.6Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Norra stationsgatan 69, SE-11364 Stockholm, Sweden
| | - Brjánn Ljótsson
- 0000 0004 1937 0626grid.4714.6Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Norra stationsgatan 69, SE-11364 Stockholm, Sweden ,0000 0004 1937 0626grid.4714.6Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, SE-171 65 Stockholm, Sweden
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Schuster R, Leitner I, Carlbring P, Laireiter AR. Exploring blended group interventions for depression: Randomised controlled feasibility study of a blended computer- and multimedia-supported psychoeducational group intervention for adults with depressive symptoms. Internet Interv 2017; 8:63-71. [PMID: 30135830 PMCID: PMC6096250 DOI: 10.1016/j.invent.2017.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 04/03/2017] [Accepted: 04/03/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Blended interventions aim to capitalise on the strengths of both computer-based and face-to-face therapy. Studies on this innovative treatment format remain scare. This especially accounts for the group treatment of depression. METHOD The present study applied eclectic psychotherapy methods to an adult sample exhibiting a variety of depressive symptoms (N = 46). Participants were recruited by a newspaper inlet and randomised either to a treatment or a waiting list condition. Computer supported components were multimedia group sessions, e-learning, online videos and worksheets, remote therapist-patient communication and online pre-post-assessment. RESULTS Large between-group effect sizes on primary outcome depressiveness (CES-D) (F(1,44) = 4.88, p = 0.032; d = 0.87) and secondary outcome personal resources (resource scales) (F(1,44) = 9.04, p = 0.004; d = 0.73 to F(1,44) = 8.82 p = 0.005, d = 1.15) were found in the intention to treat analysis (ANOVA). Subjective evaluation of the intervention revealed high treatment adherence (91%) and high perceived relevance of supportive computer and multimedia components. Participants rated computer and multimedia components comparable to treatment elements such as group interaction or specific cognitive behavioural exercises, and 25% associated the utilisation of those components with treatment success. Depressiveness and age did not predict the utilisation and the appraisal of computer and multimedia components. DISCUSSION Results provide preliminary support for the acceptability and feasibility of the investigated blended treatment in a group with non-specific depressive symptoms. However, small sample size and lack of diagnostics restrict generalizability. Additional research in clinical settings is needed.
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Affiliation(s)
| | | | - Per Carlbring
- Department of Psychology, Stockholm University, Sweden
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Mol M, Dozeman E, van Schaik DJF, Vis CPCD, Riper H, Smit JH. The therapist's role in the implementation of internet-based cognitive behavioural therapy for patients with depression: study protocol. BMC Psychiatry 2016; 16:338. [PMID: 27716108 PMCID: PMC5045637 DOI: 10.1186/s12888-016-1045-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 09/20/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Internet-based Cognitive Behavioural Therapy (iCBT) for the treatment of depressive disorders is innovative and promising. Various studies have demonstrated large effect sizes up to 2.27, but implementation in routine practice lags behind. Mental health therapists play a significant role in the uptake of internet-based interventions. Therefore, it is interesting to study factors that influence the therapists in whether they apply internet-based therapy or not. This study, as part of the European implementation project MasterMind, aims to identity the factors that promote or hinder therapists in the use of iCBT in depression care. METHODS/DESIGN The uptake of iCBT by therapists in routine mental health care practice for the treatment of depression will be evaluated by a mixed method approach, to provide an understanding of the implementation factors (quantitative), and to ascertain the facilitating and hindering factors in the involvement of therapists in the implementation of iCBT (qualitative). The involvement of therapists in the implementation of iCBT is analysed following the RE-AIM framework on the five dimensions Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance. This enables us to evaluate the reach of therapists, the impact of iCBT on depression care, the extent to which therapists adopt iCBT, the extent to which iCBT is delivered as intended, and how iCBT can be maintained over time. DISCUSSION The results will provide valuable insight into the role of therapists in the implementation of iCBT for depression in secondary mental health care settings. They will result in concrete recommendations for how therapists can be facilitated in implementing and up-scaling iCBT for depression.
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Affiliation(s)
- Mayke Mol
- Department of Research & Innovation, GGZ inGeest, A.J. Ernststraat 1187, 1081 HL, Amsterdam, The Netherlands. .,EMGO Institute for Health Care and Research and Department of Psychiatry, VU University Medical Centre, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
| | - Els Dozeman
- Department of Research & Innovation, GGZ inGeest, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands ,EMGO Institute for Health Care and Research and Department of Psychiatry, VU University Medical Centre, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Digna J. F. van Schaik
- Department of Research & Innovation, GGZ inGeest, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands ,EMGO Institute for Health Care and Research and Department of Psychiatry, VU University Medical Centre, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Christiaan P. C. D. Vis
- EMGO Institute for Health Care and Research and Department of Psychiatry, VU University Medical Centre, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands ,Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Research & Innovation, GGZ inGeest, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands ,EMGO Institute for Health Care and Research and Department of Psychiatry, VU University Medical Centre, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands ,Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Jan H Smit
- Department of Research & Innovation, GGZ inGeest, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands ,EMGO Institute for Health Care and Research and Department of Psychiatry, VU University Medical Centre, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
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van der Zweerde T, Lancee J, Slottje P, Bosmans J, Van Someren E, Reynolds C, Cuijpers P, van Straten A. Cost-effectiveness of i-Sleep, a guided online CBT intervention, for patients with insomnia in general practice: protocol of a pragmatic randomized controlled trial. BMC Psychiatry 2016; 16:85. [PMID: 27038786 PMCID: PMC4818903 DOI: 10.1186/s12888-016-0783-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 03/16/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Insomnia is a highly prevalent disorder causing clinically significant distress and impairment. Furthermore, insomnia is associated with high societal and individual costs. Although cognitive behavioural treatment for insomnia (CBT-I) is the preferred treatment, it is not used often. Offering CBT-I in an online format may increase access. Many studies have shown that online CBT for insomnia is effective. However, these studies have all been performed in general population samples recruited through media. This protocol article presents the design of a study aimed at establishing feasibility, effectiveness and cost-effectiveness of a guided online intervention (i-Sleep) for patients suffering from insomnia that seek help from their general practitioner as compared to care-as-usual. METHODS/DESIGN In a pragmatic randomized controlled trial, adult patients with insomnia disorder recruited through general practices are randomized to a 5-session guided online treatment, which is called "i-Sleep", or to care-as-usual. Patients in the care-as-usual condition will be offered i-Sleep 6 months after inclusion. An ancillary clinician, known as the psychological well-being practitioner who works in the GP practice (PWP; in Dutch: POH-GGZ), will offer online support after every session. Our aim is to recruit one hundred and sixty patients. Questionnaires, a sleep diary and wrist actigraphy will be administered at baseline, post intervention (at 8 weeks), and at 6 months and 12 months follow-up. Effectiveness will be established using insomnia severity as the main outcome. Cost-effectiveness and cost-utility (using costs per quality adjusted life year (QALY) as outcome) will be conducted from a societal perspective. Secondary measures are: sleep diary, daytime consequences, fatigue, work and social adjustment, anxiety, alcohol use, depression and quality of life. DISCUSSION The results of this trial will help establish whether online CBT-I is (cost-) effective and feasible in general practice as compared to care-as-usual. If it is, then quality of care might be increased because implementation of i-Sleep makes it easier to adhere to insomnia guidelines. Strengths and limitations are discussed. TRIAL REGISTRATION Netherlands Trial register NTR 5202 (registered April 17(st) 2015).
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Affiliation(s)
- Tanja van der Zweerde
- Department of Clinical, Neuro, and Developmental Psychology, Section Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,EMGO institute for Health Care and Research, VU University Medical Centre, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Jaap Lancee
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Pauline Slottje
- EMGO institute for Health Care and Research, VU University Medical Centre, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands ,Academic Network of Family Medicine (ANH), VU University Medical Center, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Judith Bosmans
- Department of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eus Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands ,Departments of Integrative Neurophysiology and Psychiatry, Centre for Neurogenomics and Cognitive Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Charles Reynolds
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA USA
| | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Section Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,EMGO institute for Health Care and Research, VU University Medical Centre, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro, and Developmental Psychology, Section Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,EMGO institute for Health Care and Research, VU University Medical Centre, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
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Kooistra LC, Ruwaard J, Wiersma JE, van Oppen P, van der Vaart R, van Gemert-Pijnen JEWC, Riper H. Development and initial evaluation of blended cognitive behavioural treatment for major depression in routine specialized mental health care. Internet Interv 2016; 4:61-71. [PMID: 30135791 DOI: 10.1016/j.invent.2016.01.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 12/24/2015] [Accepted: 01/25/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Blended care combines face-to-face treatment with web-based components in mental health care settings. Blended treatment could potentially improve active patient participation, by letting patients work though part of the protocol autonomously. Further, blended treatment might lower the costs of mental health care, by reducing treatment duration and/or therapist contact. However, knowledge on blended care for depression is still limited. OBJECTIVES To develop a blended cognitive behavioural treatment (bCBT) for depressed patients in an outpatient specialized mental health care centre and to conduct a preliminary evaluation of this bCBT protocol. METHOD A bCBT protocol was developed, taking recommendations into account from depressed patients (n = 3) and therapists and experts in the field of e-health (n = 18). Next, an initial evaluation of integrated high-intensive bCBT was conducted with depressed patients (n = 9) in specialized mental health care. Patients' clinical profiles were established based on pre-treatment diagnostic information and patient self-reports on clinical measures. Patient treatment adherence rates were explored, together with patient ratings of credibility and expectancy (CEQ) before treatment, and system usability (SUS) and treatment satisfaction after treatment (CSQ-8). During and after treatment, the blended treatment protocol was evaluated in supervision sessions with the participating therapists (n = 7). RESULTS Seven out of nine patients started bCBT, of whom five completed ≥ 90% of treatment. System usability was evaluated as being above average (range 63 to 85), and patients were mostly to very satisfied with bCBT (range 16 to 32). Patients reported improvements in depression, health-related quality of life and anxiety. We observed that therapists evaluated the highly structured blended treatment as a helpful tool in providing evidence-based treatment to this complex patient group. DISCUSSION Although no conclusions can be drawn based on the current study, our observations suggest that a blended CBT approach might shorten treatment duration and has the potential to be a valuable treatment option for patients with severe depression in specialized mental health care settings. Further exploration of the effectiveness of our bCBT protocol by means of a randomized controlled trial is warranted.
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Holmqvist M, Vincent N, Walsh K. Web- vs. telehealth-based delivery of cognitive behavioral therapy for insomnia: a randomized controlled trial. Sleep Med 2013; 15:187-95. [PMID: 24461370 DOI: 10.1016/j.sleep.2013.10.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 10/17/2013] [Accepted: 10/21/2013] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The purpose of our study was to evaluate and compare two methods of service delivery (web-based and telehealth-based) for chronic insomnia with regard to patient preference, clinical effectiveness, and patient satisfaction. METHODS Our study was a randomized controlled trial with manualized telehealth- and web-based delivery conditions (nonblinded). The sample comprised 73 adults with chronic insomnia. Participants received web-based delivery from their homes or telehealth-based delivery from a nearby clinic. Both interventions consisted of identical psychoeducation, sleep hygiene and stimulus control instruction, sleep restriction treatment, relaxation training, cognitive therapy, mindfulness meditation, and medication-tapering assistance. RESULTS Using a linear mixed model analysis, results showed that both delivery methods produced equivalent changes in insomnia severity, with large effect sizes. Attendance patterns favored telehealth, whereas homework adherence and preference data favored web-based delivery. CONCLUSIONS Web- and telehealth-based delivery are both helpful in treating chronic insomnia in rural-dwelling adults.
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Affiliation(s)
- M Holmqvist
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
| | - N Vincent
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada.
| | - K Walsh
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
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