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Zwerenz R, Becker J, Gerzymisch K, Siepmann M, Holme M, Kiwus U, Spörl-Dönch S, Beutel ME. Evaluation of a transdiagnostic psychodynamic online intervention to support return to work: A randomized controlled trial. PLoS One 2017; 12:e0176513. [PMID: 28481893 PMCID: PMC5421767 DOI: 10.1371/journal.pone.0176513] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 04/08/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives Given their flexibility, online interventions may be useful as an outpatient treatment option to support vocational reintegration after inpatient rehabilitation. To that purpose we devised a transdiagnostic psychodynamic online intervention to facilitate return to work, focusing on interpersonal conflicts at the workplace often responsible for work-related stress. Research design and methods In a randomized controlled trial, we included employed patients from cardiologic, psychosomatic and orthopedic rehabilitation with work-related stress or need for support at intake to inpatient rehabilitation after they had given written consent to take part in the study. Following discharge, maladaptive interpersonal interactions at the workplace were identified via weekly blogs and processed by written therapeutic comments over 12 weeks in the intervention group (IG). The control group (CG) received an augmented treatment as usual condition. The main outcome, subjective prognosis of gainful employment (SPE), and secondary outcomes (psychological complaints) were assessed by means of online questionnaires before, at the end of aftercare (3 months) and at follow-up (12 months). We used ITT analyses controlling for baseline scores and medical group. Results N = 319 patients were enrolled into IG and N = 345 into CG. 77% of the IG logged in to the webpage (CG 74%) and 65% of the IG wrote blogs. Compared to the CG, the IG reported a significantly more positive SPE at follow-up. Measures of depression, anxiety and psychosocial stressors decreased from baseline to follow-up, whereas the corresponding scores increased in the CG. Correspondingly, somatization and psychological quality of life improved in the IG. Conclusions Psychodynamic online aftercare was effective to enhance subjective prognosis of future employment and improved psychological complaints across a variety of chronic physical and psychological conditions, albeit with small effect sizes.
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Affiliation(s)
- Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jan Becker
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Katharina Gerzymisch
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Martin Siepmann
- University Medical Center of the Carl Gustav Carus Technical University, Department of Psychosomatic Medicine and Psychotherapy, Dresden, Germany
| | - Martin Holme
- German Statutory Pension Insurance Rehabilitation Center for Orthopedic Diseases, Clinic Weser, Bad Pyrmont, Germany
| | - Ulrich Kiwus
- German Statutory Pension Insurance Rehabilitation Center for Cardiovascular Diseases, Clinic Wetterau, Bad Nauheim, Germany
| | - Sieglinde Spörl-Dönch
- Clinic for Prevention and Rehabilitation of Cardiovascular Diseases 'Haus Franken' GmbH, Bad Neustadt/ Saale, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Schröder J, Berger T, Meyer B, Lutz W, Hautzinger M, Späth C, Eichenberg C, Klein JP, Moritz S. Attitudes Towards Internet Interventions Among Psychotherapists and Individuals with Mild to Moderate Depression Symptoms. COGNITIVE THERAPY AND RESEARCH 2017. [DOI: 10.1007/s10608-017-9850-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Geraghty AW, Muñoz RF, Yardley L, Mc Sharry J, Little P, Moore M. Developing an Unguided Internet-Delivered Intervention for Emotional Distress in Primary Care Patients: Applying Common Factor and Person-Based Approaches. JMIR Ment Health 2016; 3:e53. [PMID: 27998878 PMCID: PMC5209611 DOI: 10.2196/mental.5845] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 10/24/2016] [Accepted: 10/30/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Developing effective, unguided Internet interventions for mental health represents a challenge. Without structured human guidance, engagement with these interventions is often limited and the effectiveness reduced. If their effectiveness can be increased, they have great potential for broad, low-cost dissemination. Improving unguided Internet interventions for mental health requires a renewed focus on the proposed underlying mechanisms of symptom improvement and the involvement of target users from the outset. OBJECTIVE The aim of our study was to develop an unguided e-mental health intervention for distress in primary care patients, drawing on meta-theory of psychotherapeutic change and utilizing the person-based approach (PBA) to guide iterative qualitative piloting with patients. METHODS Common factors meta-theory informed the selection and structure of therapeutic content, enabling flexibility whilst retaining the proposed necessary ingredients for effectiveness. A logic model was designed outlining intervention components and proposed mechanisms underlying improvement. The PBA provided a framework for systematically incorporating target-user perspective into the intervention development. Primary care patients (N=20) who had consulted with emotional distress in the last 12 months took part in exploratory qualitative interviews, and a subsample (n=13) undertook think-aloud interviews with a prototype of the intervention. RESULTS A flexible intervention was developed, to be used as and when patients need, diverting from a more traditional, linear approach. Based on the in-depth qualitative findings, disorder terms such as "depression" were avoided, and discussions of psychological symptoms were placed in the context of stressful life events. Think-aloud interviews showed that patients were positive about the design and structure of the intervention. On the basis of patient feedback, modifications were made to increase immediate access to all therapeutic techniques. CONCLUSIONS Detailing theoretical assumptions underlying Internet interventions for mental health, and integrating this approach with systematic in-depth qualitative research with target patients is important. These strategies may provide novel ways for addressing the challenges of unguided delivery. The resulting intervention, Healthy Paths, will be evaluated in primary care-based randomized controlled trials, and deployed as a massive open online intervention (MOOI).
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Affiliation(s)
- Adam Wa Geraghty
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Ricardo F Muñoz
- Institute for International Internet Interventions for Health, Palo Alto University, Palo Alto, CA, United States.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Lucy Yardley
- Centre for Applications of Health Psychology, Academic Unit of Psychology, University of Southampton, Southampton, United Kingdom
| | | | - Paul Little
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Michael Moore
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
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Kolovos S, Kleiboer A, Cuijpers P. Effect of psychotherapy for depression on quality of life: meta-analysis. Br J Psychiatry 2016; 209:460-468. [PMID: 27539296 DOI: 10.1192/bjp.bp.115.175059] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 01/14/2016] [Accepted: 04/27/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Several meta-analyses have shown that psychotherapy is effective for reducing depressive symptom severity. However, the impact on quality of life (QoL) is as yet unknown. AIMS To investigate the effectiveness of psychotherapy for depression on global QoL and on the mental health and physical health components of QoL. METHOD We conducted a meta-analysis of 44 randomised clinical trials comparing psychotherapy for adults experiencing clinical depression or elevated depressive symptoms with a control group. We used subgroup analyses to explore the influence of various study characteristics on the effectiveness of treatment. RESULTS We detected a small to moderate effect size (Hedges' g = 0.33, 95% CI 0.24-0.42) for global QoL, a moderate effect size for the mental health component (g = 0.42, 95% CI 0.33-0.51) and, after removing an outlier, a small but statistically significant effect size for the physical health component (g = 0.16, 95% CI 0.05-0.27). Multivariate meta-regression analyses showed that the effect size of depressive symptoms was significantly related to the effect size of the mental health component of QoL. The effect size of depressive symptoms was not related to global QoL or the physical health component. CONCLUSIONS Psychotherapy for depression has a positive impact on the QoL of patients with depression. Improvements in QoL are not fully explained by improvements in depressive symptom severity.
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Affiliation(s)
- Spyros Kolovos
- Spyros Kolovos, MSc, Department of Health Sciences, VU University Amsterdam, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands; Annet Kleiboer, PhD, Department of Clinical Psychology, VU University Amsterdam, EMGO Institute for Health and Care Research, VU University, Department of Clinical and Health Psychology, Utrecht University, The Netherlands; Pim Cuijpers, PhD, Department of Clinical Psychology, VU University Amsterdam, EMGO Institute for Health and Care Research, VU University and VU University Medical Centre Amsterdam, The Netherlands, and Leuphana University, Lunebrug, Germany
| | - Annet Kleiboer
- Spyros Kolovos, MSc, Department of Health Sciences, VU University Amsterdam, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands; Annet Kleiboer, PhD, Department of Clinical Psychology, VU University Amsterdam, EMGO Institute for Health and Care Research, VU University, Department of Clinical and Health Psychology, Utrecht University, The Netherlands; Pim Cuijpers, PhD, Department of Clinical Psychology, VU University Amsterdam, EMGO Institute for Health and Care Research, VU University and VU University Medical Centre Amsterdam, The Netherlands, and Leuphana University, Lunebrug, Germany
| | - Pim Cuijpers
- Spyros Kolovos, MSc, Department of Health Sciences, VU University Amsterdam, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands; Annet Kleiboer, PhD, Department of Clinical Psychology, VU University Amsterdam, EMGO Institute for Health and Care Research, VU University, Department of Clinical and Health Psychology, Utrecht University, The Netherlands; Pim Cuijpers, PhD, Department of Clinical Psychology, VU University Amsterdam, EMGO Institute for Health and Care Research, VU University and VU University Medical Centre Amsterdam, The Netherlands, and Leuphana University, Lunebrug, Germany
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Schueller SM, Tomasino KN, Mohr DC. Integrating Human Support Into Behavioral Intervention Technologies: The Efficiency Model of Support. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2016. [DOI: 10.1111/cpsp.12173] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ebert DD, Donkin L, Andersson G, Andrews G, Berger T, Carlbring P, Rozenthal A, Choi I, Laferton JAC, Johansson R, Kleiboer A, Lange A, Lehr D, Reins JA, Funk B, Newby J, Perini S, Riper H, Ruwaard J, Sheeber L, Snoek FJ, Titov N, Ince BÜ, van Bastelaar K, Vernmark K, van Straten A, Warmerdam L, Salsman N, Cuijpers P. Does Internet-based guided-self-help for depression cause harm? An individual participant data meta-analysis on deterioration rates and its moderators in randomized controlled trials. Psychol Med 2016; 46:2679-2693. [PMID: 27649340 PMCID: PMC5560500 DOI: 10.1017/s0033291716001562] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Almost nothing is known about the potential negative effects of Internet-based psychological treatments for depression. This study aims at investigating deterioration and its moderators within randomized trials on Internet-based guided self-help for adult depression, using an individual patient data meta-analyses (IPDMA) approach. METHOD Studies were identified through systematic searches (PubMed, PsycINFO, EMBASE, Cochrane Library). Deterioration in participants was defined as a significant symptom increase according to the reliable change index (i.e. 7.68 points in the CES-D; 7.63 points in the BDI). Two-step IPDMA procedures, with a random-effects model were used to pool data. RESULTS A total of 18 studies (21 comparisons, 2079 participants) contributed data to the analysis. The risk for a reliable deterioration from baseline to post-treatment was significantly lower in the intervention v. control conditions (3.36 v. 7.60; relative risk 0.47, 95% confidence interval 0.29-0.75). Education moderated effects on deterioration, with patients with low education displaying a higher risk for deterioration than patients with higher education. Deterioration rates for patients with low education did not differ statistically significantly between intervention and control groups. The benefit-risk ratio for patients with low education indicated that 9.38 patients achieve a treatment response for each patient experiencing a symptom deterioration. CONCLUSIONS Internet-based guided self-help is associated with a mean reduced risk for a symptom deterioration compared to controls. Treatment and symptom progress of patients with low education should be closely monitored, as some patients might face an increased risk for symptom deterioration. Future studies should examine predictors of deterioration in patients with low education.
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Affiliation(s)
- D. D. Ebert
- Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - L. Donkin
- The Brain and Mind Research Institute, University of Sydney, NSW, Australia
- Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, the Netherlands
| | - G. Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - G. Andrews
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent’s Hospital, Darlinghurst, NSW, Australia
| | - T. Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - P. Carlbring
- Department of Psychology, Stockholm University, Sweden
| | - A. Rozenthal
- Department of Psychology, Stockholm University, Sweden
| | - I. Choi
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | | | - R. Johansson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - A. Kleiboer
- Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, the Netherlands
| | - A. Lange
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - D. Lehr
- Leuphana University Lüneburg, Germany
| | | | - B. Funk
- Leuphana University Lüneburg, Germany
| | - J. Newby
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent’s Hospital, Darlinghurst, NSW, Australia
| | - S. Perini
- Centre for Emotional Health, Macquarie University, Australia
| | - H. Riper
- Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, the Netherlands
| | - J. Ruwaard
- Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, the Netherlands
| | - L. Sheeber
- Oregon Research Institute, Eugene, Oregon, USA
| | - F. J. Snoek
- Department of Medical Psychology, VU University Medical Center Amsterdam, The Netherlands
- Academic Medical Center/University of Amsterdam, The Netherlands
| | - N. Titov
- eCentreClinic and MindSpot Clinic, Department of Psychology, Macquarie University, Australia
| | - B. Ünlü Ince
- Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, the Netherlands
| | - K. van Bastelaar
- Department of Medical Psychology, VU University Medical Center Amsterdam, The Netherlands
| | - K. Vernmark
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Psykologpartners, Private Practice, Linköping, Sweden
| | - A. van Straten
- Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, the Netherlands
| | - L. Warmerdam
- Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, the Netherlands
| | - N. Salsman
- School of Psychology, Xavier University, Cincinnati, USA
| | - P. Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, the Netherlands
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Chavooshi B, Mohammadkhani P, Dolatshahee B. Telemedicine vs. in-person delivery of intensive short-term dynamic psychotherapy for patients with medically unexplained pain: A 12-month randomized, controlled trial. J Telemed Telecare 2016; 23:133-141. [PMID: 27036877 DOI: 10.1177/1357633x15627382] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction This study examined the effectiveness of telemedicine in providing psychotherapy to patients with medically unexplained pain (MUP) who may not have access to in-person treatment. The impact of Internet-delivered intensive short-term dynamic psychotherapy (ID-ISTDP) was investigated for MUP via video teleconferencing (Skype™). Methods A randomized, controlled trial of ISTDP, an evidence-based intervention for MUP, was conducted to compare delivery modalities on variations in MUP symptoms. Eighty-one participants with MUP were randomized to either ID-ISTDP ( n = 39) or in-person ISTDP ( n = 42). Outcome variables included the Numeric Pain Rating Scale, Depression Anxiety Stress Scale-21, Emotion Regulation Questionnaire, Mindful Attention Awareness Scale and the Quality of Life Inventory. In addition, exploratory analyses were used to examine acceptability, satisfaction and compliance in both conditions. Participants were assessed prior to intervention, immediately following the intervention, and 12 months after. Results In the intention-to-treat analysis, in-person ISTDP participants had significantly lower pain intensity than ID-ISTDP participants, both immediately following the intervention ( d = 0.97) and at the 12-month follow-up ( d = 0.82). Moreover, there were significant decreases in depression, anxiety and stress as well as a greater increase in emotion regulation functioning, mindfulness and quality of life observed in the in-person ISTDP group at the end of the intervention and 12 months after the treatment when compared to the ID-ISTDP group. Participants rated both treatment conditions as equally credible and satisfying. Conclusion ISTDP seems most effective when delivered in person in treating MUP patients with highly comorbid conditions with benefits maintained over 12 months.
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Affiliation(s)
- Behzad Chavooshi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Parvaneh Mohammadkhani
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Behrouz Dolatshahee
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Cuijpers P, Cristea IA, Ebert DD, Koot HM, Auerbach RP, Bruffaerts R, Kessler RC. PSYCHOLOGICAL TREATMENT OF DEPRESSION IN COLLEGE STUDENTS: A METAANALYSIS. Depress Anxiety 2016; 33:400-14. [PMID: 26682536 PMCID: PMC4846553 DOI: 10.1002/da.22461] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 11/16/2015] [Accepted: 11/17/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Expanded efforts to detect and treat depression among college students, a peak period of onset, have the potential to bear high human capital value from a societal perspective because depression increases college withdrawal rates. However, it is not clear whether evidence-based depression therapies are as effective in college students as in other adult populations. The higher levels of cognitive functioning and IQ and higher proportions of first-onset cases might lead to treatment effects being different among college students relative to the larger adult population. METHODS We conducted a metaanalysis of randomized trials comparing psychological treatments of depressed college students relative to control groups and compared effect sizes in these studies to those in trials carried out in unselected populations of depressed adults. RESULTS The 15 trials on college students satisfying study inclusion criteria included 997 participants. The pooled effect size of therapy versus control was g = 0.89 (95% CI: 0.66∼1.11; NNT = 2.13) with moderate heterogeneity (I(2) = 57; 95% CI: 23∼72). None of these trials had low risk of bias. Effect sizes were significantly larger when students were not remunerated (e.g. money, credit), received individual versus group therapy, and were in trials that included a waiting list control group. No significant difference emerged in comparing effect sizes among college students versus adults either in simple mean comparisons or in multivariate metaregression analyses. CONCLUSIONS This metaanalysis of trials examining psychological treatments of depression in college students suggests that these therapies are effective and have effect sizes comparable to trials carried out among depressed adults.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
,EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
,Correspondence to: Professor Pim Cuijpers, Clinical Psychology, Department of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
| | - Ioana A. Cristea
- Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania
,Clinical Psychology Branch, Department of Surgical, Medical, Molecular, and Critical Pathology, University of Pisa, Pisa, Italy
| | - David D. Ebert
- Department of Psychology, Clinical Psychology and Psychotherapy, Friedrich-Alexander University Nuremberg-Erlangen, Erlangen, Germany
| | - Hans M. Koot
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
,EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Randy P. Auerbach
- Department of Psychiatry, Harvard Medical School, Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, Massachusetts
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum – KU Leuven, Kortenberg, Belgium
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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Lindner P, Carlbring P, Flodman E, Hebert A, Poysti S, Hagkvist F, Johansson R, Zetterqvist Westin V, Berger T, Andersson G. Does cognitive flexibility predict treatment gains in Internet-delivered psychological treatment of social anxiety disorder, depression, or tinnitus? PeerJ 2016; 4:e1934. [PMID: 27114881 PMCID: PMC4841247 DOI: 10.7717/peerj.1934] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/23/2016] [Indexed: 11/20/2022] Open
Abstract
Little is known about the individual factors that predict outcomes in Internet-administered psychological treatments. We hypothesized that greater cognitive flexibility (i.e. the ability to simultaneously consider several concepts and tasks and switch effortlessly between them in response to changes in environmental contingencies) would provide a better foundation for learning and employing the cognitive restructuring techniques taught and exercised in therapy, leading to greater treatment gains. Participants in three trials featuring Internet-administered psychological treatments for depression (n = 36), social anxiety disorder (n = 115) and tinnitus (n = 53) completed the 64-card Wisconsin Card Sorting Test (WCST) prior to treatment. We found no significant associations between perseverative errors on the WCST and treatment gains in any group. We also found low accuracy in the classification of treatment responders. We conclude that lower cognitive flexibility, as captured by perseverative errors on the WCST, should not impede successful outcomes in Internet-delivered psychological treatments.
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Affiliation(s)
- Philip Lindner
- Department of Psychology, Stockholm University, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University , Stockholm , Sweden
| | - Erik Flodman
- Department of Behavioural Sciences and Learning, Linköping University , Linköping , Sweden
| | - Amanda Hebert
- Department of Behavioural Sciences and Learning, Linköping University , Linköping , Sweden
| | - Stephanie Poysti
- Department of Behavioural Sciences and Learning, Linköping University , Linköping , Sweden
| | - Filip Hagkvist
- NeuroVux Clinic, Norrbotten County Council , Luleå , Sweden
| | - Robert Johansson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | | | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern , Bern , Switzerland
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
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de Bitencourt Machado D, Braga Laskoski P, Trelles Severo C, Margareth Bassols A, Sfoggia A, Kowacs C, Valle Krieger D, Benetti Torres M, Bento Gastaud M, Stella Wellausen R, Pigatto Teche S, Laks Eizirik C. A Psychodynamic Perspective on a Systematic Review of Online Psychotherapy for Adults. BRITISH JOURNAL OF PSYCHOTHERAPY 2016. [DOI: 10.1111/bjp.12204] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Chavooshi B, Mohammadkhani P, Dolatshahi B. A Randomized Double-Blind Controlled Trial Comparing Davanloo Intensive Short-Term Dynamic Psychotherapy as Internet-Delivered Vs Treatment as Usual for Medically Unexplained Pain: A 6-Month Pilot Study. PSYCHOSOMATICS 2016; 57:292-300. [PMID: 27017450 DOI: 10.1016/j.psym.2016.01.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 12/31/2015] [Accepted: 12/31/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research has shown that Intensive Short-Term Dynamic Psychotherapy (ISTDP) can effectively decrease pain intensity and improve quality of life in patients with medically unexplained pain. OBJECTIVE Understanding that not all patients with medically unexplained pain have access to in-person ISTDP, this study aims to investigate the efficacy of an Internet-delivered ISTDP for individuals with medically unexplained pain using Skype in comparison with treatment as usual. METHOD In this randomized controlled trial, 100 patients were randomly allocated into Internet-delivered ISTDP (n = 50) and treatment-as- usual (n = 50) groups. Treatment intervention consisted of 16 weekly, hour-long therapy sessions. The primary outcome was perceived pain assessed using the Numeric Pain Rating Scale. The secondary outcome included Depression Anxiety Stress Scale-21, Emotion Regulation Questionnaire, Mindful Attention Awareness Scale, and Quality-of-Life Inventory. Blind assessments were conducted at the baseline, posttreatment, and at a 6-month follow-up. RESULTS In the intention-to-treat analysis, pain symptoms in the intervention group were significantly reduced (p < 0.001), whereas a reduction was not observed in the treatment as usual group (p = 0.651). Moreover, there were significant decreases in depression, anxiety, and stress, as well as a greater increase in emotion regulation functioning, mindfulness, and quality of life observed in the intervention group 6 months after the treatment compared with the treatment as usual condition. CONCLUSION The results of this pilot trial demonstrate that 16 weeks of ISTDP delivered by Skype can significantly improve pain intensity and clinical symptoms of medically unexplained pain.
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Affiliation(s)
- Behzad Chavooshi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Parvaneh Mohammadkhani
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Behrouz Dolatshahi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Andersson G, Topooco N, Havik O, Nordgreen T. Internet-supported versus face-to-face cognitive behavior therapy for depression. Expert Rev Neurother 2015; 16:55-60. [PMID: 26610160 DOI: 10.1586/14737175.2015.1125783] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Major depression and depressive symptoms are highly prevalent and there is a need for different forms of psychological treatments that can be delivered from a distance at a low cost. In the present review the authors contrast face-to-face and Internet-delivered cognitive behavior therapy (ICBT) for depression. A total of five studies are reviewed in which guided ICBT was directly compared against face-to-face CBT. Meta-analytic summary statistics were calculated for the five studies involving a total of 429 participants. The average effect size difference was Hedge's g = 0.12 (95% CI: -0.06-0.30) in the direction of favoring guided ICBT. The small difference in effect has no implication for clinical practice. The overall empirical status of clinician-guided ICBT for depression is commented on and future challenges are highlighted. Among these are developing treatments for patients with more severe and long-standing depression and for children, adolescents and the elderly. Also, there is a need to investigate mechanisms of change.
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Affiliation(s)
- Gerhard Andersson
- a Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden.,b Department of Clinical Neuroscience, Psychiatry Section , Karolinska Institutet , Stoclholm , Sweden
| | - Naira Topooco
- a Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden
| | - Odd Havik
- c Department of Clinical Psychology , University of Bergen , Bergen , Norway.,d Anxiety Disorders Research Network , Haukeland University Hospital , Bergen , Norway
| | - Tine Nordgreen
- c Department of Clinical Psychology , University of Bergen , Bergen , Norway.,d Anxiety Disorders Research Network , Haukeland University Hospital , Bergen , Norway
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Abstract
During the past 15 years, much progress has been made in developing and testing Internet-delivered psychological treatments. In particular, therapist-guided Internet treatments have been found to be effective for a wide range of psychiatric and somatic conditions in well over 100 controlled trials. These treatments require (a) a secure web platform, (b) robust assessment procedures, (c) treatment contents that can be text based or offered in other formats, and (d) a therapist role that differs from that in face-to-face therapy. Studies suggest that guided Internet treatments can be as effective as face-to-face treatments, lead to sustained improvements, work in clinically representative conditions, and probably are cost-effective. Despite these research findings, Internet treatment is not yet disseminated in most places, and clinical psychologists should consider using modern information technology and evidence-based treatment programs as a complement to their other services, even though there will always be clients for whom face-to-face treatment is the best option.
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Affiliation(s)
- Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Campus Valla, Linköping SE-581 83, Sweden;
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Abstract
This article reviews the organization, infrastructure basics, applications, effectiveness, outreach, and implementation barriers related to telepsychiatry. We highlight the tremendous potential and promise that this technology holds and also discuss the importance that telepsychiatry may play in the field of psychodynamic psychiatry. Given the growing effectiveness evidence base for therapy delivered over the Internet, telepsychiatry holds a large unexplored territory to help psychodynamically minded patients connect with psychodynamically oriented psychiatrists. This economically advantageous medium can be utilized to deliver psychodynamically guided approaches to the patient, alone or in combination with pharmacological and other psychosocial interventions. We hope, this article will help psychodynamically trained psychiatrists to consider bridging the gap with the remotely located, chronically mentally ill population which oftentimes has scarcity of resources.
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Affiliation(s)
- Sy Atezaz Saeed
- Professor and Chairman, Department of Psychiatry and Behavioral Medicine, Brody School of Medicine at East Carolina University
| | - Vivek Anand
- Clinical Assistant Professor, Department of Psychiatry and Behavioral Medicine, Brody School of Medicine at East Carolina University
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Beshai S, Wallace LM, Mcdougall KH, Waldmann K, Stea JN. Reduced Contact Cognitive-Behavioral Interventions for Adult Depression: A Review. THE JOURNAL OF PSYCHOLOGY 2015; 150:252-79. [PMID: 26606161 DOI: 10.1080/00223980.2015.1087376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Depression is a highly prevalent and debilitating mental health condition. Evidence suggests that there is a widening gap between the demand for and availability of effective treatments. As such, there is a vast need for the development and dissemination of accessible and affordable treatments for depression. In the past decade, there has been a proliferation of reduced client-therapist contact protocols for depression. In this article, the authors review and compare the efficacy of reduced contact cognitive-behavioral interventions for adult depression across two degrees of therapist-client contact (i.e., no therapist-client contact versus minimal therapist-client contact interventions). The authors also discuss the methodological and theoretical limitations of this research base. The present review suggests that a) reduced contact interventions for depression can be effective in remediating the symptoms of depression; b) the effect sizes of some reduced contact protocols may approximate those reported in traditional protocols involving significantly greater client-therapist contact; and c) protocols which employ some form of client-therapist contact, on average, generate higher effect sizes than those that are purely self-help in nature. A discussion of the theoretical and applied implications of such findings, as well as areas in need of further research, is provided.
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Abstract
PURPOSE OF REVIEW This article evaluates the empirical standing of online treatment (eTherapy) for people with an established eating disorder. RECENT FINDINGS There have been four randomized controlled trials of eTherapy for people with an eating disorder. All four focused on eating disorders characterized by binge eating and recruited adult participants direct from the community. The interventions were cognitive behavioural in nature, lasted between 3 and 7 months, and were accompanied by external support. In common with eTherapy for other mental health problems, there were problems engaging and retaining the users, and maximizing their implementation of the intervention. A minority (10-37%, intent-to-treat figures) improved substantially. SUMMARY This is a new field. The findings of the four randomized controlled trials are consistent with the earlier reports indicating that guided eTherapy interventions of a cognitive behavioural nature are acceptable to (female) adults with a binge eating problem and that a subgroup improves substantially. More effective interventions are required and their use in different healthcare settings needs to be investigated. Direct-to-sufferer eTherapy interventions have the potential to increase access to effective forms of treatment and, in younger cases, they might serve as a form of secondary prevention.
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Leichsenring F, Leweke F, Klein S, Steinert C. The empirical status of psychodynamic psychotherapy - an update: Bambi's alive and kicking. PSYCHOTHERAPY AND PSYCHOSOMATICS 2015; 84:129-48. [PMID: 25833321 DOI: 10.1159/000376584] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 01/29/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Task Force on Promotion and Dissemination of Psychological Procedures proposed rigorous criteria to define empirically supported psychotherapies. According to these criteria, 2 randomized controlled trials (RCTs) showing efficacy are required for a treatment to be designated as 'efficacious' and 1 RCT for a designation as 'possibly efficacious'. Applying these criteria modified by Chambless and Hollon, this article presents an update on the evidence for psychodynamic therapy (PDT) in specific mental disorders. METHODS A systematic search was performed using the criteria by Chambless and Hollon for study selection, as follows: (1) RCT of PDT in adults, (2) use of reliable and valid measures for diagnosis and outcome, (3) use of treatment manuals or manual-like guidelines, (4) adult population treated for specific problems and (5) PDT superior to no treatment, placebo or alternative treatment or equivalent to an established treatment. RESULTS A total of 39 RCTs were included. Following Chambless and Hollon, PDT can presently be designated as efficacious in major depressive disorder (MDD), social anxiety disorder, borderline and heterogeneous personality disorders, somatoform pain disorder, and anorexia nervosa. For MDD, this also applies to the combination with pharmacotherapy. PDT can be considered as possibly efficacious in dysthymia, complicated grief, panic disorder, generalized anxiety disorder, and substance abuse/dependence. Evidence is lacking for obsessive-compulsive, posttraumatic stress, bipolar and schizophrenia spectrum disorder(s). CONCLUSIONS Evidence has emerged that PDT is efficacious or possibly efficacious in a wide range of common mental disorders. Further research is required for those disorders for which sufficient evidence does not yet exist.
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Affiliation(s)
- Falk Leichsenring
- Clinic of Psychosomatics and Psychotherapy, Justus-Liebig University Giessen, Giessen, Germany
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70
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Kleiboer A, Donker T, Seekles W, van Straten A, Riper H, Cuijpers P. A randomized controlled trial on the role of support in Internet-based problem solving therapy for depression and anxiety. Behav Res Ther 2015; 72:63-71. [PMID: 26188373 DOI: 10.1016/j.brat.2015.06.013] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 06/22/2015] [Accepted: 06/29/2015] [Indexed: 01/21/2023]
Abstract
Internet-based interventions can be effective treatments for anxiety and depression. Meta-analytic evidence suggests that they should be delivered with human support to reach optimal effects. These findings have not consistently been replicated in direct comparisons of supported and unsupported interventions, however. This study examined the role of support in Internet-based problem solving treatment (PST) for symptoms of anxiety and/or depression. Adults with mild to moderate symptoms of anxiety and/or depression were recruited from the general population and randomized to: (1) PST without support (n = 107), (2) PST with support on request (n = 108), (3) PST with weekly support (n = 106), (4) no Internet-based intervention but non-specific chat or email (n = 110), or (5) waitlist control (WLC; n = 106). Primary outcomes were symptoms of anxiety (HADS) and depression (CES-D) measured at baseline and 6 weeks later. Analyses were first based on the intention-to-treat principle (ITT) and repeated with intervention completers. Only participants who received PST with weekly support improved significantly more than WLC for depressive symptoms. Results for anxiety were less robust but in favor of the weekly support condition. The results underscore the importance of structural support in Internet-based interventions for depression and anxiety.
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Affiliation(s)
- Annet Kleiboer
- Department of Clinical Psychology and EMGO(+) Institute for Health and Care Research, VU University, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
| | - Tara Donker
- Department of Clinical Psychology and EMGO(+) Institute for Health and Care Research, VU University, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
| | - Wike Seekles
- Department of Clinical Psychology and EMGO(+) Institute for Health and Care Research, VU University, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands; University of Humanistic Studies, Kromme Nieuwe Gracht 29, 3512 HD, Utrecht, The Netherlands.
| | - Annemieke van Straten
- Department of Clinical Psychology and EMGO(+) Institute for Health and Care Research, VU University, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
| | - Heleen Riper
- Department of Clinical Psychology and EMGO(+) Institute for Health and Care Research, VU University, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
| | - Pim Cuijpers
- Department of Clinical Psychology and EMGO(+) Institute for Health and Care Research, VU University, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
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Psychodynamic therapy meets evidence-based medicine: a systematic review using updated criteria. Lancet Psychiatry 2015; 2:648-60. [PMID: 26303562 DOI: 10.1016/s2215-0366(15)00155-8] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 03/21/2015] [Accepted: 03/23/2015] [Indexed: 12/21/2022]
Abstract
Psychodynamic therapy (PDT) is an umbrella concept for treatments that operate on an interpretive-supportive continuum and is frequently used in clinical practice. The use of any form of psychotherapy should be supported by sufficient evidence. Efficacy research has been neglected in PDT for a long time. In this review, we describe methodological requirements for proofs of efficacy and summarise the evidence for use of PDT to treat mental health disorders. After specifying the requirements for superiority, non-inferiority, and equivalence trials, we did a systematic search using the following criteria: randomised controlled trial of PDT; use of treatment manuals or manual-like guidelines; use of reliable and valid measures for diagnosis and outcome; adults treated for specific mental problems. We identified 64 randomised controlled trials that provide evidence for the efficacy of PDT in common mental health disorders. Studies sufficiently powered to test for equivalence to established treatments did not find substantial differences in efficacy. These results were corroborated by several meta-analyses that suggest PDT is as efficacious as treatments established in efficacy. More randomised controlled trials are needed for some mental health disorders such as obsessive-compulsive disorder and post-traumatic stress disorder. Furthermore, more adequately powered equivalence trials are needed.
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72
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Abstract
This paper provides a comprehensive review of outcome studies and meta-analyses of effectiveness studies of psychodynamic therapy (PDT) for the major categories of mental disorders. Comparisons with inactive controls (waitlist, treatment as usual and placebo) generally but by no means invariably show PDT to be effective for depression, some anxiety disorders, eating disorders and somatic disorders. There is little evidence to support its implementation for post-traumatic stress disorder, obsessive-compulsive disorder, bulimia nervosa, cocaine dependence or psychosis. The strongest current evidence base supports relatively long-term psychodynamic treatment of some personality disorders, particularly borderline personality disorder. Comparisons with active treatments rarely identify PDT as superior to control interventions and studies are generally not appropriately designed to provide tests of statistical equivalence. Studies that demonstrate inferiority of PDT to alternatives exist, but are small in number and often questionable in design. Reviews of the field appear to be subject to allegiance effects. The present review recommends abandoning the inherently conservative strategy of comparing heterogeneous "families" of therapies for heterogeneous diagnostic groups. Instead, it advocates using the opportunities provided by bioscience and computational psychiatry to creatively explore and assess the value of protocol-directed combinations of specific treatment components to address the key problems of individual patients.
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Affiliation(s)
- Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, and The Anna Freud Centre, London, UK
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73
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Effects of an Internet intervention (Deprexis) on severe depression symptoms: Randomized controlled trial. Internet Interv 2015. [DOI: 10.1016/j.invent.2014.12.003] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Smith SK, O'Donnell JD, Abernethy AP, MacDermott K, Staley T, Samsa GP. Evaluation of Pillars4life: a virtual coping skills program for cancer survivors. Psychooncology 2015; 24:1407-15. [PMID: 25644773 DOI: 10.1002/pon.3750] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 11/25/2014] [Accepted: 12/18/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Pillars4Life is an educational program that teaches coping skills to cancer patients in a virtual group setting; it was recently implemented at 17 hospitals across the USA. The cost-effective, scalable, and assessable Pillars4Life curriculum targets psychosocial resources (e.g., self-efficacy and coping skills) as a means to reduce symptoms (e.g., depression, anxiety, and posttraumatic stress) and enhance quality of life. METHODS Cancer patients were recruited from hospitals that received the LIVESTRONG Community Impact Project Award to enroll in a pilot study of Pillars4Life. Consenting participants met with a certified instructor weekly for 10 weeks in a virtual environment; the manualized intervention trained participants in personal coping skills. Longitudinal assessments over 6 months were assessed using validated instruments to determine changes in Pillars4Life targeted resources and outcomes. Multiple linear regression models examined the relationship between changes in targeted resources and changes in outcome from baseline to 3 months post-intervention. RESULTS Participants (n = 130) had the following characteristics: mean age of 56 ± 11 years, 87% women, 11% non-Caucasian, and 77% with college degree. At 3- and 6-month follow-up, mean scores improved on all key outcome measures such as depression (Patient Health Questionnaire), anxiety (Generalized Anxiety Disorder), posttraumatic stress (Posttraumatic Stress Disorder Checklist), fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue), and well-being (Functional Assessment of Cancer Therapy-General) from baseline (all p < 0.01); results were most pronounced among participants who reported ≥4/10 on the Distress Thermometer at baseline (all p < 0.001). Changes in each targeted resource were associated with 3-month improvements in at least one outcome. CONCLUSIONS Participation in the Pillars4Life program was associated with statistically and clinically significant improvements in scores on pre-specified outcomes and targeted resources.
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Affiliation(s)
- Sophia K Smith
- Duke University School of Nursing, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA.,Duke Cancer Institute, Durham, NC, USA
| | - Jonathan D O'Donnell
- Duke Clinical Research Institute, Durham, NC, USA.,Duke University School of Medicine, Durham, NC, USA
| | - Amy P Abernethy
- Duke University School of Nursing, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA.,Duke Cancer Institute, Durham, NC, USA.,Duke University School of Medicine, Durham, NC, USA.,Duke Department of Medicine, Division of Medical Oncology, Durham, NC, USA
| | | | | | - Gregory P Samsa
- Duke Clinical Research Institute, Durham, NC, USA.,Duke University School of Medicine, Durham, NC, USA.,Duke Department of Biostatistics and Bioinformatics, Durham, NC, USA
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75
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Abstract
Over the last several years, there has been a substantial increase in the number of publications reporting on Internet interventions for mental health and addictions. This paper provides a summary of the recent research on Internet interventions for the most common mental health and addictions concerns-depression, anxiety, alcohol and smoking. There is considerable evidence for the effectiveness of Internet-based interventions targeting depression, anxiety disorders, alcohol use and smoking. Small to moderate effect sizes have been reported for interventions targeting depression, anxiety and alcohol use, and smoking interventions have shown large effects. The addition of human support to depression and anxiety interventions has generally resulted in larger treatments effects, but this trend has not been observed in trials of interventions targeting alcohol use. There is some evidence that online interventions can be as effective as face-to-face therapies, at least for anxiety disorders. Despite a proliferation of research activity in this area, gaps in knowledge remain. Future research should focus on the development and evaluation of interventions for different platforms (e.g. smartphone applications), examining the long-term impacts of these interventions, determining active intervention components and identifying methods for enhancing tailoring and engagement. Careful consideration should be given to the ongoing technical and clinical expertise required to ensure that Internet interventions are delivered safely and professionally in a rapidly changing technology environment.
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Leichsenring F, Schauenburg H. Empirically supported methods of short-term psychodynamic therapy in depression - towards an evidence-based unified protocol. J Affect Disord 2014; 169:128-43. [PMID: 25194781 DOI: 10.1016/j.jad.2014.08.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/22/2014] [Accepted: 08/04/2014] [Indexed: 12/28/2022]
Abstract
CONTEXT There is evidence that psychotherapy is helpful in depressive disorders, with no significant differences between psychotherapies. For psychodynamic therapy (PDT) various models prove to be efficacious. Thus, the evidence for PDT is "scattered" between different forms of PDT, also implying problems in training of psychotherapy and in transferring research to clinical practice. A unified protocol based on empirically-supported methods of PDT in depression may contribute to solve these problems METHODS Systematic search for randomized controlled trials fulfilling the following criteria: (a) individual psychodynamic therapy (PDT) of depressive disorders, (b) treatment manuals or manual-like guidelines, (c) PDT proved to be efficacious compared to control conditions, (d) reliable measures for diagnosis and outcome, and (f) adult patients. FINDINGS Fourteen RCTs fulfilled the inclusion criteria. By a systematic review of the applied methods of PDT seven treatment components were identified. A high consistency between components was found. The components were conceptualized in the form of seven interrelated treatment modules. CONCLUSIONS A unified psychodynamic protocol for depression may enhance the empirical status of PDT, facilitate both the training in psychotherapy and the transfer of research to clinical practice and may have an impact on the health care system.
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Affiliation(s)
- Falk Leichsenring
- Clinic of Psychosomatics and Psychotherapy, University of Giessen, Ludwigstrasse 76, 35392 Giessen, Germany.
| | - Henning Schauenburg
- Clinic for General Internal Medicine and Psychosomatics, University of Heidelberg, Germany
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Andersson G, Cuijpers P, Carlbring P, Riper H, Hedman E. Guided Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: a systematic review and meta-analysis. World Psychiatry 2014; 13:288-95. [PMID: 25273302 PMCID: PMC4219070 DOI: 10.1002/wps.20151] [Citation(s) in RCA: 669] [Impact Index Per Article: 66.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Internet-delivered cognitive behavior therapy (ICBT) has been tested in many research trials, but to a lesser extent directly compared to face-to-face delivered cognitive behavior therapy (CBT). We conducted a systematic review and meta-analysis of trials in which guided ICBT was directly compared to face-to-face CBT. Studies on psychiatric and somatic conditions were included. Systematic searches resulted in 13 studies (total N=1053) that met all criteria and were included in the review. There were three studies on social anxiety disorder, three on panic disorder, two on depressive symptoms, two on body dissatisfaction, one on tinnitus, one on male sexual dysfunction, and one on spider phobia. Face-to-face CBT was either in the individual format (n=6) or in the group format (n=7). We also assessed quality and risk of bias. Results showed a pooled effect size (Hedges' g) at post-treatment of -0.01 (95% CI: -0.13 to 0.12), indicating that guided ICBT and face-to-face treatment produce equivalent overall effects. Study quality did not affect outcomes. While the overall results indicate equivalence, there are still few studies for each psychiatric and somatic condition and many conditions for which guided ICBT has not been compared to face-to-face treatment. Thus, more research is needed to establish equivalence of the two treatment formats.
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Affiliation(s)
- Gerhard Andersson
- Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, University of LinköpingLinköping, Sweden,Department of Clinical Neuroscience, Division of Psychiatry, Karolinska InstitutetStockholm, Sweden
| | - Pim Cuijpers
- Department of Clinical Psychology, VU University AmsterdamAmsterdam, The Netherlands
| | - Per Carlbring
- Department of Psychology, University of StockholmStockholm, Sweden
| | - Heleen Riper
- Department of Clinical Psychology, VU University AmsterdamAmsterdam, The Netherlands,Leuphana UniversityLünebrug, Germany
| | - Erik Hedman
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine and Division of Psychology, Karolinska InstitutetStockholm, Sweden
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Saddichha S, Al-Desouki M, Lamia A, Linden IA, Krausz M. Online interventions for depression and anxiety - a systematic review. Health Psychol Behav Med 2014; 2:841-881. [PMID: 25750823 PMCID: PMC4346073 DOI: 10.1080/21642850.2014.945934] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 07/14/2014] [Indexed: 11/05/2022] Open
Abstract
Background: Access to mental health care is limited. Internet-based interventions (IBIs) may help bridge that gap by improving access especially for those who are unable to receive expert care. Aim: This review explores current research on the effectiveness of IBIs for depression and anxiety. Results: For depression, therapist-guided cognitive behavioral therapy (CBT) had larger effect sizes consistently across studies, ranging from 0.6 to 1.9; while stand-alone CBT (without therapist guidance) had a more modest effect size of 0.3–0.7. Even other interventions for depression (non-CBT/non-randomized controlled trial (RCT)) showed modestly high effect sizes (0.2–1.7). For anxiety disorders, studies showed robust effect sizes for therapist-assisted interventions with effect sizes of 0.7–1.7 (efficacy similar to face-to-face CBT) and stand-alone CBT studies also showed large effect sizes (0.6–1.7). Non-CBT/Non-RCT studies (only 3) also showed significant reduction in anxiety scores at the end of the interventions. Conclusion: IBIs for anxiety and depression appear to be effective in reducing symptomatology for both depression and anxiety, which were enhanced by the guidance of a therapist. Further research is needed to identify various predictive factors and the extent to which stand-alone Internet therapies may be effective in the future as well as effects for different patient populations.
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Affiliation(s)
- Sahoo Saddichha
- Deparment of Psychiatry, Melbourne Health , Melbourne , VIC 3000 , Australia
| | - Majid Al-Desouki
- Department of Psychiatry, King Khalid University Hospital , Riyadh , Saudi Arabia
| | - Alsagob Lamia
- Faculty of Medicine, King Saud bin Abdul Aziz University for Health Sciences , Riyadh , Saudi Arabia
| | - Isabelle A Linden
- Department of Psychiatry, University of British Columbia , Vancouver , Canada
| | - Michael Krausz
- Department of Psychiatry, University of British Columbia , Vancouver , Canada
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van Ballegooijen W, Cuijpers P, van Straten A, Karyotaki E, Andersson G, Smit JH, Riper H. Adherence to Internet-based and face-to-face cognitive behavioural therapy for depression: a meta-analysis. PLoS One 2014; 9:e100674. [PMID: 25029507 PMCID: PMC4100736 DOI: 10.1371/journal.pone.0100674] [Citation(s) in RCA: 248] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 05/30/2014] [Indexed: 11/19/2022] Open
Abstract
Background Internet-based cognitive behavioural therapy (iCBT) is an effective and acceptable treatment for depression, especially when it includes guidance, but its treatment adherence has not yet been systematically studied. We conducted a meta-analysis, comparing the adherence to guided iCBT with the adherence to individual face-to-face CBT. Methods Studies were selected from a database of trials that investigate treatment for adult depression (see www.evidencebasedpsychotherapies.org), updated to January 2013. We identified 24 studies describing 26 treatment conditions (14 face-to-face CBT, 12 guided iCBT), by means of these inclusion criteria: targeting depressed adults, no comorbid somatic disorder or substance abuse, community recruitment, published in the year 2000 or later. The main outcome measure was the percentage of completed sessions. We also coded the percentage of treatment completers (separately coding for 100% or at least 80% of treatment completed). Results We did not find studies that compared guided iCBT and face-to-face CBT in a single trial that met our inclusion criteria. Face-to-face CBT treatments ranged from 12 to 28 sessions, guided iCBT interventions consisted of 5 to 9 sessions. Participants in face-to-face CBT completed on average 83.9% of their treatment, which did not differ significantly from participants in guided iCBT (80.8%, P = .59). The percentage of completers (total intervention) was significantly higher in face-to-face CBT (84.7%) than in guided iCBT (65.1%, P < .001), as was the percentage of completers of 80% or more of the intervention (face-to-face CBT: 85.2%, guided iCBT: 67.5%, P = .003). Non-completers of face-to-face CBT completed on average 24.5% of their treatment, while non-completers of guided iCBT completed on average 42.1% of their treatment. Conclusion We did not find studies that compared guided iCBT and face-to-face CBT in a single trial. Adherence to guided iCBT appears to be adequate and could be equal to adherence to face-to-face CBT.
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Affiliation(s)
- Wouter van Ballegooijen
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Centre/GGZ inGeest, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Annemieke van Straten
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jan H Smit
- Department of Psychiatry, VU University Medical Centre/GGZ inGeest, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Centre/GGZ inGeest, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands; Leuphana University, Lüneburg, Germany
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Arnberg FK, Linton SJ, Hultcrantz M, Heintz E, Jonsson U. Internet-delivered psychological treatments for mood and anxiety disorders: a systematic review of their efficacy, safety, and cost-effectiveness. PLoS One 2014; 9:e98118. [PMID: 24844847 PMCID: PMC4028301 DOI: 10.1371/journal.pone.0098118] [Citation(s) in RCA: 221] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 04/28/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Greater access to evidence-based psychological treatments is needed. This review aimed to evaluate whether internet-delivered psychological treatments for mood and anxiety disorders are efficacious, noninferior to established treatments, safe, and cost-effective for children, adolescents and adults. METHODS We searched the literature for studies published until March 2013. Randomized controlled trials (RCTs) were considered for the assessment of short-term efficacy and safety and were pooled in meta-analyses. Other designs were also considered for long-term effect and cost-effectiveness. Comparisons against established treatments were evaluated for noninferiority. Two reviewers independently assessed the relevant studies for risk of bias. The quality of the evidence was graded using an international grading system. RESULTS A total of 52 relevant RCTs were identified whereof 12 were excluded due to high risk of bias. Five cost-effectiveness studies were identified and three were excluded due to high risk of bias. The included trials mainly evaluated internet-delivered cognitive behavioral therapy (I-CBT) against a waiting list in adult volunteers and 88% were conducted in Sweden or Australia. One trial involved children. For adults, the quality of evidence was graded as moderate for the short-term efficacy of I-CBT vs. waiting list for mild/moderate depression (d = 0.83; 95% CI 0.59, 1.07) and social phobia (d = 0.85; 95% CI 0.66, 1.05), and moderate for no efficacy of internet-delivered attention bias modification vs. sham treatment for social phobia (d = -0.04; 95% CI -0.24, 0.35). The quality of evidence was graded as low/very low for other disorders, interventions, children/adolescents, noninferiority, adverse events, and cost-effectiveness. CONCLUSIONS I-CBT is a viable treatment option for adults with depression and some anxiety disorders who request this treatment modality. Important questions remain before broad implementation can be supported. Future research would benefit from prioritizing adapting treatments to children/adolescents and using noninferiority designs with established forms of treatment.
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Affiliation(s)
- Filip K. Arnberg
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Steven J. Linton
- Center for Health and Medical Psychology, Department of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden
| | | | - Emelie Heintz
- Swedish Council on Health Technology Assessment, Stockholm, Sweden
- Center for Medical Technology Assessment (CMT), Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ulf Jonsson
- Swedish Council on Health Technology Assessment, Stockholm, Sweden
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Ehrenthal JC, Dinger U, Nikendei C. Aktuelle Entwicklungen der psychodynamischen Psychotherapieforschung. PSYCHOTHERAPEUT 2014. [DOI: 10.1007/s00278-014-1045-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Leichsenring F, Klein S. Evidence for psychodynamic psychotherapy in specific mental disorders: a systematic review. PSYCHOANALYTIC PSYCHOTHERAPY 2014. [DOI: 10.1080/02668734.2013.865428] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Facebook enhances antidepressant pharmacotherapy effects. ScientificWorldJournal 2014; 2014:892048. [PMID: 24574930 PMCID: PMC3916106 DOI: 10.1155/2014/892048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 10/24/2013] [Indexed: 12/14/2022] Open
Abstract
Treatment-resistant major depressive disorder (TR-MDD) is a complex condition, with very low remission rates. In recent years some studies have been conducted on the implementation of cognitive behavioral therapy and psychodynamic psychotherapy interventions via the Internet to MDD patients, and results have been promising. However, there have been no studies in patients with TR-MDD nor with the use of Facebook with the psychiatrist as “friend.” 60 TR-MDD patients were randomized to one of three groups: Facebook group with psychiatrist as “friend,” Facebook group without psychiatrist as “friend,” and control group (no Facebook use). Both Facebook groups spent at least 1 hour/day on Facebook, 7 days/week, during the 3 months. All patients maintained their usual pharmacotherapy. All participants were evaluated at baseline and at 1, 2, and 3 months for depressive symptoms using HAD17 and BDI-II. Results show that both Facebook groups had a decrease on HADM17 and BDI-II scores as well as higher remission and response rates than the control group, with better results if the psychiatrist was a “friend” on Facebook. Therefore, in TR-MDD, Facebook can be used as an effective enhancement therapy, adjuvant to pharmacological therapy with regular consultations, especially if the psychiatrist is the patient's online “friend.”
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Johansson R, Frederick RJ, Andersson G. Using the internet to provide psychodynamic psychotherapy. Psychodyn Psychiatry 2013; 41:513-540. [PMID: 24283446 DOI: 10.1521/pdps.2013.41.4.513] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Over the last 15 years, there has been a substantial increase in research and clinical implementations of Internet-delivered, cognitive behavioral therapy (ICBT). Several studies on ICBT have been in the format of guided self-help where a therapist guides the patient throughout the whole treatment. ICBT is typically in the form of self-help material (e.g., text or video) which is provided to a client over the Internet with additional therapist contact by e-mail. ICBT has been shown to be effective for various conditions and, in some studies, has shown to be as effective as face-to-face cognitive behavioral therapy for mild to moderate depression, anxiety disorders, and somatic problems. Recently, the field has expanded to include other orientations including psychodynamic psychotherapy. Currently, there are three randomized controlled trials that have tested the efficacy of psychodynamic psychotherapy delivered in this format. The latest published trial focused on an affect-focused, psychodynamic psychotherapy delivered to a sample of participants with mixed depression and anxiety disorders. This article aims to provide a deeper understanding of the process of providing psychodynamic psychotherapy via the Internet. We will give a detailed description of our latest manual and show how psychotherapeutic work is conducted utilizing this text. Furthermore, we provide examples of dialogue between therapist and client from the online environment. Similarities and differences between psychodynamic psychotherapy delivered over the Internet and in face-to-face formats are discussed.
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86
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Rosenberg A, Lenze EJ. More than just a pill. How to include psychosocial approaches sin the treatment of anxiety & depressive disorders. MISSOURI MEDICINE 2013; 110:517-23. [PMID: 24564005 PMCID: PMC6179793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Anxiety and depressive disorders are the most common psychiatric disorders, causing high personal and economic burden. Psychosocial approaches, such as psychotherapy or mind-body instruction, along with self-help approaches, exercise, and proper sleep hygiene are effective solo or additive (to pharmacotherapy) strategies. Many physicians are less familiar with these methods for treating anxiety/depressive disorders. This article seeks to illuminate psychosocial approaches for depression and anxiety that act additively or independently of pharmacotherapy and explain how physicians can utilize them.
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Johansson R, Nyblom A, Carlbring P, Cuijpers P, Andersson G. Choosing between Internet-based psychodynamic versus cognitive behavioral therapy for depression: a pilot preference study. BMC Psychiatry 2013; 13:268. [PMID: 24139066 PMCID: PMC3852703 DOI: 10.1186/1471-244x-13-268] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 10/09/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Major depression is a world-wide problem that can be treated with various forms of psychotherapy. There is strong research support for treating major depression using cognitive behavior therapy delivered in the format of guided self-help via the Internet (ICBT). Recent research also suggests that psychodynamic psychotherapy can be delivered as guided self-help via the Internet (IPDT) and that it seem to be as effective as ICBT for mild to moderate depression. However, no head-to-head comparison between the two treatments exists. In the field of Internet interventions it is largely unexplored if treatment preference affects outcome and adherence. METHODS Participants were allocated to IPDT or ICBT based on their stated preference. More than half of the participants preferred ICBT (N = 30) over IPDT (N = 14). Differences in efficacy between treatments were explored. Correlations between strength of preference and treatment outcome, adherence to treatment and completion of the whole treatment program were explored. Data were collected before and after treatment, as well as in a 7-month follow-up. RESULTS During the treatment period, both programs performed equally well in reducing symptoms. More participants who received IPDT completed the entire program. At follow-up, mixed-effects models showed that participants who chose ICBT improved more in terms of quality of life. The ICBT group also had a significant increase in participants who recovered from their depression from post-treatment to follow-up. Exploratory analyses indicated that strength of preference was correlated with adherence to treatment and completion of the whole program, and long-term outcome for the ICBT group. CONCLUSIONS Few differences were found during the acute treatment phase, but the long-term effects are in favor of ICBT. Strength of preference for treatment seems to have a predictive value. Further research comparing the efficacy of ICBT and IPDT, and the effects of preference matching and strength of preference, is warranted. TRIAL REGISTRATION This trial is a continuation of the study registered as NCT01324050 at Clinicaltrials.gov.
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Affiliation(s)
- Robert Johansson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Anna Nyblom
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Pim Cuijpers
- Department of Clinical Psychology and EMGO Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden
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Ünlü Ince B, Cuijpers P, van 't Hof E, van Ballegooijen W, Christensen H, Riper H. Internet-based, culturally sensitive, problem-solving therapy for Turkish migrants with depression: randomized controlled trial. J Med Internet Res 2013; 15:e227. [PMID: 24121307 PMCID: PMC3849840 DOI: 10.2196/jmir.2853] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 08/30/2013] [Accepted: 09/09/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Turkish migrants living in the Netherlands have a high prevalence of depressive disorders, but experience considerable obstacles to accessing professional help. Providing easily accessible Internet treatments may help to overcome these barriers. OBJECTIVE The aim of this study was to evaluate the effectiveness of a culturally sensitive, guided, self-help, problem-solving intervention through the Internet for reducing depressive symptoms in Turkish migrants. METHODS A two-armed randomized controlled trial was conducted. The primary outcome measure was the severity of depressive symptoms; secondary outcome measures were somatic symptoms, anxiety, quality of life, and satisfaction with the treatment. Participants were assessed online at baseline, posttest (6 weeks after baseline), and 4 months after baseline. Posttest results were analyzed on the intention-to-treat sample. Missing values were estimated by means of multiple imputation. Differences in clinical outcome between groups were analyzed with a t test. Cohen's d was used to determine the between-groups effect size at posttreatment and follow-up. RESULTS Turkish adults (N=96) with depressive symptoms were randomized to the experimental group (n=49) or to a waitlist control group (n=47). High attrition rates were found among the 96 participants of which 42% (40/96) did not complete the posttest (6 weeks) and 62% (59/96) participants did not complete the follow-up assessment at 4 months. No significant difference between the experimental group and the control group was found for depression at posttest. Recovery occurred significantly more often in the experimental group (33%, 16/49) than in the control group (9%, 4/47) at posttest (P=.02). Because of the high attrition rate, a completers-only analysis was conducted at follow-up. The experimental group showed significant improvement in depression compared to the control group both at posttest (P=.01) and follow-up (P=.01). CONCLUSIONS The results of this study did not show a significant effect on the reduction of depressive symptoms. However, the effect size at posttest was high, which might be an indicator of the possible effectiveness of the intervention when assessed in a larger sample and robust trial. Future research should replicate our study with adequately powered samples. TRIAL REGISTRATION Dutch Trial Register: NTR2303. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2303 (Archived by WebCite at http://www.webcitation.org/6IOxNgoDu).
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Affiliation(s)
- Burçin Ünlü Ince
- Department of Clinical Psychology, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, Netherlands.
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Ström M, Uckelstam CJ, Andersson G, Hassmén P, Umefjord G, Carlbring P. Internet-delivered therapist-guided physical activity for mild to moderate depression: a randomized controlled trial. PeerJ 2013; 1:e178. [PMID: 24109561 PMCID: PMC3792189 DOI: 10.7717/peerj.178] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 09/16/2013] [Indexed: 11/20/2022] Open
Abstract
Objective. The main hypothesis, and the objective of the study, was to test if the participants allocated to the treatment group would show a larger reduction in depressive symptoms than those in the control group. Methods. This study was a randomized nine week trial of an Internet-administered treatment based on guided physical exercise for Major Depressive Disorder (MDD). A total of 48 participants with mild to moderate depression, diagnosed using the Structured Clinical Interview for DSM-IV Axis I Disorders, were randomized either to a treatment intervention or to a waiting-list control group. The main outcome measure for depression was the Beck Depression Inventory-II (BDI-II), and physical activity level was measured using the International Physical Activity Questionnaire (IPAQ). The treatment program consisted of nine text modules, and included therapist guidance on a weekly basis. Results. The results showed significant reductions of depressive symptoms in the treatment group compared to the control group, with a moderate between-group effect size (Cohen's d = 0.67; 95% confidence interval: 0.09-1.25). No difference was found between the groups with regards to increase of physical activity level. For the treatment group, the reduction in depressive symptoms persisted at six months follow-up. Conclusions. Physical activity as a treatment for depression can be delivered in the form of guided Internet-based self-help. Trial Registration. The trial was registered at ClinicalTrials.gov (NCT01573130).
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Affiliation(s)
- Morgan Ström
- Department of Psychology, Umeå University , Sweden
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Luyten P, Blatt SJ, Fonagy P. Impairments in Self Structures in Depression and Suicide in Psychodynamic and Cognitive Behavioral Approaches: Implications for Clinical Practice and Research. Int J Cogn Ther 2013. [DOI: 10.1521/ijct.2013.6.3.265] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Johansson R, Björklund M, Hornborg C, Karlsson S, Hesser H, Ljótsson B, Rousseau A, Frederick RJ, Andersson G. Affect-focused psychodynamic psychotherapy for depression and anxiety through the Internet: a randomized controlled trial. PeerJ 2013; 1:e102. [PMID: 23862104 PMCID: PMC3709106 DOI: 10.7717/peerj.102] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 06/21/2013] [Indexed: 11/20/2022] Open
Abstract
Background. Psychodynamic psychotherapy is a psychological treatment approach that has a growing empirical base. Research has indicated an association between therapist-facilitated affective experience and outcome in psychodynamic therapy. Affect-phobia therapy (APT), as outlined by McCullough et al., is a psychodynamic treatment that emphasizes a strong focus on expression and experience of affect. This model has neither been evaluated for depression nor anxiety disorders in a randomized controlled trial. While Internet-delivered psychodynamic treatments for depression and generalized anxiety disorder exist, they have not been based on APT. The aim of this randomized controlled trial was to investigate the efficacy of an Internet-based, psychodynamic, guided self-help treatment based on APT for depression and anxiety disorders. Methods. One hundred participants with diagnoses of mood and anxiety disorders participated in a randomized (1:1 ratio) controlled trial of an active group versus a control condition. The treatment group received a 10-week, psychodynamic, guided self-help treatment based on APT that was delivered through the Internet. The treatment consisted of eight text-based treatment modules and included therapist contact (9.5 min per client and week, on average) in a secure online environment. Participants in the control group also received online therapist support and clinical monitoring of symptoms, but received no treatment modules. Outcome measures were the 9-item Patient Health Questionnaire Depression Scale (PHQ-9) and the 7-item Generalized Anxiety Disorder Scale (GAD-7). Process measures were also included. All measures were administered weekly during the treatment period and at a 7-month follow-up. Results. Mixed models analyses using the full intention-to-treat sample revealed significant interaction effects of group and time on all outcome measures, when comparing treatment to the control group. A large between-group effect size of Cohen's d = 0.77 (95% CI: 0.37-1.18) was found on the PHQ-9 and a moderately large between-group effect size d = 0.48 (95% CI: 0.08-0.87) was found on the GAD-7. The number of patients who recovered (had no diagnoses of depression and anxiety, and had less than 10 on both the PHQ-9 and the GAD-7) were at post-treatment 52% in the treatment group and 24% in the control group. This difference was significant, χ(2)(N = 100, d f = 1) = 8.3, p < .01. From post-treatment to follow-up, treatment gains were maintained on the PHQ-9, and significant improvements were seen on the GAD-7. Conclusion. This study provides initial support for the efficacy of Internet-delivered psychodynamic therapy based on the affect-phobia model in the treatment of depression and anxiety disorders. The results support the conclusion that psychodynamic treatment approaches may be transferred to the guided self-help format and delivered via the Internet.
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Affiliation(s)
- Robert Johansson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Martin Björklund
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Christoffer Hornborg
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Stina Karlsson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Hugo Hesser
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Sweden
| | - Andréas Rousseau
- Psychiatric Clinic, University Hospital of Linköping, Linköping, Sweden
| | | | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden
- Swedish Institute for Disability Research, Linköping University, Linköping, Sweden
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Carlbring P, Hägglund M, Luthström A, Dahlin M, Kadowaki Å, Vernmark K, Andersson G. Internet-based behavioral activation and acceptance-based treatment for depression: a randomized controlled trial. J Affect Disord 2013; 148:331-7. [PMID: 23357657 DOI: 10.1016/j.jad.2012.12.020] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 12/22/2012] [Accepted: 12/24/2012] [Indexed: 01/21/2023]
Abstract
BACKGROUND Internet-based cognitive behavior therapy for depression has been tested in several trials but there are no internet studies on behavioral activation (BA), and no studies on BA over the internet including components of acceptance and commitment therapy (ACT). The aim of this study was to develop and test the effects of internet-delivered BA combined with ACT against a waiting list control condition as a first test of the effects of treatment. METHODS Selection took place with a computerized screening interview and a subsequent semi-structured telephone interview. A total of 80 individuals from the general public were randomized to one of two conditions. The treatment lasted for 8 weeks after which both groups were assessed. We also included a 3 month follow-up. The treatment included interactive elements online and a CD-ROM for mindfulness and acceptance exercises. In addition, written support and feedback was given by a therapist every week. RESULTS Results at posttreatment showed a large between group effect size on the Beck Depression inventory II d=0.98 (95%CI=0.51-1.44). In the treated group 25% (10/40) reached remission defined as a BDI score ≤ 10 vs. 5% (2/40) in the control group. Results on secondary measures were smaller. While few dropped out from the study (N=2) at posttreatment, the average number of completed modules was M=5.1 out of the seven modules. LIMITATIONS The study only included a waiting-list comparison and it is not possible to determine which treatment components were the most effective. CONCLUSIONS We conclude that there is initial evidence that BA with components of ACT can be effective in reducing symptoms of depression.
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Affiliation(s)
- Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden.
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Boettcher J, Carlbring P, Renneberg B, Berger T. Internet-Based Interventions for Social Anxiety Disorder - an Overview. VERHALTENSTHERAPIE 2013. [DOI: 10.1159/000354747] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Klein JP, Berger T. Internetbasierte psychologische Behandlung bei Depressionen. VERHALTENSTHERAPIE 2013. [DOI: 10.1159/000354046] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Johansson R, Hesser H, Ljótsson B, Frederick RJ, Andersson G. Transdiagnostic, affect-focused, psychodynamic, guided self-help for depression and anxiety through the internet: study protocol for a randomised controlled trial. BMJ Open 2012; 2:e002167. [PMID: 23257775 PMCID: PMC3533089 DOI: 10.1136/bmjopen-2012-002167] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 11/28/2012] [Accepted: 11/29/2012] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Cognitive behaviour therapy delivered in the format of guided self-help via the internet has been found to be effective for a range of conditions, including depression and anxiety disorders. Recent results indicate that guided self-help via the internet is a promising treatment format also for psychodynamic therapy. However, to date and to our knowledge, no study has evaluated internet-delivered psychodynamic therapy as a transdiagnostic treatment. The affect-phobia model of psychopathology by McCullough et al provides a psychodynamic conceptualisation of a range of psychiatric disorders. The aim of this study will be to test the effects of a transdiagnostic guided self-help treatment based on the affect-phobia model in a sample of clients with depression and anxiety. METHODS AND ANALYSIS This study will be a randomised controlled trial with a total sample size of 100 participants. The treatment group receives a 10-week, psychodynamic, guided self-help treatment based on the transdiagnostic affect-phobia model of psychopathology. The treatment consists of eight text-based treatment modules and includes therapist contact in a secure online environment. Participants in the control group receive similar online therapist support without any treatment modules. Outcome measures are the 9-item Patient Health Questionnaire Depression Scale and the 7-item Generalised Anxiety Disorder Scale (GAD-7). Process measures that concerns emotional processing and mindfulness are included. All outcome and process measures will be administered weekly via the internet and at 6-month follow-up. DISCUSSION This trial will add to the body of knowledge on internet-delivered psychological treatments in general and to psychodynamic treatments in particular. We also hope to provide new insights in the effectiveness and working mechanisms of psychodynamic therapy based on the affect-phobia model.
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Affiliation(s)
- Robert Johansson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Hugo Hesser
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Linnaeus Centre HEAD, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden
| | - Brjánn Ljótsson
- Division of Psychology, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | | | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Psychiatry Section, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Can a one-item mood scale do the trick? Predicting relapse over 5.5-years in recurrent depression. PLoS One 2012; 7:e46796. [PMID: 23056456 PMCID: PMC3463530 DOI: 10.1371/journal.pone.0046796] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 09/06/2012] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND To examine whether a simple Visual Analogue Mood Scale (VAMS) is able to predict time to relapse over 5.5-years. METHODOLOGY/PRINCIPAL FINDINGS 187 remitted recurrently depressed out-patients were interviewed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the 17-item Hamilton Depression rating scale (HAM-D) to verify remission status (HAM-D <10). All patients rated their current mood with the help of a Visual Analogue Mood Scale (VAMS) at baseline and at a follow-up assessment three months later. Relapse over 5.5-years was assessed by the SCID-I. Cox regression revealed that both the VAMS at baseline and three months later significantly predicted time to relapse over 5.5-years. Baseline VAMS even predicted time to relapse when the number of previous depressive episodes and HAM-D scores were controlled for. The baseline VAMS explained 6.3% of variance in time to relapse, comparable to the HAM-D interview. CONCLUSIONS/SIGNIFICANCE Sad mood after remission appears to play a pivotal role in the course of depression. Since a simple VAMS predicted time to relapse, the VAMS might be an easy and time-effective way to monitor mood and risk of early relapse, and offers possibilities for daily monitoring using e-mail and SMS. TRIAL REGISTRATION International Standard Randomized Controlled Trial Register Identifier: ISRCTN68246470.
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