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Andrews G, Basu A, Cuijpers P, Craske MG, McEvoy P, English CL, Newby JM. Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: An updated meta-analysis. J Anxiety Disord 2018; 55:70-78. [PMID: 29422409 DOI: 10.1016/j.janxdis.2018.01.001] [Citation(s) in RCA: 488] [Impact Index Per Article: 81.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/16/2017] [Accepted: 01/03/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND A 2010 meta-analysis of internet-delivered CBT (iCBT) RCTs argued 'computer therapy for the anxiety and depressive disorders was effective, acceptable and practical health care' without data on effectiveness or practicality in routine practice. METHODS Databases, reviews and meta-analyses were searched for randomised controlled trials of cCBT or iCBT versus a control group (care as usual, waitlist, information control, psychological placebo, pill placebo, etc.) in people who met diagnostic criteria for major depression, panic disorder, social anxiety disorder or generalised anxiety disorder. Number randomised, superiority of treatment versus control (Hedges'g) on primary outcome measure, length of follow-up, follow up outcome, patient adherence and satisfaction/harm were extracted; risk of bias was assessed. A search for studies on effectiveness of iCBT in clinical practice was conducted. RESULTS 64 trials were identified. The mean effect size (efficacy) was g = 0.80 (NNT 2.34), and benefit was evident across all four disorders. Improvement was maintained at follow-with good acceptability. Research probity was good, and bias risk low. In addition, nine studies comparing iCBT with traditional face-to-face CBT and three comparing iCBT with bibliotherapy were identified. All three modes of treatment delivery appeared equally beneficial. The results of effectiveness studies were congruent with the results of the efficacy trials. LIMITATIONS Studies variably measured changes in quality of life and disability, and the lack of comparisons with medications weakens the field. CONCLUSIONS The conclusions drawn in the original meta-analysis are now supported: iCBT for the anxiety and depressive disorders is effective, acceptable and practical health care.
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Affiliation(s)
- G Andrews
- School of Psychiatry, University of New South Wales, Sydney Australia.
| | - A Basu
- University of New South Wales, Sydney, Australia
| | - P Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Vrije Universiteit and VU Medical Center Amsterdam, The Netherlands
| | - M G Craske
- Department of Psychology, University of California, Los Angeles, United States
| | - P McEvoy
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia; Centre for Clinical Interventions, Perth, Australia
| | - C L English
- St George's University of London, United Kingdom
| | - J M Newby
- School of Psychology, University of New South Wales, Sydney Australia
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Abstract
Guided internet CBT (iCBT) is a promising treatment for depression; however, it is less well known through what mechanisms iCBT works. Two possible mediators of change are the acquisition of cognitive skills and increases in behavioral activation. We report results of an 8-week waitlist controlled trial of guided iCBT, and test whether early change in cognitive skills or behavioral activation mediated subsequent change in depression. The sample was 89 individuals randomized to guided iCBT (n = 59) or waitlist (n = 30). Participants were 75% female, 72% Caucasian, and 33 years old on average. The PHQ9 was the primary outcome measure. Mediators were the Competencies of Cognitive Therapy Scale-Self Report and the Behavioral Activation Scale for Depression-Short Form. Treatment was Beating the Blues plus manualized coaching. Outcomes were analyzed using linear mixed models, and mediation with a bootstrap resampling approach. The iCBT group was superior to waitlist, with large effect sizes at posttreatment (Hedges' g = 1.45). Dropout of iCBT was 29% versus 10% for waitlist. In the mediation analyses, the acquisition of cognitive skills mediated subsequent depression change (indirect effect = -.61, 95% bootstrapped biased corrected CI: -1.47, -0.09), but increases in behavioral activation did not. iCBT is an effective treatment for depression, but dropout rates remain high. Change in iCBT appears to be mediated by improvements in the use of cognitive skills, such as critically evaluating and restructuring negative thoughts.
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103
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Thase ME, Wright JH, Eells TD, Barrett MS, Wisniewski SR, Balasubramani GK, McCrone P, Brown GK. Improving the Efficiency of Psychotherapy for Depression: Computer-Assisted Versus Standard CBT. Am J Psychiatry 2018; 175:242-250. [PMID: 28969439 PMCID: PMC5848497 DOI: 10.1176/appi.ajp.2017.17010089] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The authors evaluated the efficacy and durability of a therapist-supported method for computer-assisted cognitive-behavioral therapy (CCBT) in comparison to standard cognitive-behavioral therapy (CBT). METHOD A total of 154 medication-free patients with major depressive disorder seeking treatment at two university clinics were randomly assigned to either 16 weeks of standard CBT (up to 20 sessions of 50 minutes each) or CCBT using the "Good Days Ahead" program. The amount of therapist time in CCBT was planned to be about one-third that in CBT. Outcomes were assessed by independent raters and self-report at baseline, at weeks 8 and 16, and at posttreatment months 3 and 6. The primary test of efficacy was noninferiority on the Hamilton Depression Rating Scale at week 16. RESULTS Approximately 80% of the participants completed the 16-week protocol (79% in the CBT group and 82% in the CCBT group). CCBT met a priori criteria for noninferiority to conventional CBT at week 16. The groups did not differ significantly on any measure of psychopathology. Remission rates were similar for the two groups (intent-to-treat rates, 41.6% for the CBT group and 42.9% for the CCBT group). Both groups maintained improvements throughout the follow-up. CONCLUSIONS The study findings indicate that a method of CCBT that blends Internet-delivered skill-building modules with about 5 hours of therapeutic contact was noninferior to a conventional course of CBT that provided over 8 additional hours of therapist contact. Future studies should focus on dissemination and optimizing therapist support methods to maximize the public health significance of CCBT.
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Affiliation(s)
- Michael E. Thase
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
- Corporal Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, PA
| | | | | | - Marna S. Barrett
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Gregory K. Brown
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
- Corporal Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, PA
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104
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Wong KP, Bonn G, Tam CL, Wong CP. Preferences for Online and/or Face-to-Face Counseling among University Students in Malaysia. Front Psychol 2018; 9:64. [PMID: 29445352 PMCID: PMC5798405 DOI: 10.3389/fpsyg.2018.00064] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 01/16/2018] [Indexed: 11/13/2022] Open
Abstract
Increasingly, online counseling is considered to be a cost-effective and highly accessible method of providing basic counseling and mental health services. To examine the potential of online delivery as a way of increasing overall usage of services, this study looked at students' attitudes toward and likelihood of using both online and/or face-to-face counseling. A survey was conducted with 409 students from six universities in Malaysia participating. Approximately 35% of participants reported that they would be likely to utilize online counseling services but would be unlikely to participate in face-to-face counseling. Based on these results, it is suggested that offering online counseling, in addition to face-to-face services, could be an effective way for many university counseling centers to increase the utilization of their services and thus better serve their communities.
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Affiliation(s)
- Kah P. Wong
- School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Gregory Bonn
- King Fahd University of Petroleum and Minerals, Dhahran, Saudi Arabia
| | - Cai L. Tam
- School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Chee P. Wong
- School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
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105
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Stratton E, Lampit A, Choi I, Calvo RA, Harvey SB, Glozier N. Effectiveness of eHealth interventions for reducing mental health conditions in employees: A systematic review and meta-analysis. PLoS One 2017; 12:e0189904. [PMID: 29267334 PMCID: PMC5739441 DOI: 10.1371/journal.pone.0189904] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/04/2017] [Indexed: 02/03/2023] Open
Abstract
Background Many organisations promote eHealth applications as a feasible, low-cost method of addressing mental ill-health and stress amongst their employees. However, there are good reasons why the efficacy identified in clinical or other samples may not generalize to employees, and many Apps are being developed specifically for this group. The aim of this paper is to conduct the first comprehensive systematic review and meta-analysis evaluating the evidence for the effectiveness and examine the relative efficacy of different types of eHealth interventions for employees. Methods Systematic searches were conducted for relevant articles published from 1975 until November 17, 2016, of trials of eHealth mental health interventions (App or web-based) focused on the mental health of employees. The quality and bias of all identified studies was assessed. We extracted means and standard deviations from published reports, comparing the difference in effect sizes (Hedge’s g) in standardized mental health outcomes. We meta-analysed these using a random effects model, stratified by length of follow up, intervention type, and whether the intervention was universal (unselected) or targeted to selected groups e.g. “stressed”. Results 23 controlled trials of eHealth interventions were identified which overall suggested a small positive effect at both post intervention (g = 0.24, 95% CI 0.13 to 0.35) and follow up (g = 0.23, 95% CI 0.03 to 0.42). There were differential short term effects seen between the intervention types whereby Mindfulness based interventions (g = 0.60, 95% CI 0.34 to 0.85, n = 6) showed larger effects than the Cognitive Behaviour Therapy (CBT) based (g = 0.15, 95% CI 0.02 to 0.29, n = 11) and Stress Management based (g = 0.17, 95%CI -0.01 to 0.34, n = 6) interventions. The Stress Management interventions however differed by whether delivered to universal or targeted groups with a moderately large effect size at both post-intervention (g = 0.64, 95% CI 0.54 to 0.85) and follow-up (g = 0.69, 95% CI 0.06 to 1.33) in targeted groups, but no effect in unselected groups. Interpretation There is reasonable evidence that eHealth interventions delivered to employees may reduce mental health and stress symptoms post intervention and still have a benefit, although reduced at follow-up. Despite the enthusiasm in the corporate world for such approaches, employers and other organisations should be aware not all such interventions are equal, many lack evidence, and achieving the best outcomes depends upon providing the right type of intervention to the correct population.
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Affiliation(s)
- Elizabeth Stratton
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, Australia
- * E-mail:
| | - Amit Lampit
- School of Psychiatry, University of Sydney, Sydney, Australia
| | - Isabella Choi
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Rafael A. Calvo
- School of Electrical and Information Engineering, University of Sydney, Sydney, Australia
| | - Samuel B. Harvey
- School of Psychiatry, University of New South Wales, Sydney, Australia
- Black Dog Institute, Sydney, Australia
- St George Hospital, Sydney, Australia
| | - Nicholas Glozier
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, Australia
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106
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Carlbring P, Andersson G, Cuijpers P, Riper H, Hedman-Lagerlöf E. Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis. Cogn Behav Ther 2017; 47:1-18. [PMID: 29215315 DOI: 10.1080/16506073.2017.1401115] [Citation(s) in RCA: 638] [Impact Index Per Article: 91.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
During the last two decades, Internet-delivered cognitive behavior therapy (ICBT) has been tested in hundreds of randomized controlled trials, often with promising results. However, the control groups were often waitlisted, care-as-usual or attention control. Hence, little is known about the relative efficacy of ICBT as compared to face-to-face cognitive behavior therapy (CBT). In the present systematic review and meta-analysis, which included 1418 participants, guided ICBT for psychiatric and somatic conditions were directly compared to face-to-face CBT within the same trial. Out of the 2078 articles screened, a total of 20 studies met all inclusion criteria. Results showed a pooled effect size at post-treatment of Hedges g = .05 (95% CI, -.09 to .20), indicating that ICBT and face-to-face treatment produced equivalent overall effects. Study quality did not affect outcomes. While the overall results indicate equivalence, there have been few studies of the individual psychiatric and somatic conditions so far, and for the majority, guided ICBT has not been compared against face-to-face treatment. Thus, more research, preferably with larger sample sizes, is needed to establish the general equivalence of the two treatment formats.
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Affiliation(s)
- Per Carlbring
- a Department of Psychology , Stockholm University , Stockholm , Sweden
| | - Gerhard Andersson
- b Department of Behavioural Sciences and Learning , Swedish Institute for Disability Research, Linköping University , Linköping , Sweden.,c Department of Clinical Neuroscience, Division of Psychiatry , Karolinska Institutet , Stockholm , Sweden
| | - Pim Cuijpers
- d Department of Clinical, Neuro and Developmental Psychology, Section of Clinical Psychology , Vrije Universiteit , Amsterdam , The Netherlands
| | - Heleen Riper
- d Department of Clinical, Neuro and Developmental Psychology, Section of Clinical Psychology , Vrije Universiteit , Amsterdam , The Netherlands.,e VU University Medical Centre/GGZ inGeest , Amsterdam , The Netherlands.,f Amsterdam Public Health Research Institute , Amsterdam , The Netherlands.,g Faculty of Health Science, Telepsychiatric Unit , University of Southern Denmark, University Hospital , Odense , Denmark
| | - Erik Hedman-Lagerlöf
- h Department of Clinical Neuroscience, Osher Center for Integrative Medicine and Division of Psychology , Karolinska Institutet , Stockholm , Sweden
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107
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Elahi A, Perez Algorta G, Varese F, McIntyre JC, Bentall RP. Do paranoid delusions exist on a continuum with subclinical paranoia? A multi-method taxometric study. Schizophr Res 2017; 190:77-81. [PMID: 28318838 DOI: 10.1016/j.schres.2017.03.022] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 01/29/2017] [Accepted: 03/06/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is widespread interest in whether psychosis exists on a continuum with healthy functioning. Previous research has implied that paranoia, a common symptom of psychosis, exists on a continuum but this has not been investigated using samples including both patients and non-patients and up-to-date taxometric methods. AIM To assess the latent structure of paranoia in a diverse sample using taxometric methods. METHOD We obtained data from 2836 participants, including the general population as well as at-risk mental state and psychotic patients using the P-scale of the Paranoia and Deservedness Scale. Data were analysed using three taxometric procedures, MAMBAC, MAXEIG and L-MODE (Ruscio, 2016), and two sets of paranoia indicators (subscales and selected items from the P scale), including and excluding the patient groups. RESULTS Eleven of the twelve analyses supported a dimensional model. Using the full sample and subscales as indicators, the MAMBAC analysis was ambiguous. Overall, the findings converged on a dimensional latent structure. CONCLUSIONS A dimensional latent structure of paranoia implies that the processes involved in sub-clinical paranoia may be similar to those in clinical paranoia.
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Affiliation(s)
- A Elahi
- University of Liverpool, Institute of Psychology, Health and Society, Waterhouse Building, Block B, Brownlow St, Liverpool L69 3GL, United Kingdom.
| | - G Perez Algorta
- Lancaster University, Spectrum Centre for Mental Health Research, Furness Building C73, Lancaster LA1 4YG, United Kingdom.
| | - F Varese
- University of Manchester, Division of Psychology and Mental Health, School of Health Sciences, Zochonis Building, Manchester M13 9PL, United Kingdom.
| | - J C McIntyre
- University of Liverpool, Institute of Psychology, Health and Society, Waterhouse Building, Block B, Brownlow St, Liverpool L69 3GL, United Kingdom.
| | - R P Bentall
- University of Liverpool, Institute of Psychology, Health and Society, Waterhouse Building, Block B, Brownlow St, Liverpool L69 3GL, United Kingdom.
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108
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Schröder J, Berger T, Westermann S, Klein JP, Moritz S. Internet interventions for depression: new developments. DIALOGUES IN CLINICAL NEUROSCIENCE 2017. [PMID: 27489460 PMCID: PMC4969707 DOI: 10.31887/dcns.2016.18.2/jschroeder] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A wide range of Internet interventions, mostly grounded in methods of cognitive behavioral therapy, have been developed and tested for several mental disorders. The evidence to date shows that these interventions are effective in reducing symptoms of depression. Metaanalyses report small-to-medium effect sizes when Internet interventions are delivered as stand-alone self-help interventions (d=0.25-0.36), and medium-to-large effect sizes when delivered as therapist-guided interventions (d=0.58-0.78), both compared with usual care. Only a minority of people suffering from depression receive adequate treatment, and Internet interventions might help bridge the large treatment gap. This review summarizes the current body of evidence and highlights pros and cons of Internet interventions. It also outlines how they could be implemented in mental health care systems and points out unresolved questions, as well as future directions, in this research field.
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Affiliation(s)
- Johanna Schröder
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Stefan Westermann
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, University of Lübeck, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
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109
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Zheng PZ, Smuck M. Advice to give advice. Spine J 2017; 17:1547-1548. [PMID: 28947012 DOI: 10.1016/j.spinee.2017.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 06/19/2017] [Accepted: 06/26/2017] [Indexed: 02/03/2023]
Abstract
Matthew L. Stevens, Chung-Wei C. Lin, Flavia A. de Carvalho, Kevin Phan, Bart Koes, Chris G. Maher. Advice for acute low back pain: A comparison of what research supports and what guidelines recommend. The Spine Journal, In Press.
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Affiliation(s)
- Patricia Z Zheng
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA.
| | - Matthew Smuck
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
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Castro A, López-Del-Hoyo Y, Peake C, Mayoral F, Botella C, García-Campayo J, Baños RM, Nogueira-Arjona R, Roca M, Gili M. Adherence predictors in an Internet-based Intervention program for depression. Cogn Behav Ther 2017; 47:246-261. [PMID: 28871896 DOI: 10.1080/16506073.2017.1366546] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Internet-delivered psychotherapy has been demonstrated to be effective in the treatment of depression. Nevertheless, the study of the adherence in this type of the treatment reported divergent results. The main objective of this study is to analyze predictors of adherence in a primary care Internet-based intervention for depression in Spain. A multi-center, three arm, parallel, randomized controlled trial was conducted with 194 depressive patients, who were allocated in self-guided or supported-guided intervention. Sociodemographic and clinical characteristics were gathered using a case report form. The Mini international neuropsychiatric interview diagnoses major depression. Beck Depression Inventory was used to assess depression severity. The visual analogic scale assesses the respondent's self-rated health and Short Form Health Survey was used to measure the health-related quality of life. Age results a predictor variable for both intervention groups (with and without therapist support). Perceived health is a negative predictor of adherence for the self-guided intervention when change in depression severity was included in the model. Change in depression severity results a predictor of adherence in the support-guided intervention. Our findings demonstrate that in our sample, there are differences in sociodemographic and clinical variables between active and dropout participants and we provide adherence predictors in each intervention condition of this Internet-based program for depression (self-guided and support-guided). It is important to point that further research in this area is essential to improve tailored interventions and to know specific patients groups can benefit from these interventions.
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Affiliation(s)
- Adoración Castro
- a IUNICS-IDISBA , University of Balearic Islands , Palma de Mallorca , Spain.,b Primary Care Prevention and Health Promotion Research Network , RedIAPP , Madrid , Spain
| | - Yolanda López-Del-Hoyo
- b Primary Care Prevention and Health Promotion Research Network , RedIAPP , Madrid , Spain.,c Department of Psychiatry, Hospital Miguel Servet , University of Zaragoza , Zaragoza , Spain
| | - Christian Peake
- d Facultad de Educación, Departamento de Fundamentos de la Pedagogía , Universidad Católica de la Santísima Concepción , Concepción , Chile
| | - Fermín Mayoral
- e Mental Health Department, Institute of Biomedicine of Málaga , University Regional Hospital of Málaga , Málaga , Spain
| | - Cristina Botella
- f Faculty of Health Sciences, Department of Clinical and Basic Psychology and Biopsychology , University Jaume I , Castellon , Spain.,g CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III , Madrid , Spain
| | - Javier García-Campayo
- b Primary Care Prevention and Health Promotion Research Network , RedIAPP , Madrid , Spain.,c Department of Psychiatry, Hospital Miguel Servet , University of Zaragoza , Zaragoza , Spain
| | - Rosa María Baños
- g CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III , Madrid , Spain.,h Department of Psychological, Personality, Evaluation and Treatment , University of Valencia , Valencia , Spain
| | - Raquel Nogueira-Arjona
- i Faculty of Psychology, Department of Personality, Assessment and Psychological Treatments , University of Malaga, Malaga, Spain of Malaga , Malaga , Spain
| | - Miquel Roca
- a IUNICS-IDISBA , University of Balearic Islands , Palma de Mallorca , Spain.,b Primary Care Prevention and Health Promotion Research Network , RedIAPP , Madrid , Spain
| | - Margalida Gili
- a IUNICS-IDISBA , University of Balearic Islands , Palma de Mallorca , Spain.,b Primary Care Prevention and Health Promotion Research Network , RedIAPP , Madrid , Spain
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111
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Witt K, Spittal MJ, Carter G, Pirkis J, Hetrick S, Currier D, Robinson J, Milner A. Effectiveness of online and mobile telephone applications ('apps') for the self-management of suicidal ideation and self-harm: a systematic review and meta-analysis. BMC Psychiatry 2017; 17:297. [PMID: 28810841 PMCID: PMC5558658 DOI: 10.1186/s12888-017-1458-0] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 08/08/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Online and mobile telephone applications ('apps') have the potential to improve the scalability of effective interventions for suicidal ideation and self-harm. The aim of this review was therefore to investigate the effectiveness of digital interventions for the self-management of suicidal ideation or self-harm. METHODS Seven databases (Applied Science & Technology; CENTRAL; CRESP; Embase; Global Health; PsycARTICLES; PsycINFO; Medline) were searched to 31 March, 2017. Studies that examined the effectiveness of digital interventions for suicidal ideation and/or self-harm, or which reported outcome data for suicidal ideation and/or self-harm, within a randomised controlled trial (RCT), pseudo-RCT, or observational pre-test/post-test design were included in the review. RESULTS Fourteen non-overlapping studies were included, reporting data from a total of 3,356 participants. Overall, digital interventions were associated with reductions for suicidal ideation scores at post-intervention. There was no evidence of a treatment effect for self-harm or attempted suicide. CONCLUSIONS Most studies were biased in relation to at least one aspect of study design, and particularly the domains of participant, clinical personnel, and outcome assessor blinding. Performance and detection bias therefore cannot be ruled out. Digital interventions for suicidal ideation and self-harm may be more effective than waitlist control. It is unclear whether these reductions would be clinically meaningful at present. Further evidence, particularly with regards to the potential mechanisms of action of these interventions, as well as safety, is required before these interventions could recommended.
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Affiliation(s)
- Katrina Witt
- Population Health, Turning Point, Eastern Health Clinical School, Monash University, 54-62 Gertrude Street, Fitzroy, Victoria, 3065, Australia.
| | - Matthew J. Spittal
- 0000 0001 2179 088Xgrid.1008.9Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria Australia
| | - Gregory Carter
- 0000 0000 8831 109Xgrid.266842.cCentre for Translational Neuroscience and Mental Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales Australia
| | - Jane Pirkis
- 0000 0001 2179 088Xgrid.1008.9Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria Australia
| | - Sarah Hetrick
- 0000 0001 2179 088Xgrid.1008.9Orygen, the National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria Australia
| | - Dianne Currier
- 0000 0001 2179 088Xgrid.1008.9Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria Australia
| | - Jo Robinson
- 0000 0001 2179 088Xgrid.1008.9Orygen, the National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria Australia
| | - Allison Milner
- 0000 0001 2179 088Xgrid.1008.9Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria Australia
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Mikolasek M, Berg J, Witt CM, Barth J. Effectiveness of Mindfulness- and Relaxation-Based eHealth Interventions for Patients with Medical Conditions: a Systematic Review and Synthesis. Int J Behav Med 2017; 25:1-16. [DOI: 10.1007/s12529-017-9679-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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113
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Pommereau X. ["Mirror, mirror on the wall", the issue of digital technology in adolescent mental healthcare]. Soins Psychiatr 2017; 38:16-20. [PMID: 28683880 DOI: 10.1016/j.spsy.2017.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The digital revolution is turning lifestyles and mentalities upside down. The intuitiveness, immediacy and connectivity which characterise new information and communication technologies appeal to teenagers who find in them ways to gain recognition from their peers and to exchange with each other, without having to yield to adults. However, they expect mental health professionals to talk to them, to be engaged in their discussions and to agree to use connected tools as platforms for exchange. A wide variety of such methods can form part of the therapeutic relationship, from smartphones to chat rooms, from teleconsultations to 'cybertherapies', and from video games to serious games.
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Affiliation(s)
- Xavier Pommereau
- Centre Abadie, CHU de Bordeaux, 89, rue des Sablières, 33077 Bordeaux cedex, France.
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114
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Leavey K, Hawkins R. Is cognitive behavioural therapy effective in reducing suicidal ideation and behaviour when delivered face-to-face or via e-health? A systematic review and meta-analysis. Cogn Behav Ther 2017. [DOI: 10.1080/16506073.2017.1332095] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Katie Leavey
- Department of Psychology, James Cook University, McGregor Road, Cairns 4870, Australia
| | - Russell Hawkins
- Department of Psychology, James Cook University, McGregor Road, Cairns 4870, Australia
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Zhao D, Lustria MLA, Hendrickse J. Systematic review of the information and communication technology features of web- and mobile-based psychoeducational interventions for depression. PATIENT EDUCATION AND COUNSELING 2017; 100:1049-1072. [PMID: 28126383 DOI: 10.1016/j.pec.2017.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 12/10/2016] [Accepted: 01/07/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To examine the information and communication technology (ICT) features of psychoeducational interventions for depression delivered via the Internet or via mobile technology. METHODS Web- and mobile-based psychoeducational intervention studies published from 2004 to 2014 were selected and reviewed by two independent coders. RESULTS A total of 55 unique studies satisfied the selection criteria. The review revealed a diverse range of ICTs used to support the psychoeducational programs. Most interventions used websites as their main mode of delivery and reported greater use of communication tools compared to effective approaches like tailoring or interactive technologies games, videos, and self-monitoring tools. Many of the studies relied on medium levels of clinician involvement and only a few were entirely self-guided. CONCLUSION Programs that reported higher levels of clinician involvement also reported using more communication tools, and reported greater compliance to treatment. Future experimental studies may help unpack the effects of technology features and reveal new ways to automate aspects of clinician input. PRACTICAL IMPLICATIONS There is a need to further examine ways ICTs can be optimized to reduce the burden on clinicians whilst enhancing the delivery of proven effective therapeutic approaches.
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Affiliation(s)
- Danyang Zhao
- School of Communication, Florida State University, Tallahassee, USA.
| | | | - Joshua Hendrickse
- School of Communication, Florida State University, Tallahassee, USA.
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Wahle F, Bollhalder L, Kowatsch T, Fleisch E. Toward the Design of Evidence-Based Mental Health Information Systems for People With Depression: A Systematic Literature Review and Meta-Analysis. J Med Internet Res 2017; 19:e191. [PMID: 28566267 PMCID: PMC5471345 DOI: 10.2196/jmir.7381] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 03/10/2017] [Accepted: 04/06/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Existing research postulates a variety of components that show an impact on utilization of technology-mediated mental health information systems (MHIS) and treatment outcome. Although researchers assessed the effect of isolated design elements on the results of Web-based interventions and the associations between symptom reduction and use of components across computer and mobile phone platforms, there remains uncertainty with regard to which components of technology-mediated interventions for mental health exert the greatest therapeutic gain. Until now, no studies have presented results on the therapeutic benefit associated with specific service components of technology-mediated MHIS for depression. OBJECTIVE This systematic review aims at identifying components of technology-mediated MHIS for patients with depression. Consequently, all randomized controlled trials comparing technology-mediated treatments for depression to either waiting-list control, treatment as usual, or any other form of treatment for depression were reviewed. Updating prior reviews, this study aims to (1) assess the effectiveness of technology-supported interventions for the treatment of depression and (2) add to the debate on what components in technology-mediated MHIS for the treatment of depression should be standard of care. METHODS Systematic searches in MEDLINE, PsycINFO, and the Cochrane Library were conducted. Effect sizes for each comparison between a technology-enabled intervention and a control condition were computed using the standard mean difference (SMD). Chi-square tests were used to test for heterogeneity. Using subgroup analysis, potential sources of heterogeneity were analyzed. Publication bias was examined using visual inspection of funnel plots and Begg's test. Qualitative data analysis was also used. In an explorative approach, a list of relevant components was extracted from the body of literature by consensus between two researchers. RESULTS Of 6387 studies initially identified, 45 met all inclusion criteria. Programs analyzed showed a significant trend toward reduced depressive symptoms (SMD -0.58, 95% CI -0.71 to -0.45, P<.001). Heterogeneity was large (I2≥76). A total of 15 components were identified. CONCLUSIONS Technology-mediated MHIS for the treatment of depression has a consistent positive overall effect compared to controls. A total of 15 components have been identified. Further studies are needed to quantify the impact of individual components on treatment effects and to identify further components that are relevant for the design of future technology-mediated interventions for the treatment of depression and other mental disorders.
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Affiliation(s)
- Fabian Wahle
- Center for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zürich, Zürich, Switzerland
| | - Lea Bollhalder
- Institute of Technology Management, University of St Gallen, St Gallen, Switzerland
| | - Tobias Kowatsch
- Center for Digital Health Interventions, Institute of Technology Management, University of St Gallen, St Gallen, Switzerland
| | - Elgar Fleisch
- Institute of Technology Management, University of St Gallen, St Gallen, Switzerland
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Mohr DC, Lyon AR, Lattie EG, Reddy M, Schueller SM. Accelerating Digital Mental Health Research From Early Design and Creation to Successful Implementation and Sustainment. J Med Internet Res 2017; 19:e153. [PMID: 28490417 PMCID: PMC5443926 DOI: 10.2196/jmir.7725] [Citation(s) in RCA: 164] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 04/15/2017] [Accepted: 04/16/2017] [Indexed: 12/27/2022] Open
Abstract
Mental health problems are common and pose a tremendous societal burden in terms of cost, morbidity, quality of life, and mortality. The great majority of people experience barriers that prevent access to treatment, aggravated by a lack of mental health specialists. Digital mental health is potentially useful in meeting the treatment needs of large numbers of people. A growing number of efficacy trials have shown strong outcomes for digital mental health treatments. Yet despite their positive findings, there are very few examples of successful implementations and many failures. Although the research-to-practice gap is not unique to digital mental health, the inclusion of technology poses unique challenges. We outline some of the reasons for this gap and propose a collection of methods that can result in sustainable digital mental health interventions. These methods draw from human-computer interaction and implementation science and are integrated into an Accelerated Creation-to-Sustainment (ACTS) model. The ACTS model uses an iterative process that includes 2 basic functions (design and evaluate) across 3 general phases (Create, Trial, and Sustain). The ultimate goal in using the ACTS model is to produce a functioning technology-enabled service (TES) that is sustainable in a real-world treatment setting. We emphasize the importance of the service component because evidence from both research and practice has suggested that human touch is a critical ingredient in the most efficacious and used digital mental health treatments. The Create phase results in at least a minimally viable TES and an implementation blueprint. The Trial phase requires evaluation of both effectiveness and implementation while allowing optimization and continuous quality improvement of the TES and implementation plan. Finally, the Sustainment phase involves the withdrawal of research or donor support, while leaving a functioning, continuously improving TES in place. The ACTS model is a step toward bringing implementation and sustainment into the design and evaluation of TESs, public health into clinical research, research into clinics, and treatment into the lives of our patients.
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Affiliation(s)
- David C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Emily G Lattie
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Madhu Reddy
- Department of Communication Studies, Northwestern University, Evanston, IL, United States
| | - Stephen M Schueller
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
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Li C, Xu D, Hu M, Tan Y, Zhang P, Li G, Chen L. A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for patients with diabetes and depression. J Psychosom Res 2017; 95:44-54. [PMID: 28314548 DOI: 10.1016/j.jpsychores.2017.02.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 02/07/2017] [Accepted: 02/10/2017] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The aim of this meta-analysis was to systematically examine the efficacy of cognitive behavior therapy (CBT) for diabetic patients who have comorbid depression and to identify which aspects can be improved through intervention. METHODS A systematic literature review was performed using multiple databases. The inclusion criteria included randomized controlled trials (RCTs) of CBT that were conducted with diabetes patients with clinically relevant depression. Review Manager version 5.3 was used to obtain pooled results. RESULTS Ten RCTs, with a total sample size of 998 participants, met the inclusion criteria. Compared with control groups, the CBT groups had statistically significant, long-term improvements in depression (standardized mean differences [SMD]=-0.65, 95% confidence interval [CI] (-0.98 to -0.31), P=0.0002), quality of life (SMD=0.29, 95%CI (0.08 to 0.51), P=0.007), fasting glucose (SMD=0.21, 95%CI (0.04 to 0.37), P=0.01) and anxiety (SMD=-0.49, 95%CI (-0.88 to -0.10), P=0.01). No improvements were found in glycemic control or in diabetes-related distress. CONCLUSIONS The results of this meta-analysis showed that CBT can be effective in reducing depression symptoms and fasting glucose in diabetes patients with comorbid depression as well as in improving quality of life and anxiety in the long-term. The results showed that CBT can serve as a promising treatment alternative for diabetes patients with comorbid depression.
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Affiliation(s)
- Chen Li
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China
| | - Duo Xu
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China
| | - Mingyue Hu
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China
| | - Yongfei Tan
- College of Basic Medical Science, Jilin University, No. 126 Xinmin Street, Changchun 130021, Jilin, People's Republic of China
| | - Ping Zhang
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China
| | - Guichen Li
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China
| | - Li Chen
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China.
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Holst A, Nejati S, Björkelund C, Eriksson MCM, Hange D, Kivi M, Wikberg C, Petersson EL. Patients' experiences of a computerised self-help program for treating depression - a qualitative study of Internet mediated cognitive behavioural therapy in primary care. Scand J Prim Health Care 2017; 35:46-53. [PMID: 28277055 PMCID: PMC5361419 DOI: 10.1080/02813432.2017.1288813] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE The objective of this study was to explore primary care patients' experiences of Internet mediated cognitive behavioural therapy (iCBT) depression treatment. DESIGN Qualitative study. Data were collected from focus group discussions and individual interviews. SETTING Primary care. METHOD Data were analysed by systematic text condensation by Malterud. SUBJECTS Thirteen patients having received iCBT for depression within the PRIM-NET study. MAIN OUTCOME MEASURES Analysis presented different aspects of patients' experiences of iCBT. RESULTS The informants described a need for face-to-face meetings with a therapist. A therapist who performed check-ups and supported the iCBT process seemed important. iCBT implies that a responsibility for the treatment is taken by the patient, and some patients felt left alone, while others felt well and secure. This was a way to work in privacy and freedom with a smoothly working technology although there was a lack of confidence and a feeling of risk regarding iCBT. CONCLUSION iCBT is an attractive alternative to some patients with depression in primary care, but not to all. An individual treatment design seems to be preferred, and elements of iCBT could be included as a complement when treating depression in primary care. Such a procedure could relieve the overall treatment burden of depression. Key points Internet mediated cognitive behavioural therapy (iCBT) can be effective in treating depression in primary care, but patients' experiences of iCBT are rarely studied • Most patients express a need for human contact, real-time interaction, dialogue and guidance when treated for depression. • The patient's opportunity to influence the practical circumstances about iCBT is a success factor, though this freedom brings a large responsibility upon the receiver. • An individual treatment design seems to be crucial, and elements of iCBT could be included as a complement to face-to-face meetings.
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Affiliation(s)
- Anna Holst
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- CONTACT Anna Holst Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, PO Box 454, SE 405 30 Gothenburg, Sweden
| | - Shabnam Nejati
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Björkelund
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria C. M. Eriksson
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dominique Hange
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marie Kivi
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Carl Wikberg
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva-Lisa Petersson
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
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Cipolletta S, Mocellin D. Online counseling: An exploratory survey of Italian psychologists’ attitudes towards new ways of interaction. Psychother Res 2017; 28:909-924. [DOI: 10.1080/10503307.2016.1259533] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Sabrina Cipolletta
- Dipartimento di Psicologia Generale, Università degli Studi di Padova, Padova, Italy
| | - Damiano Mocellin
- Dipartimento di Psicologia Generale, Università degli Studi di Padova, Padova, Italy
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121
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Solem S, Ulleberg E. Internettbasert behandling av depresjon. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2017; 137:43-45. [DOI: 10.4045/tidsskr.16.0842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Abstract
The World Health Organization estimates that during a given 12-month period, approximately 34 million people suffering from major depressive disorder go untreated in Europe and the Americas alone. Barriers to treatment include geographic distance, lack of mental health insurance, prohibitive cost of treatment, long wait-lists, and perceived stigma. Over the past two decades, Internet-based cognitive-behavioral therapy (iCBT) programs have proliferated. A growing body of research supports the efficacy of iCBT for depression and other psychiatric conditions, and these programs may help address barriers that hinder access to effective treatment. The present review describes common iCBT programs along with the evidence base supporting their efficacy in reducing symptoms of depression, reviews research on moderators of treatment response, and provides suggestions for future directions in research and care.
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123
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Hull TD, Mahan K. A Study of Asynchronous Mobile-Enabled SMS Text Psychotherapy. Telemed J E Health 2016; 23:240-247. [PMID: 27797646 DOI: 10.1089/tmj.2016.0114] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Many obstacles to obtaining psychotherapy continue to diminish its reach despite its documented positive effects. Using short message service (SMS) texting and Web platforms to enable licensed psychotherapists to deliver therapy directly to the lived context of the client is one possible solution. INTRODUCTION Employing a feasibility study design, this pilot trial further evaluated the external validity for treatment outcomes of text therapy and extended findings to include mobile-enabled text platforms. MATERIALS AND METHODS Adults seeking text therapy treatment for a variety of disorders were recruited from a text therapy service (N = 57). Clinical outcomes were measured using the General Health Questionnaire-12 (GHQ-12) through 15 weeks of treatment. A process variable, the therapeutic alliance, was measured with the Working Alliance Inventory. Treatment acceptability was assessed with ratings of satisfaction for several aspects of the treatment, including affordability, effectiveness, convenience, wait times to receiving treatment, and cost-effectiveness. RESULTS Results indicate evidence for the effectiveness of the intervention (GHQ-12, Cohen's d = 1.3). Twenty-five (46%) participants experienced clinically significant symptom remission. Therapeutic alliance scores were lower than those found in traditional treatment settings, but still predicted symptom improvement (R2 = 0.299). High levels of satisfaction with text therapy were reported on dimensions of affordability, convenience, and effectiveness. Cost-effectiveness analyses suggest that text therapy is 42.2% the cost of traditional services and offers much reduced wait times. CONCLUSION Mobile-enabled asynchronous text therapy with a licensed therapist is an acceptable and clinically beneficial medium for individuals with various diagnoses and histories of psychological distress.
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Carter G, Page A, Large M, Hetrick S, Milner AJ, Bendit N, Walton C, Draper B, Hazell P, Fortune S, Burns J, Patton G, Lawrence M, Dadd L, Dudley M, Robinson J, Christensen H. Royal Australian and New Zealand College of Psychiatrists clinical practice guideline for the management of deliberate self-harm. Aust N Z J Psychiatry 2016; 50:939-1000. [PMID: 27650687 DOI: 10.1177/0004867416661039] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To provide guidance for the organisation and delivery of clinical services and the clinical management of patients who deliberately self-harm, based on scientific evidence supplemented by expert clinical consensus and expressed as recommendations. METHOD Articles and information were sourced from search engines including PubMed, EMBASE, MEDLINE and PsycINFO for several systematic reviews, which were supplemented by literature known to the deliberate self-harm working group, and from published systematic reviews and guidelines for deliberate self-harm. Information was reviewed by members of the deliberate self-harm working group, and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to successive consultation and external review involving expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest and expertise in deliberate self-harm. RESULTS The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for deliberate self-harm provide up-to-date guidance and advice regarding the management of deliberate self-harm patients, which is informed by evidence and clinical experience. The clinical practice guidelines for deliberate self-harm is intended for clinical use and service development by psychiatrists, psychologists, physicians and others with an interest in mental health care. CONCLUSION The clinical practice guidelines for deliberate self-harm address self-harm within specific population sub-groups and provide up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus.
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Affiliation(s)
- Gregory Carter
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Centre for Translational Neuroscience and Mental Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia Department of Consultation Liaison Psychiatry, Calvary Mater Newcastle Hospital, Waratah, NSW, Australia
| | - Andrew Page
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Centre for Health Research, Western Sydney University, Richmond, NSW, Australia
| | - Matthew Large
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia
| | - Sarah Hetrick
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Allison Joy Milner
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Centre for Population Health Research, School of Health and Social Development, Deakin University, Burwood VIC, Australia Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Nick Bendit
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
| | - Carla Walton
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Centre for Psychotherapy, Hunter New England Mental Health Service and Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Brian Draper
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Philip Hazell
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Sarah Fortune
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia The University of Auckland, Auckland, New Zealand University of Leeds, Leeds, UK Kidz First, Middlemore Hospital, Auckland, New Zealand
| | - Jane Burns
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Young and Well Cooperative Research Centre, The University of Melbourne, Melbourne, VIC, Australia Brain & Mind Research Institute, The University of Sydney, Sydney, NSW, Australia Orygen Youth Health Research Centre, Melbourne, VIC, Australia
| | - George Patton
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia National Health and Medical Research Council, Canberra, ACT, Australia Centre for Adolescent Health, The Royal Children's Hospital, Melbourne, VIC, Australia Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Mark Lawrence
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Tauranga Hospital, Bay of Plenty, New Zealand
| | - Lawrence Dadd
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Mental Health & Substance Use Service, Hunter New England, NSW Health, Waratah, NSW, Australia Awabakal Aboriginal Medical Service, Hamilton, NSW, Australia Pital Tarkin, Aboriginal Medical Student Mentoring Program, The Wollotuka Institute, The University of Newcastle, Callaghan, NSW, Australia Specialist Outreach NT, Darwin, Northern Territory, Australia
| | | | - Jo Robinson
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Helen Christensen
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Black Dog Institute, The University of New South Wales, Sydney, NSW, Australia
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Mogoașe C, Cobeanu O, David O, Giosan C, Szentagotai A. Internet-Based Psychotherapy for Adult Depression: What About the Mechanisms of Change? J Clin Psychol 2016; 73:5-64. [DOI: 10.1002/jclp.22326] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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126
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Wahle F, Kowatsch T, Fleisch E, Rufer M, Weidt S. Mobile Sensing and Support for People With Depression: A Pilot Trial in the Wild. JMIR Mhealth Uhealth 2016; 4:e111. [PMID: 27655245 PMCID: PMC5052463 DOI: 10.2196/mhealth.5960] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/24/2016] [Accepted: 09/07/2016] [Indexed: 11/13/2022] Open
Abstract
Background Depression is a burdensome, recurring mental health disorder with high prevalence. Even in developed countries, patients have to wait for several months to receive treatment. In many parts of the world there is only one mental health professional for over 200 people. Smartphones are ubiquitous and have a large complement of sensors that can potentially be useful in monitoring behavioral patterns that might be indicative of depressive symptoms and providing context-sensitive intervention support. Objective The objective of this study is 2-fold, first to explore the detection of daily-life behavior based on sensor information to identify subjects with a clinically meaningful depression level, second to explore the potential of context sensitive intervention delivery to provide in-situ support for people with depressive symptoms. Methods A total of 126 adults (age 20-57) were recruited to use the smartphone app Mobile Sensing and Support (MOSS), collecting context-sensitive sensor information and providing just-in-time interventions derived from cognitive behavior therapy. Real-time learning-systems were deployed to adapt to each subject’s preferences to optimize recommendations with respect to time, location, and personal preference. Biweekly, participants were asked to complete a self-reported depression survey (PHQ-9) to track symptom progression. Wilcoxon tests were conducted to compare scores before and after intervention. Correlation analysis was used to test the relationship between adherence and change in PHQ-9. One hundred twenty features were constructed based on smartphone usage and sensors including accelerometer, Wifi, and global positioning systems (GPS). Machine-learning models used these features to infer behavior and context for PHQ-9 level prediction and tailored intervention delivery. Results A total of 36 subjects used MOSS for ≥2 weeks. For subjects with clinical depression (PHQ-9≥11) at baseline and adherence ≥8 weeks (n=12), a significant drop in PHQ-9 was observed (P=.01). This group showed a negative trend between adherence and change in PHQ-9 scores (rho=−.498, P=.099). Binary classification performance for biweekly PHQ-9 samples (n=143), with a cutoff of PHQ-9≥11, based on Random Forest and Support Vector Machine leave-one-out cross validation resulted in 60.1% and 59.1% accuracy, respectively. Conclusions Proxies for social and physical behavior derived from smartphone sensor data was successfully deployed to deliver context-sensitive and personalized interventions to people with depressive symptoms. Subjects who used the app for an extended period of time showed significant reduction in self-reported symptom severity. Nonlinear classification models trained on features extracted from smartphone sensor data including Wifi, accelerometer, GPS, and phone use, demonstrated a proof of concept for the detection of depression superior to random classification. While findings of effectiveness must be reproduced in a RCT to proof causation, they pave the way for a new generation of digital health interventions leveraging smartphone sensors to provide context sensitive information for in-situ support and unobtrusive monitoring of critical mental health states.
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Affiliation(s)
- Fabian Wahle
- ETH Zürich, Department of Management, Technology and Economics, Zürich, Switzerland
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Parikh SV, Quilty LC, Ravitz P, Rosenbluth M, Pavlova B, Grigoriadis S, Velyvis V, Kennedy SH, Lam RW, MacQueen GM, Milev RV, Ravindran AV, Uher R. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 2. Psychological Treatments. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:524-39. [PMID: 27486150 PMCID: PMC4994791 DOI: 10.1177/0706743716659418] [Citation(s) in RCA: 202] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The Canadian Network for Mood and Anxiety Treatments (CANMAT) has revised its 2009 guidelines for the management of major depressive disorder (MDD) in adults by updating the evidence and recommendations. The target audiences for these 2016 guidelines are psychiatrists and other mental health professionals. METHODS Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. "Psychological Treatments" is the second of six sections of the 2016 guidelines. RESULTS Evidence-informed responses were developed for 25 questions under 5 broad categories: 1) patient characteristics relevant to using psychological interventions; 2) therapist and health system characteristics associated with optimizing outcomes; 3) descriptions of major psychotherapies and their efficacy; 4) additional psychological interventions, such as peer interventions and computer- and technology-delivered interventions; and 5) combining and/or sequencing psychological and pharmacological interventions. CONCLUSIONS First-line psychological treatment recommendations for acute MDD include cognitive-behavioural therapy (CBT), interpersonal therapy (IPT), and behavioural activation (BA). Second-line recommendations include computer-based and telephone-delivered psychotherapy. Where feasible, combining psychological treatment (CBT or IPT) with antidepressant treatment is recommended because combined treatment is superior to either treatment alone. First-line psychological treatments for maintenance include CBT and mindfulness-based cognitive therapy (MBCT). Patient preference, in combination with evidence-based treatments and clinician/system capacity, will yield the optimal treatment strategies for improving individual outcomes in MDD.
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Affiliation(s)
- Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Lena C Quilty
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Paula Ravitz
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | - Barbara Pavlova
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia
| | | | | | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | | | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia
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Kreuze E, Jenkins C, Gregoski M, York J, Mueller M, Lamis DA, Ruggiero KJ. Technology-enhanced suicide prevention interventions: A systematic review. J Telemed Telecare 2016; 23:605-617. [DOI: 10.1177/1357633x16657928] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Suicide prevention is a high priority. Scalable and sustainable interventions for suicide prevention are needed to set the stage for population-level impact. This systematic review explores how technology-enhanced interventions target suicide risk and protective factors, using the Centers for Disease Control and Prevention (CDC, 2015) Risk and Protective Factors Ecological Model. Methods Information databases (PsycINFO, PubMed and CINAHL) were systematically searched and records including technology-enhanced interventions for suicide prevention ( n = 3764) were reviewed. Records with varying technologies and diverse methodologies were integrated into the search. Results Review of the records resulted in the inclusion of 16 studies that utilized technology-enhanced interventions to address determinants of suicidal behaviour. This includes the use of standalone or, in most cases, adjunct technology-enhanced interventions for suicide prevention delivered by mobile phone application, text message, telephone, computer, web, CD-ROM and video. Conclusion Intervention effectiveness was variable, but several technology-enhanced interventions have demonstrated effectiveness in reducing suicidal ideation and mental health co-morbidities. Large-scale research and evaluation initiatives are needed to evaluate the costs and long-term population-level impact of these interventions.
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Affiliation(s)
| | - Carolyn Jenkins
- College of Nursing, Medical University of South Carolina, USA
| | - Mathew Gregoski
- College of Nursing, Medical University of South Carolina, USA
| | | | - Martina Mueller
- College of Nursing, Medical University of South Carolina, USA
| | - Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, USA
| | - Kenneth J Ruggiero
- College of Nursing, Medical University of South Carolina, USA
- Ralph H. Johnson VA Medical Center, USA
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Witt KJ, Oliver M, McNichols C. Counseling via Avatar: Professional Practice in Virtual Worlds. INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING 2016. [DOI: 10.1007/s10447-016-9269-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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130
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Vázquez MYG, Sexto CF, Rocha Á, Aguilera A. Mobile Phones and Psychosocial Therapies with Vulnerable People: a First State of the Art. J Med Syst 2016; 40:157. [PMID: 27194134 DOI: 10.1007/s10916-016-0500-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/15/2016] [Indexed: 11/25/2022]
Abstract
Mobile phones are becoming a communication tool commonly used by people all over the world; and they are started to be adopted in psychosocial therapies involving vulnerable people. We are herein presenting the results of an academic literature review. We identified scientific papers published between 2006 and 2015 resorting to academic databases available on the Internet, applying a systematic selection method based on quality criteria. Secondly, we analysed contents, highlighting the scarcity of research involving vulnerable people. The available literature specialized in psychosocial therapies offers investigation results which involve mobile phones and patients in general, focusing particularly on the clinical psychology field and, to a lesser extent, on the social work field. Particularly significant are the investigation works developed in the United States. In the present paper we introduce a first "state of the art", identifying opportunities and also the limitations surrounding the use of mobile phones in psychosocial therapies targeting the vulnerable. Issues concerning privacy and data confidentiality, and the access of vulnerable people to mobile phones and how they use them, pose significant challenges; but they offer the opportunity to reach isolated or impoverished populations, or even to facilitate access to social and healthcare services. We close this paper formulating possible orientations, hypotheses and goals to design new investigation works involving vulnerable populations.
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Affiliation(s)
- Maria Yolanda García Vázquez
- University of Santiago de Compostela, Idega, University of Santiago de Compostela, Campus Vida s/n, Santiago de Compostela, 15782, Spain.
| | - Carlos Ferrás Sexto
- University of Santiago de Compostela, Idega, Campus Vida s/n, Santiago de Compostela, 15782, Spain
| | - Álvaro Rocha
- University of Coimbra, Informatic Department, Polo II, University of Coimbra, Coimbra, 3004-531, Portugal
| | - Adrián Aguilera
- University of California, School of Social Welfare, UCBerkeley, Haviland Hall, Berkeley, California, 94720, USA
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131
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Kemmeren LL, van Schaik DJF, Riper H, Kleiboer AM, Bosmans JE, Smit JH. Effectiveness of blended depression treatment for adults in specialised mental healthcare: study protocol for a randomised controlled trial. BMC Psychiatry 2016; 16:113. [PMID: 27102812 PMCID: PMC4839153 DOI: 10.1186/s12888-016-0818-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 04/14/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Internet-based interventions are seen as an important potential strategy to improve accessibility and affordability of high quality treatments in mental healthcare. A growing number of studies have demonstrated the clinical efficacy of internet-based treatment for mood disorders, but scientific evidence for the application in routine specialised mental healthcare settings is limited. Also, little is known about the clinical and health-economic benefits of blended treatment, where online interventions are integrated with face-to-face treatment of depression in one treatment protocol. The primary aim of this study is to investigate the clinical and cost-effectiveness of blended Cognitive Behavioural Therapy (bCBT) for depression, as compared to treatment as usual (TAU) in specialised routine mental healthcare in the Netherlands. This trial is part of the E-COMPARED project which has a broader perspective, focussing on primary and specialised care in eight European countries. METHODS/DESIGN The study is a randomised controlled non-inferiority trial with two parallel conditions: bCBT and TAU. The blended treatment combines individual face-to-face CBT with CBT delivered through an Internet-based treatment platform (Moodbuster). This platform includes a mobile phone application, used for ecological momentary assessments, automated feedback and motivational messages. Weekly alternating face-to-face (10) and online (9) sessions will be delivered over a period of 19-20 weeks. TAU is defined as the routine care that subjects receive when they are diagnosed with depression in specialised mental healthcare. Adult patients ≥ 18 years old meeting DSM-IV diagnostic criteria for major depressive disorder will be recruited within participating outpatient specialised mental healthcare clinics in the Netherlands. Measurements will be taken at baseline and at 3, 6 and 12 months follow-up. The primary outcome will be depressive symptoms, measured with the PHQ-9 and QIDS. Secondary outcomes include health-related quality of life, mastery, treatment preference, working alliance, system usability, treatment satisfaction and possible negative side-effects. Moreover, a cost-effectiveness analysis will be conducted from a societal perspective and will include both direct and indirect healthcare costs. DISCUSSION The results of this study will provide insight into the health and economical outcomes of blended treatment for depression and give an indication of the value of implementing blended treatment in specialised clinical settings. TRIAL REGISTRATION Netherlands Trial Register NTR4962 . Registered 05-01-2015.
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Affiliation(s)
- L. L. Kemmeren
- Department of Psychiatry, GGZ inGeest and VU University Medical Centre, P.O. Box 7057, Amsterdam, MB 1007 The Netherlands ,EMGO+ Institute for Health Care and Research, VU University Medical Centre, Van der Boechorststraat 7, BT 1081 Amsterdam, The Netherlands
| | - D. J. F. van Schaik
- Department of Psychiatry, GGZ inGeest and VU University Medical Centre, P.O. Box 7057, Amsterdam, MB 1007 The Netherlands ,EMGO+ Institute for Health Care and Research, VU University Medical Centre, Van der Boechorststraat 7, BT 1081 Amsterdam, The Netherlands
| | - H. Riper
- Department of Psychiatry, GGZ inGeest and VU University Medical Centre, P.O. Box 7057, Amsterdam, MB 1007 The Netherlands ,EMGO+ Institute for Health Care and Research, VU University Medical Centre, Van der Boechorststraat 7, BT 1081 Amsterdam, The Netherlands ,Department of Clinical Neuro- and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, BT 1081 Amsterdam, The Netherlands ,Faculty of Health Sciences, The Institute of Clinical Research/Telepsychiatric Centre, Mental Health Services in the Region of Southern Denmark, University of Southern Denmark, Winsløwparken 19, DK-5000 Odense, Denmark
| | - A. M. Kleiboer
- EMGO+ Institute for Health Care and Research, VU University Medical Centre, Van der Boechorststraat 7, BT 1081 Amsterdam, The Netherlands ,Department of Clinical Neuro- and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, BT 1081 Amsterdam, The Netherlands
| | - J. E. Bosmans
- EMGO+ Institute for Health Care and Research, VU University Medical Centre, Van der Boechorststraat 7, BT 1081 Amsterdam, The Netherlands ,Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Van der Boechorststraat 1, BT 1081 Amsterdam, The Netherlands
| | - J. H. Smit
- Department of Psychiatry, GGZ inGeest and VU University Medical Centre, P.O. Box 7057, Amsterdam, MB 1007 The Netherlands ,EMGO+ Institute for Health Care and Research, VU University Medical Centre, Van der Boechorststraat 7, BT 1081 Amsterdam, The Netherlands
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132
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Balon R. Clinical factor 2014. PSYCHOTHERAPY AND PSYCHOSOMATICS 2016; 84:330-8. [PMID: 26398921 DOI: 10.1159/000439224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 08/06/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Richard Balon
- Departments of Psychiatry and Behavioral Neurosciences and of Anesthesiology, Wayne State University School of Medicine, Detroit, Mich., USA
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133
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Mewton L, Andrews G. Cognitive behavioral therapy for suicidal behaviors: improving patient outcomes. Psychol Res Behav Manag 2016; 9:21-9. [PMID: 27042148 PMCID: PMC4780394 DOI: 10.2147/prbm.s84589] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This systematic review provides an overview of the effectiveness of cognitive behavioral therapy (CBT) in reducing suicidal cognitions and behavior in the adult population. We identified 15 randomized controlled trials of CBT for adults (aged 18 years and older) that included suicide-related cognitions or behaviors as an outcome measure. The studies were identified from PsycINFO searches, reference lists, and a publicly available database of psychosocial interventions for suicidal behaviors. This review identified some evidence of the use of CBT in the reduction of both suicidal cognitions and behaviors. There was not enough evidence from clinical trials to suggest that CBT focusing on mental illness reduces suicidal cognitions and behaviors. On the other hand, CBT focusing on suicidal cognitions and behaviors was found to be effective. Given the current evidence, clinicians should be trained in CBT techniques focusing on suicidal cognitions and behaviors that are independent of the treatment of mental illness.
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Affiliation(s)
- Louise Mewton
- National Health and Medical Research Council Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Australia
| | - Gavin Andrews
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent's Hospital, Sydney, NSW, Australia
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134
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Walsh A, Richards D. Experiences and engagement with the design features and strategies of an internet-delivered treatment programme for generalised anxiety disorder: a service-based evaluation. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2016. [DOI: 10.1080/03069885.2016.1153039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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135
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Ciuca AM, Berger T, Crişan LG, Miclea M. Internet-based treatment for Romanian adults with panic disorder: protocol of a randomized controlled trial comparing a Skype-guided with an unguided self-help intervention (the PAXPD study). BMC Psychiatry 2016; 16:6. [PMID: 26769021 PMCID: PMC4714451 DOI: 10.1186/s12888-016-0709-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 01/06/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Efficacy of self-help internet-based cognitive behavior therapy (ICBT) for anxiety disorders has been confirmed in several randomized controlled trials. However, the amount and type of therapist guidance needed in ICBT are still under debate. Previous studies have shown divergent results regarding the role of therapist guidance and its impact on treatment outcome. This issue is central to the development of ICBT programs and needs to be addressed directly. The present study aims to compare the benefits of regular therapist guidance via online real-time audio-video communication (i.e. Skype) to no therapist guidance during a 12-week Romanian self-help ICBT program for Panic Disorder. Both treatments are compared to a waiting-list control group. METHODS/DESIGN A parallel group randomized controlled trial is proposed. The participants, 192 Romanian adults fulfilling diagnostic criteria for panic disorder according to a diagnostic interview, conducted via secured Skype or telephone, are randomly assigned to one of the three conditions: independent use of the internet-based self-help program PAXonline, the same self-help treatment with regular therapist support via secured Skype, and waiting-list control group. The primary outcomes are severity of self-report panic symptoms (PDSS-SR) and diagnostic status (assessors are blind to group assignment), at the end of the intervention (12 weeks) and at follow-up (months 3 and 6). The secondary measures address symptoms of comorbid anxiety disorders, depression, quality of life, adherence and satisfaction with ICBT. Additional measures of socio-demographic characteristics, personality traits, treatment expectancies, catastrophic cognitions, body vigilance and working alliance are considered as potential moderators and/ or mediators of treatment outcome. DISCUSSION To the best of our knowledge, the present study is the first effort to investigate the efficacy of a self-help internet-based intervention with therapist guidance via real-time video communication. A direct comparison between therapist guided versus unguided self-directed intervention for panic disorder will also be addressed for the first time. Findings from this study will inform researchers and practitioners about the added value of online video-therapy guidance sessions and the type of patients who may benefit the most from guided and unguided ICBT for Panic disorder. TRIAL REGISTRATION ACTRN12614000547640 (Australian New Zealand Clinical Trials Registry). Registered 22/05/2014.
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Affiliation(s)
- Amalia Maria Ciuca
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland. .,Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania.
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
| | | | - Mircea Miclea
- Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania.
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136
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Berger T. The therapeutic alliance in internet interventions: A narrative review and suggestions for future research. Psychother Res 2016; 27:511-524. [DOI: 10.1080/10503307.2015.1119908] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
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137
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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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138
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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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139
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Richards D, Timulak L, O'Brien E, Hayes C, Vigano N, Sharry J, Doherty G. A randomized controlled trial of an internet-delivered treatment: Its potential as a low-intensity community intervention for adults with symptoms of depression. Behav Res Ther 2015; 75:20-31. [DOI: 10.1016/j.brat.2015.10.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 09/19/2015] [Accepted: 10/16/2015] [Indexed: 10/22/2022]
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140
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Andrews G, Williams AD. Up-scaling clinician assisted internet cognitive behavioural therapy (iCBT) for depression: A model for dissemination into primary care. Clin Psychol Rev 2015; 41:40-8. [DOI: 10.1016/j.cpr.2014.05.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 04/30/2014] [Accepted: 05/28/2014] [Indexed: 01/09/2023]
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141
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Rosa C, Campbell ANC, Miele GM, Brunner M, Winstanley EL. Using e-technologies in clinical trials. Contemp Clin Trials 2015; 45:41-54. [PMID: 26176884 PMCID: PMC4648297 DOI: 10.1016/j.cct.2015.07.007] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 06/26/2015] [Accepted: 07/05/2015] [Indexed: 02/03/2023]
Abstract
Clinical trials have been slow to incorporate e-technology (digital and electronic technology that utilizes mobile devices or the Internet) into the design and execution of studies. In the meantime, individuals and corporations are relying more on electronic platforms and most have incorporated such technology into their daily lives. This paper provides a general overview of the use of e-technologies in clinical trials research, specifically within the last decade, marked by rapid growth of mobile and Internet-based tools. Benefits of and challenges to the use of e-technologies in data collection, recruitment and retention, delivery of interventions, and dissemination are provided, as well as a description of the current status of regulatory oversight of e-technologies in clinical trials research. As an example of ways in which e-technologies can be used for intervention delivery, a summary of e-technologies for treatment of substance use disorders is presented. Using e-technologies to design and implement clinical trials has the potential to reach a wide audience, making trials more efficient while also reducing costs; however, researchers should be cautious when adopting these tools given the many challenges in using new technologies, as well as threats to participant privacy/confidentiality. Challenges of using e-technologies can be overcome with careful planning, useful partnerships, and forethought. The role of web- and smartphone-based applications is expanding, and the increasing use of those platforms by scientists and the public alike make them tools that cannot be ignored.
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Affiliation(s)
- Carmen Rosa
- National Institutes of Health, National Institute on Drug Abuse, Bethesda, MD, USA.
| | - Aimee N C Campbell
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; Mount Sinai St. Luke's Hospital Department of Psychiatry and Behavioral Health, New York, NY, USA.
| | - Gloria M Miele
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA.
| | - Meg Brunner
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA.
| | - Erin L Winstanley
- The James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA.
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142
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Høifødt RS, Mittner M, Lillevoll K, Katla SK, Kolstrup N, Eisemann M, Friborg O, Waterloo K. Predictors of Response to Web-Based Cognitive Behavioral Therapy With High-Intensity Face-to-Face Therapist Guidance for Depression: A Bayesian Analysis. J Med Internet Res 2015; 17:e197. [PMID: 26333818 PMCID: PMC4642793 DOI: 10.2196/jmir.4351] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/08/2015] [Accepted: 07/08/2015] [Indexed: 01/20/2023] Open
Abstract
Background Several studies have demonstrated the effect of guided Internet-based cognitive behavioral therapy (ICBT) for depression. However, ICBT is not suitable for all depressed patients and there is a considerable level of nonresponse. Research on predictors and moderators of outcome in ICBT is inconclusive. Objective This paper explored predictors of response to an intervention combining the Web-based program MoodGYM and face-to-face therapist guidance in a sample of primary care patients with mild to moderate depressive symptoms. Methods Participants (N=106) aged between 18 and 65 years were recruited from primary care and randomly allocated to a treatment condition or to a delayed treatment condition. The intervention included the Norwegian version of the MoodGYM program, face-to-face guidance from a psychologist, and reminder emails. In this paper, data from the treatment phase of the 2 groups was merged to increase the sample size (n=82). Outcome was improvement in depressive symptoms during treatment as assessed with the Beck Depression Inventory-II (BDI-II). Predictors included demographic variables, severity variables (eg, number of depressive episodes and pretreatment depression and anxiety severity), cognitive variables (eg, dysfunctional thinking), module completion, and treatment expectancy and motivation. Using Bayesian analysis, predictors of response were explored with a latent-class approach and by analyzing whether predictors affected the slope of response. Results A 2-class model distinguished well between responders (74%, 61/82) and nonresponders (26%, 21/82). Our results indicate that having had more depressive episodes, being married or cohabiting, and scoring higher on a measure of life satisfaction had high odds for positively affecting the probability of response. Higher levels of dysfunctional thinking had high odds for a negative effect on the probability of responding. Prediction of the slope of response yielded largely similar results. Bayes factors indicated substantial evidence that being married or cohabiting predicted a more positive treatment response. The effects of life satisfaction and number of depressive episodes were more uncertain. There was substantial evidence that several variables were unrelated to treatment response, including gender, age, and pretreatment symptoms of depression and anxiety. Conclusions Treatment response to ICBT with face-to-face guidance may be comparable across varying levels of depressive severity and irrespective of the presence and severity of comorbid anxiety. Being married or cohabiting, reporting higher life satisfaction, and having had more depressive episodes may predict a more favorable response, whereas higher levels of dysfunctional thinking may be a predictor of poorer response. More studies exploring predictors and moderators of Internet-based treatments are needed to inform for whom this treatment is most effective. Trial Registration Australian New Zealand Clinical Trials Registry number: ACTRN12610000257066; https://www.anzctr.org.au/trial_view.aspx?id=335255 (Archived by WebCite at http://www.webcitation.org/6GR48iZH4).
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Affiliation(s)
- Ragnhild Sørensen Høifødt
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
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143
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Experiences of a guided smartphone-based behavioral activation therapy for depression: A qualitative study. Internet Interv 2015. [DOI: 10.1016/j.invent.2014.12.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Rozental A, Boettcher J, Andersson G, Schmidt B, Carlbring P. Negative Effects of Internet Interventions: A Qualitative Content Analysis of Patients' Experiences with Treatments Delivered Online. Cogn Behav Ther 2015; 44:223-36. [DOI: 10.1080/16506073.2015.1008033] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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145
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Abstract
PURPOSE OF REVIEW Much has been learned from the 400 randomized trials on psychotherapies for adult depression that have been conducted, but much is also still unknown. In this study some recent attempts to further reduce the disease burden of depression through psychotherapies are reviewed. RECENT FINDINGS In the past, many new psychotherapies have promised to be more effective than existing treatments, usually without success. We describe recent research on two new therapies, acceptance and commitment therapy and cognitive bias modification, and conclude that both have also not shown to be more effective than existing therapies. A growing number of studies have also focused on therapies that may be successful in further reducing the disease burden, such as treatments for chronic depression and relapse prevention. Other studies are aimed at scaling up psychological services, such as the training of lay health counselors in low-income and middle-income countries, telephone-based, and internet-based therapies. SUMMARY Psychotherapies are essential tools in the treatment of adult depression. Randomized trials have shown that these treatments are effective, and by focusing on key issues, such as chronic depression, relapse, and scaling them up, psychotherapies contribute more and more to the reduction of the disease burden of depression.
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146
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E-health: an overview of the uses of the Internet, social media, apps, and websites for mood disorders. Curr Opin Psychiatry 2015; 28:13-7. [PMID: 25420193 DOI: 10.1097/yco.0000000000000123] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The current article defines and surveys E-health: Internet and technology-guided interventions and tools useful for mood disorders. RECENT FINDINGS E-health encompasses many categories, including computerized self-help strategies, online psychotherapy, websites that provide information, social media approaches including Facebook, Internet forums for health discussions, personal blogs, and videogames. Multiple tools exist to assess and document symptoms, particularly mood charts. Although all of these approaches are popular, only online psychotherapy and videogames have actually been evaluated in studies to evaluate both validity and efficacy. The face validity of social communication strategies including social media and blogs is strong, with clear implications for stigma reduction and peer support. Informational websites continue to be primary sources of psychoeducation on mental disorders. Social media sites have widespread use by the public and a profusion of health discussions and tools, but without published research evaluation of efficacy. SUMMARY E-health strategies, particularly online psychotherapy and tools to document symptoms, are useful and likely effective. Social communication strategies show enormous popularity, but urgently require research evaluation for impact.
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Reynolds J, Griffiths KM, Cunningham JA, Bennett K, Bennett A. Clinical Practice Models for the Use of E-Mental Health Resources in Primary Health Care by Health Professionals and Peer Workers: A Conceptual Framework. JMIR Ment Health 2015; 2:e6. [PMID: 26543912 PMCID: PMC4607387 DOI: 10.2196/mental.4200] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 02/10/2015] [Accepted: 02/12/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Research into e-mental health technologies has developed rapidly in the last 15 years. Applications such as Internet-delivered cognitive behavioral therapy interventions have accumulated considerable evidence of efficacy and some evidence of effectiveness. These programs have achieved similar outcomes to face-to-face therapy, while requiring much less clinician time. There is now burgeoning interest in integrating e-mental health resources with the broader mental health delivery system, particularly in primary care. The Australian government has supported the development and deployment of e-mental health resources, including websites that provide information, peer-to-peer support, automated self-help, and guided interventions. An ambitious national project has been commissioned to promote key resources to clinicians, to provide training in their use, and to evaluate the impact of promotion and training upon clinical practice. Previous initiatives have trained clinicians to use a single e-mental health program or a suite of related programs. In contrast, the current initiative will support community-based service providers to access a diverse array of resources developed and provided by many different groups. OBJECTIVE The objective of this paper was to develop a conceptual framework to support the use of e-mental health resources in routine primary health care. In particular, models of clinical practice are required to guide the use of the resources by diverse service providers and to inform professional training, promotional, and evaluation activities. METHODS Information about service providers' use of e-mental health resources was synthesized from a nonsystematic overview of published literature and the authors' experience of training primary care service providers. RESULTS Five emerging clinical practice models are proposed: (1) promotion; (2) case management; (3) coaching; (4) symptom-focused treatment; and (5) comprehensive therapy. We also consider the service provider skills required for each model and the ways that e-mental health resources might be used by general practice doctors and nurses, pharmacists, psychologists, social workers, occupational therapists, counselors, and peer workers. CONCLUSIONS The models proposed in the current paper provide a conceptual framework for policy-makers, researchers and clinicians interested in integrating e-mental health resources into primary care. Research is needed to establish the safety and effectiveness of the models in routine care and the best ways to support their implementation.
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Affiliation(s)
- Julia Reynolds
- National Institute for Mental Health Research Research School of Population Health Australian National University Canberra Australia
| | - Kathleen M Griffiths
- National Institute for Mental Health Research Research School of Population Health Australian National University Canberra Australia
| | - John A Cunningham
- National Institute for Mental Health Research Research School of Population Health Australian National University Canberra Australia ; Centre for Addiction and Mental Health Toronto, ON Canada
| | - Kylie Bennett
- National Institute for Mental Health Research Research School of Population Health Australian National University Canberra Australia
| | - Anthony Bennett
- National Institute for Mental Health Research Research School of Population Health Australian National University Canberra Australia
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Scherer S, Urech C, Hösli I, Tschudin S, Gaab J, Berger T, Alder J. Internet-based stress management for women with preterm labour--a case-based experience report. Arch Womens Ment Health 2014; 17:593-600. [PMID: 25123471 DOI: 10.1007/s00737-014-0454-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/30/2014] [Indexed: 12/13/2022]
Abstract
Pregnant women with preterm labour (PTL) in pregnancy often experience increased distress and anxieties regarding both the pregnancy and the child's health. The pathogenesis of PTL is, among other causes, related to the stress-associated activation of the maternal-foetal stress system. In spite of these psychobiological associations, only a few research studies have investigated the potential of psychological stress-reducing interventions. The following paper will present an online anxiety and stress management self-help program for pregnant women with PTL. Structure and content of the program will be illustrated by a case-based experience report. L.B., 32 years (G3, P1), was recruited at gestational week 27 while hospitalized for PTL for 3 weeks. She worked independently through the program for 6 weeks and had regular written contact with a therapist. Processing the program had a positive impact on L.B.'s anxiety and stress levels, as well as on her experienced depressive symptoms and bonding to the foetus. As PTL and the risk of PTB are associated with distress, psychological stress-reducing interventions might be beneficial. This study examines the applicability of an online intervention for pregnant women with PTL. The case report illustrates how adequate low-threshold psychological support could be provided to these women.
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[Validity of the suicidality assessment instrument PRISM-S (Pictoral Representation of Illness Self Measure - Suicidality)]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2014; 28:192-7. [PMID: 25391337 DOI: 10.1007/s40211-014-0123-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 10/03/2014] [Indexed: 10/24/2022]
Abstract
In routine clinical practice the assessment of suicidality proves to be difficult and complex. The aim of the present study was to examine if PRISM can be used to measure validly the person's subjectively perceived suicidality. The nonverbal visualization technique PRISM (Pictoral Representation of Illness and Self Measure) has been developed by Büchi et al. (2002) to evaluate the perceived burden of suffering due to physical illness. The adapted version of PRISM used in our study is called PRISM-S (Pictoral Representation of Illness and Self Measure - Suicidality). 156 eligible inpatients, admitted voluntarily to the crisis intervention centre Winterthur, participated in the study. We used as gold standards the well established assessment tools the Beck Scale of Suicide Ideation (BSS) and the Depressive Symptome Inventory - Subscale (DSI-SS). The results showed high correlations between PRISM-S and the BSS (r = - 0,73) and the DSI-SS scores (r = - 0,76). Clinicians, general practitioners, psychiatrists and psychologists receive with PRISM-S a valid suicidality assessment tool that is very brief and easy to administer in clinical settings.
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Mahoney AEJ, Mackenzie A, Williams AD, Smith J, Andrews G. Internet cognitive behavioural treatment for obsessive compulsive disorder: A randomised controlled trial. Behav Res Ther 2014; 63:99-106. [PMID: 25461784 DOI: 10.1016/j.brat.2014.09.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/19/2014] [Accepted: 09/29/2014] [Indexed: 11/20/2022]
Abstract
Internet-based cognitive behaviour therapy (iCBT) is becoming increasing accepted as an efficacious and effective treatment for the anxiety and depressive disorders. However few studies have examined the efficacy of iCBT for obsessive compulsive disorder (OCD). This randomised controlled trial compared technician-administered iCBT (n = 32) to a treatment as usual (TAU) control group (n = 35) in patients with OCD. The primary outcome measures were the Dimensional Obsessive-Compulsive Scale (DOCS) and the Obsessional Beliefs Questionnaire (OBQ-20) administered at pre- and post-treatment (or matched time points). The iCBT group was followed-up at 3-months post-treatment when diagnostic status was assessed at clinical interview. The iCBT program was more efficacious than TAU in reducing maladaptive OC beliefs as well as symptoms of OCD, distress, and depression, with large within- and between-groups effect sizes found (>.78). Adherence was high (75%) and gains were maintained at 3 month-follow-up with 54% of treatment completers no longer meeting diagnostic criteria for OCD at follow-up. These results are comparable to outcomes obtained by clinician-administered face-to-face and internet-based programs and suggest that iCBT for OCD is efficacious when administered by a clinically-supervised technician. Future research is now needed to evaluate how effective iCBT for OCD is in routine clinical settings.
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Affiliation(s)
- Alison E J Mahoney
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent's Hospital, Level 4 O'Brien Centre, 394-404 Victoria Street, Darlinghurst, Sydney, New South Wales, 2010, Australia.
| | - Anna Mackenzie
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent's Hospital, Level 4 O'Brien Centre, 394-404 Victoria Street, Darlinghurst, Sydney, New South Wales, 2010, Australia; School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Alishia D Williams
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent's Hospital, Level 4 O'Brien Centre, 394-404 Victoria Street, Darlinghurst, Sydney, New South Wales, 2010, Australia; School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Jessica Smith
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent's Hospital, Level 4 O'Brien Centre, 394-404 Victoria Street, Darlinghurst, Sydney, New South Wales, 2010, Australia.
| | - Gavin Andrews
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent's Hospital, Level 4 O'Brien Centre, 394-404 Victoria Street, Darlinghurst, Sydney, New South Wales, 2010, Australia; School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.
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