1
|
Tng GYQ, Koh J, Soh XC, Majeed NM, Hartanto A. Efficacy of digital mental health interventions for PTSD symptoms: A systematic review of meta-analyses. J Affect Disord 2024; 357:23-36. [PMID: 38679205 DOI: 10.1016/j.jad.2024.04.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 01/30/2024] [Accepted: 04/21/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND The present systematic review aimed to synthesize the results of meta-analyses which examine the effects of digital mental health interventions (DMHIs) on post-traumatic stress disorder (PTSD) symptoms, and investigate whether intervention characteristics (i.e., technique, timeframe, and therapeutic guidance) and methodological characteristics including outcome measures and sample inclusion criteria (age, gender, socioeconomic status, country, comorbidity) moderate the efficacy of digital interventions. METHODS A systematic search of various sources (ECSCOhost PsycInfo, PubMed, Web of Science, Scopus, EBSCOhost ERIC, Google Scholar, ProQuest Dissertations & Theses) including five peer-reviewed journals was conducted to identify relevant meta-analyses up to December 2023, and 11 meta-analyses were included in the final review. RESULTS Overall, our review elucidates that DMHIs are appropriate for alleviating PTSD symptoms in adults, with more consistent evidence supporting the efficacy of cognitive behavioral therapy (CBT)-based, compared to non-CBT-based, interventions when compared to control conditions. However, we found inconclusive evidence that the efficacy of DMHIs varied according to intervention timeframe, therapeutic guidance, or sample characteristics. LIMITATIONS A relatively limited number of different populations was sampled across meta-analyses. Further, while our review focused on PTSD symptoms to indicate the efficacy of digital interventions, other indices of effectiveness were not examined. CONCLUSION Our findings indicate the clinical utility of DMHIs for managing PTSD symptoms particularly when CBT-based intervention techniques are employed.
Collapse
Affiliation(s)
| | - Jerica Koh
- Singapore Management University, Singapore
| | - Xun Ci Soh
- Singapore Management University, Singapore
| | - Nadyanna M Majeed
- Singapore Management University, Singapore; National University of Singapore, Singapore
| | | |
Collapse
|
2
|
Bevilacqua L, Fox-Smith L, Lampard O, Rojas N, Zavitsanou G, Meiser-Stedman R, Beazley P. Effectiveness of technology-assisted vs face-to-face cognitive behavioural therapy for anxiety and depression in children and young people: A systematic review and meta-analysis. Clin Child Psychol Psychiatry 2024:13591045241259070. [PMID: 38870346 DOI: 10.1177/13591045241259070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
BACKGROUND Cognitive Behavioural Therapy (CBT) has been proven to be effective for anxiety and depression in children and young people (CYP). Over the past 20 years there have been several attempts at delivering CBT through apps, online software, videogames, but also with a therapist via phone or videoconferencing platforms, with promising results for the "technology-assisted" versions. However, most research, have compared online CBT to waiting lists, and not many studies looked at the effectiveness of face-to-face (f2f) CBT versus technology-assisted CBT. METHODS Adopting the PRISMA guidelines, we evaluated 1849 citations and identified 10 eligible studies. Studies were identified through the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, PubMed/MEDLINE, Web of Science, and Scopus. RESULTS Ten studies met our inclusion criteria. The studies included a variety of technology-assisted forms of CBT, including videoconferencing and online CBT. Of these, seven looked at the effectiveness of technology-assisted CBT for anxiety in CYP, and seven looked at depression. The meta-analyses had low heterogeneity and showed that technology-assisted CBT was non-inferior to f2f CBT for anxiety and depression in CYP (d = 0.06 and 0.12 respectively). CONCLUSIONS Technology-assisted CBT may be a valid alternative for the treatment of anxiety and depression in CYP. Future studies should consider what specific delivery modalities are most cost-effective.
Collapse
Affiliation(s)
- Leonardo Bevilacqua
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, UK
| | - Lana Fox-Smith
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, UK
| | - Olivia Lampard
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, UK
| | - Natalia Rojas
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, UK
| | - Georgia Zavitsanou
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, UK
| | - Richard Meiser-Stedman
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, UK
| | - Peter Beazley
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, UK
| |
Collapse
|
3
|
Paiva JM, Dos Santos Melani M, Marques ESN, Arcosy CV, Coutinho ESF, Ventura P, Berger W. The efficacy of internet-delivered cognitive-behavioral therapy for posttraumatic stress disorder according to the mean age of patients: a systematic review and meta-analysis. PSYCHOL HEALTH MED 2024; 29:683-697. [PMID: 38083873 DOI: 10.1080/13548506.2023.2292478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 12/04/2023] [Indexed: 03/26/2024]
Abstract
Internet-delivered cognitive-behavioral therapy (I-CBT) is effective in treating post-traumatic stress disorder (PTSD) symptoms, offering enhanced accessibility and cost-effectiveness. However, it's important to note that these technologies may not be suitable for all age groups. Therefore, we conducted a systematic review and meta-analysis to determine if the effectiveness of I-CBT in treating PTSD varies based on the patients' mean age. We conducted a systematic review of the literature, focusing on randomized controlled trials (RCTs) in the ISI Web of Science, PubMed/MEDLINE, and PsycINFO databases. Following this, we performed a meta-analysis and evaluated the risk of bias using the Cochrane risk of bias quality assessment tool. In this study, we examined patient-related factors (civil or military status, age, and gender), clinical characteristics (baseline PTSD severity and type of trauma), and treatment characteristics (type of intervention, synchronous or asynchronous delivery, and the number of sessions) as independent variables. The dependent variable was the reduction in mean PTSD symptoms. Five RCTs out of 1,552 screened studies were included in this review, all of which showed some level of concern regarding potential bias. Our meta-analysis indicates that I-CBT is equally effective regardless of patients' mean age. Since all RCTs included only provide the mean age of the patients, further randomized controlled trials should address the effectiveness of I-CBT among different age groups.
Collapse
Affiliation(s)
- Jéssica Meirelles Paiva
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marina Dos Santos Melani
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Elisa Schoenche Nunes Marques
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cheyenne von Arcosy
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Paula Ventura
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - William Berger
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
4
|
Bragesjö M, Ivanov VZ, Andersson E, Rück C. Exploring the feasibility and acceptance of huddinge online prolonged exposure therapy (HOPE) for severe and complex PTSD. Eur J Psychotraumatol 2024; 15:2320607. [PMID: 38436944 PMCID: PMC10913705 DOI: 10.1080/20008066.2024.2320607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/09/2024] [Indexed: 03/05/2024] Open
Abstract
Background: Trauma-focused cognitive behavioural therapy such as prolonged exposure is considered firsthand choice for treatment of posttraumatic stress disorder (PTSD) but is seldom available in regular care. Digital therapy is proposed to bridge this gap, but its effectiveness for severe and complex PTSD is uncertain. The primary objective of the current study was to examine the feasibility, acceptability, and preliminary effects of digital therapist-guided prolonged exposure (Huddinge Online Prolonged Exposure; HOPE).Method: Thirty participants with moderate to severe PTSD, with the majority self-reporting complex PTSD symptoms, received HOPE over a ten-week period. Eighty percent of participants had been diagnosed with other psychiatric comorbidity by a mental health professional. Primary outcome was the feasibility and acceptability of treatment. Participants were repeatedly assessed using clinician- and self-rated outcome measures at baseline, during the treatment period, post-treatment, and at 1-month and 6-month follow-ups to estimate preliminary treatment effects. The Clinician Administered PTSD Scale version 5 (CAPS-5), administered by independent assessors, evaluated PTSD symptom severity.Results: HOPE proved feasible and effective, delivering evidence-based treatment content in a psychiatric outpatient setting with reduced therapist time. The treatment was well-tolerated, with no severe adverse events and a 17% dropout rate. Sixty-four percent completed the exposure-based portion of the treatment, and overall satisfaction measured by the Client Satisfaction Questionnaire was moderate. Furthermore, significant reductions in PTSD symptoms as assessed with the CAPS-5 (Cohen's d = 1.30 [95% CI -1.79 to -0.82]) at the primary endpoint 1 month which were sustained at the 6-month follow up.Conclusion: Altogether, this study indicate feasibility of treating severe and complex PTSD through a digital PE intervention, thereby building upon and extending previous research findings. Large-scale controlled trials are needed to further validate the specific effect and long-term benefits of HOPE.Trial registration: ClinicalTrials.gov identifier: NCT05560854.
Collapse
Affiliation(s)
- Maria Bragesjö
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden
| | - Volen Z. Ivanov
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden
| |
Collapse
|
5
|
McCall H, Dear BF, Landry C, Beahm JD, Gregory J, Titov N, Carleton RN, Hadjistavropoulos HD. Internet-delivered cognitive behavioural therapy for symptoms of PTSD among public safety personnel: Initial outcomes of an open cohort preference trial of transdiagnostic and disorder-specific therapy. Internet Interv 2023; 33:100656. [PMID: 37609530 PMCID: PMC10440509 DOI: 10.1016/j.invent.2023.100656] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/27/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023] Open
Abstract
Public safety personnel (PSP) face high rates of mental health problems and many barriers to care. Initial outcomes of transdiagnostic internet-delivered cognitive behavioural therapy (ICBT) tailored for PSP are promising, but prior research has not evaluated outcomes of PTSD-specific ICBT among PSP or PSP's preferences for transdiagnostic or PTSD-specific ICBT. The current paper presents the initial outcomes (N = 150) of a mixed-methods observational study designed to (a) investigate preferences for transdiagnostic or PTSD-specific ICBT among PSP with elevated symptoms of PTSD and/or a primary concern with PTSD symptoms and (b) explore potential differences in client engagement, satisfaction, and symptom changes between the two forms of ICBT. PSP completed questionnaires before and after their preferred ICBT program. Mixed-methods analyses included generalized estimating equations, descriptive statistics, and inductive conventional qualitative content analysis. More clients (n = 85; 57 %) selected transdiagnostic ICBT than PTSD-specific ICBT (n = 65; 43 %), but the difference in the number of clients who selected each course was not statistically significant. Clients in both ICBT programs reported similar and favorable treatment satisfaction (e.g., 98 % would recommend the course to a friend), treatment engagement (i.e., 69 % accessed at least four of the five lessons), and pre-post improvement in symptoms (e.g., Hedges' g = 0.81 for reduction in PTSD symptom). Transdiagnostic ICBT resulted in greater reductions in symptoms of panic disorder than PTSD-specific ICBT. Qualitative analyses showed similarities across the ICBT programs in client feedback. The current study provides further evidence supporting the use and outcomes of ICBT for PSP in both transdiagnostic and disorder-specific formats. Implications for the literatures on PSP mental health and ICBT, as well as practical recommendations, are discussed.
Collapse
Affiliation(s)
- Hugh McCall
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
- Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Blake F. Dear
- School of Psychological Sciences, Macquarie University, Balaclava Rd, Macquarie Park, NSW 2109, Australia
- eCentreClinic, Macquarie University, Balaclava Rd, Macquarie Park, NSW 2109, Australia
| | - Caeleigh Landry
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
- Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Janine D. Beahm
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
- Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Julia Gregory
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
- Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Nickolai Titov
- School of Psychological Sciences, Macquarie University, Balaclava Rd, Macquarie Park, NSW 2109, Australia
- eCentreClinic, Macquarie University, Balaclava Rd, Macquarie Park, NSW 2109, Australia
| | - R. Nicholas Carleton
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
- Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Heather D. Hadjistavropoulos
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
- Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
| |
Collapse
|
6
|
Sasseville M, LeBlanc A, Tchuente J, Boucher M, Dugas M, Gisèle M, Barony R, Chouinard MC, Beaulieu M, Beaudet N, Skidmore B, Cholette P, Aspiros C, Larouche A, Chabot G, Gagnon MP. The impact of technology systems and level of support in digital mental health interventions: a secondary meta-analysis. Syst Rev 2023; 12:78. [PMID: 37143171 PMCID: PMC10157597 DOI: 10.1186/s13643-023-02241-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 04/20/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND The majority of people with a chronic disease (e.g., diabetes, hypertension, COPD) have more than one concurrent condition and are also at higher risk for developing comorbidities in mental health, including anxiety and depression. There is an urgent need for more relevant and accurate data on digital interventions in this area to prepare for an increase demand for mental health services. The aim of this study was to conduct a meta-analysis of the digital mental health interventions for people with comorbid physical and mental chronic diseases to compare the effect of technology systems and level of support. METHODS This secondary meta-analysis follows a rapid review of systematic reviews, a virtual workshop with knowledge users to identify research questions and a modified Delphi study to guide research methods: What types of digital health interventions (according to a recognized categorization) are the most effective for the management of concomitant mental health and chronic disease conditions in adults? We conducted a secondary analysis of the primary studies identified in the rapid review. Two reviewers independently screened the titles and abstracts and applied inclusion criteria: RCT design using a digital mental health intervention in a population of adults with another chronic condition, published after 2010 in French or English, and including an outcome measurement of anxiety or depression. RESULTS Seven hundred eight primary studies were extracted from the systematic reviews and 84 primary studies met the inclusion criteria Digital mental health interventions were significantly more effective than in-person care for both anxiety and depression outcomes. Online messaging was the most effective technology to improve anxiety and depression scores; however, all technology types were effective. Interventions partially supported by healthcare professionals were more effective than self-administered. CONCLUSIONS While our meta-analysis identifies digital intervention's characteristics are associated with better effectiveness, all technologies and levels of support could be used considering implementation context and population. TRIAL REGISTRATION The protocol for this review is registered in the National Collaborating Centre for Methods and Tools (NCCMT) COVID-19 Rapid Evidence Service (ID 75).
Collapse
Affiliation(s)
- Maxime Sasseville
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada.
| | - Annie LeBlanc
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada
| | - Jack Tchuente
- VITAM Research Center on Sustainable Health, Quebec City, Canada
| | | | - Michèle Dugas
- VITAM Research Center on Sustainable Health, Quebec City, Canada
| | | | | | | | | | - Nicolas Beaudet
- Université de Sherbrooke, Omnimed, Sherbrooke, Quebec, Canada
| | - Becky Skidmore
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada
| | - Pascale Cholette
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale, Quebec City, Canada
| | - Christine Aspiros
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada
| | - Alain Larouche
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada
| | - Guylaine Chabot
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada
| | - Marie-Pierre Gagnon
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada
| |
Collapse
|
7
|
Li J, Gao L, Bao R, Ji R, He Q, Tang X, Zhang W, Qu Z. Comparative efficacy for different age groups of psychological or psychosocial treatments on post-traumatic stress disorder: protocol for systematic review, meta-analysis and meta-regression analysis. BMJ Open 2023; 13:e066569. [PMID: 36639203 PMCID: PMC9843179 DOI: 10.1136/bmjopen-2022-066569] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION It remains unknown whether psychological or psychosocial treatments for post-traumatic stress disorder (PTSD) have comparable effects across the life span. This study aims at comparing the effects of psychological/psychosocial treatments for PTSD between different age groups of youth, early-middle adults and late adults. METHODS AND ANALYSIS A systematic search will be conducted among thirteen electronic databases, including Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, EMBASE, ERIC, PubMed, SCOPUS, Web of Science, Published International Literature on Traumatic Stress, China National Knowledge Infrastructure Database, the Wanfang database, the Chinese Scientific Journal Database (VIP Database) and ProQuest Dissertations and Theses, from inception to 15 May 2022. Electronic searches will be supplemented by a comprehensive grey literature search in Conference proceedings and trial registries. Randomised controlled trials (RCTs) comparing psychological or psychosocial treatments for PTSD with control conditions in all age groups will be included. The primary outcome is the between-treatments efficacy for PTSD that refers to the outcomes of the RCTs included in the meta-analysis. Effect sizes will be calculated for all comparisons and pooled with a fixed effects model or a random effects model. Differences in the efficacy of psychological/psychosocial therapies for PTSD across the age groups will be examined by stratified analyses and meta-regression analyses. ETHICS AND DISSEMINATION Data used in this study will be anonymised. These data will not be used for other purposes than research. Authors who supply the data will be acknowledged. The authors declare that no conflicts of interest exist. The findings of this study will be disseminated through briefing reports, publications and presentations. TRIAL REGISTRATION NUMBER CRD42022334305.
Collapse
Affiliation(s)
- Jia Li
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Liru Gao
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Ruiji Bao
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Rui Ji
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Qianyun He
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Xinfeng Tang
- Department of Psychology, Renmin University, Beijing, China
| | - Weijun Zhang
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Zhiyong Qu
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| |
Collapse
|
8
|
McLean C, Davis CA, Miller M, Ruzek J, Neri E. The Effects of an Exposure-Based Mobile App on Symptoms of Posttraumatic Stress Disorder in Veterans: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2022; 10:e38951. [PMID: 36331540 PMCID: PMC9675013 DOI: 10.2196/38951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/09/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Barriers to accessing in-person care can prevent veterans with posttraumatic stress disorder (PTSD) from receiving trauma-focused treatments such as exposure therapy. Mobile apps may help to address unmet need for services by offering tools for users to self-manage PTSD symptoms. Renew is a mobile mental health app that focuses on exposure therapy and incorporates a social support function designed to promote user engagement. OBJECTIVE We examined the preliminary efficacy of Renew with and without support from a research staff member compared with waitlist among 93 veterans with clinically significant PTSD symptoms. We also examined the impact of study staff support on participant engagement with the app. METHODS In a pilot randomized controlled trial, we compared Renew with and without support from a research staff member (active use condition) with waitlist (delayed use condition) over 6 weeks. Participants were recruited through online advertisements. The Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) was used to measure PTSD symptoms at pre, post, and 6-week follow-up. Usage data were collected to assess engagement with Renew. RESULTS Results indicated a small effect size (d=-0.39) favoring those in the active use conditions relative to the delayed use condition, but the between-group difference was not significant (P=.29). There were no differences on indices of app engagement between the 2 active use conditions. Exploratory analyses found that the number of support persons users added to the app, but not the number of support messages received, was positively correlated with app engagement. CONCLUSIONS Findings suggest Renew may hold promise as a self-management tool to reduce PTSD symptoms in veterans. Involving friends and family in mobile mental health apps may help bolster engagement with no additional cost to public health systems. TRIAL REGISTRATION ClinicalTrials.gov NCT04155736; https://clinicaltrials.gov/ct2/show/NCT04155736.
Collapse
Affiliation(s)
- Carmen McLean
- National Center for Posttraumatic Stress Disorder, Dissemination and Training Division, Department of Veterans Affairs, Menlo Park, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
| | - C Adrian Davis
- National Center for Posttraumatic Stress Disorder, Dissemination and Training Division, Department of Veterans Affairs, Menlo Park, CA, United States
| | - Madeleine Miller
- National Center for Posttraumatic Stress Disorder, Dissemination and Training Division, Department of Veterans Affairs, Menlo Park, CA, United States
| | - Josef Ruzek
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
- Department of Psychology, University of Colorado, Colorado Springs, CO, United States
| | - Eric Neri
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
| |
Collapse
|
9
|
Lindsey M, Sullivan K, Chemtob C, Ancharski K, Jaccard J, Cloitre M, Urquiza A, Timmer S, Okosi M, Kaplan D. A randomized controlled trial to assess the efficacy of Parenting-STAIR in treating maternal PTSD to reduce maltreatment recidivism: protocol for the Safe Mothers, Safe Children study. Trials 2022; 23:432. [PMID: 35606818 PMCID: PMC9125354 DOI: 10.1186/s13063-022-06354-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/25/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Child maltreatment recidivism substantially increases the likelihood of adverse life outcomes, but there is little evidence that family preservation services are effective at reducing recidivism. Mothers in child welfare have very high rates of trauma exposure; maternal post-traumatic stress disorder (PTSD) is an intervention target that has the potential to reduce abuse and neglect. The Safe Mothers, Safe Children (SMSC) intervention program involves the delivery of an innovative combination of interventions, including Skills Training in Affective and Interpersonal Regulation (STAIR) and Parent-Child Interaction Therapy (PCIT). The combined intervention, Parenting-STAIR (P-STAIR), targets maternal PTSD and comorbid depression symptoms to reduce the adverse effects of PTSD on parenting, improve positive parenting skills, and prevent maltreatment recidivism. METHODS This study is a two-arm randomized controlled trial: P-STAIR (23 sessions) versus supportive counseling (23 sessions). Participants are mothers receiving child welfare family preservation services (FPS), with a child in the age range of 1-8 years old and meeting diagnostic criteria for PTSD (with/without depression). Clinical assessment occurs at pre-treatment (baseline), two in-treatment assessments (mid-assessment #1 after module 9 and mid-assessment #2 after module 15), post-treatment, and at a 6-month follow-up. Recidivism will be measured using the New York State Child Welfare Registry (NYSCWR). We will enroll a total of 220 participants over 4 years: half (N = 110) randomly assigned to the P-STAIR condition and half (N = 110) to the supportive counseling condition. DISCUSSION This is the first RCT to investigate the efficacy of P-STAIR. The findings for the trial have the potential to contribute to the expansion of evidence-based practices for maternal PTSD, maltreatment, and child welfare.
Collapse
Affiliation(s)
- Michael Lindsey
- Silver School of Social Work, New York University, New York, NY, USA. .,McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, New York, NY, USA.
| | - Kathrine Sullivan
- grid.137628.90000 0004 1936 8753Silver School of Social Work, New York University, New York, NY USA
| | - Claude Chemtob
- grid.137628.90000 0004 1936 8753Silver School of Social Work, New York University, New York, NY USA ,grid.137628.90000 0004 1936 8753Grossman School of Medicine, New York University, New York, NY USA
| | - Kelly Ancharski
- grid.137628.90000 0004 1936 8753McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, New York, NY USA
| | - James Jaccard
- grid.137628.90000 0004 1936 8753Silver School of Social Work, New York University, New York, NY USA
| | - Marylène Cloitre
- grid.240324.30000 0001 2109 4251Institute for Trauma and Stress, New York University Langone Medical Center, New York, NY USA ,grid.168010.e0000000419368956National Center for PTSD Dissemination and Training Division, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA
| | - Anthony Urquiza
- grid.27860.3b0000 0004 1936 9684CAARE Diagnostic & Treatment Center, Department of Pediatrics, University of California, Sacramento, CA USA
| | - Susan Timmer
- grid.27860.3b0000 0004 1936 9684CAARE Diagnostic & Treatment Center, Department of Pediatrics, University of California, Sacramento, CA USA
| | - Mercedes Okosi
- grid.137628.90000 0004 1936 8753McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, New York, NY USA
| | - Debra Kaplan
- grid.137628.90000 0004 1936 8753McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, New York, NY USA
| |
Collapse
|
10
|
Wright SL, Karyotaki E, Bisson JI, Cuijpers P, Papola D, Witteveen AB, Seedat S, Sijbrandij M. Protocol for individual participant data meta-analysis of interventions for post-traumatic stress. BMJ Open 2022; 12:e054830. [PMID: 35168977 PMCID: PMC8852733 DOI: 10.1136/bmjopen-2021-054830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Several evidence-based treatments are effective for post-traumatic stress disorder (PTSD), yet a substantial proportion of patients do not respond or dropout of treatment. We describe the protocol for a systematic review and individual participant data meta-analysis (IPD-MA) aimed at assessing the effectiveness and adverse effects of psychotherapy and pharmacotherapy interventions for treating PTSD. Additionally, we seek to examine moderators and predictors of treatment outcomes. METHOD AND ANALYSIS This IPD-MA includes randomised controlled trials comparing psychotherapy and pharmacotherapy interventions for PTSD. PubMed, Embase, PsycINFO, PTSDpubs and CENTRAL will be screened up till the 11th of January 2021. The target population is adults with above-threshold baseline PTSD symptoms on any standardised self-report measure. Trials will only be eligible if at least 70% of the study sample have been diagnosed with PTSD by means of a structured clinical interview. The primary outcomes of this IPD-MA are PTSD symptom severity, and response rate. Secondary outcomes include treatment dropout and adverse effects. Two independent reviewers will screen major bibliographic databases and past reviews. Authors will be contacted to contribute their participant-level datasets. Datasets will be merged into a master dataset. A one-stage IPD-MA will be conducted focusing on the effects of psychological and pharmacological interventions on PTSD symptom severity, response rate, treatment dropout and adverse effects. Subsequent analyses will focus on examining the effect of moderators and predictors of treatment outcomes. These will include sociodemographic, treatment-related, symptom-related, resilience, intervention, trauma and combat-related characteristics. By determining the individual factors that influence the effectiveness of specific PTSD treatments, we will gain insight into personalised treatment options for PTSD. ETHICS AND DISSEMINATION Specific ethics approval for an IPD-MA is not required as this study entails secondary analysis of existing anonymised data. The results of this study will be published in peer-reviewed scientific journals and presentations.
Collapse
Affiliation(s)
- Simonne Lesley Wright
- Department of Clinical, Neuro- and Developmental Psychology and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Psychiatry, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Davide Papola
- WHO Collaborating Centre for Research and Training In Mental Health and Service Evaluation, and Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Anke B Witteveen
- Department of Clinical, Neuro- and Developmental Psychology and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
11
|
Siddaway AP, Meiser‐Stedman R, Chester V, Finn J, Leary CO, Peck D, Loveridge C. Trauma-focused guided self-help interventions for posttraumatic stress disorder: A meta-analysis of randomized controlled trials. Depress Anxiety 2022; 39:675-685. [PMID: 35621368 PMCID: PMC9796235 DOI: 10.1002/da.23272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 01/27/2023] Open
Abstract
Trauma-focused guided self-help (TF-GSH) is an important alternative to psychological therapy delivered by a therapist. This meta-analysis evaluates the efficacy of TF-GSH in reducing posttraumatic stress disorder (PTSD) symptoms and comorbid depressive and anxiety symptoms. A total of 17 trials were included that compared a TF-GSH intervention (N = 610) to various control comparators (N = 570). Control conditions included treatment as usual (k = 2), waiting list (k = 11), phone monitoring (k = 1), nontrauma writing (k = 1), general support (k = 1), and supportive counseling (k = 1). A moderate- to large-sized effect favouring TF-GSH was observed for PTSD (k = 17, g = -0.81, 95% confidence interval [CI]: -1.24, -0.39) and a moderate-sized effect was observed for depressive (k = 13, g = -0.73, 95% CI: -1.16, -0.31) and anxiety (k = 11, g = -0.72, 95% CI: -1.18, -0.27) symptoms, with considerable heterogeneity. Moderator analyses were all not statistically significant. Results indicate that TF-GSH is a promising treatment for PTSD and comorbid depressive and anxiety symptoms. We discuss the nature, extent, and quality of the literature to provide a point of departure for future research. TF-GSH (and unguided self-help) may not be appropriate for certain individuals at certain times. Exploring a broad range of treatment delivery modalities will move the field closer towards a model of evidence-based care in which the likely appropriate dose and type of intervention can be matched to individuals based on presenting problems and other variables.
Collapse
Affiliation(s)
- Andy P. Siddaway
- Institute of Health & Wellbeing, University of GlasgowGlasgowScotland
| | - Richard Meiser‐Stedman
- Department of Clinical PsychologyNorwich Medical School, University of East Anglia, Norwich Research ParkNorwichUK
| | - Verity Chester
- Department of PsychiatryHertfordshire Partnership University NHS Foundation Trust, Little Plumstead HospitalNorwichUK
| | - Jack Finn
- Department of Clinical PsychologyNorwich Medical School, University of East Anglia, Norwich Research ParkNorwichUK
| | - Cliodhna O. Leary
- Department of Clinical PsychologyNorwich Medical School, University of East Anglia, Norwich Research ParkNorwichUK
| | - David Peck
- Department of Clinical PsychologyNorwich Medical School, University of East Anglia, Norwich Research ParkNorwichUK
| | - Camilla Loveridge
- Department of Clinical PsychologyNorwich Medical School, University of East Anglia, Norwich Research ParkNorwichUK
| |
Collapse
|
12
|
Schulte C, Zarski AC, Sachser C, Rosner R, Ebert DD. Internet- and mobile-based trauma-focused intervention for adolescents and young adults with posttraumatic stress disorder: a study protocol of a proof-of-concept feasibility study. Eur J Psychotraumatol 2022; 13:2101345. [PMID: 35923687 PMCID: PMC9341372 DOI: 10.1080/20008198.2022.2101345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
UNLABELLED Introduction: Although evidence-based treatments for posttraumatic stress disorder (PTSD) in adolescents and young adults exist, affected youth do not have sufficient access to these treatments due to structural and attitudinal barriers. Internet- and mobile-based interventions (IMIs) can help fill this healthcare gap, but such programmes have not yet been sufficiently evaluated in youth with PTSD. Aim: This study aims to investigate the feasibility of an IMI for youth with PTSD in a one-arm, non-randomised, prospective proof-of-concept feasibility study. Methods: We aim to recruit 32 youth between 15 and 21 years old with clinically relevant posttraumatic stress symptoms (CATS ≥ 21), who will receive access to the IMI. The IMI consists of nine sessions involving psychoeducation, emotion regulation and coping skills, written-based imaginal exposure, cognitive restructuring and relapse prevention. Participants will be guided by an eCoach, who provides weekly semi-standardised written feedback on completed sessions and adherence reminders. We will use a formal feasibility framework to assess different dimensions of feasibility: (1) recruitment capability and resulting sample characteristics, (2) data collection procedures and outcome measures, (3) acceptability of the IMI and study procedures, (4) resources and ability to manage and implement the study and IMI and (5) participants' responses to the IMI in terms of symptom severity and satisfaction. Additionally, potential negative effects related to the intervention will be assessed. Assessments take place pre-, mid- and post-intervention and at follow-up, including semi-structured clinical telephone interviews for PTSD diagnostics at pre- and post-intervention assessment. Qualitative interviews will be conducted to investigate the youth perspectives on the IMI. Discussion: This study aims to determine the feasibility of a guided IMI for youth with PTSD to adapt the IMI as closely as possible to youth needs and to inform the design, procedure and safety management of a large-scale efficacy RCT. Trial registration: German Clinical Trials Register identifier: DRKS00023341. HIGHLIGHTS Evidence-based care for adolescents after trauma is not widely available.• This study evaluates the feasibility of a guided trauma-focused Internet intervention as a time- and location-independent low-threshold treatment option for adolescents and young adults with posttraumatic stress disorder.
Collapse
Affiliation(s)
- Christina Schulte
- Department of Sports and Health Sciences, Professorship Psychology and Digital Mental Health Care, Technical University of Munich, Munich, Germany
| | - Anna-Carlotta Zarski
- Department of Sports and Health Sciences, Professorship Psychology and Digital Mental Health Care, Technical University of Munich, Munich, Germany.,Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Cedric Sachser
- Department of Child and Adolescent Psychiatry/ Psychotherapy, University Ulm, Ulm, Germany
| | - Rita Rosner
- Section of Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstätt, Germany
| | - David Daniel Ebert
- Department of Sports and Health Sciences, Professorship Psychology and Digital Mental Health Care, Technical University of Munich, Munich, Germany
| |
Collapse
|
13
|
Zuelke AE, Luppa M, Löbner M, Pabst A, Schlapke C, Stein J, Riedel-Heller SG. Effectiveness and Feasibility of Internet-Based Interventions for Grief After Bereavement: Systematic Review and Meta-analysis. JMIR Ment Health 2021; 8:e29661. [PMID: 34889769 PMCID: PMC8701663 DOI: 10.2196/29661] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although grief and its symptoms constitute a normal reaction to experiences of loss, some of those affected still report elevated levels of distress after an extended period, often termed complicated grief. Beneficial treatment effects of face-to-face therapies, for example, grief counseling or cognitive behavioral therapy against complicated grief, have been reported. Evaluations of internet- and mobile-based interventions targeting symptoms of grief in bereaved individuals with regard to objective quality criteria are currently lacking. OBJECTIVE We aim to conduct a systematic review and meta-analysis on the effectiveness and feasibility of internet- and mobile-based interventions against symptoms of grief after bereavement. METHODS We conducted systematic literature searches of randomized controlled trials or feasibility studies published before January 9, 2020, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, in PubMed, PsycINFO, Web of Science Core Collection, and the Cochrane Library. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations system. We further assessed aspects of feasibility and rated quality of interventions using criteria suggested by an expert panel on mental health care (German Association for Psychiatry, Psychotherapy, and Psychosomatics). A random-effects meta-analysis was conducted to assess between-group effect sizes. RESULTS In total, 9 trials (N=1349) were included. Of these, 7 studies were analyzed meta-analytically. Significant effects were found for symptoms of grief (g=0.54, 95% CI 0.32-0.77), depression (g=0.44, 95% CI 0.20-0.68), and posttraumatic stress (g=0.82, 95% CI 0.63-1.01). Heterogeneity was moderate for grief and depression (I2=48.75% and 55.19%, respectively) and low for posttraumatic stress symptoms (I2=0%). The overall quality of evidence was graded low (grief and depression) to moderate (posttraumatic stress). User satisfaction with the interventions was high, as was the quality of the interventions assessed using objective quality criteria. CONCLUSIONS Internet- or mobile-based interventions might constitute an effective treatment approach against symptoms of grief in bereaved adults. However, the small sample sizes and limited number of studies included in the review warrant further investigation. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) CRD42012002100; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=131428.
Collapse
Affiliation(s)
- Andrea E Zuelke
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Margrit Löbner
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Christine Schlapke
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| |
Collapse
|
14
|
Bureau R, Bemmouna D, Faria CGF, Goethals AAC, Douhet F, Mengin AC, Fritsch A, Zinetti Bertschy A, Frey I, Weiner L. My Health Too: Investigating the Feasibility and the Acceptability of an Internet-Based Cognitive-Behavioral Therapy Program Developed for Healthcare Workers. Front Psychol 2021; 12:760678. [PMID: 34925163 PMCID: PMC8677821 DOI: 10.3389/fpsyg.2021.760678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/12/2021] [Indexed: 12/22/2022] Open
Abstract
Background: The COVID-19 crisis has had a considerable mental health impact on healthcare workers. High levels of psychological distress are expected to have a significant impact on healthcare systems, warranting the need for evidence-based psychological interventions targeting stress and fostering resilience in this population. Online cognitive behavioral therapy (CBT) has proved to be effective in targeting stress and promoting resilience. However, online CBT programs targeting stress in healthcare workers are lacking. Objective: The aim of our study is to evaluate the feasibility and acceptability of an internet-based CBT intervention, the My Health Too program we developed during the first COVID-19 epidemic peak in France. Methods: We recruited 10 participants among Alsace region hospital staff during the first peak of the pandemic in France. They were given 1 week to test the website and were then asked to answer an internet survey and a semi-structured phone interview. Results: We conducted a thematic analysis of the content from the phone interviews. Major themes were identified, discussed and coded: the technical aspects, the content of the website and its impact on participants' emotions and everyday life. Overall, the participants reported finding the website easy to use and interactive. They described the resources as easy to understand, readily usable, and useful in inducing calm and in helping them practice self-compassion. Conclusion: Our results suggest that the My Health Too online CBT program is highly feasible and acceptable to healthcare workers during the highly stressful times of the pandemic peak. The feedback provided helped to improve the program whose efficacy is to be tested.
Collapse
Affiliation(s)
- Raven Bureau
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Doha Bemmouna
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Department of Psychology, Laboratoire de Psychologie des Cognitions, Université de Strasbourg, Strasbourg, France
| | | | - Anne-Aline Catteau Goethals
- Department of Psychology, Laboratoire de Psychologie des Cognitions, Université de Strasbourg, Strasbourg, France
| | - Floriane Douhet
- Department of Psychology, Laboratoire de Psychologie des Cognitions, Université de Strasbourg, Strasbourg, France
| | | | - Aurélie Fritsch
- Department of Psychology, Laboratoire de Psychologie des Cognitions, Université de Strasbourg, Strasbourg, France
| | | | - Isabelle Frey
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Department of Psychology, Laboratoire de Psychologie des Cognitions, Université de Strasbourg, Strasbourg, France
| | - Luisa Weiner
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Department of Psychology, Laboratoire de Psychologie des Cognitions, Université de Strasbourg, Strasbourg, France
| |
Collapse
|
15
|
Barnett P, Goulding L, Casetta C, Jordan H, Sheridan-Rains L, Steare T, Williams J, Wood L, Gaughran F, Johnson S. Implementation of Telemental Health Services Before COVID-19: Rapid Umbrella Review of Systematic Reviews. J Med Internet Res 2021; 23:e26492. [PMID: 34061758 PMCID: PMC8335619 DOI: 10.2196/26492] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/30/2021] [Accepted: 04/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Telemental health care has been rapidly adopted for maintaining services during the COVID-19 pandemic, and a substantial interest is now being devoted in its future role. Service planning and policy making for recovery from the pandemic and beyond should draw on both COVID-19 experiences and the substantial research evidence accumulated before this pandemic. OBJECTIVE We aim to conduct an umbrella review of systematic reviews available on the literature and evidence-based guidance on telemental health, including both qualitative and quantitative literature. METHODS Three databases were searched between January 2010 and August 2020 for systematic reviews meeting the predefined criteria. The retrieved reviews were independently screened, and those meeting the inclusion criteria were synthesized and assessed for risk of bias. Narrative synthesis was used to report these findings. RESULTS In total, 19 systematic reviews met the inclusion criteria. A total of 15 reviews examined clinical effectiveness, 8 reported on the aspects of telemental health implementation, 10 reported on acceptability to service users and clinicians, 2 reported on cost-effectiveness, and 1 reported on guidance. Most reviews were assessed to be of low quality. The findings suggested that video-based communication could be as effective and acceptable as face-to-face formats, at least in the short term. Evidence on the extent of digital exclusion and how it can be overcome and that on some significant contexts, such as children and young people's services and inpatient settings, was found to be lacking. CONCLUSIONS This umbrella review suggests that telemental health has the potential to be an effective and acceptable form of service delivery. However, we found limited evidence on the impact of its large-scale implementation across catchment areas. Combining previous evidence and COVID-19 experiences may allow realistic planning for the future implementation of telemental health.
Collapse
Affiliation(s)
- Phoebe Barnett
- Centre for Outcomes Research and Effectiveness, Division of Psychology and Language Sciences, University College London, London, United Kingdom.,NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Lucy Goulding
- King's Improvement Science, Centre for Implementation Science, King's College London, London, United Kingdom
| | - Cecilia Casetta
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom
| | - Harriet Jordan
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley NHS Trust, London, United Kingdom
| | - Luke Sheridan-Rains
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Thomas Steare
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Julie Williams
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, United Kingdom
| | - Lisa Wood
- Division of Psychiatry, University College London, London, United Kingdom
| | - Fiona Gaughran
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley NHS Trust, London, United Kingdom
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom.,Camden and Islington NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
16
|
Fitzpatrick S, Wagner AC, Crenshaw AO, Varma S, Whitfield KM, Valela R, Di Bartolomeo AA, Fulham L, Martin-Newnham C, Mensah DH, Collins A, Landy MS, Morland L, Doss BD, Monson CM. Initial outcomes of couple HOPES: A guided online couple intervention for PTSD and relationship enhancement. Internet Interv 2021; 25:100423. [PMID: 34401382 PMCID: PMC8350611 DOI: 10.1016/j.invent.2021.100423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 12/30/2022] Open
Abstract
Couple HOPES (Helping Overcome PTSD and Enhance Satisfaction) is a guided, online couple intervention adapted from Cognitive-Behavioral Conjoint Therapy for posttraumatic stress disorder (PTSD). It was created to overcome a range of barriers to accessing evidence-based treatments for PTSD and the intimate relationship problems associated with it. This manuscript describes initial outcomes of the intervention in a series of 10 couples. Participants were military, veteran and first responders with probable PTSD and their intimate partners. Couples completed the program and measurements of PTSD, relationship satisfaction, and secondary outcomes at pre-, mid-, and post-intervention. Mean satisfaction for the program was high and it was completed by seven of ten couples. Participants with PTSD evidenced significant and large pre- to post-intervention effect size improvements in PTSD symptoms (g = 0.80) and perceived health (g = 1.13). They also exhibited non-significant but medium effect size pre- to post-intervention improvements in quality of life (g = 0.62), and depression (g = 0.53), and small effect size pre- to post-intervention improvements in argumentativeness (g = 0.43), anger (g = 0.31), and anxiety (g = 0.31). Partners reported significant and moderate pre- to post-intervention effect size improvements in relationship satisfaction (g = 0.68), and medium but not significant effect size improvements in accommodation of PTSD (g = 0.56). Results provide initial support for the feasibility, acceptability, and efficacy of Couple HOPES for improving PTSD and relationship satisfaction. However, more testing in larger samples, including with randomized controlled designs, is needed.
Collapse
Affiliation(s)
- Skye Fitzpatrick
- Department of Psychology, York University, 4700 Keele St., Toronto, ON M3J 1P3, Canada,Corresponding author at: Department of Psychology, York University, 4700 Keele Street, Toronto, Ontario M3J 1P3, Canada.
| | - Anne C. Wagner
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada,Remedy, 703 Bloor St. W, #201, Toronto, ON M6G 1L5, Canada
| | - Alexander O. Crenshaw
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada
| | - Sonya Varma
- Department of Psychology, York University, 4700 Keele St., Toronto, ON M3J 1P3, Canada
| | - Kristen M. Whitfield
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada
| | - Robert Valela
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada
| | | | - Lindsay Fulham
- Department of Psychology, York University, 4700 Keele St., Toronto, ON M3J 1P3, Canada
| | - Cait Martin-Newnham
- Department of Psychology, York University, 4700 Keele St., Toronto, ON M3J 1P3, Canada
| | - Desiree H. Mensah
- Department of Psychology, York University, 4700 Keele St., Toronto, ON M3J 1P3, Canada
| | - Alexis Collins
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada
| | - Meredith S.H. Landy
- Remedy, 703 Bloor St. W, #201, Toronto, ON M6G 1L5, Canada,MindBeacon, 175 Bloor St. E., Toronto, ON M4W 358, Canada
| | - Leslie Morland
- VA San Diego Healthcare System, San Diego, CA, USA and University of California San Diego, La Jolla, 3350 La Jolla Village Dr., San Diego, CA 92161, United States of America
| | - Brian D. Doss
- University of Miami, 1320 S Dixie Hwy, Coral Gables, FL, 33146, United States of America
| | - Candice M. Monson
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3, Canada
| |
Collapse
|
17
|
Simon N, Robertson L, Lewis C, Roberts NP, Bethell A, Dawson S, Bisson JI. Internet-based cognitive and behavioural therapies for post-traumatic stress disorder (PTSD) in adults. Cochrane Database Syst Rev 2021; 5:CD011710. [PMID: 34015141 PMCID: PMC8136365 DOI: 10.1002/14651858.cd011710.pub3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Therapist-delivered trauma-focused psychological therapies are effective for post-traumatic stress disorder (PTSD) and have become the accepted first-line treatments. Despite the established evidence-base for these therapies, they are not always widely available or accessible. Many barriers limit treatment uptake, such as the number of qualified therapists available to deliver the interventions; cost; and compliance issues, such as time off work, childcare, and transportation, associated with the need to attend weekly appointments. Delivering Internet-based cognitive and behavioural therapy (I-C/BT) is an effective and acceptable alternative to therapist-delivered treatments for anxiety and depression. OBJECTIVES To assess the effects of I-C/BT for PTSD in adults. SEARCH METHODS We searched MEDLINE, Embase, PsycINFO and the Cochrane Central Register of Controlled Trials to June 2020. We also searched online clinical trial registries and reference lists of included studies and contacted the authors of included studies and other researchers in the field to identify additional and ongoing studies. SELECTION CRITERIA We searched for RCTs of I-C/BT compared to face-to-face or Internet-based psychological treatment, psychoeducation, wait list, or care as usual. We included studies of adults (aged over 16 years), in which at least 70% of the participants met the diagnostic criteria for PTSD, according to the Diagnostic and Statistical Manual (DSM) or the International Classification of Diseases (ICD). DATA COLLECTION AND ANALYSIS Two review authors independently assessed abstracts, extracted data, and entered data into Review Manager 5. The primary outcomes were severity of PTSD symptoms and dropouts. Secondary outcomes included diagnosis of PTSD after treatment, severity of depressive and anxiety symptoms, cost-effectiveness, adverse events, treatment acceptability, and quality of life. We analysed categorical outcomes as risk ratios (RRs), and continuous outcomes as mean differences (MD) or standardised mean differences (SMDs), with 95% confidence intervals (CI). We pooled data using a fixed-effect meta-analysis, except where heterogeneity was present, in which case we used a random-effects model. We independently assessed the included studies for risk of bias and we evaluated the certainty of available evidence using the GRADE approach; we discussed any conflicts with at least one other review author, with the aim of reaching a unanimous decision. MAIN RESULTS We included 13 studies with 808 participants. Ten studies compared I-C/BT delivered with therapist guidance to a wait list control. Two studies compared guided I-C/BT with I-non-C/BT. One study compared guided I-C/BT with face-to-face non-C/BT. There was substantial heterogeneity among the included studies. I-C/BT compared with face-to-face non-CBT Very low-certainty evidence based on one small study suggested face-to-face non-CBT may be more effective than I-C/BT at reducing PTSD symptoms post-treatment (MD 10.90, 95% CI 6.57 to 15.23; studies = 1, participants = 40). There may be no evidence of a difference in dropout rates between treatments (RR 2.49, 95% CI 0.91 to 6.77; studies = 1, participants = 40; very low-certainty evidence). The study did not measure diagnosis of PTSD, severity of depressive or anxiety symptoms, cost-effectiveness, or adverse events. I-C/BT compared with wait list Very low-certainty evidence showed that, compared with wait list, I-C/BT may be associated with a clinically important reduction in PTSD post-treatment (SMD -0.61, 95% CI -0.93 to -0.29; studies = 10, participants = 608). There may be no evidence of a difference in dropout rates between the I-C/BT and wait list groups (RR 1.25, 95% CI 0.97 to 1.60; studies = 9, participants = 634; low-certainty evidence). I-C/BT may be no more effective than wait list at reducing the risk of a diagnosis of PTSD after treatment (RR 0.53, 95% CI 0.28 to 1.00; studies = 1, participants = 62; very low-certainty evidence). I-C/BT may be associated with a clinically important reduction in symptoms of depression post-treatment (SMD -0.51, 95% CI -0.97 to -0.06; studies = 7, participants = 473; very low-certainty evidence). Very low-certainty evidence also suggested that I-C/BT may be associated with a clinically important reduction in symptoms of anxiety post-treatment (SMD -0.61, 95% CI -0.89 to -0.33; studies = 5, participants = 345). There were no data regarding cost-effectiveness. Data regarding adverse events were uncertain, as only one study reported an absence of adverse events. I-C/BT compared with I-non-C/BT There may be no evidence of a difference in PTSD symptoms post-treatment between the I-C/BT and I-non-C/BT groups (SMD -0.08, 95% CI -0.52 to 0.35; studies = 2, participants = 82; very low-certainty evidence). There may be no evidence of a difference between dropout rates from the I-C/BT and I-non-C/BT groups (RR 2.14, 95% CI 0.97 to 4.73; studies = 2, participants = 132; I² = 0%; very low-certainty evidence). Two studies found no evidence of a difference in post-treatment depressive symptoms between the I-C/BT and I-non-C/BT groups (SMD -0.12, 95% CI -0.78 to 0.54; studies = 2, participants = 84; very low-certainty evidence). Two studies found no evidence of a difference in post-treatment symptoms of anxiety between the I-C/BT and I-non-C/BT groups (SMD 0.08, 95% CI -0.78 to 0.95; studies = 2, participants = 74; very low-certainty evidence). There were no data regarding cost-effectiveness. Data regarding adverse effects were uncertain, as it was not discernible whether adverse effects reported were attributable to the intervention. AUTHORS' CONCLUSIONS While the review found some beneficial effects of I-C/BT for PTSD, the certainty of the evidence was very low due to the small number of included trials. This review update found many planned and ongoing studies, which is encouraging since further work is required to establish non-inferiority to current first-line interventions, explore mechanisms of change, establish optimal levels of guidance, explore cost-effectiveness, measure adverse events, and determine predictors of efficacy and dropout.
Collapse
Affiliation(s)
- Natalie Simon
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Lindsay Robertson
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Catrin Lewis
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Neil P Roberts
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- Psychology & Psychological Therapies Directorate, Cardiff and Vale University Health Board, Cardiff, UK
| | - Andrew Bethell
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
- Changing Minds UK, Warrington, UK
| | - Sarah Dawson
- Cochrane Common Mental Disorders, University of York, York, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| |
Collapse
|
18
|
Lifestyle medicine for depression: A meta-analysis of randomized controlled trials. J Affect Disord 2021; 284:203-216. [PMID: 33609955 DOI: 10.1016/j.jad.2021.02.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 01/13/2021] [Accepted: 02/01/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The treatment effect of multi-component LM interventions on depressive symptoms has not yet been examined. METHODS We systematically searched six databases from inception to February 2020 to identify randomized controlled trials (RCTs) involving any multi-component LM interventions (physical activity, nutritional advice, sleep management, and/or stress management) on depressive symptoms relative to care as usual (CAU), waitlist (WL), no intervention (NI), or attention control (AC) comparisons. RESULTS Fifty studies with 8,479 participants were included. Multi-component LM interventions reduced depressive symptoms significantly relative to the CAU (p >.001; d = 0.20) and WL/NI (p > .01; d = 0.22) comparisons at immediate posttreatment. However, no significant difference was found when compared with AC. The intervention effects were maintained in the short-term (1- to 3-month follow-up) relative to the CAU comparison (p > .05; d = 0.25), but not in the medium- and long-term. The moderator analyses examining the effect of multi-component LM interventions compared with CAU suggested that the number of lifestyle factors adopted was a significant moderator. Although disease type was not a significant moderator, there was a tendency that the clinical effect of multi-component LM interventions was stronger (d = 0.45) in those diagnosed with major depression. No publication bias was detected. LIMITATIONS Low number of RCTs available in some subgroup analyses prevented from finding meaningful effects. Results may not be extended to major depression, because data on secondary depression were captured. CONCLUSION Multi-component LM interventions appeared to be effective in mitigating depressive symptoms; however, the magnitude of the clinical effect was small. Future research is needed to assess more comprehensive and individualized LM interventions which have a greater emphasis on motivational and compliance aspects and focus solely on individuals with depression.
Collapse
|
19
|
Harrington KD, Eres R, Lim MH. The Web-Based Uprise Program for Mental Health in Australian University Students: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e21307. [PMID: 33275115 PMCID: PMC7748961 DOI: 10.2196/21307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND University students are vulnerable to poor mental health, psychological distress, and loneliness relative to nonuniversity student peers. However, the rate of seeking mental health treatment among university students is low. Web-based psychological interventions may provide an opportunity for supporting vulnerable university students who are unlikely to otherwise seek support. OBJECTIVE The aim of this study is to examine the feasibility, acceptability, safety, and efficacy of an existing web-based transdiagnostic cognitive behavioral therapy (CBT) mental health program for use among Australian university students. METHODS This is a pilot randomized controlled trial comparing a self-directed web-based CBT mental health program with a waitlist control. The self-directed modules will be augmented with optional webchat or telephone coaching with a therapist. The recruitment target is 70 university students who do not present with a clinical mental health disorder. Allocation will be made in a 1:1 ratio and will occur after the initial baseline assessment. Assessments will be completed at baseline, upon completion of a 4-week waitlist (waitlist group only), upon completion of the program, and at 3 months after completion of the program. RESULTS The trial was funded in June 2018, and the protocol was approved by the Swinburne University Human Research Ethics Committee in September 2018. Recruitment commenced in October 2018, with the first participant allocated in November 2018. A total of 70 participants were recruited to the trial. The trial recruitment ceased in June 2019, and data collection was finalized in December 2019. We expect the final data analysis to be completed by November 2020 and results to be published early in 2021. The primary outcomes are feasibility, acceptability, safety, and symptoms of depression, anxiety, and stress. The secondary outcomes are psychological wellbeing, quality of life, loneliness, self-reported physical health status, emotion regulation, and cognitive and mindfulness processes. CONCLUSIONS The acceptability, feasibility, safety, and efficacy of a web-based mental health program in university students will be evaluated. Web-based mental health programs offer the opportunity to engage university students who may be reluctant to seek support through traditional face-to-face mental health services, and the transdiagnostic approach of the program has the potential to address the breadth of mental health concerns of university students. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry ACTRN12618001604291; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001604291. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/21307.
Collapse
Affiliation(s)
- Karra D Harrington
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Australia.,Center for Healthy Aging, The Pennsylvania State University, University Park, PA, United States
| | - Robert Eres
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Australia.,Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
| | - Michelle H Lim
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Australia.,Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
| |
Collapse
|
20
|
Stefanopoulou E, Lewis D, Mughal A, Larkin J. Digital Interventions for PTSD Symptoms in the General Population: a Review. Psychiatr Q 2020; 91:929-947. [PMID: 32410130 DOI: 10.1007/s11126-020-09745-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There has been a significant development of digital interventions for the treatment of Post-Traumatic Symptom Disorder (PTSD) over the past two decades. However, the majority of research has examined their clinical efficacy for military service members and veteran populations whereas community-based trauma survivors have received significantly less attention. Their effectiveness for this population, therefore, remains unclear. The aim of this review was to evaluate the effectiveness of digitally delivered psychological therapies to alleviate PTSD symptomatology in the general population. Findings showed that digitally delivered Cognitive Behavioural Therapy (iCBT) produced more consistently significant improvements in PTSD symptoms, compared to interapy, expressive writing, psychoeducation, mindfulness, cognitive tasks and psychosocial interventions. iCBT - associated improvements were also independent of the focus (i.e. trauma vs. non-trauma) of the intervention, the provision of therapeutic support (e.g. guided vs. unguided), type of feedback (e.g. automated vs. individualised) or the number of sessions provided. Nevertheless, the number of included studies for subgroup analyses was relatively low. Digital interventions have an enormous potential to improve accessibility, efficiency, clinical effectiveness and personalisation of mental health interventions. Future research is needed to investigate further the use of a wider range of therapeutic approaches across different clinical and subclinical groups and settings and test the impact of these interventions (or components) against a wider range of comparison conditions (e.g. face to face CBT) with optimal power.
Collapse
Affiliation(s)
| | - David Lewis
- Turning Point, Standon House, 21 Mansell Street, London, E1 8AA, UK
| | - Aneesah Mughal
- Turning Point, Standon House, 21 Mansell Street, London, E1 8AA, UK
| | - Jan Larkin
- Turning Point, Standon House, 21 Mansell Street, London, E1 8AA, UK
| |
Collapse
|
21
|
Mendes-Santos C, Andersson G, Weiderpass E, Santana R. Mitigating COVID-19 Impact on the Portuguese Population Mental Health: The Opportunity That Lies in Digital Mental Health. Front Public Health 2020; 8:553345. [PMID: 33313033 PMCID: PMC7701327 DOI: 10.3389/fpubh.2020.553345] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 09/04/2020] [Indexed: 01/09/2023] Open
Abstract
COVID-19 mitigation measures present unprecedented challenges in mental healthcare delivery, posing high risk to the mental health of at-risk populations, namely patients diagnosed with COVID-19, frontline healthcare providers, and those submitted to quarantine or isolation measures, as well as the general population. Ensuring safe and equitable access to mental healthcare by these groups entails resorting to innovative psychosocial intervention strategies, such as digital mental health. In this perspective piece, we describe the impact of COVID-19 on the Portuguese population's mental health, present an overview on initiatives developed to address the challenges currently faced by the Portuguese mental healthcare system, and discuss how the timely implementation of a comprehensive digital mental health strategy, coupling research, education, implementation, and quality assessment initiatives, might buffer COVID-19's impact on the Portuguese society.
Collapse
Affiliation(s)
- Cristina Mendes-Santos
- Department of Culture and Society, Linköping University, Linköping, Sweden
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Fraunhofer Center for Assistive Information and Communication Solutions, Porto, Portugal
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Psychiatry Section, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Rui Santana
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| |
Collapse
|
22
|
Dores AR, Geraldo A, Carvalho IP, Barbosa F. The Use of New Digital Information and Communication Technologies in Psychological Counseling during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207663. [PMID: 33096650 PMCID: PMC7589044 DOI: 10.3390/ijerph17207663] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 12/20/2022]
Abstract
The use of digital information and communication technologies (ICTs) has enabled many professionals to continue to provide their services during the COVID-19 pandemic. However, little is known about the adoption of ICTs by psychologists and the impact of such technologies on their practice. This study aimed to explore psychologists’ practices related with the use of ICTs before and during the COVID-19 lockdown, to identify the main changes that the pandemic has brought and the impact that such changes have had on their practice with clients, and also identify the factors that potentially have affected such changes. The Portuguese Psychologists Association announced the study, and 108 psychologists responded to an online survey during the mandatory lockdown. The results showed that these professionals continued to provide their services due to having adopted ICTs. Comparing with face-to-face interventions, psychologists recognized that additional precautions/knowledge were needed to use such technologies. Despite the challenges identified, they described the experience with the use of ICTs as positive, meeting clients’ adherence, and yielding positive results. Psychologists with the most years of professional experience maintained their services the most, but those with average experience showed the most favorable attitudes toward the use of technologies and web-based interventions.
Collapse
Affiliation(s)
- Artemisa R. Dores
- Center for Rehabilitation Research, School of Health, Polytechnic Institute of Porto, 4200-072 Porto, Portugal
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences of University of Porto, 4200-135 Porto, Portugal; (A.G.); (F.B.)
- Correspondence:
| | - Andreia Geraldo
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences of University of Porto, 4200-135 Porto, Portugal; (A.G.); (F.B.)
| | - Irene P. Carvalho
- CINTESIS and Department of Clinical Neurosciences and Mental Health, School of Medicine, University of Porto (FMUP), 4200-319 Porto, Portugal;
| | - Fernando Barbosa
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences of University of Porto, 4200-135 Porto, Portugal; (A.G.); (F.B.)
| |
Collapse
|
23
|
Etzelmueller A, Vis C, Karyotaki E, Baumeister H, Titov N, Berking M, Cuijpers P, Riper H, Ebert DD. Effects of Internet-Based Cognitive Behavioral Therapy in Routine Care for Adults in Treatment for Depression and Anxiety: Systematic Review and Meta-Analysis. J Med Internet Res 2020; 22:e18100. [PMID: 32865497 PMCID: PMC7490682 DOI: 10.2196/18100] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/06/2020] [Accepted: 06/03/2020] [Indexed: 01/23/2023] Open
Abstract
Background Although there is evidence for the efficacy of internet-based cognitive behavioral therapy (iCBT), the generalizability of results to routine care is limited. Objective This study systematically reviews effectiveness studies of guided iCBT interventions for the treatment of depression or anxiety. Methods The acceptability (uptake, participants’ characteristics, adherence, and satisfaction), effectiveness, and negative effects (deterioration) of nonrandomized pre-post designs conducted under routine care conditions were synthesized using systematic review and meta-analytic approaches. Results A total of 19 studies including 30 groups were included in the analysis. Despite high heterogeneity, individual effect sizes of investigated studies indicate clinically relevant changes, with effect sizes ranging from Hedges’ g=0.42-1.88, with a pooled effect of 1.78 for depression and 0.94 for anxiety studies. Uptake, participants’ characteristics, adherence, and satisfaction indicate a moderate to high acceptability of the interventions. The average deterioration across studies was 2.9%. Conclusions This study provides evidence supporting the acceptability and effectiveness of guided iCBT for the treatment of depression and anxiety in routine care. Given the high heterogeneity between interventions and contexts, health care providers should select interventions that have been proven in randomized controlled clinical trials. The successful application of iCBT may be an effective way of increasing health care in multiple contexts.
Collapse
Affiliation(s)
- Anne Etzelmueller
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,GET.ON Institute GmbH, Hamburg, Germany.,Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Mental Health, Amsterdam, Netherlands
| | - Christiaan Vis
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Mental Health, Amsterdam, Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands.,Department of Global Health and Social Medicine, Harvard Medical School, USA, Boston, MA, United States
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Nickolai Titov
- eCentre Clinic Department of Psychology, Macquarie University, Sydney, Australia
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Mental Health, Amsterdam, Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Mental Health, Amsterdam, Netherlands.,Community Mental Health Centre GGZ inGeest, Amsterdam, Netherlands
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,GET.ON Institute GmbH, Hamburg, Germany.,Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
24
|
Barawi KS, Lewis C, Simon N, Bisson JI. A systematic review of factors associated with outcome of psychological treatments for post-traumatic stress disorder. Eur J Psychotraumatol 2020; 11:1774240. [PMID: 33029317 PMCID: PMC7473314 DOI: 10.1080/20008198.2020.1774240] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Psychological interventions for post-traumatic stress disorder (PTSD) are not always effective and can leave some individuals with enduring symptoms. Little is known about factors that are associated with better or worse treatment outcome. Our objective was to address this gap. METHOD We undertook a systematic review following Cochrane Collaboration Guidelines. We included 126 randomized controlled trials (RCTs) of psychological interventions for PTSD and examined factors that were associated with treatment outcome, in terms of severity of PTSD symptoms post-treatment, and recovery or remission. RESULTS Associations were neither consistent nor strong. Two factors were associated with smaller reductions in severity of PTSD symptoms post-treatment: comorbid diagnosis of depression, and higher PTSD symptom severity at baseline assessment. Higher education, adherence to homework and experience of a more recent trauma were associated with better treatment outcome. CONCLUSION Identifying and understanding why certain factors are associated with treatment outcome is vital to determine which individuals are most likely to benefit from particular treatments and to develop more effective treatments in the future. There is an urgent need for consistent and standardized reporting of factors associated with treatment outcome in all clinical trials.
Collapse
Affiliation(s)
- Kali S Barawi
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Wales, UK
| | - Catrin Lewis
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Wales, UK
| | - Natalie Simon
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Wales, UK
| | - Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Wales, UK
| |
Collapse
|
25
|
|
26
|
Ehlers A, Wild J, Warnock-Parkes E, Grey N, Murray H, Kerr A, Rozental A, Beierl ET, Tsiachristas A, Perera-Salazar R, Andersson G, Clark DM. A randomised controlled trial of therapist-assisted online psychological therapies for posttraumatic stress disorder (STOP-PTSD): trial protocol. Trials 2020; 21:355. [PMID: 32326954 PMCID: PMC7181498 DOI: 10.1186/s13063-020-4176-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/17/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Over the last few decades, effective psychological treatments for posttraumatic stress disorder (PTSD) have been developed, but many patients are currently unable to access these treatments. There is initial evidence that therapist-assisted internet-based psychological treatments are effective for PTSD and may help increase access, but it remains unclear which of these treatments work best and are most acceptable to patients. This randomised controlled trial will compare a trauma-focussed and a nontrauma-focussed therapist-assisted cognitive behavioural Internet treatment for PTSD: Internet-delivered cognitive therapy for PTSD (iCT-PTSD) and internet-delivered stress management therapy (iStress-PTSD). METHODS/DESIGN The study is a single-blind, randomised controlled trial comparing iCT-PTSD, iStress-PTSD and a 13-week wait-list condition, with an embedded process study. Assessors of treatment outcome will be blinded to trial arm. Two hundred and seventeen participants who meet DSM-5 criteria for PTSD will be randomly allocated by a computer programme to iCT-PTSD, iStress-PTSD or wait-list at a 3:3:1 ratio. The primary assessment point is at 13 weeks, and further assessments are taken at 6, 26, 39 and 65 weeks. The primary outcome measure is the severity of PTSD symptoms as measured by the PTSD Checklist for DSM-5 (PCL-5). Secondary measures of PTSD symptoms are the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) and the Impact of Event Scale-Revised (IES-R). Other symptoms and well-being will be assessed with the Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder Scale (GAD-7), WHO (Five) Well-Being Index, Work and Social Adjustment Scale (WSAS), Endicott Quality of Life Scale (QoL), and Insomnia Sleep Index (ISI). Health economics analyses will consider quality of life, productivity, health resource utilisation, employment status and state benefits, and treatment delivery costs. Process analyses will investigate candidate mediators and moderators of outcome. Patient experience will be assessed by interview and questionnaire. DISCUSSION This study will be the first to compare the efficacy of a trauma-focussed and nontrauma-focussed therapist-assisted online cognitive behavioural treatment for people with posttraumatic stress disorder. TRIAL REGISTRATION ISRCTN16806208. Registered prospectively on 5 January 2018.
Collapse
Affiliation(s)
- Anke Ehlers
- Department of Experimental Psychology, University of Oxford, Paradise Square, Oxford, OX1 1TW, UK.
- Oxford Health NHS Foundation Trust, Oxford, OX3 7JX, UK.
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, SE5 8AF, UK.
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ, UK.
| | - Jennifer Wild
- Department of Experimental Psychology, University of Oxford, Paradise Square, Oxford, OX1 1TW, UK
- Oxford Health NHS Foundation Trust, Oxford, OX3 7JX, UK
| | - Emma Warnock-Parkes
- Department of Experimental Psychology, University of Oxford, Paradise Square, Oxford, OX1 1TW, UK
- Oxford Health NHS Foundation Trust, Oxford, OX3 7JX, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ, UK
| | - Nick Grey
- Sussex Partnership NHS Foundation Trust, Aldrington House, 35 New Church Road, Hove, BN3 4AG, UK
| | - Hannah Murray
- Department of Experimental Psychology, University of Oxford, Paradise Square, Oxford, OX1 1TW, UK
- Oxford Health NHS Foundation Trust, Oxford, OX3 7JX, UK
| | - Alice Kerr
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ, UK
| | - Alexander Rozental
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, 113 64, Stockholm, Sweden
| | - Esther T Beierl
- Department of Experimental Psychology, University of Oxford, Paradise Square, Oxford, OX1 1TW, UK
- Oxford Health NHS Foundation Trust, Oxford, OX3 7JX, UK
| | - Apostolos Tsiachristas
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Rafael Perera-Salazar
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, OX2 6GG, UK
| | - Gerhard Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, 113 64, Stockholm, Sweden
- Department of Behavioural Sciences and Learning, Linköping University, 581 83, Linköping, Sweden
| | - David M Clark
- Department of Experimental Psychology, University of Oxford, Paradise Square, Oxford, OX1 1TW, UK
- Oxford Health NHS Foundation Trust, Oxford, OX3 7JX, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ, UK
| |
Collapse
|
27
|
Luppa M, Löbner M, Pabst A, Schlapke C, Stein J, Riedel-Heller SG. Effectiveness and feasibility of internet-based and mobile-based interventions for individuals experiencing bereavement: a systematic review protocol. BMJ Open 2020; 10:e036034. [PMID: 32327480 PMCID: PMC7204864 DOI: 10.1136/bmjopen-2019-036034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/28/2020] [Accepted: 03/20/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Internet-based and mobile-based interventions (IMIs) provide an innovative and efficient self-management tool for mental health problems. This systematic review aims to summarise and critically evaluate studies addressing the effectiveness and feasibility of IMIs for normal and complicated grief in bereaved adults. METHODS AND ANALYSIS The databases MEDLINE, Cochrane Library, PsycINFO, Embase and Web of Science and Google Scholar (for 'grey' literature) will be systematically searched for feasibility studies or randomised controlled trials of IMIs for bereaved adults who were experiencing normal/complicated grief. Data will be extracted and evaluated independently by two reviewers from studies eligible for inclusion. Quality of evidence will be assessed, and results will be synthesised qualitatively and pooled meta-analytically, if sufficient outcome data are available. Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards and Grades of Recommendation, Assessment, Development and Evaluation methodology will be used. ETHICS AND DISSEMINATION No primary data will be collected; thus, ethical approval is not required. The results will be disseminated through a peer-reviewed publication and conference presentations. TRIAL REGISTRATION NUMBER CRD42019131428.
Collapse
Affiliation(s)
- Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Faculty of Medicine, Leipzig, Sachsen, Germany
| | - Margrit Löbner
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Faculty of Medicine, Leipzig, Sachsen, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Faculty of Medicine, Leipzig, Sachsen, Germany
| | - Christine Schlapke
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Faculty of Medicine, Leipzig, Sachsen, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Faculty of Medicine, Leipzig, Sachsen, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Faculty of Medicine, Leipzig, Sachsen, Germany
| |
Collapse
|
28
|
Lewis C, Roberts NP, Andrew M, Starling E, Bisson JI. Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis. Eur J Psychotraumatol 2020; 11:1729633. [PMID: 32284821 PMCID: PMC7144187 DOI: 10.1080/20008198.2020.1729633] [Citation(s) in RCA: 147] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 12/23/2019] [Accepted: 01/24/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Psychological therapies are the recommended first-line treatment for post-traumatic stress disorder (PTSD). Previous systematic reviews have grouped theoretically similar interventions to determine differences between broadly distinct approaches. Consequently, we know little regarding the relative efficacy of the specific manualized therapies commonly applied to the treatment of PTSD. Objective: To determine the effect sizes of manualized therapies for PTSD. Methods: We undertook a systematic review following Cochrane Collaboration guidelines. A pre-determined definition of clinical importance was applied to the results and the quality of evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Results: 114 randomized-controlled trials (RCTs) of 8171 participants were included. There was robust evidence that the therapies broadly defined as CBT with a trauma focus (CBT-T), as well as Eye Movement Desensitization and Reprocessing (EMDR), had a clinically important effect. The manualized CBT-Ts with the strongest evidence of effect were Cognitive Processing Therapy (CPT); Cognitive Therapy (CT); and Prolonged Exposure (PE). There was also some evidence supporting CBT without a trauma focus; group CBT with a trauma focus; guided internet-based CBT; and Present Centred Therapy (PCT). There was emerging evidence for a number of other therapies. Conclusions: A recent increase in RCTs of psychological therapies for PTSD, results in a more confident recommendation of CBT-T and EMDR as the first-line treatments. Among the CBT-Ts considered by the review CPT, CT and PE should be the treatments of choice. The findings should guide evidence informed shared decision-making between patient and clinician.
Collapse
Affiliation(s)
- Catrin Lewis
- National Centre for Mental Health (NCMH), Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Neil P. Roberts
- National Centre for Mental Health (NCMH), Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
- Directorate of Psychology and Psychological Therapies, Cardiff & Vale University Health Board, Cardiff, UK
| | - Martin Andrew
- Cardiff Traumatic Stress Service, Cardiff & Vale University Health Board, Cardiff, UK
| | - Elise Starling
- National Centre for Mental Health (NCMH), Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Jonathan I. Bisson
- National Centre for Mental Health (NCMH), Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| |
Collapse
|
29
|
Sunjaya AP, Chris A, Novianti D. Efficacy, patient-doctor relationship, costs and benefits of utilizing telepsychiatry for the management of post-traumatic stress disorder (PTSD): a systematic review. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2020; 42:102-110. [DOI: 10.1590/2237-6089-2019-0024] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/17/2019] [Indexed: 01/18/2023]
|
30
|
Lewis C, Roberts NP, Gibson S, Bisson JI. Dropout from psychological therapies for post-traumatic stress disorder (PTSD) in adults: systematic review and meta-analysis. Eur J Psychotraumatol 2020; 11:1709709. [PMID: 32284816 PMCID: PMC7144189 DOI: 10.1080/20008198.2019.1709709] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 02/01/2023] Open
Abstract
Background: Despite the established efficacy of psychological therapies for post-traumatic stress disorder (PTSD) there has been little systematic exploration of dropout rates. Objective: To ascertain rates of dropout across different modalities of psychological therapy for PTSD and to explore potential sources of heterogeneity. Method: A systematic review of dropout rates from randomized controlled trials (RCTs) of psychological therapies was conducted. The pooled rate of dropout from psychological therapies was estimated and reasons for heterogeneity explored using meta-regression. Results:: The pooled rate of dropout from RCTs of psychological therapies for PTSD was 16% (95% CI 14-18%). There was evidence of substantial heterogeneity across studies. We found evidence that psychological therapies with a trauma-focus were significantly associated with greater dropout. There was no evidence of greater dropout from therapies delivered in a group format; from studies that recruited participants from clinical services rather than via advertisements; that included only military personnel/veterans; that were limited to participants traumatized by sexual traumas; that included a higher proportion of female participants; or from studies with a lower proportion of participants who were university educated. Conclusions: Dropout rates from recommended psychological therapies for PTSD are high and this appears to be particularly true of interventions with a trauma focus. There is a need to further explore the reasons for dropout and to look at ways of increasing treatment retention.
Collapse
Affiliation(s)
- Catrin Lewis
- National Centre for Mental Health (NCMH), Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Neil P Roberts
- National Centre for Mental Health (NCMH), Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK.,Psychology and Psychological Therapies, Cardiff & Vale University Health Board, Cardiff, UK.,Cardiff University Traumatic Stress Service, Cardiff & Vale University Health Board, Cardiff, UK
| | - Samuel Gibson
- National Centre for Mental Health (NCMH), Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Jonathan I Bisson
- National Centre for Mental Health (NCMH), Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| |
Collapse
|
31
|
Lewis C, Roberts NP, Simon N, Bethell A, Bisson JI. Internet-delivered cognitive behavioural therapy for post-traumatic stress disorder: systematic review and meta-analysis. Acta Psychiatr Scand 2019; 140:508-521. [PMID: 31359407 DOI: 10.1111/acps.13079] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether Internet-delivered cognitive behavioural therapy (i-CBT) is an effective treatment for those who meet diagnostic criteria for post-traumatic stress disorder (PTSD). METHOD A systematic review was undertaken according to Cochrane Collaboration Guidelines. The primary outcome measures were reduction in PTSD symptoms and drop-out. Categorical outcomes were meta-analysed as risk ratios (RRs) and continuous outcomes as mean differences (MDs) or standardised mean differences (SMDs). RESULTS Ten studies with 720 participants were included. Evidence showed that i-CBT may be associated with a clinically important reduction in post-treatment PTSD symptoms compared with wait list (SMD -0.60, 95% confidence interval -0.97 to -0.24; N = 560); however, only three studies reported follow-up data, and there was no evidence to support the maintenance of symptom improvement at follow-up of 3-6 months. There was no evidence of a difference in PTSD symptoms between i-CBT and Internet-delivered non-CBT post-treatment. There was evidence of greater treatment effect from trauma-focused i-CBT than i-CBT without a trauma focus, as well as evidence that treatment effect was increased by the provision of guidance. CONCLUSIONS While the review found some beneficial effects of i-CBT for PTSD post-treatment, the quality of the evidence was very low because of the small number of included trials and there was insufficient evidence to support the maintenance of improvement at follow-up of 3-6 months. Further work is required to establish non-inferiority to current first-line interventions; to determine long-term efficacy; to explore mechanisms of effect; and to establish optimal levels of guidance.
Collapse
Affiliation(s)
- C Lewis
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - N P Roberts
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK.,Directorate of Psychology and Psychological Therapies, Cardiff & Vale University Health Board, Cardiff, UK
| | - N Simon
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - A Bethell
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - J I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| |
Collapse
|
32
|
Smith P, Dalgleish T, Meiser‐Stedman R. Practitioner Review: Posttraumatic stress disorder and its treatment in children and adolescents. J Child Psychol Psychiatry 2019; 60:500-515. [PMID: 30350312 PMCID: PMC6711754 DOI: 10.1111/jcpp.12983] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2018] [Indexed: 01/19/2023]
Abstract
Important advances in understanding traumatic stress reactions in children and young people have been made in recent years. The aim of this review was to synthesise selected recent research findings, with a focus on their relevance to clinical practice. We therefore address: findings on the epidemiology of trauma exposure and Posttraumatic Stress Disorder (PTSD); recent changes to diagnostic classification; implications for screening and assessment of traumatic stress reactions; and treatment outcome studies including interventions for acute and chronic PTSD, dissemination of effective treatments into community settings, and early interventions. We conclude with recommendations for clinical practice and suggestions for future areas of research.
Collapse
Affiliation(s)
- Patrick Smith
- Department of PsychologyInstitute of Psychiatry Psychology & NeuroscienceKing's College LondonLondonUK
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences UnitUniversity of CambridgeCambridgeUK,Cambridgeshire and Peterborough NHS Foundation TrustCambridgeUK
| | - Richard Meiser‐Stedman
- Department of Clinical Psychology, Norwich Medical SchoolUniversity of East AngliaNorwichUK
| |
Collapse
|
33
|
Evidenced-Based Treatment of Posttraumatic Stress Disorder: An Updated Review of Validated Psychotherapeutic and Pharmacological Approaches. Harv Rev Psychiatry 2019; 26:99-115. [PMID: 29734225 DOI: 10.1097/hrp.0000000000000186] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
LEARNING OBJECTIVES After participating in this activity, learners should be better able to:• Evaluate psychotherapeutic and pharmacologic approaches to treating patients with posttraumatic stress disorder. ABSTRACT A strong evidence base exists for psychological and pharmacological interventions for the treatment of posttraumatic stress disorder (PTSD). The published literature investigating the effectiveness of these treatments in reducing the symptoms and impairments associated with PTSD has expanded substantially in recent years. This review provides a concise overview of the empirical literature examining these treatment approaches. Evidence-based, trauma-focused therapies are recommended as first-line interventions, with the most support for cognitive- and exposure-based approaches. Prolonged exposure and cognitive processing therapy are the two most cited and rigorously investigated. Various other evidence-supported protocols are discussed. Pharmacotherapies can be used when evidence-based psychotherapies are not available or are ineffective, or on the basis of patient preference. Pharmacotherapy with the most support for PTSD includes selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Evidence supports the implementation of these interventions across genders, populations, and settings. Given that little research directly compares the effectiveness of different PTSD interventions and their mechanisms of action, it remains uncertain how to best select and tailor treatments to optimize individual outcomes. Future directions and novel, ongoing research are discussed.
Collapse
|
34
|
Stefanopoulou E, Lewis D, Taylor M, Broscombe J, Larkin J. Digitally Delivered Psychological Interventions for Anxiety Disorders: a Comprehensive Review. Psychiatr Q 2019; 90:197-215. [PMID: 30488330 DOI: 10.1007/s11126-018-9620-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Digital interventions for anxiety disorders have been well-researched over the past two decades. However, reviews to date have focused on internet-based cognitive behavioural therapy (iCBT), whereas other psychological interventions have received less attention. The aim of this review was therefore to evaluate the effectiveness of digitally delivered psychological therapies (CBT, Attention Bias Modification, Exposure Therapy, Applied Relaxation, Bibliotherapy, Psychodynamic Therapy, Mindfulness, Behavioural Stress Management, Counselling) compared with control conditions and/or other psychological interventions for anxiety disorders (Social Anxiety Disorder (SAD), Health Anxiety, Obsessive-Compulsive Disorder (OCD), Post-traumatic Stress Disorder (PTSD), Specific Phobias, Panic Disorder (PD), Generalised Anxiety Disorder (GAD)]. 68 randomised controlled trials (RCTs) were reviewed. SAD was the anxiety disorder for which the most RCTs were conducted. Overall, findings support the effectiveness of iCBT for SAD; for the remaining interventions, although some RCTs indicated significant improvement (within groups) at post-treatment and/or follow up, between group findings were less consistent and overall, methodological differences across trials failed to provide strong supporting evidence. Finally, the level of therapist contact or expertise did not appear to affect much treatment effectiveness. Additional large, methodologically rigorous trials are needed to investigate further whether different digitally delivered psychological interventions are equally effective for anxiety disorders. Moreover, further studies are pertinent in order to examine the maintenance of therapy gains after the end of treatments and understand how these work [(e.g. the influence of therapist factors, user engagement and/or satisfaction, potential access barriers and treatments with diverse population groups (e.g. BME groups)].
Collapse
Affiliation(s)
- Evgenia Stefanopoulou
- Turning Point, Registered Charity, Standon House, 21 Mansell Street, London, E1 8AA, UK.
| | - David Lewis
- Turning Point, Registered Charity, Standon House, 21 Mansell Street, London, E1 8AA, UK
| | - Matthew Taylor
- Turning Point, Registered Charity, Standon House, 21 Mansell Street, London, E1 8AA, UK
| | - James Broscombe
- Turning Point, Registered Charity, Standon House, 21 Mansell Street, London, E1 8AA, UK
| | - Jan Larkin
- Turning Point, Registered Charity, Standon House, 21 Mansell Street, London, E1 8AA, UK
| |
Collapse
|
35
|
Simon N, McGillivray L, Roberts NP, Barawi K, Lewis CE, Bisson JI. Acceptability of internet-based cognitive behavioural therapy (i-CBT) for post-traumatic stress disorder (PTSD): a systematic review. Eur J Psychotraumatol 2019; 10:1646092. [PMID: 31497259 PMCID: PMC6719262 DOI: 10.1080/20008198.2019.1646092] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/26/2019] [Accepted: 07/03/2019] [Indexed: 11/28/2022] Open
Abstract
Background: Internet-delivered Cognitive Behavioural Therapy (i-CBT) offers potential as an alternative, accessible, clinically and cost-effective treatment for post-traumatic stress disorder (PTSD), but little is known about its acceptability. Objective: To review the available evidence to understand the acceptability of i-CBT for PTSD. Method: We undertook a mixed-methods systematic review according to Cochrane Collaboration Guidelines, of randomised controlled trials (RCTs) of i-CBT for adults with PTSD. We examined included studies for measures of acceptability, and possible proxy indicators of acceptability, including dropout rates, which were meta-analysed as risk ratios (RRs). Results: Ten studies with 720 participants were included. We found i-CBT to be acceptable according to specific acceptability measures, and suggestions for acceptability according to some proxy measures of i-CBT programme usage. There was, however, evidence of greater dropout from i-CBT than waitlist (RR 1.39, CI 1.03-1.88; 8 studies; participants = 585) and no evidence of a difference in dropout between i-CBT and i-non-CBT (RR 2.14, CI 0.97-4.73; participants = 132; 2 studies). Conclusion: i-CBT appears a potentially acceptable intervention for adults with PTSD. We identified clinical and research questions, including the status of proxy indicators, and call for standardised, consistent treatment acceptability measurement.
Collapse
Affiliation(s)
- Natalie Simon
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Leah McGillivray
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Neil P Roberts
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK.,Psychology and Psychological Therapies Directorate, Cardiff and Vale University Health Board, Cardiff, UK
| | - Kali Barawi
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Catrin E Lewis
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| |
Collapse
|
36
|
Lewis C, Roberts NP, Bethell A, Robertson L, Bisson JI. Internet-based cognitive and behavioural therapies for post-traumatic stress disorder (PTSD) in adults. Cochrane Database Syst Rev 2018; 12:CD011710. [PMID: 30550643 PMCID: PMC6516951 DOI: 10.1002/14651858.cd011710.pub2] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Therapist-delivered trauma-focused psychological therapies are an effective treatment for post-traumatic stress disorder (PTSD). These have become the accepted first-line treatments for the disorder. Despite the established evidence-base for these therapies, they are not always widely available or accessible. Many barriers limit treatment uptake, such as the limited number of qualified therapists to deliver the interventions, cost, and compliance issues, such as time off work, childcare, and transportation, associated with the need to attend weekly appointments. Delivering cognitive behavioural therapy (CBT) on the Internet is an effective and acceptable alternative to therapist-delivered treatments for anxiety and depression. However, fewer Internet-based therapies have been developed and evaluated for PTSD, and uncertainty surrounds the efficacy of Internet-based cognitive and behavioural therapy (I-C/BT) for PTSD. OBJECTIVES To assess the effects of I-C/BT for PTSD in adults. SEARCH METHODS We searched the Cochrane Common Mental Disorders Group's Specialised Register (CCMDCTR) to June 2016 and identified four studies meeting the inclusion criteria. The CCMDCTR includes relevant randomised controlled trials (RCT) from MEDLINE, Embase, and PsycINFO. We also searched online clinical trial registries and reference lists of included studies, and contacted researchers in the field to identify additional and ongoing studies. We ran an update search on 1 March 2018, and identified four additional completed studies, which we added to the analyses along with two that were previously awaiting classification. SELECTION CRITERIA We searched for RCTs of I-C/BT compared to face-to-face or Internet-based psychological treatment, psychoeducation, wait list or care as usual. We included studies of adults (aged over 16 years or over), in which at least 70% of the participants met the diagnostic criteria for PTSD, according to the Diagnostic and Statistical Manual (DSM) or the International Classification of Diseases (ICD). DATA COLLECTION AND ANALYSIS We entered data into Review Manager 5 software. We analysed categorical outcomes as risk ratios (RRs), and continuous outcomes as mean differences (MD) or standardised mean differences (SMDs), with 95% confidence intervals (CI). We pooled data with a fixed-effect meta-analysis, except where heterogeneity was present, in which case we used a random-effects model. Two review authors independently assessed the included studies for risk of bias; any conflicts were discussed with a third author, with the aim of reaching a unanimous decision. MAIN RESULTS We included 10 studies with 720 participants in the review. Eight of the studies compared I-C/BT delivered with therapist guidance to a wait list control. Two studies compared guided I-C/BT with I-non-C/BT. There was considerable heterogeneity among the included studies.Very low-quality evidence showed that, compared with wait list, I-C/BT may be associated with a clinically important reduction in PTSD post-treatment (SMD -0.60, 95% CI -0.97 to -0.24; studies = 8, participants = 560). However, there was no evidence of a difference in PTSD symptoms when follow-up was less than six months (SMD -0.43, 95% CI -1.41 to 0.56; studies = 3, participants = 146). There may be little or no difference in dropout rates between the I-C/BT and wait list groups (RR 1.39, 95% CI 1.03 to 1.88; studies = 8, participants = 585; low-quality evidence). I-C/BT was no more effective than wait list at reducing the risk of a diagnosis of PTSD after treatment (RR 0.53, 95% CI 0.28 to 1.00; studies = 1, participants = 62; very low-quality evidence). I-C/BT may be associated with a clinically important reduction in symptoms of depression both post-treatment (SMD -0.61, 95% CI -1.17 to -0.05; studies = 5, participants = 425; very low-quality evidence). Very low-quality evidence also suggested that I-C/BT may be associated with a clinically important reduction in symptoms of anxiety post-treatment (SMD -0.67, 95% CI -0.98 to -0.36; studies = 4, participants = 305), and at follow-up less than six months (MD -12.59, 95% CI -20.74 to -4.44; studies = 1, participants = 42; very low-quality evidence). The effects of I-C/BT on quality of life were uncertain (SMD 0.60, 95% CI 0.08 to 1.12; studies = 2, participants = 221; very low-quality evidence).Two studies found no difference in PTSD symptoms between the I-C/BT and I-non-C/BT groups when measured post-treatment (SMD -0.08, 95% CI -0.52 to 0.35; studies = 2, participants = 82; very low-quality evidence), or when follow-up was less than six months (SMD 0.08, 95% CI -0.41 to 0.57; studies = 2, participants = 65; very low-quality evidence). However, those who received I-C/BT reported their PTSD symptoms were better at six- to 12-month follow-up (MD -8.83, 95% CI -17.32 to -0.34; studies = 1, participants = 18; very low-quality evidence). Two studies found no difference in depressive symptoms between the I-C/BT and I-non-C/BT groups when measured post-treatment (SMD -0.12, 95% CI -0.78 to 0.54; studies = 2, participants = 84; very low-quality evidence) or when follow-up was less than six months (SMD 0.20, 95% CI -0.31 to 0.71; studies = 2, participants = 61; very low-quality evidence). However, those who received I-C/BT reported their depressive symptoms were better at six- to 12-month follow-up (MD -8.34, 95% CI -15.83 to -0.85; studies = 1, participants = 18; very low-quality evidence). Two studies found no difference in symptoms of anxiety between the I-C/BT and I-non-C/BT groups when measured post-treatment (SMD 0.08, 95% CI -0.78 to 0.95; studies = 2, participants = 74; very low-quality evidence) or when follow-up was less than six months (SMD -0.16, 95% CI -0.67 to 0.35; studies = 2, participants = 60; very low-quality evidence). However, those who received I-C/BT reported their symptoms of anxiety were better at six- to 12-month follow-up (MD -8.05, 95% CI -15.20 to -0.90; studies = 1, participants = 18; very low-quality evidence).None of the included studies reported on cost-effectiveness or adverse events. AUTHORS' CONCLUSIONS While the review found some beneficial effects of I-C/BT for PTSD, the quality of the evidence was very low due to the small number of included trials. Further work is required to: establish non-inferiority to current first-line interventions, explore mechanisms of change, establish optimal levels of guidance, explore cost-effectiveness, measure adverse events, and determine predictors of efficacy and dropout.
Collapse
Affiliation(s)
- Catrin Lewis
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff, UK, CF24 4HQ
| | | | | | | | | |
Collapse
|
37
|
Nollett C, Lewis C, Kitchiner N, Roberts N, Addison K, Brookes-Howell L, Cosgrove S, Cullen K, Ehlers A, Heke S, Kelson M, Lovell K, Madden K, McEwan K, McNamara R, Phillips C, Pickles T, Simon N, Bisson J. Pragmatic RAndomised controlled trial of a trauma-focused guided self-help Programme versus InDividual trauma-focused cognitive Behavioural therapy for post-traumatic stress disorder (RAPID): trial protocol. BMC Psychiatry 2018; 18:77. [PMID: 29580220 PMCID: PMC5870753 DOI: 10.1186/s12888-018-1665-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/14/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There is good evidence that trauma-focused therapies for Post-Traumatic Stress Disorder are effective. However, they are not always feasible to deliver due a shortage of trained therapists and demands on the patient. An online trauma-focused Guided Self-Help (GSH) programme which could overcome these barriers has shown promise in a pilot study. This study will be the first to evaluate GSH against standard face-to-face therapy to assess its suitability for use in the NHS. METHODS The study is a large-scale multi-centre pragmatic randomised controlled non-inferiority trial, with assessors masked to treatment allocation. One hundred and ninety-two participants will be randomly allocated to receive either face-to-face trauma-focused cognitive behaviour therapy (TFCBT) or trauma-focused online guided self-help (GSH). The primary outcome will be the severity of symptoms of PTSD over the previous week as measured by the Clinician Administered PTSD Scale for DSM5 (CAPS-5) at 16 weeks post-randomisation. Secondary outcome measures include PTSD symptoms over the previous month as measured by the CAPS-5 at 52 weeks plus the Impact of Event Scale - revised (IES-R), Work and Social Adjustment Scale (WSAS), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), Alcohol Use Disorders Test (AUDIT-O), Multidimensional Scale for Perceived Social Support (MSPSS), short Post-Traumatic Cognitions Inventory (PTCI), Insomnia Severity Index (ISI) and General Self Efficacy Scale (GSES) measured at 16 and 52 weeks post-randomisation. Changes in health-related quality of life will be measured by the EQ-5D and the level of healthcare resource utilisation for health economic analysis will be determined by an amended version of the Client Socio-Demographic and Service Receipt Inventory European Version. The Client Satisfaction Questionnaire (CSQ) will be collected at 16 weeks post-randomisation to evaluate treatment satisfaction. DISCUSSION This study will be the first to compare online GSH with usual face-to-face therapy for PTSD. The strengths are that it will test a rigorously developed intervention in a real world setting to inform NHS commissioning. The potential challenges of delivering such a pragmatic study may include participant recruitment, retention and adherence, therapist retention, and fidelity of intervention delivery. TRIAL REGISTRATION ISRCTN13697710 registered on 20/12/2016.
Collapse
Affiliation(s)
- Claire Nollett
- Centre for Trials Research, Cardiff University, 4th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Catrin Lewis
- 0000 0001 0807 5670grid.5600.3Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Haydn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK
| | - Neil Kitchiner
- 0000 0001 0807 5670grid.5600.3Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Haydn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK ,0000 0001 0807 5670grid.5600.3Cardiff & Vale University Health Board, Cardiff University School of Medicine, Haydn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK
| | - Neil Roberts
- 0000 0001 0807 5670grid.5600.3Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Haydn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK ,0000 0001 0807 5670grid.5600.3Cardiff & Vale University Health Board, Cardiff University School of Medicine, Haydn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK
| | - Katy Addison
- 0000 0001 0807 5670grid.5600.3Centre for Trials Research, Cardiff University, 4th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Lucy Brookes-Howell
- 0000 0001 0807 5670grid.5600.3Centre for Trials Research, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Sarah Cosgrove
- Independent Public and Patient Involvement (PPI) representative, Cardiff, UK
| | - Katherine Cullen
- 0000 0001 0658 8800grid.4827.9Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP UK
| | - Anke Ehlers
- grid.470387.fDepartment of Experimental Psychology, Oxford Centre for Anxiety Disorders and Trauma, Paradise Square, Oxford, OX1 1TW UK
| | - Sarah Heke
- grid.439501.aGrenfell Emotional Health and Wellbeing service, Central and Northwest London (CNWL) NHS Trust, St Charles Hospital, Exmoor Street, London, UK ,0000 0004 0581 2008grid.451052.7Formerly at Institute of Psychotrauma, East London Foundation NHS Trust, 86 Old Montague Street, London, E1 8NN UK
| | - Mark Kelson
- 0000 0004 1936 8024grid.8391.3Department of Mathematics, Laver Building, University of Exeter, Exeter, EX4 4QRE UK
| | - Karina Lovell
- 0000000121662407grid.5379.8Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Room 6.322a, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Kim Madden
- 0000 0001 0807 5670grid.5600.3Centre for Trials Research, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Kirsten McEwan
- 0000 0001 2232 4004grid.57686.3aDepartment of Psychology, University of Derby, Kedleston Road, Derby, DE22 1GB UK
| | - Rachel McNamara
- 0000 0001 0807 5670grid.5600.3Centre for Trials Research, Cardiff University, 4th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Ceri Phillips
- 0000 0001 0658 8800grid.4827.9Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP UK
| | - Timothy Pickles
- 0000 0001 0807 5670grid.5600.3Centre for Trials Research, Cardiff University, 4th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Natalie Simon
- 0000 0001 0807 5670grid.5600.3Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Haydn Ellis Building, Maindy Road, Cardiff, CF24 4HQ UK
| | - Jonathan Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Haydn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK.
| |
Collapse
|
38
|
Bakalar JL, Carlin EA, Blevins CL, Ghahramanlou-Holloway M. Generalizability of Evidence-Based PTSD Psychotherapies to Suicidal Individuals: A Review of the Veterans Administration and Department of Defense Clinical Practice Guidelines. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jennifer L. Bakalar
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - Elisabeth A. Carlin
- Trauma Services Program, Washington DC Veterans Affairs Medical Center, Washington, D.C
| | - Cara L. Blevins
- Department of Health Psychology, The University of North Carolina at Charlotte
| | | |
Collapse
|
39
|
Kunovski I, Donker T, Driessen E, Cuijpers P, Andersson G, Sijbrandij M. Internet-delivered cognitive behavioral therapy for posttraumatic stress disorder in international humanitarian aid workers: Study protocol. Internet Interv 2017; 10:23-28. [PMID: 30135749 PMCID: PMC6084880 DOI: 10.1016/j.invent.2017.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/11/2017] [Accepted: 09/17/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Humanitarian aid workers are likely to be exposed or witness complex emergencies. Posttraumatic stress disorder (PTSD) is one of the most widespread and most commonly studied mental health problems after exposure to adversities and trauma. However, face-to-face treatment has limited utilization in the resource-constrained settings where humanitarian aid workers often operate. Internet-delivered cognitive behavioral therapy (iCBT) is a treatment option with the potential to improve the access to evidence-based care for humanitarian aid workers. Until now, only a few studies have evaluated iCBT in the treatment of PTSD. No studies have yet explored the feasibility of iCBT for humanitarian aid workers with PTSD. The aim of this study is to investigate the participants' experiences and progress with the treatment, in order to determine whether TELLUS is acceptable for humanitarian aid workers. METHODS AND DESIGN A pilot feasibility study will be conducted with 20 humanitarian aid workers with a full or subclinical PTSD diagnosis according to DSM-IV criteria. The intervention used is TELLUS, which is a therapist-assisted Internet-delivered treatment program based on trauma-focused CBT components for individuals with PTSD. It contains eight text-based modules, where each module is expected to be completed within one week. DISCUSSION This study may set the ground for a large-scale randomized control trial that would test the effectiveness and cost-effectiveness of the program. The study may contribute to the better understanding of PTSD treatment and increase the availability of evidence-based treatments in resource-constrained settings.
Collapse
Affiliation(s)
- Ivo Kunovski
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands
| | - Tara Donker
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands
| | - Ellen Driessen
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands
| | - Gerhard Andersson
- Department of Behavioral Sciences and Learning, Linköping University, Sweden, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Marit Sijbrandij
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands
| |
Collapse
|
40
|
Lewis CE, Farewell D, Groves V, Kitchiner NJ, Roberts NP, Vick T, Bisson JI. Internet-based guided self-help for posttraumatic stress disorder (PTSD): Randomized controlled trial. Depress Anxiety 2017; 34:555-565. [PMID: 28557299 DOI: 10.1002/da.22645] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 02/27/2017] [Accepted: 02/27/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND There are numerous barriers that limit access to evidence-based treatment for posttraumatic stress disorder (PTSD). Internet-based guided self-help is a treatment option that may help widen access to effective intervention, but the approach has not been sufficiently explored for the treatment of PTSD. METHODS Forty two adults with DSM-5 PTSD of mild to moderate severity were randomly allocated to internet-based self-help with up to 3 h of therapist assistance, or to a delayed treatment control group. The internet-based program included eight modules that focused on psychoeducation, grounding, relaxation, behavioural activation, real-life and imaginal exposure, cognitive therapy, and relapse prevention. The primary outcome measure was reduction in clinician-rated traumatic stress symptoms using the clinician administered PTSD scale for DSM-V (CAPS-5). Secondary outcomes were self-reported PTSD symptoms, depression, anxiety, alcohol use, perceived social support, and functional impairment. RESULTS Posttreatment, the internet-based guided self-help group had significantly lower clinician assessed PTSD symptoms than the delayed treatment control group (between-group effect size Cohen's d = 1.86). The difference was maintained at 1-month follow-up and dissipated once both groups had received treatment. Similar patterns of difference between the two groups were found for depression, anxiety, and functional impairment. The average contact with treating clinicians was 2½ h. CONCLUSIONS Internet-based trauma-focused guided self-help for PTSD is a promising treatment option that requires far less therapist time than current first line face-to-face psychological therapy.
Collapse
Affiliation(s)
| | | | | | | | | | - Tracey Vick
- Cardiff and Vale University Health Board, Cardiff, UK
| | | |
Collapse
|
41
|
Addressing the Needs of Children and Youth in the Context of War and Terrorism: the Technological Frontier. Curr Psychiatry Rep 2017; 19:30. [PMID: 28447296 DOI: 10.1007/s11920-017-0786-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This paper reviews recent literature on the mental health needs of youth in the context of war and terrorism. A human rights lens is used to explore issues of accessibility and sustainability in service utilization during times of crisis. The authors present the evolution of services over the last several decades, progressing through individual, school-based, and community-wide interventions by exploring models that focus on symptom reduction and building resilience. This paper highlights the benefits and limitations of traditional intervention methods and proposes a new frontier of intervention development and research. The authors focus on the emerging field of e-mental health services and specifically highlight the utility of virtual reality games in treating trauma-exposed youth. The rapid and easily accessible nature of e-mental health models is presented as one potential solution to barriers in accessibility that can help promote the human rights of youth exposed to war and terrorism.
Collapse
|
42
|
Simblett S, Birch J, Matcham F, Yaguez L, Morris R. A Systematic Review and Meta-Analysis of e-Mental Health Interventions to Treat Symptoms of Posttraumatic Stress. JMIR Ment Health 2017; 4:e14. [PMID: 28526672 PMCID: PMC5451639 DOI: 10.2196/mental.5558] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 01/30/2017] [Accepted: 03/05/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a stress disorder characterized by unwanted intrusive re-experiencing of an acutely distressing, often life-threatening, event, combined with symptoms of hyperarousal, avoidance, as well as negative thoughts and feelings. Evidence-based psychological interventions have been developed to treat these symptoms and reduce distress, the majority of which were designed to be delivered face-to-face with trained therapists. However, new developments in the use of technology to supplement and extend health care have led to the creation of e-Mental Health interventions. OBJECTIVE Our aim was to assess the scope and efficacy of e-Mental Health interventions to treat symptoms of PTSD. METHODS The following databases were systematically searched to identify randomized controlled trials of e-Mental Health interventions to treat symptoms of PTSD as measured by standardized and validated scales: the Cochrane Library, MEDLINE, EMBASE, and PsycINFO (in March 2015 and repeated in November 2016). RESULTS A total of 39 studies were found during the systematic review, and 33 (N=3832) were eligible for meta-analysis. The results of the primary meta-analysis revealed a significant improvement in PTSD symptoms, in favor of the active intervention group (standardized mean difference=-0.35, 95% confidence interval -0.45 to -0.25, P<.001, I2=81%). Several sensitivity and subgroup analyses were performed suggesting that improvements in PTSD symptoms remained in favor of the active intervention group independent of the comparison condition, the type of cognitive behavioral therapy-based intervention, and the level of guidance provided. CONCLUSIONS This review demonstrates an emerging evidence base supporting e-Mental Health to treat symptoms of PTSD.
Collapse
Affiliation(s)
- Sara Simblett
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King's College London, London, United Kingdom
| | - Jennifer Birch
- Springfield University Hospital, South West London and St Georges Mental Health NHS Trust, London, United Kingdom
| | - Faith Matcham
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, United Kingdom
| | - Lidia Yaguez
- King's College Hospital, Clinical Neuropsychology Department, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Robin Morris
- King's College Hospital, Clinical Neuropsychology Department, King's College Hospital NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
43
|
The effect of insurance type on trauma patient access to psychiatric care under the Affordable Care Act. Gen Hosp Psychiatry 2017; 45:19-24. [PMID: 28274334 DOI: 10.1016/j.genhosppsych.2016.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 12/13/2016] [Accepted: 12/16/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The objective of the study was to assess the effect of insurance type (Medicaid, Medicare, private insurance or cash pay) on patients' access to psychiatrists for a new patient consultation. METHOD 240 psychiatrists identified as interested in treating patients with PTSD were called across 8 states. The caller requested an appointment for her fictitious boyfriend who had been in a car accident to be evaluated for PTSD. Each office was called four times to assess the responses for each payment type. From each call, whether an appointment was offered and barriers to an appointment were recorded. RESULTS 21% of psychiatrists would see new patients. 15% of offices scheduled an appointment for a patient with Medicaid, compared to 34% for Medicare, 54% for BlueCross and 93% for cash pay (p<0.001). Medicaid patients confronted more barriers to receiving appointments and had more trouble scheduling appointments in states with expanded Medicaid eligibility. The overall number of Medicaid patients who would be able to theoretically schedule an appointment in states with versus states without expanded Medicaid eligibility was approximately equivalent. Psychiatry practice characteristics, such as whether the practice was academic, were not significantly associated with acceptance of Medicaid. CONCLUSIONS Access to a psychiatrist for a new patient consultation is challenging. Despite expansion of the Affordable Care Act, substantial barriers remain for Medicaid patients in accessing psychiatric care compared to patients with Medicare, private insurance or those who pay cash.
Collapse
|
44
|
Pearl SB, Norton PJ. Transdiagnostic versus diagnosis specific cognitive behavioural therapies for anxiety: A meta-analysis. J Anxiety Disord 2017; 46:11-24. [PMID: 27466074 DOI: 10.1016/j.janxdis.2016.07.004] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/13/2016] [Accepted: 07/14/2016] [Indexed: 12/21/2022]
Abstract
Research evaluating transdiagnostic CBT (tCBT) demonstrates its efficacy. Some evidence suggests equivalence between tCBT and diagnosis-specific CBT (dxCBT), however more investigations are necessary to clarify any difference in efficacy. This meta-analysis was conducted to compare tCBT and dxCBT, and to investigate the differential impact of comorbidity on effect sizes. Pre and post scores from primary anxiety measures in 83 treatment conditions, taken from studies primarily targeting anxiety disorders, were summarised and compared. Meta-regression analyses were then used to test the effects of comorbidity. DxCBT and tCBT meta-effects were found to be large, where g=0.951, 95% CI: 0.874-1.027, and g=1.059, 95% CI: 0.876-1.242, respectively. While statistically different (p=0.008), overlap of confidence intervals indicated a lack of clinical significance. Furthermore, no relationship between comorbidity rate and tCBT outcome was observed. These results were discussed in the context of previous findings in the transdiagnostic CBT literature.
Collapse
Affiliation(s)
- Shaun B Pearl
- School of Psychological Sciences, Clayton, Victoria, Australia
| | - Peter J Norton
- School of Psychological Sciences, Clayton, Victoria, Australia.
| |
Collapse
|
45
|
Gaebel W, Großimlinghaus I, Mucic D, Maercker A, Zielasek J, Kerst A. EPA guidance on eMental health interventions in the treatment of posttraumatic stress disorder (PTSD). Eur Psychiatry 2017; 41:140-152. [PMID: 28242486 DOI: 10.1016/j.eurpsy.2017.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/04/2017] [Accepted: 01/09/2017] [Indexed: 10/20/2022] Open
Abstract
The aim of this EPA guidance was to develop recommendations on eMental health interventions in the treatment of posttraumatic stress disorder (PTSD). A systematic literature search was performed and 40 articles were retrieved and assessed with regard to study characteristics, applied technologies, therapeutic approaches, diagnostic ascertainment, efficacy, sustainability of clinical effects, practicability and acceptance, attrition rates, safety, clinician-supported vs. non-supported interventions and active vs. waiting-list controls. The reviewed studies showed a great heterogeneity concerning study type, study samples, interventions and outcome measures. Based on these findings, five graded recommendations dealing with symptom reduction, acceptability, type of administration, clinician support, self-efficacy and coping were developed.
Collapse
Affiliation(s)
- W Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; LVR Institute for Healthcare Research, Cologne, Germany; WHO Collaborating Center for Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany.
| | - I Großimlinghaus
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; LVR Institute for Healthcare Research, Cologne, Germany; WHO Collaborating Center for Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
| | - D Mucic
- Treatment Centre Little Prince, Copenhagen, Denmark
| | - A Maercker
- Psychopathology and Clinical Intervention, University of Zürich, Zürich, Switzerland
| | - J Zielasek
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; LVR Institute for Healthcare Research, Cologne, Germany; WHO Collaborating Center for Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
| | - A Kerst
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; WHO Collaborating Center for Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
| |
Collapse
|
46
|
Olthuis JV, Wozney L, Asmundson GJG, Cramm H, Lingley-Pottie P, McGrath PJ. Distance-delivered interventions for PTSD: A systematic review and meta-analysis. J Anxiety Disord 2016; 44:9-26. [PMID: 27697658 DOI: 10.1016/j.janxdis.2016.09.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 09/20/2016] [Accepted: 09/20/2016] [Indexed: 12/20/2022]
Abstract
This systematic review and meta-analysis evaluated the efficacy of distance-delivered, guided approaches to treatment (e.g., delivered via telephone, Internet, mail, videoconferencing) for clinical and subclinical posttraumatic stress disorder (PTSD). A comprehensive search yielded 19 randomized controlled trials (1491 participants) to be included. Meta-analyses revealed that distance-delivered interventions led to significant within-group improvements in PTSD symptoms at post-treatment (g=0.81, 95% CI 0.65 to 0.97) and 3-6 month follow-up (g=0.78, 95% CI 0.59 to 0.97). Within-group depression and quality of life outcomes showed similar results, with medium post-treatment and follow-up effects. Compared to a waiting list, distance delivery (specifically, Internet treatments) led to superior PTSD outcomes (g=0.68, 95% CI 0.51 to 0.86). Compared to face-to-face interventions, distance delivery (specifically, videoconferencing treatments) did not result in significantly different PTSD outcomes at post-treatment (g=-0.05, 95% CI -0.31 to 0.20) but led to inferior outcomes at 3-6 month follow-up (g=-0.25, 95% CI -0.44 to -0.07). Distance delivery of PTSD treatment is promising, but research is needed to determine its optimal use.
Collapse
Affiliation(s)
- Janine V Olthuis
- Department of Psychology, University of New Brunswick, PO Box 4400, Fredericton, NB, E3B 5A3, Canada.
| | - Lori Wozney
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS.
| | | | - Heidi Cramm
- School of Rehabilitation Therapy, Queen's University, Kingston, ON.
| | - Patricia Lingley-Pottie
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS; Department of Psychiatry, Dalhousie University, Canada.
| | - Patrick J McGrath
- Departments of Psychiatry, Pediatrics, and Community Health and Epidemiology, Dalhousie University, Canada; IWK Health Centre and Nova Scotia Health Authority, Halifax, NS.
| |
Collapse
|
47
|
Sijbrandij M, Kunovski I, Cuijpers P. EFFECTIVENESS OF INTERNET-DELIVERED COGNITIVE BEHAVIORAL THERAPY FOR POSTTRAUMATIC STRESS DISORDER: A SYSTEMATIC REVIEW AND META-ANALYSIS. Depress Anxiety 2016; 33:783-91. [PMID: 27322710 DOI: 10.1002/da.22533] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/18/2016] [Accepted: 05/22/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Internet-delivered cognitive behavioral therapy (iCBT) is a relatively novel treatment method that may improve the accessibility of mental health care for individuals with posttraumatic stress disorder (PTSD). The aim of this meta-analysis was to evaluate the effectiveness of iCBT compared to inactive (waitlist control and treatment-as-usual (TAU)) and active other interventions in reducing PTSD symptoms. METHODS A meta-analysis of 12 randomized controlled trials (14 comparisons) and 1,306 participants was conducted. RESULTS The pooled effect size of the 11 comparisons (10 studies, 1,139 participants) that compared iCBT to waitlist and TAU control was moderate (g = 0.71, 95% CI [0.49-0.93], P < .001), and showed moderate heterogeneity. The pooled effect size of the three studies (three comparisons) comparing iCBT to other interventions was small (g = 0.28, 95% CI [-0.00 to 0.56], P = .05), with low heterogeneity. CONCLUSION The findings of this systematic review and meta-analysis show that iCBT is an effective treatment for individuals with PTSD and comorbid depressive symptoms. However, further research is needed for effective dissemination of iCBT in clinical practice.
Collapse
Affiliation(s)
- Marit Sijbrandij
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands. .,EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, , VU University, , The Netherlands.
| | - Ivo Kunovski
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, , VU University, , The Netherlands
| |
Collapse
|
48
|
Xu W, Wang J, Wang Z, Li Y, Yu W, Xie Q, He L, Maercker A. Web-based intervention improves social acknowledgement and disclosure of trauma, leading to a reduction in posttraumatic stress disorder symptoms. J Health Psychol 2016; 21:2695-2708. [PMID: 25934590 DOI: 10.1177/1359105315583371] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aims to investigate the effectiveness of web-based intervention on social acknowledgement and disclosure of trauma and to examine the mediating effect of the improvement in social acknowledgement and disclosure of trauma on the reduction of posttraumatic stress disorder symptoms. A randomized controlled trial was used, with 21 participants in a web-based intervention group and 29 participants in a wait-list control group completing a pre-test and post-test. Results showed that social acknowledgement and disclosure of trauma improved significantly after 1-month intervention, and this improvement mediated the reduction in the posttraumatic stress disorder symptoms. Implications and limitations of this study are discussed.
Collapse
Affiliation(s)
- Wei Xu
- 1 Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, P.R. China
| | - Jianping Wang
- 1 Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, P.R. China.,2 Capital Medical University, P.R. China
| | | | - Yifei Li
- 1 Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, P.R. China
| | - Wei Yu
- 1 Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, P.R. China
| | - Qiuyuan Xie
- 1 Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, P.R. China
| | - Li He
- 1 Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, P.R. China
| | | |
Collapse
|
49
|
Sachser C, Rassenhofer M, Goldbeck L. [Trauma-focused Cognitive-behavioral Therapy with children and adolescents: Practice, evidence base, and future directions]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2016; 44:479-490. [PMID: 27270191 DOI: 10.1024/1422-4917/a000436] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Trauma-focused cognitive behavioral therapy (Tf-CBT) is an evidence-based trauma therapy for children and adolescents aged 3–17 years with posttraumatic stress disorder (PTSD). One supportive caregiver is regularly included in the therapeutic process. Tf-CBT consists of eight components and can be summarized by the acronym P.R.A.C.T.I.C.E: Psychoeducation and Parenting skills, Relaxation skills, Affective modulation skills, Cognitive coping skills, Trauma narrative and cognitive processing of the traumatic event(s), In vivo mastery of trauma reminders, Conjoint child-parent sessions, and Enhancing safety and future developmental trajectory. Based on a total of 13 randomized controlled trials, several meta-analyses and systematic reviews confirm the efficacy of Tf-CBT, which received evidence level Ia in several international guidelines and is therefore recommended as first-line treatment for children and adolescents with PTSD.
Collapse
Affiliation(s)
- Cedric Sachser
- 1 Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm
| | - Miriam Rassenhofer
- 1 Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm
| | - Lutz Goldbeck
- 1 Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm
| |
Collapse
|
50
|
Wildeboer G, Kelders SM, van Gemert-Pijnen JEWC. The relationship between persuasive technology principles, adherence and effect of web-Based interventions for mental health: A meta-analysis. Int J Med Inform 2016; 96:71-85. [PMID: 27117057 DOI: 10.1016/j.ijmedinf.2016.04.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research has shown that web-based interventions concerning mental health can be effective, although there is a broad range in effect sizes. Why some interventions are more effective than others is not clear. Persuasive technology is one of the aspects which has a positive influence on changing attitude and/or behavior, and can contribute to better outcomes. According to the Persuasive Systems Design Model there are various principles that can be deployed. It is unknown whether the number and combinations of principles used in a web-based intervention affect the effectiveness. Another issue in web-based interventions is adherence. Little is known about the relationship of adherence on the effectiveness of web-based interventions. OBJECTIVE This study examines whether there is a relationship between the number and combinations of persuasive technology principles used in web-based interventions and the effectiveness. Also the influence of adherence on effectiveness of web-based interventions is investigated. METHODS This study elaborates on the systematic review by [37] and therefore the articles were derived from that study. Only web-based interventions were included that were intended to be used on more than one occasion and studies were excluded when no information on adherence was provided. 48 interventions targeted at mental health were selected for the current study. A within-group (WG) and between-group (BG) meta-analysis were performed and subsequently subgroup analyses regarding the relationship between the number and combinations of persuasive technology principles and effectiveness. The influence of adherence on the effectiveness was examined through a meta-regression analysis. RESULTS For the WG meta-analysis 40 treatment groups were included. The BG meta-analysis included 19 studies. The mean pooled effect size in the WG meta-analysis was large and significant (Hedges' g=0.94), while for the BG meta-analysis this was moderate to large and significant (Hedges' g=0.78) in favor of the web-based interventions. With regard to the number of persuasive technology principles, the differences between the effect sizes in the subgroups were significant in the WG subgroup analyses for the total number of principles and for the number of principles in the three categories Primary Task Support, Dialogue Support, and Social Support. In the BG subgroup analyses only the difference in Primary Task Support was significant. An increase in the total number of principles and Dialogue Support principles yielded larger effect sizes in the WG subgroup analysis, indicating that more principles lead to better outcomes. The number of principles in the Primary Task Support (WG and BG) and Social Support (WG) did not show an upward trend but had varying effect sizes. We identified a number of combinations of principles that were more effective, but only in the WG analyses. The association between adherence and effectiveness was not significant. CONCLUSIONS There is a relationship between the number of persuasive technology principles and the effectiveness of web-based interventions concerning mental health, however this does not always mean that implementing more principles leads to better outcomes. Regarding the combinations of principles, specific principles seemed to work well together (e.g. tunneling and tailoring; reminders and similarity; social learning and comparison), but adding another principle can diminish the effectiveness (e.g. tunneling, tailoring and reduction). In this study, an increase in adherence was not associated with larger effect sizes. The findings of this study can help developers to decide which persuasive principles to include to make web-based interventions more persuasive.
Collapse
Affiliation(s)
- Gina Wildeboer
- University of Twente, Department of Psychology, Health and Technology, Center for eHealth Research, Enschede, The Netherlands
| | - Saskia M Kelders
- University of Twente, Department of Psychology, Health and Technology, Center for eHealth Research, Enschede, The Netherlands.
| | - Julia E W C van Gemert-Pijnen
- University of Twente, Department of Psychology, Health and Technology, Center for eHealth Research, Enschede, The Netherlands
| |
Collapse
|