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Thai M, Olson EA, Nickels S, Dillon DG, Webb CA, Ren B, Killgore WDS, Rauch SL, Rosso IM, Pizzagalli DA. Neural and behavioral markers of inhibitory control predict symptom improvement during internet-delivered cognitive behavioral therapy for depression. Transl Psychiatry 2024; 14:303. [PMID: 39043642 PMCID: PMC11266709 DOI: 10.1038/s41398-024-03020-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 06/24/2024] [Accepted: 07/10/2024] [Indexed: 07/25/2024] Open
Abstract
Poor inhibitory control contributes to deficits in emotion regulation, which are often targeted by treatments for major depressive disorder (MDD), including cognitive behavioral therapy (CBT). Brain regions that contribute to inhibitory control and emotion regulation overlap; thus, inhibitory control might relate to response to CBT. In this study, we examined whether baseline inhibitory control and resting state functional connectivity (rsFC) within overlapping emotion regulation-inhibitory control regions predicted treatment response to internet-based CBT (iCBT). Participants with MDD were randomly assigned to iCBT (N = 30) or a monitored attention control (MAC) condition (N = 30). Elastic net regression was used to predict post-treatment Patient Health Questionnaire-9 (PHQ-9) scores from baseline variables, including demographic variables, PHQ-9 scores, Flanker effects (interference, sequential dependency, post-error slowing), and rsFC between the dorsal anterior cingulate cortex, bilateral anterior insula (AI), and right temporoparietal junction (TPJ). Essential prognostic predictor variables retained in the elastic net regression included treatment group, gender, Flanker interference response time (RT), right AI-TPJ rsFC, and left AI-right AI rsFC. Prescriptive predictor variables retained included interactions between treatment group and baseline PHQ-9 scores, age, gender, Flanker RT, sequential dependency effects on accuracy, post-error accuracy, right AI-TPJ rsFC, and left AI-right AI rsFC. Inhibitory control and rsFC within inhibitory control-emotion regulation regions predicted reduced symptom severity following iCBT, and these effects were stronger in the iCBT group than in the MAC group. These findings contribute to a growing literature indicating that stronger inhibitory control at baseline predicts better outcomes to psychotherapy, including iCBT.
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Affiliation(s)
- Michelle Thai
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Elizabeth A Olson
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Stefanie Nickels
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Daniel G Dillon
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Christian A Webb
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Boyu Ren
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Psychiatric Biostatistics Laboratory, McLean Hospital, Belmont, MA, USA
| | - William D S Killgore
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Scott L Rauch
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Isabelle M Rosso
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Diego A Pizzagalli
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Imaging Center, McLean Hospital, Belmont, MA, USA
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Pollmann Y, Clancy KJ, Devignes Q, Ren B, Kaufman M, Rosso IM. Ecological Momentary Assessments of Trauma-Related Intrusive Memories: Potential Clinical Utility. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.15.24307377. [PMID: 38798682 PMCID: PMC11118638 DOI: 10.1101/2024.05.15.24307377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
As the global prevalence of trauma rises, there is a growing need for accessible and scalable treatments for trauma-related disorders like posttraumatic stress disorder (PTSD). Trauma-related intrusive memories (TR-IMs) are a central PTSD symptom and a target of exposure-based therapies, gold-standard treatments that are effective but resource-intensive. This study examined whether a brief ecological momentary assessment (EMA) protocol assessing the phenomenology of TR-IMs could reduce intrusion symptoms in trauma-exposed adults. Participants (N=131) experiencing at least 2 TR-IMs per week related to a DSM-5 criterion A trauma completed a 2-week EMA protocol during which they reported on TR-IM properties three times per day, and on posttraumatic stress symptoms at the end of each day. Longitudinal symptom measurements were entered into linear mixed-effects models to test the effect of Time on TR-IMs. Over the 2-week EMA protocol, intrusion symptom severity (cluster B scores) significantly declined (t = -2.78, p = 0.006), while other symptom cluster scores did not significantly change. Follow-up analyses demonstrated that this effect was specific to TR-IMs (t = -4.02, p < 0.001), and was not moderated by survey completion rate, total PTSD symptom severity, or ongoing treatment. Our findings indicate that implementing an EMA protocol assessing intrusive memories could be an effective trauma intervention. Despite study limitations like its quasi-experimental design and absence of a control group, the specificity of findings to intrusive memories argues against a mere regression to the mean. Overall, an EMA approach could provide a cost-effective and scalable treatment option targeting intrusive memory symptoms.
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De Jesús-Romero R, Holder-Dixon AR, Buss JF, Lorenzo-Luaces L. Race, Ethnicity, and Other Cultural Background Factors in Trials of Internet-Based Cognitive Behavioral Therapy for Depression: Systematic Review. J Med Internet Res 2024; 26:e50780. [PMID: 38300699 PMCID: PMC10870215 DOI: 10.2196/50780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/05/2023] [Accepted: 11/16/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND There is a growing interest in developing scalable interventions, including internet-based cognitive behavioral therapy (iCBT), to meet the increasing demand for mental health services. Given the growth in diversity worldwide, it is essential that the clinical trials of iCBT for depression include diverse samples or, at least, report information on the race, ethnicity, or other background indicators of their samples. Unfortunately, the field lacks data on how well diversity is currently reported and represented in the iCBT literature. OBJECTIVE Thus, the main objective of this systematic review was to examine the overall reporting of racial and ethnic identities in published clinical trials of iCBT for depression. We also aimed to review the representation of specific racial and ethnic minoritized groups and the inclusion of alternative background indicators such as migration status or country of residence. METHODS Studies were included if they were randomized controlled trials in which iCBT was compared to a waiting list, care-as-usual, active control, or another iCBT. The included papers also had to have a focus on acute treatment (eg, 4 weeks to 6 months) of depression, be delivered via the internet on a website or a smartphone app and use guided or unguided self-help. Studies were initially identified from the METAPSY database (n=59) and then extended to include papers up to 2022, with papers retrieved from Embase, PubMed, PsycINFO, and Cochrane (n=3). Risk of bias assessment suggested that reported studies had at least some risk of bias due to use of self-report outcome measures. RESULTS A total of 62 iCBT randomized controlled trials representing 17,210 participants are summarized in this study. Out of those 62 papers, only 17 (27%) of the trials reported race, and only 12 (19%) reported ethnicity. Reporting outside of the United States was very poor, with the United States accounting for 15 (88%) out of 17 of studies that reported race and 9 (75%) out of 12 for ethnicity. Out of 3,623 participants whose race was reported in the systematic review, the racial category reported the most was White (n=2716, 74.9%), followed by Asian (n=209, 5.8%) and Black (n=274, 7.6%). Furthermore, only 25 (54%) out of the 46 papers conducted outside of the United States reported other background demographics. CONCLUSIONS It is important to note that the underreporting observed in this study does not necessarily indicate an underrepresentation in the actual study population. However, these findings highlight the poor reporting of race and ethnicity in iCBT trials for depression found in the literature. This lack of diversity reporting may have significant implications for the scalability of these interventions.
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Affiliation(s)
- Robinson De Jesús-Romero
- Department of Psychological and Brain Sciences, Indiana University - Bloomington, Bloomington, IN, United States
| | - Amani R Holder-Dixon
- Department of Psychological and Brain Sciences, Indiana University - Bloomington, Bloomington, IN, United States
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - John F Buss
- Department of Psychological and Brain Sciences, Indiana University - Bloomington, Bloomington, IN, United States
| | - Lorenzo Lorenzo-Luaces
- Department of Psychological and Brain Sciences, Indiana University - Bloomington, Bloomington, IN, United States
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Cho CH, Lee HJ, Kim YK. Telepsychiatry in the Treatment of Major Depressive Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1456:333-356. [PMID: 39261437 DOI: 10.1007/978-981-97-4402-2_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
This chapter explores the transformative role of telepsychiatry in managing major depressive disorders (MDD). Traversing geographical barriers and reducing stigma, this innovative branch of telemedicine leverages digital platforms to deliver effective psychiatric care. We investigate the evolution of telepsychiatry, examining its diverse interventions such as videoconferencing-based psychotherapy, medication management, and mobile applications. While offering significant advantages like increased accessibility, cost-effectiveness, and improved patient engagement, challenges in telepsychiatry include technological barriers, privacy concerns, ethical and legal considerations, and digital literacy gaps. Looking forward, emerging technologies like virtual reality, artificial intelligence, and precision medicine hold immense potential to personalize and enhance treatment effectiveness. Recognizing its limitations and advocating for equitable access, this chapter underscores telepsychiatry's power to revolutionize MDD treatment, making quality mental healthcare a reality for all.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yong-Ku Kim
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea.
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Wang M, Chen H, Yang F, Xu X, Li J. Effects of digital psychotherapy for depression and anxiety: A systematic review and bayesian network meta-analysis. J Affect Disord 2023; 338:569-580. [PMID: 37392941 DOI: 10.1016/j.jad.2023.06.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/18/2023] [Accepted: 06/26/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of digital psychotherapies for depression and anxiety. We conducted a systematic review and network meta-analyses (NMA) to make comparisons of digital psychotherapies. METHODS A bayesian NMA was conducted in this study. The databases including PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials and CINAL were searched for all eligible randomized controlled trials (RCTs) published from Jan 1, 2012 to Oct 1, 2022. We used the Cochrane Collaboration's Risk of bias tool for quality assessment. The primary outcomes were set as a standardized mean difference model in efficacy to describe continuous outcomes. We used STATA and WinBUGS to conduct a bayesian network meta-analysis of all interventions based on a random-effects model. This study was registered with PROSPERO, number CRD42022374558. RESULTS From the retrieved 16,750 publications, we included 72 RCTs (13,096 participants) with the overall medium quality and above. In terms of depression scale, cognitive behavioral therapy (CBT) was more effective than TAU (SMDs 0.53) and NT (SMDs 0.98). In terms of anxiety scale, CBT (SMDs 0.68; SMDs 0.72) and exercise therapy (ERT) (SMDs 1.01; SMDs 1.05) were more effective than TAU and NT. LIMITATIONS Uneven quality of literature, simple network, and subjective judgment. CONCLUSION Based on NMA results, we suggest that CBT, which is the most commonly used digital technology, should be preferred among digital psychotherapy for relieving depression and anxiety symptoms. Digital exercise therapy is an effective strategy to relieve some anxiety problems in the context of COVID-19.
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Affiliation(s)
- Min Wang
- Institute of Medical Information/Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100020, China
| | - Haoran Chen
- Institute of Medical Information/Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100020, China
| | - Fengchun Yang
- Institute of Medical Information/Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100020, China
| | - Xiaowei Xu
- Institute of Medical Information/Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100020, China
| | - Jiao Li
- Institute of Medical Information/Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100020, China.
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Lin Z, Cheng L, Han X, Wang H, Liao Y, Guo L, Shi J, Fan B, Teopiz KM, Jawad MY, Zhang H, Chen Y, Lu C, McIntyre RS. The Effect of Internet-Based Cognitive Behavioral Therapy on Major Depressive Disorder: Randomized Controlled Trial. J Med Internet Res 2023; 25:e42786. [PMID: 37738092 PMCID: PMC10559190 DOI: 10.2196/42786] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/10/2023] [Accepted: 07/31/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Many people living with major depressive disorder (MDD) in China do not receive treatment owing to a lack of mental health services, along with significant stigma toward mental illness. Internet-based cognitive behavioral therapy (ICBT) has been proposed to increase access to mental health care for people with MDD. OBJECTIVE The aims of this study were to (1) evaluate the efficacy of ICBT for depressive symptoms in patients with MDD; (2) evaluate the effect of ICBT on anxiety symptoms, nonspecific psychological distress, general self-efficacy, depression stigma, social function, and health-related quality of life (HRQoL); and (3) explore the acceptability of and satisfaction with the ICBT program among participants. METHODS Patients with MDD were enrolled and randomized to the ICBT group or the waiting-list control (WLC) group. The ICBT group received ICBT delivered through a WeChat mini-program with general support by nonspecialists. Participants in the 2 groups were self-evaluated online at baseline and posttreatment for changes in the primary outcome (ie, depressive symptoms) and secondary outcomes (ie, anxiety symptoms, nonspecific psychological distress, general self-efficacy, depression stigma, social functional impairment, and HRQoL). Changes in outcomes were measured by changes in overall scores on respective scales, and response and remission rates were calculated based on depressive symptoms. The acceptability of and satisfaction with the ICBT program were measured by treatment adherence and participants' feelings (ie, modules seriously completed, perceived benefit, and satisfaction). RESULTS We included 40 patients who were randomly assigned to the ICBT group and 44 who were assigned to the WLC group. Compared with the WLC group, the ICBT group had fewer depressive symptoms, fewer anxiety symptoms, less nonspecific psychological distress, and greater general self-efficacy. Moreover, the ICBT group had higher response (18/31, 58%) and remission rates (17/31, 55%). The adherence rate in the ICBT group was 78% (31/40), and the majority of participants who completed all ICBT modules were satisfied with the ICBT program. CONCLUSIONS ICBT demonstrated greater improvements in depressive symptoms, anxiety symptoms, nonspecific psychological distress, and general self-efficacy among selected patients with MDD in comparison with the findings in waiting-list controls. The ICBT program in this study had good acceptability and satisfaction among participants. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2100046425); https://tinyurl.com/bdcrj4zv.
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Affiliation(s)
- Ziyi Lin
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China
| | - Lu Cheng
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Xue Han
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Hongqiong Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China
| | - Yuhua Liao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China
| | - Jingman Shi
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China
| | - Beifang Fan
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Kayla M Teopiz
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Muhammad Youshay Jawad
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Huimin Zhang
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Yan Chen
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China
| | - Roger S McIntyre
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Mamukashvili-Delau M, Koburger N, Dietrich S, Rummel-Kluge C. Long-Term Efficacy of Internet-Based Cognitive Behavioral Therapy Self-Help Programs for Adults With Depression: Systematic Review and Meta-Analysis of Randomized Controlled Trials. JMIR Ment Health 2023; 10:e46925. [PMID: 37606990 PMCID: PMC10481211 DOI: 10.2196/46925] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/20/2023] [Accepted: 07/11/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Depression is a worldwide mental disorder and a leading cause of disability. Many people with depression do not want to take medication or have the motivation to seek psychotherapy treatment for many reasons. Guided internet-based self-help programs may be a promising solution for addressing these issues. This kind of intervention has proven to be effective in reducing depression symptoms on a short-term scale. However, as treatment often is a long-term rehabilitation process, it is important to examine not only the short-term effects of internet-based cognitive behavioral therapy (iCBT) self-help treatment but also the follow-up or long-term efficacy of this kind of intervention. OBJECTIVE This systematic review and meta-analysis aimed to identify studies that examined follow-up data ≥8 weeks after posttreatment measurements and thereby examined the long-term efficacy of iCBT self-help programs with minimal weekly guidance for people with depression. It aimed to analyze the long-term efficacy of iCBT treatments compared to control conditions as well as long-term efficacy within the iCBT treatment conditions. Additionally, it aimed to conduct subgroup analyses according to the follow-up time points for each outcome. Finally, it examined long-term improvements in quality of life. METHODS The Cochrane Collaboration Depression, Anxiety, and Neurosis Controlled Trials Register (CCDANCTR), grey literature, reference lists, and correspondence were used to search for published and unpublished randomized controlled trials (RCTs) that reported the long-term or follow-up efficacy of computer-based or iCBT self-help treatments for depression with minimal guidance of up to 10 min/wk. The search took place between 2015 and 2022 (October). RESULTS The search resulted in a total of 2809 study abstracts, of which 15 studies (with 17 samples) met all inclusion criteria and were included in the long-term analysis. The results showed that the depression outcomes of all follow-up time points together in the treatment conditions were favored over the control conditions with a medium effect size of 0.43 (n=1689 participants; 9 RCTs; standardized mean difference [SMD] -0.43, 95% CI -0.67 to -0.20; P<.001). The analysis of long-term efficacy within the iCBT treatment conditions showed that the follow-up outcomes of the treatment groups were favored over the posttreatment outcomes with a small effect size of 0.20 (n=2196 participants; 17 RCTs; SMD 0.20, 95% CI 0.07-0.49; P=.003). Findings for improving quality of life also showed that the iCBT conditions were favored over the control conditions with a small effect size of 0.19 (n=1345 participants; 3 RCTs; SMD 0.19, 95% CI 0.08-0.30; P<.001). CONCLUSIONS This systematic review and meta-analysis found that iCBT self-help interventions had a superior long-term efficacy for individuals with depressive symptoms compared to control groups. The within-group analysis of iCBT treatment conditions also showed statistically significant improvements in reducing depressive symptoms at follow-up compared to posttreatment measurements.
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Affiliation(s)
- Megi Mamukashvili-Delau
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Nicole Koburger
- Department of Research and Transfer, Leipzig University, Leipzig, Germany
| | - Sandra Dietrich
- Leipzig Travel, Leipzig Tourismus und Marketing GmbH, Leipzig, Germany
| | - Christine Rummel-Kluge
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Leipzig, Leipzig, Germany
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Bai P. Application and Mechanisms of Internet-Based Cognitive Behavioral Therapy (iCBT) in Improving Psychological State in Cancer Patients. J Cancer 2023; 14:1981-2000. [PMID: 37497400 PMCID: PMC10367931 DOI: 10.7150/jca.82632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/18/2023] [Indexed: 07/28/2023] Open
Abstract
This review article is an overview of the effectiveness of internet-based cognitive behavioral therapy (iCBT) in Improving Psychological State in Cancer Patients. iCBT's effectiveness has been investigated in treating and managing conditions like depression, psychiatric disorders, generalized anxiety disorder (GAD), panic disorder, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), adjustment disorder, bipolar disorder, chronic pain, and phobias. iCBT's role in the treatment of medical conditions such as diabetes mellitus with comorbid psychiatric illnesses was also explored. We conducted a thorough literature search using PubMed, Embase, Google Scholar, and Wanfang with no restrictions on the date. iCBT's role in treating and controlling psychiatric illnesses in cancer patients has been established in the literature. Development and popularization of iCBT, treament forms of iCBT, platforms for iCBT, application of iCBT, strategies and efficacy of iCBT for insomnia in cancer patients, current status of iCBT application, and genetic researches on iCBT for anxiety disorders were all reviewed and discussed in this review. From the data compiled, we conclude that iCBT is useful in treating or improving psychological state in cancer patients.
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Affiliation(s)
- Ping Bai
- Department of Operating Rooms, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
- Department of Operating Rooms, National Cancer Center/National Clinical Research Center for Cancer/Hebei Cancer Hospital, Chinese Academy of Medical Sciences, Langfang, 065001, China
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Hanuka S, Olson EA, Admon R, Webb CA, Killgore WDS, Rauch SL, Rosso IM, Pizzagalli DA. Reduced anhedonia following internet-based cognitive-behavioral therapy for depression is mediated by enhanced reward circuit activation. Psychol Med 2023; 53:4345-4354. [PMID: 35713110 DOI: 10.1017/s0033291722001106] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is a highly prevalent psychiatric condition, yet many patients do not receive adequate treatment. Novel and highly scalable interventions such as internet-based cognitive-behavioral-therapy (iCBT) may help to address this treatment gap. Anhedonia, a hallmark symptom of MDD that refers to diminished interest and ability to experience pleasure, has been associated with reduced reactivity in a neural reward circuit that includes medial prefrontal and striatal brain regions. Whether iCBT can reduce anhedonia severity in MDD patients, and whether these therapeutic effects are accompanied by enhanced reward circuit reactivity has yet to be examined. METHODS Fifty-two MDD patients were randomly assigned to either 10-week iCBT (n = 26) or monitored attention control (MAC, n = 26) programs. All patients completed pre- and post-treatment assessments of anhedonia (Snaith-Hamilton Pleasure Scale; SHAPS) and reward circuit reactivity [monetary incentive delay (MID) task during functional magnetic resonance imaging (fMRI)]. Healthy control participants (n = 42) also underwent two fMRI scans while completing the MID task 10 weeks apart. RESULTS Both iCBT and MAC groups exhibited a reduction in anhedonia severity post-treatment. Nevertheless, only the iCBT group exhibited enhanced nucleus accumbens (Nacc) and subgenual anterior cingulate cortex (sgACC) activation and functional connectivity from pre- to post-treatment in response to reward feedback. Enhanced Nacc and sgACC activations were associated with reduced anhedonia severity following iCBT treatment, with enhanced Nacc activation also mediating the reduction in anhedonia severity post-treatment. CONCLUSIONS These findings suggest that increased reward circuit reactivity may contribute to a reduction in anhedonia severity following iCBT treatment for depression.
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Affiliation(s)
- Shir Hanuka
- School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Elizabeth A Olson
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Roee Admon
- School of Psychological Sciences, University of Haifa, Haifa, Israel
- The Integrated Brain and Behavior Research Center (IBBRC), University of Haifa, Haifa, Israel
| | - Christian A Webb
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | | | - Scott L Rauch
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Isabelle M Rosso
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Diego A Pizzagalli
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Hornstein S, Zantvoort K, Lueken U, Funk B, Hilbert K. Personalization strategies in digital mental health interventions: a systematic review and conceptual framework for depressive symptoms. Front Digit Health 2023; 5:1170002. [PMID: 37283721 PMCID: PMC10239832 DOI: 10.3389/fdgth.2023.1170002] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/05/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction Personalization is a much-discussed approach to improve adherence and outcomes for Digital Mental Health interventions (DMHIs). Yet, major questions remain open, such as (1) what personalization is, (2) how prevalent it is in practice, and (3) what benefits it truly has. Methods We address this gap by performing a systematic literature review identifying all empirical studies on DMHIs targeting depressive symptoms in adults from 2015 to September 2022. The search in Pubmed, SCOPUS and Psycinfo led to the inclusion of 138 articles, describing 94 distinct DMHIs provided to an overall sample of approximately 24,300 individuals. Results Our investigation results in the conceptualization of personalization as purposefully designed variation between individuals in an intervention's therapeutic elements or its structure. We propose to further differentiate personalization by what is personalized (i.e., intervention content, content order, level of guidance or communication) and the underlying mechanism [i.e., user choice, provider choice, decision rules, and machine-learning (ML) based approaches]. Applying this concept, we identified personalization in 66% of the interventions for depressive symptoms, with personalized intervention content (32% of interventions) and communication with the user (30%) being particularly popular. Personalization via decision rules (48%) and user choice (36%) were the most used mechanisms, while the utilization of ML was rare (3%). Two-thirds of personalized interventions only tailored one dimension of the intervention. Discussion We conclude that future interventions could provide even more personalized experiences and especially benefit from using ML models. Finally, empirical evidence for personalization was scarce and inconclusive, making further evidence for the benefits of personalization highly needed. Systematic Review Registration Identifier: CRD42022357408.
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Affiliation(s)
- Silvan Hornstein
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kirsten Zantvoort
- Institute of Information Systems, Leuphana University, Lueneburg, Germany
| | - Ulrike Lueken
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Burkhardt Funk
- Institute of Information Systems, Leuphana University, Lueneburg, Germany
| | - Kevin Hilbert
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
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11
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Biagianti B, Foti G, Di Liberto A, Bressi C, Brambilla P. CBT-informed psychological interventions for adult patients with anxiety and depression symptoms: A narrative review of digital treatment options. J Affect Disord 2023; 325:682-694. [PMID: 36690081 DOI: 10.1016/j.jad.2023.01.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/03/2023] [Accepted: 01/13/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Across a range of age, educational and clinical characteristics, adults experiencing depression and anxiety already use digital technology to manage their symptoms. Although several reviews and meta-analyses indicated feasibility and efficacy for adults with depression and anxiety, digital treatments are poorly accessed and disseminated. This review illustrates potentials and limitations of interventions that specifically leveraged unique features of digital technology and were grounded in the principles of Cognitive Behavioral Therapy (CBT). METHODS This systematic review followed the PRISMA guidelines. An electronic database search was conducted in October 2021. Peer-reviewed, English-language studies were included if i) they reported data from RCTs for adults aged 18+ who engaged with CBT-informed digital interventions targeting primarily depression and anxiety; ii) they used at least PHQ-9 or GAD-7 as standardized and validated assessment self-report measures for depression and anxiety. RESULTS Findings from 35 RCTs examining 33 interventions (25 internet-based, 6 mobile-based, a2 mobile/web) are discussed. The quality of the evidence differed widely as many small-scale RCTs reported only short-term feasibility and preliminary efficacy. Effects of CBT-informed digital interventions were substantially larger when compared to waitlist than active control conditions. Greater therapeutic benefits were observed for interventions that offered clinical assistance or were used in combination with other treatments. CONCLUSIONS CBT-informed digital interventions have accumulated enough scientific evidence to be positioned today as: i) a low-intensity tool for those with subclinical levels of symptoms; ii) a first step in a stepped-care approach to service delivery iii) a low-cost, easily accessible option for targeted preventive programs.
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Affiliation(s)
- Bruno Biagianti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.
| | | | | | - Cinzia Bressi
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
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12
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Zhao W, Chen S, Hu J, Zhou Q, Tao J, Gao R, Zhang J, Su S, Wang Y, Su Y, Peng Y, Wu Y, Fan Q, Zhang W, Jiang W, Cai J, Qiu J. The applicability and efficacy of Micro-Video Psychological Training Camp in groups with mild to moderate symptoms of depression and anxiety: A prospective and randomized controlled trial protocol. Front Psychiatry 2023; 13:991465. [PMID: 36733416 PMCID: PMC9887015 DOI: 10.3389/fpsyt.2022.991465] [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: 07/26/2022] [Accepted: 12/12/2022] [Indexed: 01/18/2023] Open
Abstract
Background Mental health is a global issue requiring global attention. Depression and anxiety are two of the most common mental disorders (CMDs) and are characterized by high incidence and high comorbidity. In recent years, the prolonged COVID-19 pandemic and exacerbated social instability have posed significant challenges to the mental resilience and mental health outcomes of the global population. Now more than ever, with an increase in mental health needs, it has become even more crucial to find an effective solution to provide universal mental healthcare. Psychotherapy is of vital importance for those coping with symptoms of depression and anxiety and is used to enhance mental resilience. However, such therapy can be difficult to access in reality. In this context, the Micro-Video Psychological Training Camp (MVPTC) platform will be developed. Objectives As an online self-help platform for psychological intervention, the MVPTC platform was developed for those who suffer from mild to moderate symptoms of depression and/or anxiety and is tasked with the goal of reducing depressive and anxious symptoms while improving mental resilience. Thus, this study will be carried out to verify its efficacy and applicability. Methods In this parallel-group, randomized controlled trial, a total of 200 mild to moderately depressed and/or anxious adults seeking self-help will be randomly recruited and assigned to either the micro-video psychological intervention group or the wait list control group. Online measurements by self-assessment will be taken at baseline, post-intervention, 1-month, and 3-month follow-up. Results The primary results will involve symptoms of depression and anxiety. The secondary results will involve mental resilience. An analysis will be conducted based on the intention-to-treat principle. Discussion This trial will examine whether the MVPTC platform for the relief of symptoms and the enhancement of resilience in a population screened for depression and anxiety symptoms proves effective and applicable. Large-scale resilience enhancement may benefit public mental health in terms of preventive interventions, managing depressive and anxiety symptoms, and promoting mental health. With the MVPTC-based method being applied, a brief, efficient, and structured intervention model can potentially be established, having the potential to provide necessary and accessible mental support for an extensive target group. Clinical trial registration http://www.chictr.org.cn/, identifier ChiCTR2100043725.
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Affiliation(s)
- Wenqing Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuangyi Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Hu
- Shanghai Xuhui Mental Health Center, Shanghai, China
| | - Qing Zhou
- Shanghai Xuhui Mental Health Center, Shanghai, China
| | - Jing Tao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui Gao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shanshan Su
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yousong Su
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yihua Peng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanru Wu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Fan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weibo Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenhui Jiang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Cai
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianyin Qiu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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13
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Yuan LL, Chen TY, Huang ZQ. Effects of paroxetine hydrochloride combined with idebenone on inflammatory factors and antioxidant molecules in treatment of depression after ischemic stroke. Pak J Med Sci 2023; 39:17-22. [PMID: 36694748 PMCID: PMC9843014 DOI: 10.12669/pjms.39.1.5679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 11/01/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives To evaluate the effects of paroxetine hydrochloride combined with idebenone on inflammatory factors and antioxidant molecules in the treatment of depression after ischemic stroke. Methods Randomized controlled trial was adopted on 80 patients with depression after ischemic stroke were randomly divided into two groups, with 40 patients in each group at Xingtai Sanli Health Quannan Clinic from March 17, 2019 to December 20, 2021. Both groups were given basic treatment. On this basis, the control group was treated with paroxetine hydrochloride, while the study group was treated with paroxetine hydrochloride combined with idebenone. The clinical efficacy was evaluated using the Hamilton Rating Scale for Depression (HRSD) before and after treatment. Additionally, the difference in HRSD score after treatment and the improvement in inflammatory factors and antioxidant molecules were compared and analyzed between the two groups. Results After treatment, the HRSD score of the study group was significantly improved compared with that of the control group (p= 0.00). The effective rate was 82.5% in the study group, which was significantly higher than 62.5% in the control group (p= 0.04). After treatment, TNF-a, CRP and IL-6 in the study group were significantly lower than those in the control group (p= 0.00). Serum SOD, TAC and CAT levels in the study group were significantly higher than those in the control group after treatment (SOD and TAC, p= 0.00; CAT, p= 0.01). The incidence of adverse reactions was 37.5% in the study group and 25% in the control group. Although the incidence of adverse reactions in the study group was higher than that in the control group, the difference was not statistically significant (p= 0.23). Conclusion Paroxetine hydrochloride combined with idebenone in the treatment of depression after ischemic stroke can significantly improve HRSD score, enhance clinical efficacy, reduce the levels of inflammatory factors, and increase the levels of antioxidant factors, without a significant increase in adverse reactions. Therefore, it is a safe and effective treatment method.
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Affiliation(s)
- Li-li Yuan
- Li-li Yuan, Xingtai Sanli Health Quannan Clinic, Xingtai 054001, Hebei, P. R. China
| | - Tian-yu Chen
- Tian-yu Chen, Applied Psychology Major of Shijiazhuang University, Shijiazhuang 050024, Hebei, P. R. China
| | - Zhi-qiang Huang
- Zhi-qiang Huang Department of Neurology, The First Affiliated Hospital of Xingtai Medical College, Xingtai 054001, Hebei, P. R. China
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Werson AD, Meiser-Stedman R, Laidlaw K. A meta-analysis of CBT efficacy for depression comparing adults and older adults. J Affect Disord 2022; 319:189-201. [PMID: 36113691 DOI: 10.1016/j.jad.2022.09.020] [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] [Received: 03/10/2021] [Revised: 09/03/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION This meta-analysis investigates CBT treatment efficacy fordepression, and compares outcomes between adults (young and middle aged) and older adults (OA). METHODOLOGY Effect sizes (Hedges' g) were obtained from 37 peer-reviewed RCTs, 25 adult papers (participant n = 2948) and 12 OA papers (participant n = 551), and analysed with the random effects model. RESULTS No significant difference between age groups is reported in terms of CBT efficacy for depression compared to other treatments (Qbetween (1) = 0.06, p = .89), with the overall effect favouring CBT over any other treatments (g = 0.48, 95 % CI = 0.29-0.68). The same pattern of results was found when restricting studies to those which used active control conditions (Qbetween (1) = 0.03, p = .86) or passive control conditions (Q (1) = 2.45, p = .12). DISCUSSION No significant differences in efficacy for CBT treatment for depression are found when comparing adults and OA. CBT is as efficacious with OA as with adults.
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Affiliation(s)
- Alessa D Werson
- Norwich Medical School, University of East Anglia, United Kingdom; Department of Psychology: College of Life and Environmental Sciences, University of Exeter, United Kingdom.
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, United Kingdom
| | - Ken Laidlaw
- Department of Psychology: College of Life and Environmental Sciences, University of Exeter, United Kingdom
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Mamukashvili-Delau M, Koburger N, Dietrich S, Rummel-Kluge C. Efficacy of computer- and/or internet-based cognitive-behavioral guided self-management for depression in adults: a systematic review and meta-analysis of randomized controlled trials. BMC Psychiatry 2022; 22:730. [PMID: 36424570 PMCID: PMC9685980 DOI: 10.1186/s12888-022-04325-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/19/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Depression is a worldwide disease. CBT-based self-help treatment allows patients with mild to moderate depression symptoms to improve their depression or to bridge the waiting- or pandemic period until they receive further clinical treatment. OBJECTIVE This systematic review and meta-analysis aims to explore the efficacy, acceptability and improvement in quality of life of computer-delivered and/or internet-based CBT self-help interventions with minimal guidance (up to 10 min) for depression. The second aim was to compare the effectiveness of reducing depression symptoms at post-treatment of treatment by the type of minimal guidance: (1) e-mail, (2) telephone calls, (3) e-mail and telephone together, or (4) face-to-face. METHODS The Cochrane depression, anxiety, and neurosis review group's specialized register electronic searches, grey literature, reference lists and correspondence were used to search for published and unpublished RCTs that reported efficacy of computer- and/or internet-based CBT self-help treatments for depression with minimal guidance up to 10 min per week. Methodological quality of included studies was evaluated with Cochrane Collaboration tools for assessing risk of bias. The meta-analysis was accomplished using the RevMen software. RESULTS In total, 2809 study abstracts were checked for eligibility. Out of these, 19 studies (21 samples) with a total of 3226 participants were included. The results showed that concerning efficacy, the treatment group is superior to the control group with a medium to large effect size of 0.65. Also, treatment groups with combined guidance by e-mail and telephone calls together had greater effects (SMD -0.76) than groups with other types of minimal guidance (guided by e-mail SMD -0.63; guided face to-face SMD - 0.66; guided by telephone calls SMD -0.49). Findings showed also, that iCBT with minimal guidance had small but statistically significant effect size of 0.28 in improving quality of life. Moreover, there were higher drop-out rates in the treatment condition (RR 1.36) than in the control groups. CONCLUSIONS The results of this meta-analysis support the efficacy of computer- and/or internet-based CBT self-help programs with minimal weekly guidance up to only 10 min for improving depression symptoms at post-treatment for adults. In addition, the results are pointing towards two practical implications. Firstly, depressed persons can use self-help treatment with minimal guidance at home to improve their symptoms or to bridge the waiting time - or pandemic period - before they receive professional face-to-face treatment. Secondly, it can help clinicians to make the decision about using CBT-based self-help treatments for patients that do not need urgent professional treatment, or to combine it with face-to-face therapy.
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Affiliation(s)
- Megi Mamukashvili-Delau
- grid.9647.c0000 0004 7669 9786Department of Psychiatry and Psychotherapy, Klinik Und Poliklinik Für Psychiatrie Und Psychotherapie, Medical Faculty, Leipzig University, Semmelweisstraße 10, Haus 13, 04103 Leipzig, Leipzig, Germany ,grid.411339.d0000 0000 8517 9062Department of Psychiatry and Psychotherapy, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Nicole Koburger
- grid.9647.c0000 0004 7669 9786Department of Personnel Development and Academic Personnel Development, Leipzig University, Leipzig, Germany
| | - Sandra Dietrich
- Leipzig Travel, Leipzig Tourismus and Marketing GmbH, Leipzig, Germany
| | - Christine Rummel-Kluge
- Department of Psychiatry and Psychotherapy, Klinik Und Poliklinik Für Psychiatrie Und Psychotherapie, Medical Faculty, Leipzig University, Semmelweisstraße 10, Haus 13, 04103, Leipzig, Leipzig, Germany. .,Department of Psychiatry and Psychotherapy, Universitätsklinikum Leipzig, Leipzig, Germany.
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Børtveit L, Dechsling A, Sütterlin S, Nordgreen T, Nordahl-Hansen A. Guided Internet-Delivered Treatment for Depression: Scoping Review. JMIR Ment Health 2022; 9:e37342. [PMID: 36194467 PMCID: PMC9579933 DOI: 10.2196/37342] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/01/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies on guided internet-delivered treatment have demonstrated promising results for patients with depressive disorder. OBJECTIVE The aim of this study was to provide an overview of this research area and identify potential gaps in the research. METHODS In this scoping review, web-based databases were used to identify research papers published between 2010 and 2022 where guided internet-delivered treatment was administered to participants with depressive disorders, a standardized rating scale of depressive symptoms was used as the primary outcome measure, and the treatment was compared with a control condition. RESULTS A total of 111 studies were included, and an overview of the studies was provided. Several gaps in the research were identified regarding the design of the studies, treatments delivered, participant representation, and treatment completion. CONCLUSIONS This review provides a comprehensive overview of the research area, and several research gaps were identified. The use of other designs and active control conditions is recommended. Future studies should provide access to treatment manuals, and more replications should be conducted. Researchers should aim to include underrepresented populations and provide reports of comorbidities. Definitions of adequate dosage, reports of completion rates, and reasons for treatment dropout are recommended for future studies.
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Affiliation(s)
- Line Børtveit
- Faculty of Health, Welfare and Organisation, Østfold University College, Halden, Norway.,Faculty of Health Sciences, Department of Behavioral Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Anders Dechsling
- Department of Education, ICT, and Learning, Østfold University College, Halden, Norway
| | - Stefan Sütterlin
- Faculty of Health, Welfare and Organisation, Østfold University College, Halden, Norway.,Faculty of Computer Science, Albstadt-Sigmaringen University, Sigmaringen, Germany
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Departement of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Anders Nordahl-Hansen
- Department of Education, ICT, and Learning, Østfold University College, Halden, Norway
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Skaczkowski G, van der Kruk S, Loxton S, Hughes-Barton D, Howell C, Turnbull D, Jensen N, Smout M, Gunn K. Web-Based Interventions to Help Australian Adults Address Depression, Anxiety, Suicidal Ideation, and General Mental Well-being: Scoping Review. JMIR Ment Health 2022; 9:e31018. [PMID: 35133281 PMCID: PMC8864526 DOI: 10.2196/31018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/23/2021] [Accepted: 08/12/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND A large number of Australians experience mental health challenges at some point in their lives. However, in many parts of Australia, the wait times to see general practitioners and mental health professionals can be lengthy. With increasing internet use across Australia, web-based interventions may help increase access to timely mental health care. As a result, this is an area of increasing research interest, and the number of publicly available web-based interventions is growing. However, it can be confusing for clinicians and consumers to know the resources that are evidence-based and best meet their needs. OBJECTIVE This study aims to scope out the range of web-based mental health interventions that address depression, anxiety, suicidal ideation, or general mental well-being and are freely available to Australian adults, along with their impact, acceptability, therapeutic approach, and key features. METHODS The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews (PRISMA-ScR [PRISMA extension for Scoping Reviews]) guided the review process. Keywords for the search were depression, anxiety, suicide, and well-being. The search was conducted using Google as well as the key intervention databases Beacon, Head to Health, and e-Mental Health in Practice. Interventions were deemed eligible if they targeted depression, anxiety, suicidal ideation, or general mental well-being (eg, resilience) in adults; and were web-based, written in English, interactive, free, and publicly available. They also had to be guided by an evidence-based therapeutic approach. RESULTS Overall, 52 eligible programs were identified, of which 9 (17%) addressed depression, 15 (29%) addressed anxiety, 13 (25%) addressed general mental well-being, and 13 (25%) addressed multiple issues. Only 4% (2/52) addressed distress in the form of suicidal ideation. The most common therapeutic approach was cognitive behavioral therapy. Half of the programs guided users through exercises in a set sequence, and most programs enabled users to log in and complete the activities on their own without professional support. Just over half of the programs had been evaluated for their effectiveness in reducing symptoms, and 11% (6/52) were being evaluated at the time of writing. Program evaluation scores ranged from 44% to 100%, with a total average score of 85%. CONCLUSIONS There are numerous web-based programs for depression, anxiety, suicidal ideation, and general well-being, which are freely and publicly available in Australia. However, identified gaps include a lack of available web-based interventions for culturally and linguistically diverse populations and programs that use newer therapeutic approaches such as acceptance and commitment therapy and dialectical behavior therapy. Despite most programs included in this review being of good quality, clinicians and consumers should pay careful attention when selecting which program to recommend and use, as variations in the levels of acceptability and impact of publicly available programs do exist.
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Affiliation(s)
- Gemma Skaczkowski
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Shannen van der Kruk
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Sophie Loxton
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Donna Hughes-Barton
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Cate Howell
- Australian Medical Placements Health Education and Training, Adelaide, Australia
- Torrens University, Adelaide, Australia
| | - Deborah Turnbull
- School of Psychology, The University of Adelaide, Adelaide, Australia
- Freemasons Centre for Male Health and Wellbeing, Adelaide, Australia
| | - Neil Jensen
- Freemasons Centre for Male Health and Wellbeing, Adelaide, Australia
| | - Matthew Smout
- Justice and Society, University of South Australia, Adelaide, Australia
| | - Kate Gunn
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
- Freemasons Centre for Male Health and Wellbeing, Adelaide, Australia
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Chan M, Jiang Y, Lee CYC, Ramachandran HJ, Teo JYC, Seah CWA, Lin Y, Wang W. Effectiveness of eHealth‐based cognitive behavioural therapy on depression: A systematic review and meta‐analysis. J Clin Nurs 2022; 31:3021-3031. [DOI: 10.1111/jocn.16212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/27/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Ming Chan
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of MedicineNational University of Singapore Singapore City Singapore
| | - Ying Jiang
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of MedicineNational University of Singapore Singapore City Singapore
| | - Cheuk Yiu Charlotte Lee
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of MedicineNational University of Singapore Singapore City Singapore
| | - Hadassah Joann Ramachandran
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of MedicineNational University of Singapore Singapore City Singapore
| | - Jun Yi Claire Teo
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of MedicineNational University of Singapore Singapore City Singapore
| | - Chuen Wei Alvin Seah
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of MedicineNational University of Singapore Singapore City Singapore
| | - Yanjun Lin
- Department of Nursing Fujian Medical University Union Hospital Fuzhou China
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of MedicineNational University of Singapore Singapore City Singapore
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Leung C, Pei J, Hudec K, Shams F, Munthali R, Vigo D. The effects of non-clinician guidance on effectiveness and process outcomes of digital mental health interventions: A systematic review and meta-analysis (Preprint). J Med Internet Res 2021; 24:e36004. [PMID: 35511463 PMCID: PMC9244656 DOI: 10.2196/36004] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/15/2022] [Accepted: 04/25/2022] [Indexed: 01/22/2023] Open
Abstract
Background Digital mental health interventions are increasingly prevalent in the current context of rapidly evolving technology, and research indicates that they yield effectiveness outcomes comparable to in-person treatment. Integrating professionals (ie, psychologists and physicians) into digital mental health interventions has become common, and the inclusion of guidance within programs can increase adherence to interventions. However, employing professionals to enhance mental health programs may undermine the scalability of digital interventions. Therefore, delegating guidance tasks to paraprofessionals (peer supporters, technicians, lay counsellors, or other nonclinicians) can help reduce costs and increase accessibility. Objective This systematic review and meta-analysis evaluates the effectiveness, adherence, and other process outcomes of nonclinician-guided digital mental health interventions. Methods Four databases (MEDLINE, Embase, CINAHL, and PsycINFO) were searched for randomized controlled trials published between 2010 and 2020 examining digital mental health interventions. Three journals that focus on digital intervention were hand searched; gray literature was searched using ProQuest and the Cochrane Central Register of Control Trials (CENTRAL). Two researchers independently assessed risk of bias using the Cochrane risk-of-bias tool version 2. Data were collected on effectiveness, adherence, and other process outcomes, and meta-analyses were conducted for effectiveness and adherence outcomes. Nonclinician-guided interventions were compared with treatment as usual, clinician-guided interventions, and unguided interventions. Results Thirteen studies qualified for inclusion. Nonclinician-guided interventions yielded higher posttreatment effectiveness outcomes when compared to conditions involving control programs (eg, online psychoeducation and monitored attention control) or wait-list controls (k=7, Hedges g=–0.73; 95% CI –1.08 to –0.38). There were also significant differences between nonclinician-guided interventions and unguided interventions (k=6, Hedges g=–0.17; 95% CI –0.23 to –0.11). In addition, nonclinician-guided interventions did not differ in effectiveness from clinician-guided interventions (k=3, Hedges g=0.08; 95% CI –0.01 to 0.17). These results suggest that guided digital mental health interventions are helpful to improve mental health outcomes regardless of the qualifications of the individual performing the intervention, and that the presence of a nonclinician guide improves effectiveness outcomes compared to having no guide. Nonclinician-guided interventions did not yield significantly different adherence outcomes when compared with unguided interventions (k=3, odds ratio 1.58; 95% CI 0.51 to 4.92), although a general trend of improved adherence was observed within nonclinician-guided interventions. Conclusions Integrating paraprofessionals and nonclinicians appears to improve the outcomes of digital mental health interventions, and may also enhance adherence outcomes (though this trend was nonsignificant). Further research should focus on the specific types of tasks these paraprofessionals can successfully provide (ie, psychosocial support, therapeutic alliance, and technical augmentation) and their associated outcomes. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020191226; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=191226
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Affiliation(s)
- Calista Leung
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julia Pei
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kristen Hudec
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Farhud Shams
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Richard Munthali
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Daniel Vigo
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Liu Z, Qiao D, Xu Y, Zhao W, Yang Y, Wen D, Li X, Nie X, Dong Y, Tang S, Jiang Y, Wang Y, Zhao J, Xu Y. The Efficacy of Computerized Cognitive Behavioral Therapy for Depressive and Anxiety Symptoms in Patients With COVID-19: Randomized Controlled Trial. J Med Internet Res 2021; 23:e26883. [PMID: 33900931 PMCID: PMC8128049 DOI: 10.2196/26883] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/14/2021] [Accepted: 04/24/2021] [Indexed: 12/20/2022] Open
Abstract
Background The prevalence of depressive and anxiety symptoms in patients with COVID-19 is higher than usual. Previous studies have shown that there are drug-to-drug interactions between antiretroviral drugs and antidepressants. Therefore, an effective and safe treatment method was needed. Cognitive behavioral therapy (CBT) is the first-line psychological therapy in clinical treatment. Computerized CBT (cCBT) was proven to be an effective alternative to CBT and does not require face-to-face therapy between a therapist and the patient, which suited the COVID-19 pandemic response. Objective This study aims to evaluate the efficacy of the cCBT program we developed in improving depressive and anxiety symptoms among patients with COVID-19. Methods We customized a cCBT program focused on improving depressive and anxiety symptoms among patients with COVID-19, and then, we assessed its effectiveness. Screening was based on symptoms of depression or anxiety for patients who scored ≥7 on the Hamilton Depression Rating Scale (HAMD17) or the Hamilton Anxiety Scale (HAMA). A total of 252 patients with COVID-19 at five sites were randomized into two groups: cCBT + treatment as usual (TAU; n=126) and TAU without cCBT (n=126). The cCBT + TAU group received the cCBT intervention program for 1 week. The primary efficacy measures were the HAMD17 and HAMA scores. The secondary outcome measures were the Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), and Athens Insomnia Scale (AIS). Assessments were carried out pre- and postintervention. The patients’ symptoms of anxiety and depression in one of the centers were assessed again within 1 month after the postintervention assessment. Results The cCBT + TAU group displayed a significantly decreased score on the HAMD17, HAMA, SDS, SAS, and AIS after the intervention compared to the TAU group (all P<.001). A mixed-effects repeated measures model revealed significant improvement in symptoms of depression (HAMD17 and SDS scores, both P<.001), anxiety (HAMA and SAS scores, both P<.001), and insomnia (AIS score, P=.002) during the postintervention and follow-up periods in the cCBT + TAU group. Additionally, the improvement of insomnia among females (P=.14) and those with middle school education (P=.48) in the cCBT + TAU group showed no significant differences when compared to the TAU group. Conclusions The findings of this study suggest that the cCBT program we developed was an effective nonpharmacological treatment for symptoms of anxiety, depression, and insomnia among patients with COVID-19. Further research is warranted to investigate the long-term effects of cCBT for symptoms of anxiety, depression, and insomnia in patients with COVID-19. Trial Registration Chinese Clinical Trial Registry ChiCTR2000030084; http://www.chictr.org.cn/showprojen.aspx?proj=49952
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Affiliation(s)
- Zhifen Liu
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Dan Qiao
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yifan Xu
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Wentao Zhao
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yang Yang
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Dan Wen
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xinrong Li
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaoping Nie
- Department of Medical Service, Chongqing Public Health Medical Center, Chongqing, China
| | - Yongkang Dong
- The Fourth People's Hospital of Taiyuan, Taiyuan, China
| | - Shiyou Tang
- Department of Psychiatry, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Yi Jiang
- Department of Respiratory and Critical Disease Medicine, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ying Wang
- Department of Geriatrics, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Juan Zhao
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yong Xu
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China
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21
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Tokgöz P, Hrynyschyn R, Hafner J, Schönfeld S, Dockweiler C. Digital Health Interventions in Prevention, Relapse, and Therapy of Mild and Moderate Depression: Scoping Review. JMIR Ment Health 2021; 8:e26268. [PMID: 33861201 PMCID: PMC8087966 DOI: 10.2196/26268] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/15/2021] [Accepted: 02/19/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Depression is a major cause for disability worldwide, and digital health interventions are expected to be an augmentative and effective treatment. According to the fast-growing field of information and communication technologies and its dissemination, there is a need for mapping the technological landscape and its benefits for users. OBJECTIVE The purpose of this scoping review was to give an overview of the digital health interventions used for depression. The main goal of this review was to provide a comprehensive review of the system landscape and its technological state and functions, as well as its evidence and benefits for users. METHODS A scoping review was conducted to provide a comprehensive overview of the field of digital health interventions for the treatment of depression. PubMed, PSYNDEX, and the Cochrane Library were searched by two independent researchers in October 2020 to identify relevant publications of the last 10 years, which were examined using the inclusion and exclusion criteria. To conduct the review, we used Rayyan, a freely available web tool. RESULTS In total, 65 studies were included in the qualitative synthesis. After categorizing the studies into the areas of prevention, early detection, therapy, and relapse prevention, we found dominant numbers of studies in the area of therapy (n=52). There was only one study for prevention, 5 studies for early detection, and 7 studies for relapse prevention. The most dominant therapy approaches were cognitive behavioral therapy, acceptance and commitment therapy, and problem-solving therapy. Most of the studies revealed significant effects of digital health interventions when cognitive behavioral therapy was applied. Cognitive behavioral therapy as the most dominant form was often provided through web-based systems. Combined interventions consisting of web-based and smartphone-based approaches are increasingly found. CONCLUSIONS Digital health interventions for treating depression are quite comprehensive. There are different interventions focusing on different fields of care. While most interventions can be beneficial to achieve a better depression treatment, it can be difficult to determine which approaches are suitable. Cognitive behavioral therapy through digital health interventions has shown good effects in the treatment of depression, but treatment for depression still stays very individualistic.
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Affiliation(s)
- Pinar Tokgöz
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Robert Hrynyschyn
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Health and Nursing Science, Berlin, Germany
| | - Jessica Hafner
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Simone Schönfeld
- School of Public Health, Bielefeld University, Bielefeld, Germany.,LWL-Klinik Lippstadt und Warstein, Lippstadt, Germany.,Universität Witten/Herdecke, Institut für Integrative Gesundheitsversorgung und Gesundheitsförderung, Witten, Germany
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22
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Karyotaki E, Efthimiou O, Miguel C, Bermpohl FMG, Furukawa TA, Cuijpers P. Internet-Based Cognitive Behavioral Therapy for Depression: A Systematic Review and Individual Patient Data Network Meta-analysis. JAMA Psychiatry 2021; 78:361-371. [PMID: 33471111 PMCID: PMC8027916 DOI: 10.1001/jamapsychiatry.2020.4364] [Citation(s) in RCA: 321] [Impact Index Per Article: 107.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/23/2020] [Indexed: 12/11/2022]
Abstract
Importance Personalized treatment choices would increase the effectiveness of internet-based cognitive behavioral therapy (iCBT) for depression to the extent that patients differ in interventions that better suit them. Objective To provide personalized estimates of short-term and long-term relative efficacy of guided and unguided iCBT for depression using patient-level information. Data Sources We searched PubMed, Embase, PsycInfo, and Cochrane Library to identify randomized clinical trials (RCTs) published up to January 1, 2019. Study Selection Eligible RCTs were those comparing guided or unguided iCBT against each other or against any control intervention in individuals with depression. Available individual patient data (IPD) was collected from all eligible studies. Depression symptom severity was assessed after treatment, 6 months, and 12 months after randomization. Data Extraction and Synthesis We conducted a systematic review and IPD network meta-analysis and estimated relative treatment effect sizes across different patient characteristics through IPD network meta-regression. Main Outcomes and Measures Patient Health Questionnaire-9 (PHQ-9) scores. Results Of 42 eligible RCTs, 39 studies comprising 9751 participants with depression contributed IPD to the IPD network meta-analysis, of which 8107 IPD were synthesized. Overall, both guided and unguided iCBT were associated with more effectiveness as measured by PHQ-9 scores than control treatments over the short term and the long term. Guided iCBT was associated with more effectiveness than unguided iCBT (mean difference [MD] in posttreatment PHQ-9 scores, -0.8; 95% CI, -1.4 to -0.2), but we found no evidence of a difference at 6 or 12 months following randomization. Baseline depression was found to be the most important modifier of the relative association for efficacy of guided vs unguided iCBT. Differences between unguided and guided iCBT in people with baseline symptoms of subthreshold depression (PHQ-9 scores 5-9) were small, while guided iCBT was associated with overall better outcomes in patients with baseline PHQ-9 greater than 9. Conclusions and Relevance In this network meta-analysis with IPD, guided iCBT was associated with more effectiveness than unguided iCBT for individuals with depression, benefits were more substantial in individuals with moderate to severe depression. Unguided iCBT was associated with similar effectiveness among individuals with symptoms of mild/subthreshold depression. Personalized treatment selection is entirely possible and necessary to ensure the best allocation of treatment resources for depression.
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Affiliation(s)
- Eirini Karyotaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Psychiatry, University of Oxford, Oxford, England
| | - Clara Miguel
- Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | | | - Toshi A. Furukawa
- Department of Clinical Psychology and Psychotherapy, University of Wuppertal, Wuppertal, Germany
- Department of Health Promotion and Human Behavior, Department of Clinical Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Pim Cuijpers
- Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Köhnen M, Dreier M, Seeralan T, Kriston L, Härter M, Baumeister H, Liebherz S. Evidence on Technology-Based Psychological Interventions in Diagnosed Depression: Systematic Review. JMIR Ment Health 2021; 8:e21700. [PMID: 33565981 PMCID: PMC7904404 DOI: 10.2196/21700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/30/2020] [Accepted: 11/18/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Evidence on technology-based psychological interventions (TBIs) for the treatment of depression is rapidly growing and covers a broad scope of research. Despite extensive research in this field, guideline recommendations are still limited to the general effectiveness of TBIs. OBJECTIVE This study aims to structure evidence on TBIs by considering different application areas (eg, TBIs for acute treatment and their implementation in health care, such as stand-alone interventions) and treatment characteristics (eg, therapeutic rationale of TBIs) to provide a comprehensive evidence base and to identify research gaps in TBIs for diagnosed depression. Moreover, the reporting of negative events in the included studies is investigated in this review to enable subsequent safety assessment of the TBIs. METHODS Randomized controlled trials on adults diagnosed with unipolar depression receiving any kind of psychotherapeutic treatment, which was at least partly delivered by a technical medium, were eligible for inclusion in our preregistered systematic review. We searched for trials in CENTRAL (Cochrane Central Register of Controlled Trials; until August 2020), MEDLINE, PsycINFO, PSYNDEX, CINAHL; until the end of January 2018), clinical trial registers, and sources of gray literature (until the end of January 2019). Study selection and data extraction were conducted by 2 review authors independently. RESULTS Database searches resulted in 15,546 records, of which 241 publications were included, representing 83 completed studies and 60 studies awaiting classification (ie, preregistered studies, study protocols). Almost all completed studies (78/83, 94%) addressed the acute treatment phase, being largely either implemented as stand-alone interventions (66/83, 80%) or blended treatment approaches (12/83, 14%). Studies on TBIs for aftercare (4/83, 5%) and for bridging waiting periods (1/83, 1%) were scarce. Most TBI study arms (n=107) were guided (59/107, 55.1%), delivered via the internet (80/107, 74.8%), and based on cognitive behavioral treatment approaches (88/107, 79.4%). Almost all studies (77/83, 93%) reported information on negative events, considering dropouts from treatment as a negative event. However, reports on negative events were heterogeneous and largely unsystematic. CONCLUSIONS Research has given little attention to studies evaluating TBIs for aftercare and for bridging waiting periods in people with depression, even though TBIs are seen as highly promising in these application areas; thus, high quality studies are urgently needed. In addition, the variety of therapeutic rationales on TBIs has barely been represented by identified studies hindering the consideration of patient preferences when planning treatment. Finally, future studies should use specific guidelines to systematically assess and report negative events. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) CRD42016050413; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42016050413. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2018-028042.
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Affiliation(s)
- Moritz Köhnen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mareike Dreier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tharanya Seeralan
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Harald Baumeister
- Department for Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Sarah Liebherz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Saberi P, McCuistian C, Agnew E, Wootton AR, Legnitto Packard DA, Dawson-Rose C, Johnson MO, Gruber VA, Neilands TB. Video-Counseling Intervention to Address HIV Care Engagement, Mental Health, and Substance Use Challenges: A Pilot Randomized Clinical Trial for Youth and Young Adults Living with HIV. TELEMEDICINE REPORTS 2021; 2:14-25. [PMID: 33575683 PMCID: PMC7869821 DOI: 10.1089/tmr.2020.0014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 05/04/2023]
Abstract
Background: Substance use and mental health are two barriers to engagement in care and antiretroviral therapy (ART) adherence among youth and young adults living with HIV (YLWH). The consequences of suboptimal adherence in YLWH are increased risk of HIV transmission and a future generation of immunodeficient adults with drug-resistant virus. Methods: The Youth to Telehealth and Texting for Engagement in Care (Y2TEC) study was a pilot randomized crossover trial that examined the feasibility and acceptability of a novel video-counseling series and accompanying text messages aimed at mental health, substance use, and HIV care engagement for YLWH. The intervention consisted of twelve 20-30-min weekly video-counseling sessions focused on identifying and addressing barriers to HIV care, mental health, and substance use challenges. Participants completed quantitative surveys at baseline, 4 months, and 8 months. Feasibility and acceptability were evaluated using prespecified benchmarks. Results: Fifty YLWH aged 18-29 years living in the San Francisco Bay Area were enrolled. Eighty-six percent and 75% of participants were retained at 4 and 8 months, respectively. A total of 455 (76%) video-counseling sessions were completed. In 82% of sessions, participants responded that they strongly agreed/agreed with this statement: "I felt heard, understood, and respected by the counselor." In 81% of sessions, participants responded that they strongly agreed/agreed with this statement: "Overall, today's session was right for me." At baseline, among participants reporting mental health challenges, only 10% noted having ever received mental health services, and among those who reported substance use challenges, ∼19% reported ever receiving substance use services. After 4 months of the Y2TEC intervention, participants reported slightly higher ART adherence and HIV knowledge, decreased depression and anxiety, and reduced stigma related to mental health and substance use. Conclusions: The Y2TEC intervention using video-counseling and text messaging was feasible and acceptable for YLWH. ClinicalTrials.gov ID: NCT03681145.
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Affiliation(s)
- Parya Saberi
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
- Address correspondence to: Parya Saberi, PharmD, MAS, Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, UCSF Box 0886, 550 16th Street, 3rd Floor, San Francisco, CA 94143, USA
| | - Caravella McCuistian
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Emily Agnew
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Angie R. Wootton
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Dominique A. Legnitto Packard
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Carol Dawson-Rose
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Mallory O. Johnson
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Valerie A. Gruber
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Torsten B. Neilands
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
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Köhnen M, Kriston L, Härter M, Baumeister H, Liebherz S. Effectiveness and acceptance of technology-based psychological interventions for the acute treatment of unipolar depression: a systematic review and meta-analysis (Preprint). J Med Internet Res 2020; 23:e24584. [PMID: 36260395 PMCID: PMC8386371 DOI: 10.2196/24584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/08/2021] [Accepted: 04/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background Evidence on technology-based psychological interventions (TBIs) for the acute treatment of depression is rapidly growing. Despite extensive research in this field, there is a lack of research determining effectiveness and acceptance of TBIs considering different application formats in people with a formally diagnosed depressive disorder. Objective The goal of the review was to investigate the effectiveness and acceptance of TBIs in people with diagnosed depression with particular focus on application formats (stand-alone interventions, blended treatments, collaborative and/or stepped care interventions). Methods Studies investigating adults with diagnosed unipolar depressive disorders receiving any kind of psychotherapeutic treatment delivered (at least partly) by a technical medium and conducted as randomized controlled trials (RCTs) were eligible for inclusion. We searched CENTRAL (Cochrane Central Register of Controlled Trials; August 2020), MEDLINE, PsycINFO, PSYNDEX, CINAHL (January 2018), clinical trial registers, and sources of grey literature (January 2019). Two independent authors decided about study inclusion and extracted data. We performed random effects meta-analyses to synthesize the data. Results Database searches resulted in 15,546 records of which 78 completed studies were included. TBIs delivered as stand-alone interventions showed positive effects on posttreatment depression severity when compared to treatment as usual (SMD –0.44, 95% CI –0.73 to –0.15, k=10; I²=86%), attention placebo (SMD –0.51, 95% CI –0.73 to –0.30; k=12; I²=66%), and waitlist controls (SMD –1.01, 95% CI –1.23 to –0.79; k=19; I²=73%). Superior long-term effects on depression severity were shown when TBIs were compared to treatment as usual (SMD –0.24, 95% CI –0.41 to –0.07; k=6; I²=48%) attention placebo (SMD –0.23, 95% CI –0.40 to –0.07; k=7; I²=21%) and waitlist controls (SMD –0.74, 95% CI –1.31 to –0.18; k=3; I²=79%). TBIs delivered as blended treatments (providing a TBI as an add-on to face-to-face treatment) yielded beneficial effects on posttreatment depression severity (SMD –0.27, 95% CI –0.48 to –0.05; k=8; I²=53%) compared to face-to-face treatments only. Additionally, TBIs delivered within collaborative care trials were more effective in reducing posttreatment (SMD –0.20, 95% CI –0.36 to –0.04; k=2; I²=0%) and long-term (SMD –0.23, 95% CI –0.39 to –0.07; k=2; I²=0%) depression severity than usual care. Dropout rates did not differ between the intervention and control groups in any comparison (all P≥.09). Conclusions We found that TBIs are effective not only when delivered as stand-alone interventions but also when they are delivered as blended treatments or in collaborative care trials for people with diagnosed depression. Our results may be useful to inform routine care, since we focused specifically on different application formats, formally diagnosed patients, and the long-term effectiveness of TBIs. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42016050413; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42016050413 International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2018-028042
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Affiliation(s)
- Moritz Köhnen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Harald Baumeister
- Department for Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
| | - Sarah Liebherz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Fromberger P, Schröder S, Bauer L, Siegel B, Tozdan S, Briken P, Buntrock C, Etzler S, Rettenberger M, Leha A, Müller JL. @myTabu-A Placebo Controlled Randomized Trial of a Guided Web-Based Intervention for Individuals Who Sexually Abused Children and Individuals Who Consumed Child Sexual Exploitation Material: A Clinical Study Protocol. Front Psychiatry 2020; 11:575464. [PMID: 33488416 PMCID: PMC7820175 DOI: 10.3389/fpsyt.2020.575464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/01/2020] [Indexed: 11/13/2022] Open
Abstract
Background: There is a high demand for evidence-based and cost-effective treatment concepts for convicted individuals who sexually abused children (ISAC) and individuals who consumed child sexual exploitation material (ICCSEM) under community supervision (CS). The @myTabu-consortium developed a guided web-based intervention for convicted ISAC and ICCSEM under CS consisting of six online modules targeting psychological meaningful risk factors. The study aims to evaluate the effectiveness of this guided web-based intervention in reducing dynamic risk factors and the risk to re-offend compared to a placebo condition. Furthermore, these dynamic risk factors are measured before and after every module to evaluate their individual effectiveness to reduce the respective risk factor as well as risk to re-offend. This clinical trial protocol describes the planned methods as well as the intervention concept. Methods: The methodological design is a placebo controlled randomized add-on trial (N = 582) with follow-ups at 8 points in time. The placebo condition controls for attention and expectation effects and comprises the same amount of modules with a comparable temporal effort as the experimental intervention. The trial is conducted as an add-on to community supervision as usually done. Primary outcomes are dynamic risk factors assessed by self-report risk assessment tools and officially recorded re-offenses. Discussion: To the best of our knowledge, the study is the first to compare the (cost-) effectiveness of a guided web-based intervention for convicted ISAC and ICCSEM under community supervision against a placebo condition. Methodological limitations (e.g., potential ceiling- or volunteers-effects) are discussed. Clinical Trial Registration: German Clinical Trial Register (DRKS 00021256). Prospectively registered: 24.04.2020.
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Affiliation(s)
- Peter Fromberger
- Clinic for Psychiatry and Psychotherapy-Forensic Psychiatry, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
| | - Sonja Schröder
- Clinic for Psychiatry and Psychotherapy-Forensic Psychiatry, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
| | - Louisa Bauer
- Clinic for Psychiatry and Psychotherapy-Forensic Psychiatry, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
| | - Bruno Siegel
- Clinic for Psychiatry and Psychotherapy-Forensic Psychiatry, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
| | - Safiye Tozdan
- Center for Psychosocial Medicine, Institute for Sex Research, Sexual Medicine & Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peer Briken
- Center for Psychosocial Medicine, Institute for Sex Research, Sexual Medicine & Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | | | | | - Andreas Leha
- Department of Medical Statistics, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
| | - Jürgen L Müller
- Clinic for Psychiatry and Psychotherapy-Forensic Psychiatry, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
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Kouvonen A, Mänty M, Harkko J, Sumanen H, Konttinen H, Lahti J, Pietilainen O, Blomgren J, Tuovinen E, Ketonen EL, Stenberg JH, Donnelly M, Sivertsen B, Mittendorfer-Rutz E, Pirkola S, Rahkonen O, Lallukka T. Effectiveness of internet-delivered cognitive behavioural therapy in reducing sickness absence among young employees with depressive symptoms: study protocol for a large-scale pragmatic randomised controlled trial. BMJ Open 2019; 9:e032119. [PMID: 31690647 PMCID: PMC6858165 DOI: 10.1136/bmjopen-2019-032119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Depression is a highly prevalent condition with typical onset in early adulthood. Internet-delivered cognitive behavioural therapy (iCBT) is a promising cost-effective and more widely available alternative to face-to-face CBT. However, it is not known whether it can reduce sickness absence in employees showing depressive symptoms. The randomised controlled trial component of the DAQI (Depression and sickness absence in young adults: a quasi-experimental trial and web-based treatment intervention) project aims to investigate if iCBT is effective in reducing sickness absence compared with care as usual (CAU) among young employees with depressive symptoms in primary care provided in an occupational health setting. METHODS AND ANALYSIS This study will use a randomised controlled single-centre service-based trial of an existing iCBT programme (Mental Hub iCBT for Depression) to evaluate whether or not this treatment can reduce the number of sickness absence days in public sector employees aged 18-34 years who present at the occupational health service with mild depressive symptoms (score ≥9 on the Beck Depression Inventory-IA). Control participants will be offered CAU, with no constraints regarding the range of treatments. The active condition will consist of seven weekly modules of iCBT, with support from a web therapist. Primary outcome will be participants' all-cause sickness absence as indicated in employer's and national administrative records up to 6 months from study entry. Secondary outcomes relating to long-term sickness absence (over 11 calendar days) for mental and musculoskeletal disorders and psychotropic medication use will be obtained from the Finnish Social Insurance Institution's administrative records; and short sickness absence spells (up to 11 calendar days) will be extracted from employer's records. Analyses will be conducted on an intention-to-treat basis. ETHICS AND DISSEMINATION The Coordinating Ethics Committee of the Hospital District of Helsinki and Uusimaa has approved the study (HUS/974/2019). The results will be published in peer-reviewed scientific journals and in publications for lay audience. TRIAL REGISTRATION NUMBER ISRCTN10877837.
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Affiliation(s)
- Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Research Institute of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Minna Mänty
- Unit of Statistics and Research, City of Vantaa, Vantaa, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jaakko Harkko
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Hilla Sumanen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Unit of Health Care and Emergency Care, South-Eastern Finland University of Applied Sciences, Kotka, Finland
| | - Hanna Konttinen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Jouni Lahti
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Olli Pietilainen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jenni Blomgren
- Research Unit, The Social Insurance Institution of Finland, Helsinki, Finland
| | | | | | - Jan-Henry Stenberg
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Børge Sivertsen
- Department of Public Mental Health, Norwegian Institute of Public Health, Bergen, Norway
- Department of Research and Innovation, Helse Fonna HF, Haugesund, Norway
| | - Ellenor Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sami Pirkola
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Facilitating access to iCBT: a randomized controlled trial assessing a translated version of an empirically validated program using a minimally monitored delivery model. Behav Cogn Psychother 2019; 48:185-202. [PMID: 31416489 DOI: 10.1017/s135246581900047x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Despite its established efficacy, access to internet-delivered CBT (iCBT) remains limited in a number of countries. Translating existing programs and using a minimally monitored model of delivery may facilitate its dissemination across countries. AIMS This randomized control trial aims to evaluate the efficacy of an iCBT transdiagnostic program translated from English to French and offered in Canada using a minimally monitored delivery model for the treatment of anxiety and depression. METHOD Sixty-three French speakers recruited in Canada were randomized to iCBT or a waiting-list. A French translation of an established program, the Wellbeing Course, was offered over 8 weeks using a minimally monitored delivery model. Primary outcome measures were the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), which were obtained pre-treatment, post-treatment and at 3-month follow-up. RESULTS Mixed-effects models revealed that participants in the treatment group had significantly lower PHQ-9 and GAD-7 scores post-treatment than controls with small between-groups effect sizes (d = 0.34 and 0.37, respectively). Within-group effect sizes on primary outcome measures were larger in the treatment than control group. Clinical recovery rates on the PHQ-9 and GAD-7 were significantly higher among the treatment group (40 and 56%, respectively) than the controls (13 and 16%, respectively). CONCLUSIONS The provision of a translated iCBT program using a minimally monitored delivery model may improve patients' access to treatment of anxiety and depression across countries. This may be an optimal first step in improving access to iCBT before sufficient resources can be secured to implement a wider range of iCBT services.
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Abstract
Tremendous biomedical advancements in HIV prevention and treatment have led to aspirational efforts to end the HIV epidemic. However, this goal will not be achieved without addressing the significant mental health and substance use problems among people living with HIV (PLWH) and people vulnerable to acquiring HIV. These problems exacerbate the many social and economic barriers to accessing adequate and sustained healthcare, and are among the most challenging barriers to achieving the end of the HIV epidemic. Rates of mental health problems are higher among both people vulnerable to acquiring HIV and PLWH, compared with the general population. Mental health impairments increase risk for HIV acquisition and for negative health outcomes among PLWH at each step in the HIV care continuum. We have the necessary screening tools and efficacious treatments to treat mental health problems among people living with and at risk for HIV. However, we need to prioritize mental health treatment with appropriate resources to address the current mental health screening and treatment gaps. Integration of mental health screening and care into all HIV testing and treatment settings would not only strengthen HIV prevention and care outcomes, but it would additionally improve global access to mental healthcare.
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Auerbach RP, Mortier P, Bruffaerts R, Alonso J, Benjet C, Cuijpers P, Demyttenaere K, Ebert DD, Green JG, Hasking P, Murray E, Nock MK, Pinder-Amaker S, Sampson NA, Stein DJ, Vilagut G, Zaslavsky AM, Kessler RC. WHO World Mental Health Surveys International College Student Project: Prevalence and distribution of mental disorders. JOURNAL OF ABNORMAL PSYCHOLOGY 2018; 127:623-638. [PMID: 30211576 PMCID: PMC6193834 DOI: 10.1037/abn0000362] [Citation(s) in RCA: 867] [Impact Index Per Article: 144.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Increasingly, colleges across the world are contending with rising rates of mental disorders, and in many cases, the demand for services on campus far exceeds the available resources. The present study reports initial results from the first stage of the WHO World Mental Health International College Student project, in which a series of surveys in 19 colleges across 8 countries (Australia, Belgium, Germany, Mexico, Northern Ireland, South Africa, Spain, United States) were carried out with the aim of estimating prevalence and basic sociodemographic correlates of common mental disorders among first-year college students. Web-based self-report questionnaires administered to incoming first-year students (45.5% pooled response rate) screened for six common lifetime and 12-month DSM-IV mental disorders: major depression, mania/hypomania, generalized anxiety disorder, panic disorder, alcohol use disorder, and substance use disorder. We focus on the 13,984 respondents who were full-time students: 35% of whom screened positive for at least one of the common lifetime disorders assessed and 31% screened positive for at least one 12-month disorder. Syndromes typically had onsets in early to middle adolescence and persisted into the year of the survey. Although relatively modest, the strongest correlates of screening positive were older age, female sex, unmarried-deceased parents, no religious affiliation, nonheterosexual identification and behavior, low secondary school ranking, and extrinsic motivation for college enrollment. The weakness of these associations means that the syndromes considered are widely distributed with respect to these variables in the student population. Although the extent to which cost-effective treatment would reduce these risks is unclear, the high level of need for mental health services implied by these results represents a major challenge to institutions of higher education and governments. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Randy P. Auerbach
- Department of Psychiatry, Columbia University, New York, USA; Division of Clinical Developmental Neuroscience, Sackler Institute, New York, USA
| | - Philippe Mortier
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Jordi Alonso
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Koen Demyttenaere
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - David D. Ebert
- Department for Psychology, Clinical Psychology and Psychotherapy Friedrich-Alexander University Erlangen Nuremberg, Erlangen, Germany
| | | | - Penelope Hasking
- School of Psychology & Speech Pathology, Curtin University, Perth, Australia
| | - Elaine Murray
- School of Biomedical Sciences, Ulster University, Derry-Londonderry, Northern Ireland
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, USA
| | - Stephanie Pinder-Amaker
- Department of Psychiatry, Harvard Medical School, Boston, USA; McLean Hospital, Belmont, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, USA
| | - Dan J. Stein
- Department of Psychiatry and MRC Unit on Risk & Resilience in Mental Disorders, University of Cape Town, South Africa
| | - Gemma Vilagut
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Alan M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, USA
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Sun KS, Lam TP, Wu D. Chinese perspectives on primary care for common mental disorders: Barriers and policy implications. Int J Soc Psychiatry 2018; 64:417-426. [PMID: 29781372 DOI: 10.1177/0020764018776347] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The World Health Organization (WHO) has called for integration of mental health into primary care for a decade. In Western countries, around 15% to 25% of patients with common mental disorders including mood and anxiety disorders seek help from primary care physicians (PCPs). The rate is only about 5% in China. AIMS This article reviews the Chinese findings on the barriers to primary care for common mental disorders and how they compared with Western findings. METHODS A narrative literature review was conducted, focusing on literature published from mid-1990s in English or Chinese. Patient, PCP and health system factors were reviewed. RESULTS Although Chinese and Western findings show similar themes of barriers, the Chinese have stronger barriers in most aspects, including under-recognition of the need for treatment, stigma on mental illness, somatization, worries about taking psychiatric drugs, uncertainties in the role, competency and legitimacy of PCPs in mental health care and short consultation time. CONCLUSION Current policies in China emphasize enhancement of mental health facilities and workforce in the community. Our review suggests that patients' intention to seek help and PCPs' competency in mental health care are other fundamental factors to be addressed.
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Affiliation(s)
- Kai Sing Sun
- 1 Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Tai Pong Lam
- 1 Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Dan Wu
- 2 University of North Carolina at Chapel Hill Project-China, Guangzhou, China
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Andrews G, Basu A, Cuijpers P, Craske MG, McEvoy P, English CL, Newby JM. Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: An updated meta-analysis. J Anxiety Disord 2018; 55:70-78. [PMID: 29422409 DOI: 10.1016/j.janxdis.2018.01.001] [Citation(s) in RCA: 488] [Impact Index Per Article: 81.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/16/2017] [Accepted: 01/03/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND A 2010 meta-analysis of internet-delivered CBT (iCBT) RCTs argued 'computer therapy for the anxiety and depressive disorders was effective, acceptable and practical health care' without data on effectiveness or practicality in routine practice. METHODS Databases, reviews and meta-analyses were searched for randomised controlled trials of cCBT or iCBT versus a control group (care as usual, waitlist, information control, psychological placebo, pill placebo, etc.) in people who met diagnostic criteria for major depression, panic disorder, social anxiety disorder or generalised anxiety disorder. Number randomised, superiority of treatment versus control (Hedges'g) on primary outcome measure, length of follow-up, follow up outcome, patient adherence and satisfaction/harm were extracted; risk of bias was assessed. A search for studies on effectiveness of iCBT in clinical practice was conducted. RESULTS 64 trials were identified. The mean effect size (efficacy) was g = 0.80 (NNT 2.34), and benefit was evident across all four disorders. Improvement was maintained at follow-with good acceptability. Research probity was good, and bias risk low. In addition, nine studies comparing iCBT with traditional face-to-face CBT and three comparing iCBT with bibliotherapy were identified. All three modes of treatment delivery appeared equally beneficial. The results of effectiveness studies were congruent with the results of the efficacy trials. LIMITATIONS Studies variably measured changes in quality of life and disability, and the lack of comparisons with medications weakens the field. CONCLUSIONS The conclusions drawn in the original meta-analysis are now supported: iCBT for the anxiety and depressive disorders is effective, acceptable and practical health care.
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Affiliation(s)
- G Andrews
- School of Psychiatry, University of New South Wales, Sydney Australia.
| | - A Basu
- University of New South Wales, Sydney, Australia
| | - P Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Vrije Universiteit and VU Medical Center Amsterdam, The Netherlands
| | - M G Craske
- Department of Psychology, University of California, Los Angeles, United States
| | - P McEvoy
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia; Centre for Clinical Interventions, Perth, Australia
| | - C L English
- St George's University of London, United Kingdom
| | - J M Newby
- School of Psychology, University of New South Wales, Sydney Australia
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Webb CA, Olson EA, Killgore WDS, Pizzagalli DA, Rauch SL, Rosso IM. Rostral Anterior Cingulate Cortex Morphology Predicts Treatment Response to Internet-Based Cognitive Behavioral Therapy for Depression. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2018; 3:255-262. [PMID: 29486867 PMCID: PMC6005352 DOI: 10.1016/j.bpsc.2017.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/21/2017] [Accepted: 08/15/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Rostral and subgenual anterior cingulate cortex (rACC and sgACC) activity and, to a lesser extent, volume have been shown to predict depressive symptom improvement across different antidepressant treatments. This study extends prior work by examining whether rACC and/or sgACC morphology predicts treatment response to Internet-based cognitive behavioral therapy (iCBT) for major depressive disorder. This is the first study to examine neural predictors of response to iCBT. METHODS Hierarchical linear modeling tested whether pretreatment rACC and sgACC volumes predicted depressive symptom improvement during a six-session (10-week) randomized clinical trial of iCBT (n = 35) versus a monitored attention control condition (n = 38). Analyses also tested whether pretreatment rACC and sgACC volumes differed between patients who achieved depression remission versus patients who did not remit. RESULTS Larger pretreatment right rACC volume was a significant predictor of greater depressive symptom improvement in iCBT even when controlling for demographic (age, gender, race) and clinical (baseline depression, anhedonia, and anxiety) variables previously linked to treatment response. In addition, pretreatment right rACC volume was larger among patients receiving iCBT whose depression eventually remitted relative to patients who did not remit. Corresponding analyses in the monitored attention control group and for the sgACC were not significant. CONCLUSIONS rACC volume before iCBT demonstrated incremental predictive validity beyond clinical and demographic variables previously found to predict symptom improvement. Such findings may help inform our understanding of the mediating anatomy of iCBT and, if replicated, may suggest neural targets to augment treatment response (e.g., via modulation of rACC function).
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Affiliation(s)
- Christian A Webb
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth A Olson
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | | | - Diego A Pizzagalli
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Scott L Rauch
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Isabelle M Rosso
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
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Ahern E, Kinsella S, Semkovska M. Clinical efficacy and economic evaluation of online cognitive behavioral therapy for major depressive disorder: a systematic review and meta-analysis. Expert Rev Pharmacoecon Outcomes Res 2018; 18:25-41. [PMID: 29145746 DOI: 10.1080/14737167.2018.1407245] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/16/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Leading cause of disability worldwide, depression is the most prevalent mental disorder with growing societal costs. As mental health services demand often outweighs provision, accessible treatment options are needed. Our systematic review and meta-analysis evaluated the clinical efficacy and economic evidence for the use of online cognitive behavioral therapy (oCBT) as an accessible treatment solution for depression. AREAS COVERED Electronic databases were searched for controlled trials published between 2006 and 2016. Of the reviewed 3,324 studies, 29 met the criteria for inclusion in the efficacy meta-analysis. The systematic review identified five oCBT economic evaluations. Therapist-supported oCBT was equivalent to face-to-face CBT at improving depressive symptoms and superior to treatment-as-usual, waitlist control, and attention control. Depression severity, number of sessions, or support did not affect efficacy. From a healthcare provider perspective, oCBT tended to show greater costs with greater benefits in the short term, relative to comparator treatments. EXPERT COMMENTARY Although efficacious, further economic evidence is required to support the provision of oCBT as a cost-effective treatment for depression. Economic evaluations that incorporate a societal perspective will better account for direct and indirect treatment costs. Nevertheless, oCBT shows promise of effectively improving depressive symptoms, considering limited mental healthcare resources.
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Affiliation(s)
- Elayne Ahern
- a Department of Psychology , University of Limerick , Limerick , Ireland
- b Department of Economics , Kemmy Business School, University of Limerick , Limerick , Ireland
| | - Stephen Kinsella
- b Department of Economics , Kemmy Business School, University of Limerick , Limerick , Ireland
| | - Maria Semkovska
- a Department of Psychology , University of Limerick , Limerick , Ireland
- c Health Research Institute , University of Limerick , Limerick , Ireland
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Josephine K, Josefine L, Philipp D, David E, Harald B. Internet- and mobile-based depression interventions for people with diagnosed depression: A systematic review and meta-analysis. J Affect Disord 2017; 223:28-40. [PMID: 28715726 DOI: 10.1016/j.jad.2017.07.021] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/05/2017] [Accepted: 07/08/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND To summarize and critically evaluate the effectiveness of internet- and mobile-based interventions (IMIs) for depression in adults with a diagnosed depression. METHODS Preregistered systematic review of RCTs investigating internet- and mobile-based interventions (IMIs) targeting adults with diagnosed depression. IMIs had to be compared with waitlist, attention placebo, other IMIs or other (face-to-face) therapies. A comprehensive search of primary studies was conducted. Study selection and data extraction was done by two independent researchers. Primary outcome was symptom severity of depression. Furthermore, treatment response, depression remission, treatment adherence, anxiety and quality of life were investigated. Random-effects meta-analyses were conducted where possible, as well as pre-planned subgroup and sensitivity analyses. RESULTS Database search resulted in 4858 references, of which 19 studies were eligible for inclusion and provided data on 29 IMIs. IMIs showed beneficial effects on depression severity when compared to waitlist conditions at the end of treatment (pooled standardized mean difference (SMD) g = -0.90, 95% CI -1.07 to -0.73, n = 10). The comparison between different IMIs did not result in any superiority or inferiority. All IMIs reduced depression symptoms from pre- to post-treatment (within group SMD range -2.24; -0.64, n = 29) and from pre-treatment to follow-up assessments (SMD range -3.07; -0.93, n = 27). CONCLUSION IMIs significantly reduce depression symptoms in adults with diagnosed depression at the end of treatment and at follow-up assessments when compared to waitlist conditions. These findings argue for IMIs to be recommended in depression treatment guidelines.
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Affiliation(s)
- Königbauer Josephine
- University of Ulm, Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, Germany
| | - Letsch Josefine
- University of Ulm, Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, Germany
| | - Doebler Philipp
- TU Dortmund University, Faculty of Statistics, Chair of Statistical Methods in Social Sciences, Germany
| | - Ebert David
- Friedrich-Alexander University of Erlangen-Nürnberg, Clinical Psychology and Psychotherapy, Germany
| | - Baumeister Harald
- University of Ulm, Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, Germany.
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Abstract
The World Health Organization estimates that during a given 12-month period, approximately 34 million people suffering from major depressive disorder go untreated in Europe and the Americas alone. Barriers to treatment include geographic distance, lack of mental health insurance, prohibitive cost of treatment, long wait-lists, and perceived stigma. Over the past two decades, Internet-based cognitive-behavioral therapy (iCBT) programs have proliferated. A growing body of research supports the efficacy of iCBT for depression and other psychiatric conditions, and these programs may help address barriers that hinder access to effective treatment. The present review describes common iCBT programs along with the evidence base supporting their efficacy in reducing symptoms of depression, reviews research on moderators of treatment response, and provides suggestions for future directions in research and care.
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