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Flynt S, Koscinski B, Accorso C, Knapp A, Gorka S, Suhr J, Austin M, Allan NP. A One-Arm Pilot Trial of a Telehealth CBT-Based Group Intervention Targeting Transdiagnostic Risk for Emotional Distress. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.23.24306218. [PMID: 38712129 PMCID: PMC11071586 DOI: 10.1101/2024.04.23.24306218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
The COVID-19 pandemic had a significant impact on mental health, straining an already overburdened healthcare system. A modular, transdiagnostic approach to treating psychopathology may be ideal to target common transdiagnostic risk factors for emotional distress and related disorders likely to be impacted by circumstances related to this once-in-a-lifetime environmental stressor. Anxiety sensitivity (AS), or fear of anxious arousal, intolerance of uncertainty (IU), or distress when confronted with uncertainty, and loneliness are three transdiagnostic risk factors impacted by the pandemic and robust predictors of emotional distress beyond that. We completed a pilot feasibility, acceptability, and utility trial of Coping Crew, our group, telehealth-delivered transdiagnostic treatment protocol in 17 participants who completed the intervention (M age = 22.00, SD = 4.46; 71% female). The intervention and study protocol were feasible to deliver and were rated as acceptable and useful to address intervention targets. Evidence was mixed regarding feasibility, acceptability, and usefulness of the mobile app component. Sixteen of 17 participants (94%) completed at least one survey a day on 80% of the days but only 6 participants (35%) completed at least 80% of the mobile app surveys delivered over the course of the intervention. Most participants rated use of the app as acceptable and relevant to psychological improvements made due to the intervention. Sizeable effect size reductions in transdiagnostic risk factors were found at post-intervention and maintained at 1- and 3-month follow-up, supporting next steps in the development of this modular transdiagnostic treatment.
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Affiliation(s)
- Sierra Flynt
- Department of Psychology, Ohio University, Athens, OH, USA
| | | | | | - Ashley Knapp
- Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - Stephanie Gorka
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA
| | | | | | - Nicholas P. Allan
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, United States
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Martínez-Borba V, Martínez-García L, Peris-Baquero Ó, Osma J, del Corral-Beamonte E. Unified Protocol for the transdiagnostic treatment of emotional disorders in people with post COVID-19 condition: study protocol for a multiple baseline n-of-1 trial. Front Psychol 2023; 14:1160692. [PMID: 37920733 PMCID: PMC10618554 DOI: 10.3389/fpsyg.2023.1160692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 09/28/2023] [Indexed: 11/04/2023] Open
Abstract
Background Post COVID-19 syndrome, defined as the persistence of COVID-19 symptoms beyond 3 months, is associated with a high emotional burden. Post COVID-19 patients frequently present comorbid anxiety, depressive and related disorders (emotional disorders, EDs) which have an important impact on their quality of life. Unfortunately, psychological interventions to manage these EDs are rarely provided to post COVID-19 patients. Also importantly, most psychological interventions do not address comorbidity, namely simultaneous EDs present in COVID-19 patients. This study will explore the clinical utility and acceptability of a protocol-based cognitive-behavioral therapy called the Unified Protocol for the transdiagnostic treatment of EDs in patients suffering post COVID-19 condition. Methods A multiple baseline n-of-1 trial will be used, as it allows participants to be their own comparison control. Sample will be composed of 60 patients diagnosed with post COVID-19 conditions and comorbid EDs from three Spanish hospitals. After meeting the eligibility criteria, participants will answer the pre-assessment protocol and then they will be randomly assigned to three different baseline conditions (6, 8, or 10 days of assessments before the intervention). Participants and professionals will be unblinded to participants' allocation. Once the baseline assessment has been completed, participants will receive the online psychological individual intervention through video-calls. The Unified Protocol intervention will comprise 8 sessions of a 1 h duration each. After the intervention, participants will answer the post-assessment protocol. Additional follow-up assessments will be conducted at one, three, six, and twelve months after the intervention. Primary outcomes will be anxiety and depressive symptoms. Secondary outcomes include quality of life, emotion dysregulation, distress tolerance, and satisfaction with the programme. Data analyses will include between-group and within-group differences and visual analysis of patients' progress. Discussion Results from this study will be disseminated in scientific journals. These findings may help to provide valuable information in the implementation of psychological interventions for patients suffering post COVID-19 conditions. Clinical trial registration https://clinicaltrials.gov, identifier (NCT05581277).
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Affiliation(s)
| | - Laura Martínez-García
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Universidad de Zaragoza, Zaragoza, Spain
| | - Óscar Peris-Baquero
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Universidad de Zaragoza, Zaragoza, Spain
| | - Jorge Osma
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Universidad de Zaragoza, Zaragoza, Spain
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Gual-Montolio P, Suso-Ribera C, García-Palacios A, Castilla D, Zaragoza I, Bretón-López J. Enhancing Internet-based psychotherapy for adults with emotional disorders using ecological momentary assessments and interventions: Study protocol of a feasibility trial with "My EMI, Emotional Well-being" app. Internet Interv 2023; 31:100601. [PMID: 36686334 PMCID: PMC9852876 DOI: 10.1016/j.invent.2023.100601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Emotional disorders are the most frequent mental health problems globally. To ensure the dissemination of psychological treatments for these conditions, novel forms of delivery (e.g., Internet or mobile apps) and more scalable forms of psychotherapy (e.g., transdiagnostic interventions) have become increasingly popular. Research, however, shows that a significant number of patients, around 40 % according to some studies, do not respond to the interventions as expected (i.e., not-on-track patients). Ecological momentary assessments (EMAs) and ecological momentary interventions (EMIs) could simplify tailoring treatments to the patients' progress and rapidly respond to undesired outcomes during psychotherapy. Therefore, these would facilitate measurement-based care with little therapist involvement. This study aims to explore the feasibility of an app-based system called My EMI, Emotional Well-being for people with emotional disorders. According to daily EMAs, the app will provide personalized EMIs while participants receive a self-applied online transdiagnostic treatment. The app will be used as an add-tool to the online intervention to address emotion dysregulation, foster adherence, and reinforce contents. The current study describes the study protocol for this trial. METHOD AND ANALYSIS A single-group, open trial design will be used. Participants will be 30 adults suffering from emotional disorders. Primary outcomes will be app usability, acceptability, and response rates. Secondary outcomes will be either evaluated in Qualtrics at pre-treatment, post-treatment, and 3-month follow-up (depression and anxiety severity, and transdiagnostic dimensions of emotional disorders) or daily throughout the study with the app (EMAs of mood and five transdiagnostic mechanisms of therapeutic change). EMIs will consist of brief, evidence-based transdiagnostic CBT digital content (images, infographics, or videos) delivered just-in-time. Only if problems persist, short phone calls or episodic videocalls will be conducted. The Ethics Committee of the Jaume I University approved the study and all its procedures (CD/111/2021) in December 2021. DISCUSSION Identifying personalized and scalable interventions is paramount to improve mental health care, especially its accessibility, and to reduce the psychological distress of people with mental health problems. Feasibility data of the app (EMA and EMI system) supported by a self-applied online transdiagnostic intervention will be important to explore whether this modern approach is a real option to move forward personalized psychological interventions for persons with emotional disorders. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05109780. Registered 05 November 2021, https://clinicaltrials.gov/ct2/show/NCT05109780.
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Affiliation(s)
- Patricia Gual-Montolio
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, 12071 Castellon de la Plana, Spain
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, 12071 Castellon de la Plana, Spain,CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain,Corresponding author at: Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, 12071 Castellon de la Plana, Spain.
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, 12071 Castellon de la Plana, Spain,CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Diana Castilla
- Department of Personality, Assessment, and Psychological Treatments, Universidad de Valencia, 46010 Valencia, Spain,CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Irene Zaragoza
- Department of Personality, Assessment, and Psychological Treatments, Universidad de Valencia, 46010 Valencia, Spain,CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Juana Bretón-López
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, 12071 Castellon de la Plana, Spain,CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
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Li Y, Nazari N, Sadeghi M. Internet delivered, non-inferiority, two-arm, assessor-blinded intervention comparing mindfulness-based stress reduction and cognitive-behavioral treatment for insomnia: a protocol study for a randomized controlled trial for nursing staff with insomnia. Trials 2022; 23:1020. [PMID: 36527137 PMCID: PMC9756716 DOI: 10.1186/s13063-022-06986-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 12/06/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Insomnia and poor sleep quality are highly prevalent conditions related to coronavirus disease 2019 (COVID-19) complications among clinical nurses. Although cognitive behavioral therapy for insomnia (CBT-I) is a first-line treatment, CBT-I suffers from several major drawbacks. This study investigates whether the application of the internet-delivered mindfulness-based stress reduction (iMBSR) intervention will produce effects that are non-inferior to the internet-delivered CBT-I (iCBT-I) intervention in reducing the severity of insomnia in clinical nurses with insomnia at the end of the study. METHODS This study protocol presents an internet-delivered, parallel-groups, assessor-blinded, two-arm, non-inferiority randomized controlled trial. The primary outcome is sleep quality, assessed by the Insomnia Severity Index. Secondary outcomes include depression, dysfunctional beliefs, five facets of mindfulness, and client satisfaction. CONCLUSION It is expected that this study may address several gaps in the literature. The non-inferiority study design is a novel approach to evaluating whether a standardized, complementary treatment (i.e., MBSR) is as practical as a gold standard treatment rather than its potential benefits. This approach may lead to expanded evidence-based practice and improve patient access to effective treatments. TRIAL REGISTRATION Trial registration number: ISRCTN36198096 . Registered on 24th May 2022.
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Affiliation(s)
- Yaling Li
- grid.499351.30000 0004 6353 6136Mental Health Education and Counseling Center, Shenzhen Technology University, Shenzhen, 518118 Guangdong China
| | - Nabi Nazari
- grid.411406.60000 0004 1757 0173Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Iran
| | - Masoud Sadeghi
- grid.411406.60000 0004 1757 0173Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Iran
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