A meta-analysis of self-help treatment approaches

Adherence to Online Interventions for Family Caregivers of People With Dementia: A Meta-Analysis and Systematic Review

OBJECTIVE

Online interventions hold promise in supporting the well-being of family caregivers and enhancing the quality of care they provide for individuals with long-term or chronic conditions. However, dropout rates from support programs among specific groups of caregivers, such as caregivers of people with dementia, pose a challenge. Focused reviews are needed to provide more accurate insights and estimates in this specific research area.

METHODS

A meta-analysis of dropout rates from available online interventions for family caregivers of people with dementia was conducted to assess treatment acceptability. A systematic search yielded 18 studies involving 1,215 caregivers.

RESULTS

The overall pooled dropout rate was 18.4%, with notable heterogeneity indicating varied intervention adherence. Interventions incorporating human contact, interactive features, and personalization strategies for specific types and stages of dementia predicted significantly lower dropout rates. Methodological assessment revealed variability in study quality.

CONCLUSION

Findings support the effectiveness of social support, personalization strategies, and co-design in enhancing intervention adherence among dementia family caregivers. Further research is needed to explore factors influencing dropout rates and conduct robust trials to refine the implementation of future interventions.

Efficacy of low intensity interventions for geriatric depression and anxiety - A systematic review and meta-analysis

BACKGROUND

This systematic review and meta-analysis examined the efficacy of low intensity psychological interventions for older adults (60+ years) with clinical anxiety and/or depressive disorders.

METHOD

Systematic review and meta-analysis of randomised control trials of low-intensity psychological interventions for anxiety and/or depression with an active or passive control condition (e.g., waitlist, treatment-as-usual or active control) in any setting. Low intensity psychological interventions (e.g., cognitive behaviour therapy [CBT]) targeted anxiety and/or depression as primary outcomes, were primarily self-help, and included support from trained practitioners/facilitators with <6 h total contact time (typically <30 min p/contact).

RESULTS

Seven studies consisting of 304 older adults (65-78 years, Mage = 70, SD = 4) were identified and six included in the meta-analysis of depression outcomes and three for anxiety. A random effects meta-analysis of group differences in symptom change from pre-post treatment found evidence favouring low intensity psychological interventions over passive control groups for the treatment of depressive and anxiety symptoms, with moderate effect sizes for depression (Cohen's d = -0.62) and large effect sizes for anxiety (Cohen's d = -0.84) at post-treatment.

LIMITATIONS

Results are limited by study design of included studies such that the efficacy of interventions compared to treatment-as-usual, non-CBT approaches, in adults >80 years and long-term effects are unknown.

CONCLUSIONS

There is some evidence supporting the clinical benefits of low intensity psychological interventions for depressive and anxiety symptoms in older adults compared to passive controls. More research is needed to examine efficacy compared to active control conditions, and among those over 80 years.

Use of a Self-guided Computerized Cognitive Behavioral Tool During COVID-19: Evaluation Study

BACKGROUND

Internet-based programs can help provide accessible and inexpensive behavioral health care to those in need; however, the evaluation of these interventions has been mostly limited to controlled trials. Data regarding patterns of use and effectiveness of self-referred, open-access online interventions are lacking. We evaluated an online-based treatment designed to address stress, depression, and conflict management, the Dartmouth PATH Program, in a freely available and self-guided format during the COVID-19 pandemic.

OBJECTIVE

The primary aim is to determine users' levels of stress and depression, and the nature of problems and triggers they reported during the COVID-19 pandemic. A secondary objective is to assess the acceptability and usability of the PATH content and determine whether such a program would be useful as a stand-alone open-access resource. The final objective is understanding the high dropout rates associated with online behavioral programs by contrasting the use pattern and program efficacy of individuals who completed session one and did not return to the program with those who came back to complete more sessions.

METHODS

Cumulative anonymous data from 562 individuals were analyzed. Stress triggers, stress responses, and reported problems were analyzed using qualitative analysis techniques. Scores on usability and acceptability questionnaires were evaluated using the sign test and Wilcoxon signed rank test. Mixed-effects linear modeling was used to evaluate changes in stress and depression over time.

RESULTS

A total of 2484 users registered from April through October 2020, most of whom created an account without initiating a module. A total of 562 individuals started the program and were considered in the data analysis. The most common stress triggers individuals reported involved either conflicts with family or spouses and work or workload. The most common problems addressed in the mood module were worry, anxiousness, or stress and difficulty concentrating or procrastination. The attrition rate was high with 13% (21/156) completing the conflict module, 17% (50/289) completing session one of the mood module, and 14% (16/117) completing session one of the stress module. Usability and acceptability scores for the mood and stress modules were significantly better than average. In those who returned to complete sessions, symptoms of stress showed a significant improvement over time (P=.03), and there was a significant decrease in depressive symptoms over all time points (P=.01). Depression severity decreased on average by 20% (SD 35.2%; P=.60) between sessions one and two.

CONCLUSIONS

Conflicts with others, worry, and difficulty concentrating were some of the most common problems people used the programs to address. Individuals who completed the modules indicated improvements in self-reported stress and depression symptoms. Users also found the modules to be effective and rated the program highly for usability and acceptability. Nevertheless, the attrition rate was very high, as has been found with other freely available online-based interventions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02726061; https://clinicaltrials.gov/ct2/show/NCT02726061.

Bibliotherapy for Sexual Dysfunctions: A Systematic Review and Meta-Analysis

AIM

The objective of this study was to assess the efficacy of bibliotherapy for sexual dysfunctions, when compared with no treatment and compared with other interventions.

METHODS

MEDLINE, EMBASE, and PsycINFO were searched from 1970 to January 2020. Selection criteria were randomized controlled trials evaluating assisted or unassisted bibliotherapy for all types of sexual dysfunctions compared with no treatment (wait list or placebo) or with other psychological interventions. Bibliotherapy is defined as psychological treatment using printed instruction to be used by the individual or couple suffering from sexual dysfunction. Primary outcome measures were male and female sexual functioning level and continuation/remission of sexual dysfunction. Secondary outcomes were sexual satisfaction and dropout rate. Sexual functioning and sexual satisfaction were self-reported by participants using validated questionnaires.

RESULTS

Fifteen randomized controlled trials with a total of 1,113 participants (781 women; 332 men) met inclusion criteria. Compared with no treatment, unassisted bibliotherapy resulted in larger proportions of female participants reporting remission of sexual dysfunction, and sexual satisfaction was higher in treated participants, both female and male participants. Compared with no treatment, assisted bibliotherapy had significant positive effects on female sexual functioning; no effects on male sexual functioning were found. Results of unassisted and assisted bibliotherapy did not differ from those of other intervention types on any outcome. Throughout, no differences between study conditions were found regarding dropout rates. The certainty of the evidence for all outcomes was rated as very low.

CONCLUSION

We found indications of positive effects of bibliotherapy for sexual dysfunctions. Across studies, more significant effects were found for women than for men. However, owing to limitations in the study designs and imprecision of the findings, we were unable to draw firm conclusions about the use of bibliotherapy for sexual dysfunction. More high quality and larger trials are needed. Relevant outcome measures for future studies should be defined as well as unified grading systems to measure these endpoints. In addition, future studies should report on treatment acceptability and adherence. van Lankveld JJDM, van de Wetering FT, Wylie, K et al. Bibliotherapy for Sexual Dysfunctions: A Systematic Review and Meta-Analysis. J Sex Med 2021;18:582-614.

Two randomized controlled trials of the efficacy of acceptance and commitment therapy-based educational course for body shape dissatisfaction

The main aim of this project was to explore the efficacy of Acceptance and Commitment Therapy (ACT)-based educational course in different formats (i.e., pure and guided self-help with different durations, and guided self-help with and without access to a discussion forum) for body shape dissatisfaction. Two randomized controlled studies (RCT) were carried out. In the first RCT, the participants were randomized to a 12- or 16-week guided self-help, a 16-week pure self-help, or a waitlist control condition. In the second RCT, the efficacy of 12-week guided self-help with or without access to a discussion forum was investigated. ACT-based self-help resulted in promising improvements in body shape dissatisfaction, and modest effects on general health indicators (i.e., symptom of depression, self-esteem, satisfaction with life, and quality of life). The findings also showed no additional effects of support, access to the online discussion forum, and longer duration of self-help, suggesting the 12-week self-help with or without support is a viable option for reducing body shape dissatisfaction.

Smartphone-based exposure treatment for dental phobia: a pilot randomized clinical trial

OBJECTIVES

High levels of dental care-related fear/anxiety, as well as phobia, result in delay or avoidance of dental care, which are associated with poorer oral and overall health. Both pharmacotherapeutic and psychosocial methods are available to treat those with high levels of dental fear/anxiety or phobia, but they are infrequently used and not easily accessed. Smartphones are a potential vehicle for delivering exposure therapy (e.g., a treatment involving systematic encounter with fear-evoking stimuli), but there is a need to test the acceptability of this approach in regard to treatment of high levels of dental anxiety/fear and phobia.

METHODS

There were 36 patients with high dental anxiety/fear/phobia randomly assigned to either a treatment or a waitlist condition. Participants completed a pre- and two-week post-multimodal assessment, including a dental behavioral avoidance task. The treatment condition included 2 weeks of self-directed exposure delivered via a personal smartphone in the patients' natural environment.

RESULTS

Participants in the treatment condition utilized the smartphone exposure an average of 1.6 times daily (SD = 0.85), and found the self-directed exposure highly acceptable. Moreover, they had lower self-reported anxiety and decreased cardiac reactivity at the postassessment compared with the preassessment; no change in anxiety was found for the control condition from pre- to postassessment.

CONCLUSIONS

Highly anxious, fearful, and dental phobic participants utilized smartphone-delivered exposure therapy, and found it to be an acceptable treatment method. Results support the utility and promise for further testing of the personal smartphone in delivering self-directed exposure therapy for high dental fear/anxiety and phobia.

A Randomized Study Comparing Video-Based Mindfulness-Based Cognitive Therapy With Video-Based Traditional Cognitive Behavioral Therapy in a Sample of Women Struggling to Achieve Orgasm

INTRODUCTION

This study examines the effectiveness of integrating mindfulness-based techniques within therapy for women suffering to achieve orgasm. Although widely applied in psychotherapy, this approach has only recently been introduced in the treatment of female sexual dysfunction.

AIM

To compare the effectiveness of a video-based self-administered treatment, rooted within the cognitive behavioral treatment (CBT) framework, with a video-based self-administered mindfulness treatment applying cognitive behavioral sexual therapy (mindfulness-based cognitive therapy), the latter of which was specifically created to increase women's ability to achieve orgasm.

METHODS

A convenience sample of 65 women suffering from difficulties to achieve orgasm, aged 18 to 58 years (mean = 32.66, standard deviation = 9.48), were randomly allocated using a randomization procedure to either a mindfulness-based cognitive therapy (N = 35) or CBT (N = 30) group. Each participant completed questionnaires before and after the start of treatment and 2 months after its completion.

MAIN OUTCOME MEASURE

We applied repeated-measure general linear models to compare the 2 groups (ie, between participant factor) on each dependent variable across time (ie, the within-participant factor). Compare mean analyses for paired samples were only conducted when the interaction effect between condition and time was significant (ie, P <.05).

RESULTS

Statistical analyses show that women in both groups presented increased sexual functioning (P = .001) and decreased sexual distress (P < .001), as well as improved desire, arousal, orgasm, and sexual satisfaction (P < .05) after their respective treatments. Contrary to our hypothesis, significant reductions in sexual pain were only observed in CBT participants.

CLINICAL IMPLICATIONS

To the best of our knowledge, this is the first study to apply a randomized allocation procedure to evaluate the effectiveness of a video-based mindfulness intervention for women struggling to achieve orgasm. These results should guide clinicians' decisions with respect to evaluating the relevance and the real added value of proposing mindfulness exercises to their patients with such difficulties.

CONCLUSION

When women suffering from difficulties to achieve orgasm are randomly assigned to a mindfulness group or an active control, improvements in sexual functioning and reductions in sexual distress can be observed after both treatments. Adam F, De Sutter P, Day J, et al. A Randomized Study Comparing Video-Based Mindfulness-Based Cognitive Therapy With Video-Based Traditional Cognitive Behavioral Treatment in a Sample of Women Struggling to Achieve Orgasm. J Sex Med 2020;17:312-324.

Evaluating ACT Processes in Relation to Outcome in Self-Help Treatment for Anxiety-Related Problems

Evaluating how, for whom, and under what conditions psychosocial treatments work is an important component of anxiety disorder treatment development. Yet, research regarding mediators and moderators of self-help interventions is sparse. The current project is a secondary analysis of mediators, moderators, and correlates of outcome of a randomized wait-list-controlled trial assessing acceptance and commitment therapy (ACT) self-help bibliotherapy for anxiety and related problems. Participants (n = 503) were randomized to an immediate workbook (n = 256) or wait-list condition (n = 247). Nonparametric bootstrapped mediation analyses showed that pre-post positive changes in ACT treatment processes accounted for the relation between treatment and pre-post improvement on the primary outcomes of anxiety symptoms, depressive symptoms, and quality of life. Results indicated no baseline variables were significant moderators. Finally, hierarchical regression analyses indicated that the degree of improvement for each primary outcome was positively correlated with the degree to which participants reported applying the workbook material to their day-to-day life, over and above how much of the book they reported reading. This study provided support for the ACT model of change in a self-help context and highlighted the importance of actively applying self-help material, addressing theoretical and practical questions about how and why ACT self-help works.

How should a virtual agent present psychoeducation? Influence of verbal and textual presentation on adherence

BACKGROUND AND OBJECTIVE

With the rise of autonomous e-mental health applications, virtual agents can play a major role in improving trustworthiness, therapy outcome and adherence. In these applications, it is important that patients adhere in the sense that they perform the tasks, but also that they adhere to the specific recommendations on how to do them well. One important construct in improving adherence is psychoeducation, information on the why and how of therapeutic interventions. In an e-mental health context, this can be delivered in two different ways: verbally by a (virtual) embodied conversational agent or just via text on the screen. The aim of this research is to study which presentation mode is preferable for improving adherence.

METHODS

This study takes the approach of evaluating a specific part of a therapy, namely psychoeducation. This was done in a non-clinical sample, to first test the general constructs of the human-computer interaction. We performed an experimental study on the effect of presentation mode of psychoeducation on adherence. In this study, we took into account the moderating effects of attitude towards the virtual agent and recollection of the information. Within the paradigm of expressive writing, we asked participants (n= 46) to pick one of their worst memories to describe in a digital diary after receiving verbal or textual psychoeducation.

RESULTS AND CONCLUSION

We found that both the attitude towards the virtual agent and how well the psychoeducation was recollected were positively related to adherence in the form of task execution. Moreover, after controlling for the attitude to the agent and recollection, presentation of psychoeducation via text resulted in higher adherence than verbal presentation by the virtual agent did.

Effectiveness of a Self Help Cognitive Behavioural Treatment Program for Problem Gamblers: A Randomised Controlled Trial

The study aimed to strengthen the scarce literature on self-help treatments for Problem Gambling (PG) by comparing the effectiveness of a Self-Help Cognitive Behavioral Treatment (SHCBT) program (n = 23) with a 6-week Waitlist condition (n = 32) in problem gamblers. Participants were community volunteers with gambling problems and were randomly allocated to the Waitlist and treatment conditions. Results showed significant improvements at post-treatment in gambling behaviors including frequency of gambling, average amount gambled per day and PG symptoms as well as a number of gambling correlates including psychological states (e.g., depression, anxiety and stress), gambling cognitions, gambling urges, gambling related self-efficacy, satisfaction with life, and quality of life among those who completed the SHCBT program, when compared with the waitlist condition. The effect size (partial η ²) ranged from .25 to .57 for all assessed outcomes that showed significant improvement from pre- to post-treatment. It was concluded that a self-help CBT program can be beneficial for treating community problem gamblers.

Use of written cognitive–behavioural therapy self-help materials to treat depression

Both primary and secondary care practitioners often wish to offer their patients access to effective psychosocial interventions, yet the lengthy waiting-lists for specialised psychological or psychotherapeutic services create frustration among both referrers and their patients. There is therefore a need for new ways of accessing such treatments that can be delivered in most psychiatric team settings. For this to be realistic, such delivery must be possible within the time available to most practitioners (10–20 minutes for many consultant psychiatrists). One approach is to offer structured self-help materials.

The evidence base for cognitive—behavioural therapy in depression: delivery in busy clinical settings

The evidence base for cognitive–behavioural therapy (CBT) for depression is discussed with reference to the review documentTreatment Choice in Psychological Therapies and Counselling (Department of Health). This identifies the need to deliver evidence-based psychosocial interventions and identifies CBT as having the strongest research base for effectiveness, but does not cover how to deliver CBT within National Health Service settings. The traditional CBT model of weekly face-to-face appointments is widely offered, yet there is little evidence to support these traditions in the outcome literature. Reducing face-to-face contact by introducing self-help into treatment may be one method of improving access. The SPIRIT course is discussed which teaches how to offer core cognitive–behavioural skills using structured self-help materials.

Peer Support Services for Bereaved Survivors: A Systematic Review

This systematic literature review assesses the evidence regarding benefits of peer support services for bereaved survivors of sudden or unexpected death. Reports were included that addressed peer support services for adults who experienced death of a family member, close friend, or coworker. Of the 32 studies meeting all inclusion criteria, most showed evidence that peer support was helpful to bereaved survivors, reducing grief symptoms and increasing well-being and personal growth. Studies also showed benefits to providers of peer support, including increased personal growth and positive meaning in life. Several studies addressed the growing trend of Internet-based peer support programs, finding that these are beneficial in part due to their easy accessibility. Peer support appears to be especially valuable for survivors of suicide loss, a result that may be related to stigma and lack of support from family and friends experienced by many suicide survivors. The reviewed studies provide consistent evidence that peer support is beneficial to bereaved survivors.

A next-generation social media-based relapse prevention intervention for youth depression: Qualitative data on user experience outcomes for social networking, safety, and clinical benefit

Major depressive disorder (MDD) has a high prevalence and relapse rate among young people. For many individuals depression exhibits a severe course, and it is therefore critical to invest in innovative online interventions for depression that are cost-effective, acceptable and feasible. At present, there is a scarcity of research reporting on qualitative data regarding the subjective user experience of young people using social networking-based interventions for depression. This study provides in-depth qualitative insights generated from 38 semi-structured interviews, and a follow-up focus group, with young people (15-25 years) after the implementation of a moderated online social therapy intervention for depression relapse prevention ("Rebound"). Exploratory analysis identified patterns of content from interview data related to three main themes: 1) preferred content compared to perceived helpfulness of the online platform, 2) interest in social networking, and 3) protective environment. Two clear groups emerged; those who perceived the social networking component of the intervention as the most helpful component; and those who preferred to engage in therapy content, receiving individualized content suggested by moderators. The Rebound intervention was shown to be acceptable for young people with major depression. Integration of social networking features appears to enhance intervention engagement for some young people recovering from depression.

Who (or What) Can Do Psychotherapy: The Status and Challenge of Nonprofessional Therapies

Research suggests that paraprofessional therapists usually produce effects that are greater than effects for control conditions and comparable to those for professional therapist treatment Other nonprofessional psychological treatments, such as self-administered materials and self-help groups, have also demonstrated positive effects Because of the promise of these nonprofessional treatments, their potential for low-cost service delivery, and the important theoretical questions that studies comparing them can answer, psychotherapy outcome research should shift away from comparisons of different professional therapies and instead compare nonprofessional therapies with professional therapy

Effects of cognitive behavioral therapy with relaxation vs. imagery rescripting on test anxiety: A randomized controlled trial

BACKGROUND

Test anxiety is a common condition in students, which may lead to impaired academic performance as well as to distress. The primary objective of this study was to evaluate the effectiveness of two cognitive-behavioral interventions designed to reduce test anxiety. Test anxiety in the participants was diagnosed as social or specific phobia according to DSM-IV. Subsequently subjects were randomized to three groups: a moderated self-help group, which served as a control group, and two treatment groups, where either relaxation techniques or imagery rescripting were applied.

METHODS

Students suffering from test anxiety were recruited at two German universities (n=180). The randomized controlled design comprised three groups which received test anxiety treatment in weekly three-hour sessions over a period of five weeks. Treatment outcome was assessed with a test anxiety questionnaire, which was administered before and after treatment, as well as in a six-month follow-up.

RESULTS

A repeated-measures ANOVA for participants with complete data (n=59) revealed a significant reduction of test anxiety from baseline to six-month follow-up in all three treatment groups (p<.001).

LIMITATIONS

Participants were included if they had a clinical diagnosis of test anxiety. The sample may therefore represent only more severe forms of text anxiety . Moreover, the sample size in this study was small, the numbers of participants per group differed, and treatment results were based on self-report. Due to the length of the treatment, an implementation of the group treatments used in this study might not be feasible in all settings.

CONCLUSIONS

Group treatments constitute an effective method of treating test anxiety, e.g. in university settings. Imagery rescripting may particularly contribute to treatment efficacy.

Reminders make people adhere better to a self-help sleep intervention

The experiment presented in this paper investigated the effects of different kinds of reminders on adherence to automated parts of a cognitive behavioural therapy for insomnia (CBT-I) delivered via a mobile device. Previous studies report that computerized health interventions can be effective. However, treatment adherence is still an issue. Reminders are a simple technique that could improve adherence. A minimal intervention prototype in the realm of sleep treatment was developed to test the effects of reminders on adherence. Two prominent ways to determine the reminder-time are: a) ask users when they want to be reminded, and b) let an algorithm decide when to remind users. The prototype consisted of a sleep diary, a relaxation exercise and reminders. A within subject design was used in which the effect of reminders and two underlying principles were tested by 45 participants that all received the following three different conditions (in random order): a) event-based reminders b) time-based reminders c) no reminders. Both types of reminders improved adherence compared to no reminders. No differences were found between the two types of reminders. Opportunity and self-empowerment could partly mediate adherence to filling out the sleep diary, but not to the number of relaxation exercises conducted. Although the study focussed on CBT-I, we expect that designers of other computerized health interventions benefit from the tested opportunity and self-empowerment principles for reminders to improve adherence, as well.

Event-level impact of Promescent on quality of sexual experience in men with subjective premature ejaculation

Promescent is a lidocaine-based ejaculation delaying spray that absorbs into the skin of the penis prior to sexual activity. This article aimed to evaluate the effect of Promescent on the experience of orgasm, ejaculatory latency time and quality of sexual experience (QSE). Additionally, we assessed ease of application of Promescent and the extent to which it enhanced or interrupted the sexual experience. The analytic sample consisted of 91 men with self-reported subjective premature ejaculation who were sent a sample of Promescent and completed a 14-day internet-based prospective daily electronic report. Average ejaculatory latency time was 11.16 min during product use events, compared with 6.81 min during product non-use events. Both members of the couple had an orgasm 65.6% of the time when they used the product, compared with 44.1% when they did not use the product. QSE was significantly improved on product use days (P<0.05). Quality also significantly improved each subsequent time the product was used (P<0.01). The product was reported as easy to use and did not interrupt the sexual experience. Findings suggest that the use of this topical spray significantly improves QSE and perception of partner experience, and that these improve with longer duration of use.

The Effect of Team Building on Performance

In this article, meta-analytic integration of research examining the effects of team building on performance is reported. Overall, there was no significant effect of team building on performance. However, the effects of team building varied as a function of the type of operationalization of performance: On objective measures of performance, there was a nonsignificant tendency for team building to decrease performance, whereas on subjective measures of performance, there was a significant, albeit small, tendency for team building to increase performance. Examination of the specific components of team building revealed that interventions emphasizing role clarification were more likely to increase performance, whereas interventions that emphasized goal setting, problem solving, or interpersonal relations were no more likely to render an increase or decrease in performance. Finally, the effects of team building decreased as a function of the size of the team. The discussion considers implications of these effects of team building on performance.

The Active Client: Therapy as Self-Help

A model of how therapy works is proposed that locates the source of therapeutic change in the client, while the therapist is the provider of opportunities, ideas, and experiences. Ultimately all therapy is self-help. This model is contrasted with the medical-like model of therapy as treatment and hopes to account for research findings of equal effectiveness among different therapies. Although the active client model developed from existential-humanistic ideas, it can be compatible with all approaches.

Graded Exercise Therapy Guided Self-Help Trial for Patients with Chronic Fatigue Syndrome (GETSET): Protocol for a Randomized Controlled Trial and Interview Study

Background

Chronic fatigue syndrome, also known as myalgic encephalomyelitis (CFS/ME), is characterized by chronic disabling fatigue and other symptoms, which are not explained by an alternative diagnosis. Previous trials have suggested that graded exercise therapy (GET) is an effective and safe treatment. GET itself is therapist-intensive with limited availability.

Objective

While guided self-help based on cognitive behavior therapy appears helpful to patients, Guided graded Exercise Self-help (GES) is yet to be tested.

Methods

This pragmatic randomized controlled trial is set within 2 specialist CFS/ME services in the South of England. Adults attending secondary care clinics with National Institute for Health and Clinical Excellence (NICE)-defined CFS/ME (N=218) will be randomly allocated to specialist medical care (SMC) or SMC plus GES while on a waiting list for therapist-delivered rehabilitation. GES will consist of a structured booklet describing a 6-step graded exercise program, supported by up to 4 face-to-face/telephone/Skype™ consultations with a GES-trained physiotherapist (no more than 90 minutes in total) over 8 weeks. The primary outcomes at 12-weeks after randomization will be physical function (SF-36 physical functioning subscale) and fatigue (Chalder Fatigue Questionnaire). Secondary outcomes will include healthcare costs, adverse outcomes, and self-rated global impression change scores. We will follow up all participants until 1 year after randomization. We will also undertake qualitative interviews of a sample of participants who received GES, looking at perceptions and experiences of those who improved and worsened.

Results

The project was funded in 2011 and enrolment was completed in December 2014, with follow-up completed in March 2016. Data analysis is currently underway and the first results are expected to be submitted soon.

Conclusions

This study will indicate whether adding GES to SMC will benefit patients who often spend many months waiting for rehabilitative therapy with little or no improvement being made during that time. The study will indicate whether this type of guided self-management is cost-effective and safe. If this trial shows GES to be acceptable, safe, and comparatively effective, the GES booklet could be made available on the Internet as a practitioner and therapist resource for clinics to recommend, with the caveat that patients also be supported with guidance from a trained physiotherapist. The pragmatic approach in this trial means that GES findings will be generalizable to usual National Health Service (NHS) practice.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRTCTN): 22975026; http://www.isrctn.com/ISRCTN22975026 (Archived by WebCite at http://www.webcitation.org/6gBK00CUX)

Predictors of IAPT psychological well-being practitioners’ intention to use CBT self-help materials routinely in their clinical practice

Despite efficacy and effectiveness evidence, and recommendations from the National Institute for Health and Care Excellence (NICE), use of CBT self-help materials remains inconsistent in UK mental health services. Since 2006, the Improving Access to Psychological Therapies (IAPT) programme has provided standardized training and mandates routine use of CBT self-help materials by their trainee psychological well-being practitioners (PWPs). This study tested whether the main constructs of the theory of planned behaviour (TPB; attitudes, subjective norms, and perceived behavioural control), past use, prior training and demographic characteristics, would predict PWPs’ intention to use self-help materials routinely in their clinical practice. Stage 1 utilized a standardized procedure to create measures for the constructs of TPB, before the design and testing of a web-based, cross-sectional questionnaire. In stage 2, the questionnaire was administered to a convenience sample of trainee PWPs (n = 94). Data was analysed using multiple linear regression, mediation analyses, and content analysis. TPB constructs predicted intention to use self-help materials, with only direct attitude contributing significantly to 70% of the variance in intention. Past use of materials predicted intention, via direct and indirect mediation. Qualitative data from 43 trainees highlighted clients’ experience of self-help materials as positive, albeit with some practical constraints. The results suggest that the main constructs of TPB have some utility in predicting trainee PWPs’ intention to use self-help materials routinely. Future prospective, longitudinal research could investigate actual use of self-help materials to elucidate cognitive factors involved in trainees’ clinical decision-making post-qualification.

The acceptability and feasibility of an anxiety reduction intervention for emergency department patients with non-cardiac chest pain

Despite good physical prognosis, patients who receive a diagnosis of non-cardiac chest pain (NCCP) may experience persistent pain and distress. While cognitive-behavioural interventions have been found to be effective for this group, they are difficult to deliver in busy emergency department (ED) settings. Addressing the acceptability and relevance of self-help interventions is an important initial step in addressing this need. This study sought to examine the acceptability and relevance of an evidence-based self-help intervention for ED patients with persistent NCCP and anxiety. Patient (interviews: N = 11) and specialist chest pain nurse (focus group: N = 4) views on acceptability and feasibility were examined. Data were analysed using thematic analysis. Patients and nurses reported that there was a need for the intervention, as stress and anxiety are common among patients with NCCP, and provision of psychosocial support is currently lacking. Both patients and nurses reported that the intervention was relevant, acceptable, and potentially useful. Some changes to the intervention were suggested. Nurses reported that the intervention could be used within the existing staff resources available in an ED setting. This study represents an important first step towards developing a brief self-help intervention for ED patients with NCCP and anxiety. Further research should seek to determine the efficacy of the intervention in a pilot trial.

Adherence to Technology-Mediated Insomnia Treatment: A Meta-Analysis, Interviews, and Focus Groups

Background

Several technologies have been proposed to support the reduction of insomnia complaints. A user-centered assessment of these technologies could provide insight into underlying factors related to treatment adherence.

Objective

Gaining insight into adherence to technology-mediated insomnia treatment as a solid base for improving those adherence rates by applying adherence-enhancing strategies.

Methods

Adherence to technology-mediated sleep products was studied in three ways. First, a meta-analysis was performed to investigate adherence rates in technology-mediated insomnia therapy. Several databases were queried for technology-mediated insomnia treatments. After inclusion and exclusion steps, data from 18 studies were retrieved and aggregated to find an average adherence rate. Next, 15 semistructured interviews about sleep-support technologies were conducted to investigate perceived adherence. Lastly, several scenarios were written about the usage of a virtual sleep coach that could support adherence rates. The scenarios were discussed in six different focus groups consisting of potential users (n=15), sleep experts (n=7), and coaches (n=9).

Results

From the meta-analysis, average treatment adherence appeared to be approximately 52% (95% CI 43%-61%) for technology-mediated insomnia treatments. This means that, on average, half of the treatment exercises were not executed, suggesting there is a substantial need for adherence and room for improvement in this area. However, the users in the interviews believed they adhered quite well to their sleep products. Users mentioned relying on personal commitment (ie, willpower) for therapy adherence. Participants of the focus groups reconfirmed their belief in the effectiveness of personal commitment, which they regarded as more effective than adherence-enhancing strategies.

Conclusions

Although adherence rates for insomnia interventions indicate extensive room for improvement, users might not consider adherence to be a problem; they believe willpower to be an effective adherence strategy. A virtual coach should be able to cope with this “adherence bias” and persuade users to accept adherence-enhancing strategies, such as reminders, compliments, and community building.

Treating nighttime fears in young children with bibliotherapy: evaluating anxiety symptoms and monitoring behavior change

OBJECTIVE

Children's nighttime fears are a normal part of child development and are transient for most children, but result in considerable distress for others. The present study evaluated a 4-week bibliotherapy intervention designed to treat young children with persistent and interfering nighttime fears utilizing a multiple baseline design.

METHOD

Nine children between 5 and 7 years of age with specific phobia diagnoses were randomized into one of three baseline control conditions (1, 2, or 3 weeks). The treatment protocol involved parents reading Uncle Lightfoot, Flip that Switch: Overcoming Fear of the Dark, Academic Version (Coffman, 2012) with their children over 4 weeks while engaging in activities prescribed in the book. Assessments took place at baseline, post treatment, and 1 month following treatment. Daily and weekly tracking of nighttime behaviors was also obtained.

RESULTS

Pre-post group analyses revealed that eight of the nine children demonstrated clinically significant change in anxiety severity. In addition, decreases in child-reported nighttime fears were observed, as were parent-reported decreases in separation anxiety and increases in the number of nights children slept in their own bed.

CONCLUSIONS

The present study provides initial support for the use of bibliotherapy in the treatment of nighttime fears. Further replication and evaluation are needed to determine appropriate length of treatment and long-term effects. Implications of the findings are discussed.

A multicentre randomised controlled trial of a carer supervised culturally adapted CBT (CaCBT) based self-help for depression in Pakistan

BACKGROUND

Cognitive Behaviour Therapy (CBT) based self-help has been found to be effective for treating depression and anxiety. There is some evidence to suggest that CBT needs to be culturally adapted for it to be effective in non-Western cultures. CBT is not widely used in low and middle income countries and there is a need to test its effectiveness in different settings and formats, including self-help.

METHODS

We describe a RCT of a Culturally adapted CBT (CaCBT) based self-help manual in Pakistan. The trial was conducted in psychiatry departments in three cities. Assessments were carried out at baseline and at 12 weeks, using Hospital Anxiety and Depression Scale, Bradford somatic Inventory and brief disability Questionnaire.

RESULTS

At the end of the trial CaCBT based self-help was found to be effective against care as usual in reducing the symptoms of depression and anxiety, as well as somatic symptoms and disability.

LIMITATIONS

This study was conducted only in secondary care and required either patient or a carer to be able to read and write.

CONCLUSIONS

This is the first study outside West of a CBT based self-help intervention for depression. This study highlights the importance of using cost effective interventions in developing world in low intensity formats. Future studies should focus on trying these resources in different settings, like primary care, and with the use of audio/video or multimedia resources to improve compliance in patients with lower literacy.

Media-delivered cognitive behavioural therapy and behavioural therapy (self-help) for anxiety disorders in adults

BACKGROUND

Anxiety disorders are the most common mental health problems. They are chronic and unremitting. Effective treatments are available, but access to services is limited. Media-delivered behavioural and cognitive behavioural interventions (self-help) aim to deliver treatment with less input from professionals compared with traditional therapies.

OBJECTIVES

To assess the effects of media-delivered behavioural and cognitive behavioural therapies for anxiety disorders in adults.

SEARCH METHODS

Published and unpublished studies were considered without restriction by language or date. The Cochrane Depression, Anxiety and Neurosis Review Group's Specialized Register (CCDANCTR) was searched all years to 1 January 2013. The CCDANCTR includes relevant randomised controlled trials from the following bibliographic databases: The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). Complementary searches were carried out on Ovid MEDLINE (1950 to 23 February 2013) and PsycINFO (1987 to February, Week 2, 2013), together with International trial registries (the trials portal of the World Health Organization (ICTRP) and ClinicalTrials.gov). Reference lists from previous meta-analyses and reports of randomised controlled trials were checked, and authors were contacted for unpublished data.

SELECTION CRITERIA

Randomised controlled trials of media-delivered behavioural or cognitive behavioural therapy in adults with anxiety disorders (other than post-traumatic stress disorder) compared with no intervention (including attention/relaxation controls) or compared with face-to-face therapy.

DATA COLLECTION AND ANALYSIS

Both review authors independently screened titles and abstracts. Study characteristics and outcomes were extracted in duplicate. Outcomes were combined using random-effects models, and tests for heterogeneity and for small study bias were conducted. We examined subgroup differences by type of disorder, type of intervention provided, type of media, and recruitment methods used.

MAIN RESULTS

One hundred and one studies with 8403 participants were included; 92 studies were included in the quantitative synthesis. These trials compared several types of media-delivered interventions (with varying levels of support) with no treatment and with face-to-face interventions. Inconsistency and risk of bias reduced our confidence in the overall results. For the primary outcome of symptoms of anxiety, moderate-quality evidence showed medium effects compared with no intervention (standardised mean difference (SMD) 0.67, 95% confidence interval (CI) 0.55 to 0.80; 72 studies, 4537 participants), and low-quality evidence of small effects favoured face-to-face therapy (SMD -0.23, 95% CI -0.36 to -0.09; 24 studies, 1360 participants). The intervention was associated with greater response than was seen with no treatment (risk ratio (RR) 2.34, 95% CI 1.81 to 3.03; 21 studies, 1547 participants) and was not significantly inferior to face-to-face therapy in these studies (RR 0.78, 95 % CI 0.56 to 1.09; 10 studies, 575 participants), but the latter comparison included versions of therapies that were not as comprehensive as those provided in routine clinical practice. Evidence suggested benefit for secondary outcome measures (depression, mental-health related disability, quality of life and dropout), but this evidence was of low to moderate quality. Evidence regarding harm was lacking.

AUTHORS' CONCLUSIONS

Self-help may be useful for people who are not able or are not willing to use other services for people with anxiety disorders; for people who can access it, face-to-face cognitive behavioural therapy is probably clinically superior. Economic analyses were beyond the scope of this review.Important heterogeneity was noted across trials. Recent interventions for specific problems that incorporate clinician support may be more effective than transdiagnostic interventions (i.e. interventions for multiple disorders) provided with no guidance, but these issues are confounded in the available trials.Although many small trials have been conducted, the generalisability of their findings is limited. Most interventions tested are not available to consumers. Self-help has been recommended as the first step in the treatment of some anxiety disorders, but the short-term and long-term effectiveness of media-delivered interventions has not been established. Large, pragmatic trials are needed to evaluate and to maximise the benefits of self-help interventions.

A systematic review of minimal-contact psychological treatments for symptom management in irritable bowel syndrome

OBJECTIVE

Psychological treatments are effective in alleviating symptoms of IBS but are not widely available. The need for wider dissemination of treatments has encouraged the development of 'minimal-contact' therapies requiring fewer resources than existing psychological treatments which rely on face-to-face contact.

METHOD

Using comprehensive search terms, the Embase, Medline and PsychInfo databases (all years) were searched.

RESULTS

Twelve studies--nine RCTs and three non-controlled preliminary studies - meeting inclusion criteria were reviewed and assessed for quality using objective criteria. Apart from one study of expressive writing, all interventions were based on cognitive (and/or) behavioural principles or hypnosis and tended to be adaptations of existing therapist-led interventions. Compared to control conditions, minimal-contact interventions were efficacious, the majority of studies showing statistically significant improvements by the end of treatment. For cognitive-behaviour-therapy-based interventions effects sizes were large. The two studies that compared minimal-contact with therapist-delivered interventions broadly suggest comparable outcomes between these modalities.

CONCLUSIONS

Minimal-contact cognitive-behavioural interventions show promise in the treatment of IBS. Because of the lower quality of studies of hypnosis and those involving interventions delivered entirely remotely, further support is needed before such approaches can be recommended for widespread use. More generally, future research should use representative samples, active control conditions, and intention to treat analysis. Nonetheless, existing high quality studies suggest that minimal-contact therapies may be a safe, effective means of achieving scaleability of psychological treatments for IBS.

Efficacy of psychological treatment for headaches: an overview of systematic reviews and analysis of potential modifiers of treatment efficacy

OBJECTIVES

A variety of psychological treatments exist for headaches (HAs). Their efficacy has been evaluated through systematic reviews with meta-analysis. Our goal was to evaluate the scope of these reviews and reevaluate the efficacy of treatments considering potential sources of variation systematically. These findings should help guide clinical practice and will provide guidance to researchers planning to address the efficacy of psychological treatments for HAs.

MATERIALS AND METHODS

Two systematic reviews were conducted: one searched for systematic reviews with meta-analysis exploring the efficacy of psychological treatments for HA in Cochrane Database, DARE, EMBASE, ISI Web of Knowledge, Medline, and PsychINFO from inception to December 2011. Two independent reviewers screened, evaluated quality, and extracted data. The second review searched for primary studies from the included reviews estimating the efficacy of psychological treatments for a clinically significant change.

RESULTS

Eighteen reviews met a priori criteria for inclusion. The broad scope of research on efficacy of psychological treatments for HA is reflected by variation in clinical and methodological characteristics of the reviews. These variations were explored through meta-analysis and subgroup analysis of 41 primary studies and showed that some of these variations, including time of assessment, treatment type, age, HA diagnosis, and study quality, can impact the magnitude of treatment effect.

DISCUSSION

There is substantial evidence in favor of psychological treatments for HA management. Further investigation, especially in specific treatments (cognitive-behavioral or autogenic treatment) for HA disorders, is needed. The assessment of these systematic reviews highlighted key areas where improvement should be made to increase the quality of evidence.

Effectiveness of group and self-help cognitive behavior therapy in reducing problematic menopausal hot flushes and night sweats (MENOS 2): a randomized controlled trial

OBJECTIVE

The aim of this study was to examine the effectiveness of group cognitive behavioral therapy (CBT) and guided self-help CBT in reducing hot flush and night sweat (HF/NS) problem rating at 6 and 26 weeks after randomization.

METHODS

This was a randomized control trial of 140 women having 10 or more problematic HF/NS a week for at least a month. The primary outcome was HF/NS problem rating (1-10) at 6 weeks after randomization. Secondary outcomes were physiologically measured HF/NS at 6 weeks; HF/NS problem rating at 6 weeks; and frequency, mood (Women's Health Questionnaire), and health-related quality of life (General Health Survey Short Form-36) at 6 and 26 weeks. Intention-to-treat analysis was used, and between-group differences were estimated using linear mixed models.

RESULTS

Baseline mean (SD) HF/NS weekly frequency was 63.15 (49.24), and problem rating was 5.87 (2.28). Group and self-help CBT both significantly reduced HF/NS problem rating at 6 weeks-group CBT versus no treatment control (NTC; adjusted mean difference, 2.12; 95% CI, 1.36-2.88; P < 0.001) and self-help CBT versus NTC (adjusted mean difference, 2.08; 95% CI, 1.29-2.86; P < 0.001)-and at 26 weeks-group CBT versus NTC (adjusted mean difference, 1.33; 95% CI, 0.54-2.13; P = 0.001) and self-help CBT versus NTC (adjusted mean difference, 1.19; 95% CI, 0.36-2.02; P = 0.005). Group and self-help CBT significantly reduced night sweat frequency at 6 and 26 weeks. There were improvements in mood and quality of life at 6 weeks and improved emotional and physical functioning for group CBT at 26 weeks.

CONCLUSIONS

These results suggest that CBT delivered in group or self-help format is an effective treatment option for women during the menopause transition and postmenopause with problematic HF/NS.

Understanding children's dental anxiety and psychological approaches to its reduction

BACKGROUND

Dental anxiety is a common problem, which can affect people of all ages, but appears to develop mostly in childhood and adolescence. Childhood dental anxiety is not only distressing for the child and their family but is also associated with poor oral health outcomes and an increased reliance on costly specialist dental services.

AIM

This article will consider the prevalence, development, and implications of children's dental anxiety. It will also discuss the opportunities for and challenges of psychological approaches such as cognitive behavioural therapy aimed at the reduction of dental anxiety in children.

A brief self-help toolkit intervention for gambling problems: a randomized multisite trial

Two studies conducted in Massachusetts and Nevada evaluated the efficacy of a self-help toolkit for problem gambling. Individuals concerned about gambling-related problems, in response to public notices and newspaper advertisements, volunteered for a randomized trial of the self-help toolkit, Your First Step to Change: Gambling. Participants were randomly assigned to 1 of 3 conditions: (a) a printed toolkit, (b) the toolkit and a brief guide to the toolkit's content, or (c) assignment to a wait-list condition. Participants, 145 in Massachusetts and 170 in Nevada, reported their gambling behavior, beliefs and attitudes about chance, and recent and planned help seeking at baseline, 88% at 1 month later, and 79% at 3 months later. Findings for the complete and intent-to-treat analyses at both sites indicated that participants significantly improved. At the end of the study period, significantly more toolkit recipients than control group participants reported recently abstaining from gambling. Minimally invasive, self-directed resources like this self-help toolkit can assist remediating gambling-related problems among gamblers who do not engage in formal treatment.

Supported self-management: a simple, effective way to improve depression care

OBJECTIVES

To introduce supported self-management (SSM) for depression, examine it through the use of a quality assessment framework, and show its potential for enhancing the Canadian health care system.

METHOD

SSM is examined in terms of quality criteria: relevance, effectiveness, appropriateness, efficiency, safety, acceptability, and sustainability. Critical research is highlighted, and a case study is presented to illustrate the use of SSM with depressed patients.

RESULTS

SSM is defined by access to a self-management guide (workbook or website) plus encouragement and coaching by health care provider, family member, or other supporter. It has high relevance to depression care in Canada, high cost-effectiveness, high appropriateness for most people with depression, and high safety. Acceptability of this intervention is more problematic: many providers remain doubtful of its acceptability to their poorly motivated patients. Sustainability of SSM as a component of mental health care will require ongoing knowledge exchange among policy-makers, health care providers, and researchers.

CONCLUSION

The introduction of SSM represents a unique opportunity to enhance the delivery of depression care in Canada. Actively engaging the distressed individual in changing depressive patterns can improve outcomes without mobilizing substantial new resources. Over time, we will learn more about making SSM compatible with constraints on provider time, increasing access to self-management tools, and evaluating the benefit to everyday clinical work.

Efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders: systematic review

BACKGROUND

Self-help interventions for psychiatric disorders represent an increasingly popular alternative to therapist-administered psychological therapies, offering the potential of increased access to cost-effective treatment.

AIMS

To determine the efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders.

METHOD

Randomised controlled trials (RCTs) of self-help interventions for anxiety disorders were identified by searching nine online databases. Studies were grouped according to disorder and meta-analyses were conducted where sufficient data were available. Overall meta-analyses of self-help v. waiting list and therapist-administered treatment were also undertaken. Methodological quality was assessed independently by two researchers according to criteria set out by the Cochrane Collaboration.

RESULTS

Thirty-one RCTs met inclusion criteria for the review. Results of the overall meta-analysis comparing self-help with waiting list gave a significant effect size of 0.84 in favour of self-help. Comparison of self-help with therapist-administered treatments revealed a significant difference in favour of the latter with an effect size of 0.34. The addition of guidance and the presentation of multimedia or web-based self-help materials improved treatment outcome.

CONCLUSIONS

Self-help interventions appear to be an effective way of treating individuals diagnosed with social phobia and panic disorder. Further research is required to evaluate the cost-effectiveness and acceptability of these interventions.

An interview study investigating experiences of psychological change without psychotherapy

OBJECTIVES

Given that most people who experience psychological distress resolve this distress without the assistance of psychotherapy, the study sought to increase our understanding of naturally occurring change including the facilitators of this change.

DESIGN

The study sought to replicate and extend earlier work in this area. The design involved recruiting participants who had experienced some form of psychological distress and had resolved this distress without accessing psychotherapy services.

METHODS

Qualitative methods were used for this study because the lived experience of the participants was of interest. Semi-structured interviews were used following a pro forma developed in earlier work. Interpretive Phenomenological Analysis was the analytical method adopted for this study to identify themes and patterns in the transcripts of the interviews of the participants.

RESULTS

Data analysis identified the themes of identity, connection, threshold, desire to change, change as a sudden and gradual process, and thinking process. An unexpected finding was the subjectivity associated with deciding whether or not a problem had actually resolved.

CONCLUSIONS

The results are discussed in terms of their implications for clinical practice including the apparent importance of people reaching an emotional threshold prior to change. A sense of identity also appears to be important in change experiences.

Self-care in mental health services: a narrative review

Self-care is an important approach to the management of long-term health conditions and in preventing ill-health by living a healthy lifestyle. The concept has been used to a limited extent in relation to mental health, but it overlaps with the related concepts of recovery, self-management and self-help. These related concepts all entail individuals having more choice and control over treatment and a greater role in recovery and maintaining their health and well-being. This paper reviews qualitative empirical research that provides information on the nature of self-care in mental health from the perspective of people experiencing mental health problems. Twenty qualitative studies were identified from a systematic search of the literature. The methods used in these studies were critically appraised and key themes across studies identified self-care behaviours and processes supporting self-care. The paper also highlights challenges to this approach in mental health and provides a conceptual framework of the relationships between self-care support, self-care behaviours and strategies, and well-being for the individual. It also highlights limitations in the current evidence base and identifies areas for future research.

Comparing Two Brief Psychological Interventions to Usual Care in Panic Disorder Patients Presenting to the Emergency Department with Chest Pain

Background: Panic disorder (PD) is a common, often unrecognized condition among patients presenting with chest pain to the emergency departments (ED). Nevertheless, psychological treatment is rarely initiated. We are unaware of studies that evaluated the efficacy of brief cognitive-behavioural therapy (CBT) for this population. Aim: Evaluate the efficacy of two brief CBT interventions in PD patients presenting to the ED with chest pain. Method: Fifty-eight PD patients were assigned to either a 1-session CBT-based panic management intervention (PMI) (n = 24), a 7-session CBT intervention (n = 19), or a usual-care control condition (n = 15). A structured diagnostic interview and self-reported questionnaires were administered at pre-test, post-test, 3- and 6-month follow-ups. Results: Statistical analysis showed significant reduction in PD severity following both interventions compared to usual care control condition, but with neither showing superiority compared to the other. Conclusions: CBT-based interventions as brief as a single session initiated within 2 weeks after an ED visit for chest pain appear to be effective for PD. Given the high prevalence of PD in emergency care settings, greater efforts should be made to implement these interventions in the ED and/or primary care setting.

Effectiveness of a college-level self-management course on successful behavior change

Studies have shown that college-level self-management (SM) courses, which typically require students to complete an individual project as part of the course, can be an effective method for promoting successful self-change (i.e., targeted behavioral change). However, only a handful of studies have focused on and investigated the intensity of the SM component required for successfully changing a target behavior. The purpose of this study was to (a) examine the effectiveness of a SM course in improving a target behavior within a college setting, (b) determine the level of SM course intensity necessary for successful behavioral change, and (c) identify the characteristics of successful self-managers in terms of strategy use. A total of 84 college students were enrolled in a high-intensity SM course, low-intensity SM course, or non-SM course (i.e., control group). Self-report questionnaires were administered at the beginning and end of the courses. Results showed that only the high-intensity SM course was effective for successful behavioral change and helped increase certain psychosocial characteristics (e.g., internal locus of control, expectancy of success). Overall, successful self-managers used significantly more SM strategies than participants who were unable to meet their behavioral goals. Implications and limitations are also discussed.