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Mueller L, Kallogjeri D, Frumkin MR, Dizdar K, Shin J, Rodebaugh T, Piccirillo JF. Predictors of Response to Cognitive Behavioral Therapy in Patients With Tinnitus. JAMA Otolaryngol Head Neck Surg 2024:2822008. [PMID: 39088223 PMCID: PMC11295060 DOI: 10.1001/jamaoto.2024.2264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/07/2024] [Indexed: 08/02/2024]
Abstract
Importance Clinical guidelines recommend cognitive behavioral therapy (CBT) as a treatment for tinnitus. However, patient response to CBT is variable, and currently, there are no known predictors of response to CBT treatment for tinnitus. Objective To identify the clinical predictors of patient response to CBT for treatment of tinnitus. Design, Setting, and Participants This was a secondary cohort analysis of a single-arm clinical study including adults with chronic bothersome tinnitus recruited from Washington University School of Medicine in St Louis (Missouri) from September 2019 to February 2023. Participants completed an 8-week group CBT program with a licensed clinical psychologist. Each week consisted of 2.5 hours of CBT, amounting to 20 hours of total CBT participation, primarily delivered through a virtual platform. Conjunctive consolidation was used to create a predictive classification system for response to CBT based on tinnitus bother and anxiety levels. Main Outcome and Measure Response to CBT was predefined as a 13-point or greater decrease in the Tinnitus Functional Index (TFI) survey score. Results The study sample included 88 adult patients (median [IQR] age, 59 [49-66] years; 47 [53%] females and 41 [47%] males) with chronic bothersome tinnitus, of whom 53 (60%) had at least 13-point decrease in TFI and were considered to be responders. In univariable and multivariable logistic regression analyses, high to moderate anxiety level and severe tinnitus bother were associated with treatment response (adjusted odds ratio: anxiety, 3.33; 95% CI, 0.90-12.30; tinnitus bother, 12.08; 95% CI, 1.48-98.35). The clinical stratification system showed good predictive and discriminative ability (χ2 for linear trend = 20.0; C statistic = 0.75; 95% CI, 0.65-0.85). Conclusions and Relevance The findings of this study show that assessment of bother and anxiety levels in patients with tinnitus may be useful for identifying those who are more likely to respond to CBT. Before incorporation into clinical practice, future research should externally validate this finding in a separate population.
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Affiliation(s)
- Lauren Mueller
- Department of Otolaryngology−Head and Neck Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
- School of Medicine, Tulane University, New Orleans, Louisiana
| | - Dorina Kallogjeri
- Department of Otolaryngology−Head and Neck Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
- Statistics Editor, JAMA Otolaryngology−Head & Neck Surgery
| | - Madelyn R. Frumkin
- Department of Psychological & Brain Sciences, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Karmela Dizdar
- Department of Otolaryngology−Head and Neck Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Jin Shin
- Department of Psychological & Brain Sciences, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Thomas Rodebaugh
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | - Jay F. Piccirillo
- Department of Otolaryngology−Head and Neck Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
- Editor in Chief, JAMA Otolaryngology−Head & Neck Surgery
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Skelton M, Catarino A, Brown S, Carr E, Davies MR, Peel AJ, Rayner C, Breen G, Eley TC. Trajectories of depression symptoms, anxiety symptoms and functional impairment during internet-enabled cognitive-behavioural therapy. Behav Res Ther 2023; 169:104386. [PMID: 37634279 DOI: 10.1016/j.brat.2023.104386] [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: 06/14/2022] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 08/29/2023]
Abstract
Underlying classes capture differences between patient symptom trajectories during psychological therapy. This has not been explored for one-to-one internet-delivered therapy or functional impairment trajectories. Patients experiencing depression or anxiety received cognitive-behavioural therapy with a therapist using an online chat platform (N = 52,029). Trajectory classes of depression symptoms (PHQ9), anxiety symptoms (GAD7) and functional impairment (WSAS) were investigated using growth mixture modelling. Multinomial regressions tested associations between baseline variables and trajectory class. A four-class trajectory model was selected for each outcome, and these were highly similar. Each outcome showed three classes with initially moderate-severe symptoms or impairment: one demonstrated no change, one gradual improvement and one fast improvement. A fourth class had mild baseline scores and minimal improvement. In the moderate-severe classes, patients in the two with improvement were more likely to be employed and not to have obsessive-compulsive disorder. Fast improvement was likelier than gradual improvement or no change for patients with older age, no disability (e.g., physical, learning), or lower comorbid symptom or impairment scores. Associations with functional impairment classes were more similar to associations with depression classes than anxiety classes. Results were largely consistent with findings from face-to-face therapy. This study is an important step towards personalising therapy in terms of suitability and continuation.
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Affiliation(s)
- Megan Skelton
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ana Catarino
- Digital Futures Lab, ieso, Cowley Road, The Jeffreys Building, Milton, Cambridge, UK
| | - Stephanie Brown
- Digital Futures Lab, ieso, Cowley Road, The Jeffreys Building, Milton, Cambridge, UK
| | - Ewan Carr
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Molly R Davies
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alicia J Peel
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christopher Rayner
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gerome Breen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Thalia C Eley
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK.
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Mahoney A, Shiner CT, Grierson AB, Sharrock MJ, Loughnan SA, Harrison V, Millard M. Online cognitive behaviour therapy for maternal antenatal and postnatal anxiety and depression in routine care. J Affect Disord 2023; 338:121-128. [PMID: 37295653 DOI: 10.1016/j.jad.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/15/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Perinatal depression and anxiety are associated with significant adverse effects for the mother and child. Online cognitive behavioural therapy (iCBT) can provide scalable access to psychological interventions to improve perinatal depression and anxiety, however, few studies have examined the effectiveness of these interventions in routine care. This study investigated the uptake and treatment outcomes of women living in the Australian community who enrolled in a pregnancy or postnatal iCBT program for their symptoms of depression and anxiety. METHODS 1502 women commenced iCBT (529 pregnancy and 973 postnatal) and completed measures of anxiety and depression symptom severity, and psychological distress pre- and post-treatment. RESULTS 35.0 % of women in the pregnancy program and 41.6 % in the postnatal program completed all 3 lessons, with lower pre-treatment depression symptom severity significantly associated with increased likelihood of perinatal program completion. Both iCBT programs were associated with medium pre- to post-treatment effect size reductions in generalised anxiety symptom severity (gs = 0.63 and 0.71), depression symptom severity (gs = 0.58 and 0.64), and psychological distress (gs = 0.52 and 0.60). LIMITATIONS Lack of control group and long-term follow-up, as well as detailed information on nature of the sample (e.g., health status, relationship status). Additionally, the sample was limited to Australian residents. CONCLUSION iCBT for perinatal anxiety and depression was associated with significant symptom improvement. Current findings support the use of iCBT in perinatal populations and its integration within routine healthcare provision.
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Affiliation(s)
- Alison Mahoney
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia; School of Psychiatry, University of New South Wales, Sydney, New South Wales 2052, Australia.
| | - Christine T Shiner
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia; School of Clinical Medicine, University of New South Wales, Sydney, New South Wales 2052, Australia
| | - Ashlee B Grierson
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia.
| | - Maria J Sharrock
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia.
| | - Siobhan A Loughnan
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, Queensland, Australia.
| | - Virginia Harrison
- School of Psychology and Counselling, The Open University, Milton Keynes MK7 6AA, United Kingdom.
| | - Michael Millard
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia; School of Psychiatry, University of New South Wales, Sydney, New South Wales 2052, Australia.
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Cukor J, Xu Z, Vekaria V, Wang F, Olfson M, Banerjee S, Simon G, Alexopoulos G, Pathak J. Longitudinal Trajectories of Symptom Change During Antidepressant Treatment Among Managed Care Patients with Co-Occurring Depression and Anxiety. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.25.23295985. [PMID: 37808868 PMCID: PMC10557805 DOI: 10.1101/2023.09.25.23295985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Depression and anxiety are highly correlated, yet little is known about the course of each condition when presenting concurrently. This study aimed to identify longitudinal patterns and changes in depression and anxiety symptoms during antidepressant treatment, and evaluate clinical factors associated with each response pattern. Self-report Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) scores were used to track the courses of depression and anxiety respectively over a three-month window, and group-based trajectory modeling was used to derive subgroups of patients who have similar response patterns. Multinomial regression was used to associate various clinical variables with trajectory subgroup membership. Of the 577 included adults, 373 (64.6%) were women, and the mean age was 39.3 (SD: 12.9) years. Six depression and six anxiety trajectory subgroups were computationally derived; three depression subgroups demonstrated symptom improvement, and three exhibited nonresponse. Similar patterns were observed in the six anxiety subgroups. Factors associated with treatment nonresponse included higher pretreatment depression and anxiety severity and poorer sleep quality, while better overall health and younger age were associated with higher rates of remission. Synchronous and asynchronous paths to improvement were also observed between depression and anxiety. High baseline depression or anxiety severity alone may be an insufficient predictor of treatment nonresponse. These findings have the potential to motivate clinical strategies aimed at treating depression and anxiety simultaneously.
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Terrill DR, Dellavella C, King BT, Hubert T, Wild H, Zimmerman M. Latent classes of symptom trajectories during partial hospitalization for major depressive disorder and generalized anxiety disorder. J Affect Disord 2023; 331:101-111. [PMID: 36948468 DOI: 10.1016/j.jad.2023.03.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/27/2023] [Accepted: 03/15/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND A variety of treatments have been empirically validated in the treatment of major depressive disorder and generalized anxiety disorder. Researchers commonly evaluate symptom change during treatment using single model curves, however, modeling multiple curves simultaneously allows for the identification of subgroups of patients that progress through treatment on distinct paths. METHODS Latent growth mixture modeling was used to identify and characterize distinct classes of symptom trajectories among two samples of patients with either MDD or GAD receiving treatment in a daily partial hospital program. RESULTS Four depression symptom trajectories were identified in the MDD sample, and three anxiety symptom trajectories were identified in the GAD sample. Both samples shared symptom trajectory classes of responders, rapid responders, and minimal responders, while the MDD sample demonstrated an additional class of early rapid responders. In both samples, low symptom severity at baseline was associated with membership in the responder class, though few other patterns emerged in baseline characteristics predicting trajectory class membership. At treatment discharge, those in the minimal responder class reported poorer outcomes on every clinical measure. Patients within each class reported similar scores at discharge as compared to each other class, indicating that class membership affects clinical measures beyond symptom severity. LIMITATIONS Patient demographic characteristics were relatively homogeneous. Group-based trajectory modeling inherently involves some degree of uncertainty regarding the number and shape of trajectories. CONCLUSIONS Identifying symptom trajectories can provide information regarding how patients are likely to progress through treatment, and thus inform clinicians when a patient deviates from expected progress.
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Affiliation(s)
- Douglas R Terrill
- Department of Psychology, University of Kentucky, United States of America.
| | - Christian Dellavella
- Rhode Island Hospital Department of Psychiatry, United States of America; Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI, United States of America
| | - Brittany T King
- Rhode Island Hospital Department of Psychiatry, United States of America; Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI, United States of America
| | - Troy Hubert
- Department of Psychology, University of Kentucky, United States of America
| | - Hannah Wild
- Department of Psychology, University of Kentucky, United States of America
| | - Mark Zimmerman
- Rhode Island Hospital Department of Psychiatry, United States of America; Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI, United States of America
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Wang X, Zhu X, Ji X, Yang J, Zhou J. Group-Based Symptom Trajectory of Intramuscular Administration of Scopolamine Augmentation in Moderate to Severe Major Depressive Disorder: A Post-Hoc Analysis. Neuropsychiatr Dis Treat 2023; 19:1043-1053. [PMID: 37153351 PMCID: PMC10162387 DOI: 10.2147/ndt.s408794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/21/2023] [Indexed: 05/09/2023] Open
Abstract
Objective Developing new strategies for rapid and sustained relief of depressive symptom has been the focus of research in the field of major depressive disorder (MDD). Scopolamine exerts rapid antidepressant effect in recent years but is controversial. Therefore, we aimed to identify a sensitive patient who may respond to intramuscular injections of scopolamine added to antidepressants based on distinct trajectory patterns. Methods We analyzed longitudinal post hoc data collected from 66 MDD patients at Beijing Anding Hospital, Capital Medical University, over a 4-week period. In addition to demographics, depressive symptoms were assessed using the 16-item Quick Inventory of Depressive Symptomatology and Self-Report (QIDS-SR16) Scale and 17-item Hamilton Rating Scale for Depression (HRSD-17) following an i.m. injection of scopolamine. We explored different longitudinal patterns of depressive symptoms using a group-based trajectory model (GBTM). We used multiple logistic regression models to help identify predictors of different depressive symptom trajectories. Results A two-class GBTM was identified as optimal for classifying depressive symptoms: high/rapidly declining (39.4%) and moderate/gradually declining depression trajectories (60.6%) were distinguished based on the HRSD-17. The high/rapidly declining depression trajectory was characterized by high initial depression followed by a rapid decrease at the end of the study. The moderate/gradual decline trajectory was dominated by moderate depression and gradual decline over 4 weeks. There were no significant associations of age, gender, education, or age of onset with the two trajectory groups. Conclusion Scopolamine added to antidepressants can effectively relieve the symptoms of patients with severe depression, and it decreases faster than patients with moderate depression.
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Affiliation(s)
- Xiao Wang
- The National Clinical Research Center for Mental Disorders & Beijing Anding Hospital of Capital Medical University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Mental Disorders & Beijing Anding Hospital of Capital Medical University, Beijing, People’s Republic of China
| | - Xuequan Zhu
- The National Clinical Research Center for Mental Disorders & Beijing Anding Hospital of Capital Medical University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Mental Disorders & Beijing Anding Hospital of Capital Medical University, Beijing, People’s Republic of China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of China
| | - Xiao Ji
- The National Clinical Research Center for Mental Disorders & Beijing Anding Hospital of Capital Medical University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Mental Disorders & Beijing Anding Hospital of Capital Medical University, Beijing, People’s Republic of China
| | - Jian Yang
- The National Clinical Research Center for Mental Disorders & Beijing Anding Hospital of Capital Medical University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Mental Disorders & Beijing Anding Hospital of Capital Medical University, Beijing, People’s Republic of China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of China
- Correspondence: Jian Yang; Jingjing Zhou, The National Clinical Research Center for Mental Disorders & Beijing Anding Hospital of Capital Medical University, 5 Ankang Lane, Dewai Avenue, Xicheng District, Beijing, 100088, People’s Republic of China, Email ;
| | - Jingjing Zhou
- The National Clinical Research Center for Mental Disorders & Beijing Anding Hospital of Capital Medical University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Mental Disorders & Beijing Anding Hospital of Capital Medical University, Beijing, People’s Republic of China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of China
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Stochl J, Soneson E, Stuart F, Fritz J, Walsh AEL, Croudace T, Hodgekins J, Patel U, Russo DA, Knight C, Jones PB, Perez J. Determinants of patient-reported outcome trajectories and symptomatic recovery in Improving Access to Psychological Therapies (IAPT) services. Psychol Med 2022; 52:3231-3240. [PMID: 33682645 PMCID: PMC9693716 DOI: 10.1017/s0033291720005395] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Despite evidence for the general effectiveness of psychological therapies, there exists substantial heterogeneity in patient outcomes. We aimed to identify factors associated with baseline severity of depression and anxiety symptoms, rate of symptomatic change over the course of therapy, and symptomatic recovery in a primary mental health care setting. METHODS Using data from a service evaluation involving 35 527 patients in England's psychological and wellbeing [Improving Access to Psychological Therapies (IAPT)] services, we applied latent growth models to explore which routinely-collected sociodemographic, clinical, and therapeutic variables were associated with baseline symptom severity and rate of symptomatic change. We used a multilevel logit model to determine variables associated with symptomatic recovery. RESULTS Being female, younger, more functionally impaired, and more socioeconomically disadvantaged was associated with higher baseline severity of both depression and anxiety symptoms. Being older, less functionally impaired, and having more severe baseline symptomatology was associated with more rapid improvement of both depression and anxiety symptoms (male gender and greater socioeconomic disadvantage were further associated with rate of change for depression only). Therapy intensity and appointment frequency seemed to have no correlation with rate of symptomatic improvement. Patients with lower baseline symptom severity, less functional impairment, and older age had a greater likelihood of achieving symptomatic recovery (as defined by IAPT criteria). CONCLUSIONS We must continue to investigate how best to tailor psychotherapeutic interventions to fit patients' needs. Patients who begin therapy with more severe depression and/or anxiety symptoms and poorer functioning merit special attention, as these characteristics may negatively impact recovery.
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Affiliation(s)
- Jan Stochl
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- National Institute for Health Research Applied Research Collaboration (ARC) East of England (EoE), Cambridge, UK
- Department of Kinanthropology, Charles University, Prague, Czechia
| | - Emma Soneson
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Freya Stuart
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Jessica Fritz
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Annabel E. L. Walsh
- Institution of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tim Croudace
- School of Health Sciences, University of Dundee, Dundee, UK
| | | | - Ushma Patel
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Debra A. Russo
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Clare Knight
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- National Institute for Health Research Applied Research Collaboration (ARC) East of England (EoE), Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- National Institute for Health Research Applied Research Collaboration (ARC) East of England (EoE), Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
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Cumpanasoiu C, Enrique A, Palacios J, Duffy D, McNamara S, Richards D. Trajectories of symptoms in digital interventions for depression and anxiety using Routine Outcome Monitoring data: A secondary analysis study (Preprint). JMIR Mhealth Uhealth 2022. [PMID: 37436812 PMCID: PMC10372559 DOI: 10.2196/41815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Research suggests there is heterogeneity in treatment response for internet-delivered cognitive behavioral therapy (iCBT) users, but few studies have investigated the trajectory of individual symptom change across iCBT treatment. Large patient data sets using routine outcome measures allows the investigation of treatment effects over time as well as the relationship between outcomes and platform use. Understanding trajectories of symptom change, as well as associated characteristics, may prove important for tailoring interventions or identifying patients who may not benefit from the intervention. OBJECTIVE We aimed to identify latent trajectories of symptom change during the iCBT treatment course for depression and anxiety and to investigate the patients' characteristics and platform use for each of these classes. METHODS This is a secondary analysis of data from a randomized controlled trial designed to examine the effectiveness of guided iCBT for anxiety and depression in the UK Improving Access to Psychological Therapies (IAPT) program. This study included patients from the intervention group (N=256) and followed a longitudinal retrospective design. As part of the IAPT's routine outcome monitoring system, patients were prompted to complete the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) after each supporter review during the treatment period. Latent class growth analysis was used to identify the underlying trajectories of symptom change across the treatment period for both depression and anxiety. Differences in patient characteristics were then evaluated between these trajectory classes, and the presence of a time-varying relationship between platform use and trajectory classes was investigated. RESULTS Five-class models were identified as optimal for both PHQ-9 and GAD-7. Around two-thirds (PHQ-9: 155/221, 70.1%; GAD-7: 156/221, 70.6%) of the sample formed various trajectories of improvement classes that differed in baseline score, the pace of symptom change, and final clinical outcome score. The remaining patients were in 2 smaller groups: one that saw minimal to no gains and another with consistently high scores across the treatment journey. Baseline severity, medication status, and program assigned were significantly associated (P<.001) with different trajectories. Although we did not find a time-varying relationship between use and trajectory classes, we found an overall effect of time on platform use, suggesting that all participants used the intervention significantly more in the first 4 weeks (P<.001). CONCLUSIONS Most patients benefit from treatment, and the various patterns of improvement have implications for how the iCBT intervention is delivered. Identifying predictors of nonresponse or early response might inform the level of support and monitoring required for different types of patients. Further work is necessary to explore the differences between these trajectories to understand what works best for whom and to identify early on those patients who are less likely to benefit from treatment.
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Li I, Chen AZ, Newby JM, Kladnitski N, Haskelberg H, Millard M, Mahoney A. The uptake and outcomes of an online self-help mindfulness programme during COVID-19. CLIN PSYCHOL-UK 2022. [DOI: 10.1080/13284207.2022.2045866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Ian Li
- Clinical Research Unit for Anxiety and Depression, St Vincent’s Hospital, Darlinghurst, Sydney, New South Wales, Australia
| | - Aileen Z. Chen
- Clinical Research Unit for Anxiety and Depression, St Vincent’s Hospital, Darlinghurst, Sydney, New South Wales, Australia
| | - Jill M. Newby
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW, Australia
- Black Dog Institute, Randwick, NSW, Australia
| | - Natalie Kladnitski
- Clinical Research Unit for Anxiety and Depression, St Vincent’s Hospital, Darlinghurst, Sydney, New South Wales, Australia
| | - Hila Haskelberg
- Clinical Research Unit for Anxiety and Depression, St Vincent’s Hospital, Darlinghurst, Sydney, New South Wales, Australia
| | - Michael Millard
- Clinical Research Unit for Anxiety and Depression, St Vincent’s Hospital, Darlinghurst, Sydney, New South Wales, Australia
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Alison Mahoney
- Clinical Research Unit for Anxiety and Depression, St Vincent’s Hospital, Darlinghurst, Sydney, New South Wales, Australia
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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The Relationship Between CBT-Mindedness and iCBT Outcomes Amongst a Large Adult Sample. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10298-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract
Background
Predicting response to cognitive behavior therapy (CBT) assists efforts to enhance treatment outcome when predictive factors are modifiable prior to, or during, treatment. The extent to which clients hold beliefs and attitudes consistent with CBT (termed CBT-mindedness) is a relatively new concept with research suggesting it predicts response to CBT amongst small samples of adults with anxiety. This study aimed to investigate CBT-mindedness amongst a larger clinical population receiving internet-delivered CBT (iCBT).
Method
1132 adults with anxiety, depression or mixed anxiety and depression who accessed iCBT with or without therapist support via the THIS WAY UP clinic completed a brief self-report measure of CBT-mindedness along with measures of distress, anxiety, and depression. Measures were completed pre- and post-treatment.
Results
The 3-factor structure of the CBT Suitability Scale (CBT-SUITS) was confirmed and scores were unrelated or very weakly related to symptoms/distress. CBT-mindedness increased amongst treatment completers. CBT-mindedness predicted post-treatment distress (but not symptoms), and change in CBT-mindedness predicted lower post-treatment symptoms and distress.
Conclusions
The CBT-SUITS represents a psychometrically sound measure of CBT-mindedness. Results amongst this large sample of adults accessing iCBT in a community service indicate that CBT-mindedness (or CBT-mindedness change) is an important predictor of therapy response.
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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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Sharrock MJ, Mahoney AE, Haskelberg H, Millard M, Newby JM. The uptake and outcomes of Internet-based cognitive behavioural therapy for health anxiety symptoms during the COVID-19 pandemic. J Anxiety Disord 2021; 84:102494. [PMID: 34763219 PMCID: PMC8570415 DOI: 10.1016/j.janxdis.2021.102494] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 09/16/2021] [Accepted: 10/26/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Internet cognitive behavioural therapy (iCBT) for health anxiety has demonstrated efficacy but has not been evaluated during the COVID-19 pandemic. This study presents the first evaluation of the uptake and outcomes of iCBT for health anxiety during the COVID-19 pandemic. METHODS THIS WAY UP is an Australian digital mental health service which delivers iCBT interventions to community members. We compared the uptake of THIS WAY UP's iCBT course for health anxiety in an Australian adult sample who started the course before the pandemic (12th September 2019-11 th March 2020) to during the pandemic (12th March to 11th June 2020). The course was accessible to Australian adults over 18 years old, with no inclusion criteria. Outcomes included course registrations and commencements, lesson and course completion, and self-reported health anxiety (Short Health Anxiety Inventory), depression (Patient Health Questionnaire 9-item) and distress (Kessler-10). RESULTS From March to June 2020, we observed significant increases in course registrations (N = 238 vs N = 1057); and course commencements (N = 126 vs. N = 778). Large, significant improvements in health anxiety (g = 0.89), and distress (K10: g = 0.91), and medium improvements in depression (g = 0.55) were found. Course completion during COVID was 30.5%. CONCLUSIONS iCBT improved health anxiety during the COVID-19 pandemic, and provides scalable intervention that can address increased demands for mental health services in the community.
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Affiliation(s)
- Maria J. Sharrock
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent’s Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia
| | - Alison E.J. Mahoney
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent’s Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia,School of Psychiatry, University of New South Wales, Sydney, New South Wales 2052, Australia,Corresponding author at: Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent’s Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia
| | - Hila Haskelberg
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia.
| | - Michael Millard
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia; School of Psychiatry, University of New South Wales, Sydney, New South Wales 2052, Australia.
| | - Jill M. Newby
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, New South Wales, 2052, Australia,Black Dog Institute, Hospital Road, Randwick, New South Wales 2031, Australia,Corresponding author at: School of Psychology, Faculty of Science, University of New South Wales, Sydney, New South Wales, 2052, Australia
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13
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COVID-19 related differences in the uptake and effects of internet-based cognitive behavioural therapy for symptoms of obsessive-compulsive disorder. Behav Cogn Psychother 2021; 50:219-236. [PMID: 34753528 DOI: 10.1017/s1352465821000448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The impacts of COVID-19 for people with obsessive-compulsive disorder (OCD) may be considerable. Online cognitive behavioural therapy (iCBT) programmes provide scalable access to psychological interventions, although the effectiveness of iCBT for OCD during COVID-19 has not been evaluated. AIM This study investigated the uptake and effectiveness of iCBT for OCD (both self- and clinician-guided courses) during the first 8 months of the pandemic in Australia (March to October 2020) and compared outcomes with the previous year. METHOD 1,343 adults (824/1343 (61.4%) female, mean age 33.54 years, SD = 12.00) commenced iCBT for OCD (1061 during the pandemic and 282 in the year before) and completed measures of OCD (Dimensional Obsessive-Compulsive Scale) and depression (Patient Health Questionaire-9) symptom severity, psychological distress (Kessler-10), and disability (WHO Disability Assessment Schedule) pre- and post-treatment. RESULTS During COVID-19, there was a 522% increase in monthly course registrations compared with the previous year, with peak uptake observed between April and June 2020 (a 1191% increase compared with April to June 2019). OCD and depression symptom severity were similar for the COVID and pre-COVID groups, although COVID-19 participants were more likely to enrol in self-guided courses (versus clinician-guided). In both pre- and during-COVID groups, the OCD iCBT course was associated with medium effect size reductions in OCD (g = 0.65-0.68) and depression symptom severity (g = 0.56-0.65), medium to large reductions in psychological distress (g = 0.77-0.83) and small reductions in disability (g = 0.35-.50). CONCLUSION Results demonstrate the considerable uptake of online psychological services for those experiencing symptoms of OCD during COVID-19 and highlight the scalability of effective digital mental health services.
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Mahoney A, Li I, Grierson A, Millard M, Haskelberg H, Mason E. Internet-based cognitive behaviour therapy for insomnia before and during the COVID-19 pandemic. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1080/00050067.2021.1979884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Alison Mahoney
- Clinical Research Unit for Anxiety and Depression, St Vincent’s Hospital, Sydney, Australia
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Ian Li
- Clinical Research Unit for Anxiety and Depression, St Vincent’s Hospital, Sydney, Australia
| | - Ashlee Grierson
- Clinical Research Unit for Anxiety and Depression, St Vincent’s Hospital, Sydney, Australia
| | - Michael Millard
- Clinical Research Unit for Anxiety and Depression, St Vincent’s Hospital, Sydney, Australia
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Hila Haskelberg
- Clinical Research Unit for Anxiety and Depression, St Vincent’s Hospital, Sydney, Australia
| | - Elizabeth Mason
- Clinical Research Unit for Anxiety and Depression, St Vincent’s Hospital, Sydney, Australia
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15
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Mahoney AE, Elders A, Li I, David C, Haskelberg H, Guiney H, Millard M. A tale of two countries: Increased uptake of digital mental health services during the COVID-19 pandemic in Australia and New Zealand. Internet Interv 2021; 25:100439. [PMID: 34401395 PMCID: PMC8350613 DOI: 10.1016/j.invent.2021.100439] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Digital mental health services (DMHS) provide highly accessible psychological supports and interventions that can supplement existing mental health services. Concerns about the mental health impact of the COVID-19 pandemic have been widespread and provide a unique impetus to examine the utility and responsivity of DMHS. This study examined the service utilisation and user characteristics of two DMHS (THIS WAY UP and Just a Thought) in Australia and New Zealand before and during the early pandemic period in these countries (March to June 2020). METHODS Service use indices (website visits, course registrations and prescriptions, clinician registrations) were compared across different time periods before (12, 6 and 3 months) and during the pandemic in Australia and New Zealand. The demographic and clinical characteristics of course registrants (anxiety and depression symptom severity and psychological distress) were also compared across the pre- and during-COVID periods. RESULTS Comparing pre-COVID to during-COVID time periods, we observed substantial increases across all service use indices in both DMHS (increases of >100% on the majority of service use indices). For example, in the 3 months prior to the pandemic, 2806 people registered for a THIS WAY UP course and 1907 people registered for a Just a Thought course, whereas 21,872 and 5442 registered for a THIS WAY UP and Just a Thought course, respectively, during the first 3 months of the COVID pandemic. Slight differences in the demographic and clinical profiles of course registrants were found between pre- and during-COVID time periods, with limited evidence of elevated anxiety and depression symptom severity in the COVID period. CONCLUSIONS Following the outbreak of COVID-19 in Australia and New Zealand, the volume of users accessing DMHS increased yet the demographic and clinical characteristics of course registrants remained stable. Results underscore how nimble and scalable DMHS can be during periods of high demand.
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Affiliation(s)
- Alison E.J. Mahoney
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Anna Elders
- Just a Thought, Wise Group, Kākāriki House, 293 Grey Street, Hamilton 3216, New Zealand
| | - Ian Li
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia
| | - Charlie David
- Just a Thought, Wise Group, Kākāriki House, 293 Grey Street, Hamilton 3216, New Zealand
| | - Hila Haskelberg
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia
| | - Hayley Guiney
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, 362 Leith Street, Dunedin 9016, New Zealand
| | - Michael Millard
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
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16
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Mahoney A, Li I, Haskelberg H, Millard M, Newby JM. The uptake and effectiveness of online cognitive behaviour therapy for symptoms of anxiety and depression during COVID-19. J Affect Disord 2021; 292:197-203. [PMID: 34126311 PMCID: PMC8177308 DOI: 10.1016/j.jad.2021.05.116] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/05/2021] [Accepted: 05/31/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The mental health impacts of COVID-19 have been considerable with many individuals experiencing significant anxiety and depression. Online cognitive behavioural therapy (iCBT) programs provide scalable access to psychological interventions, however the effectiveness of these programs during the pandemic has not been investigated. This study examined the uptake and effectiveness of iCBT for symptoms of anxiety and depression during the first eight months of the pandemic in Australia (March- October 2020) and compared outcomes to the 12 months prior to COVID-19. METHODS 6,132 adults commenced iCBT (5,074 during the pandemic and 1,058 in the year before) and completed measures of anxiety and depression symptom severity, and psychological distress pre- and post-treatment. RESULTS In the COVID-19 period, we observed a 504% increase in the number of monthly course registrations compared to the year prior (with a peak increase of 1,138% between April and June 2020). Baseline anxiety and depression symptom severity were similar for the COVID and pre-COVID groups. Prior to and during the pandemic, the iCBT course was associated with large effect size reductions in anxiety (g = 0.94-1.18) and depression (g = 0.92-1.12) symptom severity, as well as psychological distress (g = 1.08-1.35). LIMITATIONS lack of control group and long-term follow-up, as well as lack of detailed information about course users (e.g., health status and life context). CONCLUSION Results indicate the considerable increase in demand for psychological support during the COVID-19 pandemic in Australia and demonstrate the effectiveness and scalability of iCBT for symptoms of anxiety and depression.
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Affiliation(s)
- Alison Mahoney
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales, 2010, Australia; School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Ian Li
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales, 2010, Australia
| | - Hila Haskelberg
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales, 2010, Australia
| | - Michael Millard
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales, 2010, Australia; School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Jill M Newby
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW, 2052, Australia; Black Dog Institute, Hospital Road, Randwick, NSW, Australia 2031
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17
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Mahoney AEJ, Haskelberg H, Mason E, Millard M, Newby J. Comorbid personality difficulties are not associated with poorer outcomes for online cognitive behaviour therapy for symptoms of anxiety and depression. Personal Ment Health 2021; 15:173-185. [PMID: 33650772 DOI: 10.1002/pmh.1506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/13/2021] [Accepted: 02/17/2021] [Indexed: 12/11/2022]
Abstract
Little is known about the prevalence and impact on treatment of comorbid personality disorders for adults undertaking online cognitive behaviour therapy (internet-delivered or internet-based cognitive behaviour therapy (iCBT)) for anxiety and depressive disorders. This study explored how common comorbid personality difficulties were in a large sample of consecutive patients (N = 1 132) seeking iCBT for their symptoms of anxiety and depression in routine care settings. Patients completed the Standardized Assessment of Personality-abbreviated Scale Self-Report prior to commencing an iCBT programme, as well as completing assessments of anxiety and depression symptom severity and psychological distress pre-iCBT and post-iCBT. Consistent with previous studies, a high proportion of the sample (62.6%) reported experiencing comorbid personality difficulties. However, comorbid personality difficulties were not significantly associated with poorer treatment adherence or higher post-treatment symptom severity or psychological distress (controlling for baseline symptom severity, demographic characteristics and treatment variables). Current findings support an inclusive approach to iCBT provision where comorbid personality difficulties do not appear to be a contraindication for treatment. © 2021 John Wiley & Sons, Ltd.
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Affiliation(s)
- Alison E J Mahoney
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, New South Wales, Australia.,School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Hila Haskelberg
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Elizabeth Mason
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Michael Millard
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, New South Wales, Australia.,School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Jill Newby
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia.,Black Dog Institute, Sydney, New South Wales, Australia
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Alavi N, Stephenson C, Yang M, Shirazi A, Shao Y, Kumar A, Yee CS, Miller S, Stefatos A, Gholamzadehmir M, Abbaspour Z, Patel A, Patel C, Reshetukha T, Omrani M, Groll D. Determining the Efficacy of Electronic Cognitive Behavioral Therapy for Generalized Anxiety Disorder Compared to Pharmaceutical Interventions: Protocol for a Quasi-Experimental Study. JMIR Res Protoc 2021; 10:e27772. [PMID: 33857917 PMCID: PMC8193484 DOI: 10.2196/27772] [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: 02/05/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Generalized anxiety disorder (GAD) is an extremely prevalent and debilitating mental health disorder. Currently, the gold standard treatment for GAD is cognitive behavioral therapy (CBT) and/or pharmacotherapy. The most common medications used to treat GAD are selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors. While CBT is the gold standard treatment for GAD, it is costly, time-consuming, and often inaccessible. Fortunately, the electronic delivery of CBT (e-CBT) has emerged as a promising solution to address these barriers. e-CBT has shown to offer comparable results to in-person CBT while improving accessibility for patients and time efficiency for clinicians. OBJECTIVE This study aims to investigate the treatment efficacy of e-CBT compared to and in conjunction with pharmacotherapy for GAD. METHODS This study will use a quasi-experimental design to allow patients the freedom to choose which treatment modality they would like to receive. Participants with a diagnosis of GAD will be enrolled in 1 of 3 possible treatment arms: (1) e-CBT, (2) medication, or (3) a combination of e-CBT and medication. The e-CBT program will include a 12-week psychotherapy program delivered through the Online Psychotherapy Tool-a secure, cloud-based, digital mental health platform. The treatment efficacy of e-CBT will be compared with that of medication alone and medication in combination with e-CBT. RESULTS The study received ethics approval in April 2019 and participant recruitment began in June 2019. Participant recruitment has been conducted through social media advertisements, physical advertisements, and physician referrals. To date, 146 participants (e-CBT: n=53; medication: n=49; combination: n=44) have been recruited. Data collection is expected to conclude by June 2021, and data analysis is expected to be completed by October 2021. Linear regression (for continuous outcomes) and binomial regression (for categorical outcomes) analysis will be conducted using interpretive qualitative methods. CONCLUSIONS If either the efficacy of e-CBT is shown to be comparable to that of medication or the effects of both treatments are augmented when used in tandem, these findings could have major implications on the mental health care system. e-CBT is a more accessible and affordable treatment that could increase mental health care capacity 4-fold if proven viable. TRIAL REGISTRATION ClinicalTrials.gov NCT04478526; https://clinicaltrials.gov/ct2/show/NCT04478526. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/27772.
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Affiliation(s)
- Nazanin Alavi
- Department of Psychiatry, Queen's University, Kingston, ON, Canada.,Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Callum Stephenson
- Department of Psychiatry, Queen's University, Kingston, ON, Canada.,Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Megan Yang
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Amirhossein Shirazi
- Department of Psychiatry, Queen's University, Kingston, ON, Canada.,Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.,OPTT Inc, Toronto, ON, Canada
| | - Yijia Shao
- Department of Psychiatry, Queen's University, Kingston, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Anchan Kumar
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Caitlin S Yee
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Shadé Miller
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Anthi Stefatos
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | | | - Zara Abbaspour
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Archana Patel
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Charmy Patel
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Taras Reshetukha
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | | | - Dianne Groll
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
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Merson F, Newby J, Shires A, Millard M, Mahoney A. The temporal stability of the Kessler Psychological Distress Scale. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1080/00050067.2021.1893603] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Francis Merson
- Graduate School of Health, University of Technology, Ultimo, Australia
| | - Jill Newby
- School of Psychology, University of New South Wales, Sydney, Australia
- Prince of Wales Hospital, Black Dog Institute, Randwick, Australia
| | - Alice Shires
- Graduate School of Health, University of Technology, Ultimo, Australia
| | - Michael Millard
- Clinical Research Unit for Anxiety and Depression, St Vincent’s Hospital and School of Psychiatry, University of New South Wales, Darlinghurst, Australia
| | - Alison Mahoney
- Clinical Research Unit for Anxiety and Depression, St Vincent’s Hospital and School of Psychiatry, University of New South Wales, Darlinghurst, Australia
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Seidler D, Altmann U, Schäfer R, Jenett D, Franz M. [Long-Term Patterns of Depressive Symptomload and their Predictors in Hospitalised Patients Undergoing Psychodynamic Psychotherapy: Findings of the STOP-D Study]. Psychother Psychosom Med Psychol 2021; 71:265-273. [PMID: 33450780 DOI: 10.1055/a-1300-2995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Depression is one of the most common mental disorders. While the general effectiveness of in- and outpatient psychotherapy is proven, different long-term patterns in treatment of symptoms of depression have been described. The aim of the present study was to show different patterns of benefit in the context of inpatient psychodynamic psychotherapy of depressive disorders and to detect predictors of different types of response that help to identify possible non-responders and adjust treatments accordingly. METHODS Data of the naturalistic multicentre intervention study were collected in 15 German psychosomatic hospital units employing a predominantly psychodynamic approach to treatment. The sample includes n=432 patients (women: age 25-45 years) with typical symptoms of depression. The patterns of outcome were identified using a latent state model with a method factor and a latent class analysis; potential course predictors were analysed using regression analysis. RESULTS Three long-term patterns of outcome were identified: patients with significant treatment benefit, whose symptom decline was stable even in a 6-month catamnesis (Responders: 76.9%), patients without a significant symptom decrease during treatment and in the follow-up survey (Non-responders: 18.8%), as well as patients with a significant symptom decrease but showing an increase of symptoms in the catamnesis (Backsliders: 4.4%). The severity of baseline depressive symptom load was determined as a predictor for the pattern of Backsliders. Non-responders differed from responders in having had psychosomatic pre-treatments more frequently. DISCUSSION In the case of backsliders, further studies should, for instance, verify whether relapses can be explained by the patient's symptoms, treatment, or social environment. In the case of non-response due to numerous unsuccessful pre-treatments, the question arises whether psychosomatic treatment offers the right setting for these patients or how therapy settings should be modified. CONCLUSION Long-term patterns reported in the literature were partially confirmed. There are indications of an influence of the initial symptom-load severity on the outcome of treatment. It is important to consider how treatment settings can be modified accordingly.
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Affiliation(s)
- Daniel Seidler
- Medizinische Fakultät, Klinisches Institut für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Düsseldorf
| | - Uwe Altmann
- Institut für Psychosoziale Medizin, Psychotherapie und Psychoonkologie (IPMPP), Universitätsklinikum Jena
| | - Ralf Schäfer
- Medizinische Fakultät, Klinisches Institut für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Düsseldorf
| | - Dörte Jenett
- Medizinische Fakultät, Klinisches Institut für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Düsseldorf
| | - Matthias Franz
- Medizinische Fakultät, Klinisches Institut für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Düsseldorf
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21
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Barrett K, Stewart I. A preliminary comparison of the efficacy of online Acceptance and Commitment Therapy (ACT) and Cognitive Behavioural Therapy (CBT) stress management interventions for social and healthcare workers. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:113-126. [PMID: 32613644 DOI: 10.1111/hsc.13074] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 05/23/2020] [Accepted: 06/02/2020] [Indexed: 06/11/2023]
Abstract
Social and healthcare workers have been shown to experience greater levels of illness, depression and burnout as a result of chronic workplace stress. The purpose of this study was to examine whether brief online ACT and CBT interventions could reduce the experience of stress and burnout in employees, while also improving mental health and psychological flexibility. A total of 42 individuals working within the social and healthcare professions were randomly assigned to either a 2-week online ACT or CBT intervention. Recruitment was undertaken internationally, although the majority of participants were based in Ireland at the time of their participation (79%). Participants' perceived stress, burnout, mental health and work-related psychological flexibility were assessed at baseline and post-treatment. Intent-to-treat analyses were conducted on all data. Outcomes indicated that both interventions resulted in significant improvements in stress, burnout and mental health scores from baseline to post-treatment. No significant differences were observed between ACT and CBT conditions, or in psychological flexibility scores from baseline to post-treatment. Reliable Change Index (RCI) scores indicated that clinically significant improvements in stress and mental health were seen in 42% and 19% of programme-completers, respectively. These results provide preliminary evidence for the usefulness of brief internet-delivered ACT and CBT interventions for the treatment of occupational stress and its comorbid symptoms. Online programmes with a longer duration and additional therapist support should be evaluated, as these may improve the outcomes of future interventions.
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Affiliation(s)
- Kate Barrett
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Ian Stewart
- School of Psychology, National University of Ireland, Galway, Ireland
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Altmann U, Gawlytta R, Hoyer J, Leichsenring F, Leibing E, Beutel M, Willutzki U, Herpertz S, Strauss B. Typical symptom change patterns and their predictors in patients with social anxiety disorder: A latent class analysis. J Anxiety Disord 2020; 71:102200. [PMID: 32126336 DOI: 10.1016/j.janxdis.2020.102200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/08/2020] [Accepted: 02/15/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The use of trajectories and analysis of change patterns is a promising way toward better differentiation of subgroups in psychotherapy studies. Research on change patterns in social anxiety disorder (SAD) are still rare, although SAD is one of the most common mental disorders. In a secondary analysis of data from the SOPHO-NET-trial (ISRCTN53517394) this study aimed to investigate change patterns and their predictors in a sample of SAD patients. METHODS Patients with SAD (N = 357) were randomly assigned to cognitive-behavioral or psychodynamic therapy. The Liebowitz Social Anxiety Scale (LSAS) was assessed at 1st session (pre), 8th session, 15th session and at the end of treatment (post). We used latent state variables and latent class analysis for the classification of change patterns and logistic regression for the identification of different predictors. RESULTS Analyses revealed three typical patterns: (i.) responders with a high initial impairment (N = 57), (ii.) responders with a moderate initial impairment (N = 225), and (iii.) patients with a high initial impairment and no remission (N = 75). Among other significant predicators, patient´s attachment anxiety and therapeutic alliance at session eight contributed to the prediction of change patterns. DISCUSSION Psychotherapy of SAD should consider patient's attachment and focus on the establishment of a solid therapeutic alliance in an early therapy stage.
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Affiliation(s)
- Uwe Altmann
- Universitätsklinikum Jena, Institute of Psychosocial Medicine and Psychotherapy, Stoystr. 3, 07740 Jena Germany.
| | - Romina Gawlytta
- Universitätsklinikum Jena, Institute of Psychosocial Medicine and Psychotherapy, Stoystr. 3, 07740 Jena Germany.
| | - Jürgen Hoyer
- Technische Universität Dresden, Institute of Clinical Psychology and Psychotherapy, Hohe Straße 53, 01187 Dresden Germany.
| | - Falk Leichsenring
- Universitätsklinikum Giessen, Clinic of Psychosomatic and Psychotherapy, Friedrichstr. 33, 35392 Gießen Germany.
| | - Eric Leibing
- Universitätsmedizin Göttingen Clinic of Psychosomatic Medicine and Psychotherapy Von-Siebold-Str. 5, 37075 Göttingen Germany.
| | - Manfred Beutel
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, Untere Zahlbacher Strasse 8, 55131 Mainz Germany.
| | - Ulrike Willutzki
- Universität Witten/Herdecke, Department of Psychology and Psychotherapy, Alfred-Herrhausen-Straße 44, 58455 Witten Germany.
| | - Stephan Herpertz
- LWL-Universitätsklinikum der Ruhr-Universität Bochum Clinic of Psychosomatic Medicine and Psychotherapy Alexandrinenstr. 1-3, 44791 Bochum Germany.
| | - Bernhard Strauss
- Universitätsklinikum Jena, Institute of Psychosocial Medicine and Psychotherapy, Stoystr. 3, 07740 Jena Germany.
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Kladnitski N, Smith J, Uppal S, James MA, Allen AR, Andrews G, Newby JM. Transdiagnostic internet-delivered CBT and mindfulness-based treatment for depression and anxiety: A randomised controlled trial. Internet Interv 2020; 20:100310. [PMID: 32140427 PMCID: PMC7044661 DOI: 10.1016/j.invent.2020.100310] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/06/2020] [Accepted: 02/11/2020] [Indexed: 12/11/2022] Open
Abstract
AIM To examine the efficacy of transdiagnostic internet-delivered cognitive behavioural therapy (iCBT), mindfulness-enhanced iCBT, and stand-alone online mindfulness training compared with a usual care control group (TAU) for clinical anxiety and depression. METHOD Individuals (N = 158) with a DSM-5 diagnosis of a depressive and/or anxiety disorder were randomised to one of the three clinician-guided online interventions, or TAU over a 14-week intervention period. The primary outcomes were self-reported depression (PHQ-9) and anxiety (GAD-7) severity at post-treatment. Secondary outcomes included adherence rates, functional impairment (WHODAS-II), general distress (K-10), and diagnostic status at the 3-month follow-up (intervention groups). RESULTS All three programs achieved significant and large reductions in symptoms of depression (g = 0.89-1.53), anxiety (g = 1.04-1.40), and distress (g = 1.25-1.76); and medium to large reductions in functional impairment (g = 0.53-0.98) from baseline to post-treatment and 3-month follow-up. Intention-to-treat linear mixed models showed that all three online programs were superior to usual care at reducing symptoms of depression (g = 0.89-1.18) and anxiety (g = 1.00-1.23). CONCLUSION Transdiagnostic iCBT, mindfulness-enhanced iCBT and online mindfulness training are more efficacious for treating depression and anxiety disorders than usual care, and represent an accessible treatment option for these disorders.
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Affiliation(s)
- Natalie Kladnitski
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia
| | - Jessica Smith
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia
| | - Shivani Uppal
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia
| | - Mathew A. James
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia
| | - Adrian R. Allen
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia
| | - Gavin Andrews
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia
| | - Jill M. Newby
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW 2052, Australia
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Newby JM, Haskelberg H, Hobbs MJ, Mahoney AEJ, Mason E, Andrews G. The effectiveness of internet-delivered cognitive behavioural therapy for health anxiety in routine care. J Affect Disord 2020; 264:535-542. [PMID: 31780130 DOI: 10.1016/j.jad.2019.11.087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/17/2019] [Accepted: 11/12/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Randomised controlled trials have shown that internet-delivered cognitive behavioural treatment (iCBT) is an effective treatment for health anxiety, but the effectiveness of these programs in routine care has not been investigated. This study examined the effectiveness of iCBT for health anxiety symptoms in routine care settings in the community. METHODS Using an open-trial design, we investigated adherence to, and effectiveness of a 6-lesson iCBT program for health anxiety symptoms amongst individuals (n = 391, mean age 41 years, 64% female) who enrolled in the program either self-guided (n = 312) or under the supervision of community clinicians (general practitioners, psychologists and other allied health professionals) (n = 79). Primary outcome was health anxiety severity on the Short Health Anxiety Inventory (SHAI), and secondary outcomes were depression severity on the Patient Health Questionnaire 9-item (PHQ-9) (depression) and distress (Kessler-10: K-10). RESULTS Adherence to the iCBT program was modest (45.6% in the clinician-supervised group, 33.0% in the unguided group), but within-subjects effect sizes were large (SHAI: g = 1.66, 95%CI: 1.45-1.88; PHQ-9: g = 1.12, 95%CI: 0.92-1.32; K-10: g = 1.35, 95%CI: 1.15-1.56). LIMITATIONS No control group, lack of follow-up data. CONCLUSIONS iCBT is an effective treatment for health anxiety symptoms in routine care, but methods to increase adherence are needed to optimise benefits to participants. Randomised controlled effectiveness trials with long-term follow-up are needed.
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Affiliation(s)
- Jill M Newby
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Darlinghurst, NSW, Australia; School of Psychology, University of New South Wales, NSW, Australia.
| | - Hila Haskelberg
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Megan J Hobbs
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Darlinghurst, NSW, Australia; School of Psychiatry, University of New South Wales, NSW, Australia
| | - Alison E J Mahoney
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Elizabeth Mason
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Gavin Andrews
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Darlinghurst, NSW, Australia; School of Psychiatry, University of New South Wales, NSW, Australia
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25
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Zagorscak P, Heinrich M, Bohn J, Stein J, Knaevelsrud C. How individuals change during internet-based interventions for depression: A randomized controlled trial comparing standardized and individualized feedback. Brain Behav 2020; 10:e01484. [PMID: 31777204 PMCID: PMC6955845 DOI: 10.1002/brb3.1484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 10/26/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Standardized and individualized Internet-based interventions (IBI) for depression yield significant symptom improvements. However, change patterns during standardized or individualized IBI are unknown. Identifying subgroups that experience different symptom courses during IBI and their characteristics is vital for improving response. METHODS Mildly to moderately depressed individuals according to self-report (N = 1,089) were randomized to receive module-wise feedback that was either standardized or individualized by a counselor within an otherwise identical cognitive-behavioral IBI for depression (seven modules over six weeks). Depressive symptoms were assessed at baseline and before each module (Patient Health Questionnaire; PHQ-9). Other individual characteristics (self-report) and the presence of an affective disorder (structured clinical interview) were assessed at baseline. Growth mixture modeling was used to identify and compare subgroups with discernable change patterns and associated client variables across conditions. RESULTS Model comparisons suggest equal change patterns in both conditions. Across conditions, a group of immediate (62.5%) and a group of delayed improvers (37.5%) were identified. Immediate improvers decreased their PHQ-9 score by 5.5 points from pre to post, with 33% of improvement occurring before treatment commenced. Delayed improvers were characterized by stable symptom severity during the first two modules and smaller overall symptom decrease (3.4 points). Higher treatment expectations, a current major depressive disorder (interview), and lower social support were associated with delayed improvement. CONCLUSION Internet-based interventions for depression with individualized and with standardized feedback lead to comparable patterns of change. Expectation management and bolstering of social support are promising strategies for individuals that are at risk for delayed improvement.
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Affiliation(s)
- Pavle Zagorscak
- Department of Clinical-Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Manuel Heinrich
- Department of Clinical-Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Johannes Bohn
- Department of Clinical-Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Jana Stein
- Department of Clinical-Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Christine Knaevelsrud
- Department of Clinical-Psychological Intervention, Freie Universität Berlin, Berlin, Germany
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Stavropoulos V, Cokorilo S, Kambouropoulos A, Collard J, Gomez R. Cognitive Behavioral Therapy Online for Adult Depression: A 10 Year Systematic Literature Review. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2019. [DOI: 10.2174/1573400515666190628125914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background:
Acceptance, adherence and efficacy aspects of Cognitive Behavioural
Therapy (CBT) online have invited significant interest, especially in the context of “stepped care”
models, which advocate progressive stages of intervention in addressing depression. Objectives: The
current work aspires to comprehensively identify critical factors linked to the applicability of online
CBT, in order to inform clinical practices and future research targeting depressive behaviors in early
and middle adulthood.
Methods:
To serve these goals: a) the PRISMA systematic literature perspective is followed; b) a
systematic search of online databases between 2008-2018 was undertaken and; c) a compositehybrid
model, resulting from the integration of broadly adopted conceptualizations from the areas of
psychological treatment and internet use behaviors, was combined with an interpretative phenomenological
analysis perspective to organize the findings.
Results:
In total, 28 studies were included in the present review. Factors defining the efficacy, adherence
and acceptability of online CBT targeting depression (during early and middle adulthood)
were classified into parameters related to the individual receiver, the context and the CBT activities
involved.
Conclusion:
Despite the cautiousness warranted by the limitations, as well as the diverge methodology of
the reviewed studies, findings appear to favour the provision of brief, therapist supported, online
CBT interventions, especially in addressing moderate depression during early and middle adulthood.
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Affiliation(s)
| | - Sandra Cokorilo
- The Cairnmillar Institute, School of Psychology, Melbourne, Australia
| | | | - James Collard
- The Cairnmillar Institute, School of Psychology, Melbourne, Australia
| | - Rapson Gomez
- Federation University, Mount Helen, VIC 3350, Australia
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27
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Knittle K, Gellert P, Moore C, Bourke N, Hull V. Goal Achievement and Goal-Related Cognitions in Behavioral Activation Treatment for Depression. Behav Ther 2019; 50:898-909. [PMID: 31422846 DOI: 10.1016/j.beth.2019.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 12/03/2018] [Accepted: 01/18/2019] [Indexed: 11/28/2022]
Abstract
This study investigates the extent to which achieving goals during behavioral activation (BA) treatment predicts depressive symptom improvement, and whether goal-related cognitions predict goal achievement or treatment response. Patients (n = 110, mean age 37.6, 54% female) received low-intensity cognitive behavioral therapy for depression, which included setting up to three behavioral goals in each of three BA-focused sessions (i.e., 9 goals per patient). Patients completed items from the Self-Regulation Skills Battery to assess goal-related cognitions and goal achievement for these goals, and depressive symptoms were assessed weekly with the PHQ-9. Multilevel models investigated the relationships between goal-related cognitions, goal achievement and depressive symptoms. Depressive symptoms improved curve-linearly during treatment (B = 0.12, p < .001), but were not predicted by contemporaneous or time-lagged goal achievement. While cumulative goal achievement predicted end-of-treatment depressive symptoms (r = -.23; p < .01), this relationship became nonsignificant after controlling for depressive symptoms at baseline. Readiness, planning and action control predicted greater goal achievement, whereas greater goal ownership predicted less goal achievement (all p < .05). Motivation and outcome expectancy were related to subsequent, but not contemporaneous, improvements in depressive symptoms (all p < .05). This study indicates the importance of goal-related cognitions in BA treatments, and future research should investigate potential moderators of the relationships between goal-related cognitions, goal achievement, and improvements in depressive symptoms.
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Affiliation(s)
| | | | - Clair Moore
- Sunderland Psychological Wellbeing Service, Monkwearmouth Hospital
| | - Natalie Bourke
- Sunderland Psychological Wellbeing Service, Monkwearmouth Hospital
| | - Victoria Hull
- Sunderland Psychological Wellbeing Service, Monkwearmouth Hospital
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28
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Katz DE, Cassin S, Weerasinghe R, Rector NA. Changes in post-event processing during cognitive behavioural therapy for social anxiety disorder: A longitudinal analysis using post-session measurement and experience sampling methodology. J Anxiety Disord 2019; 66:102107. [PMID: 31284123 DOI: 10.1016/j.janxdis.2019.102107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/24/2019] [Accepted: 06/07/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Post-event processing (PEP) is posited to be an important factor in the maintenance of social anxiety symptoms. Previous research has demonstrated that general PEP tendencies are sensitive to treatment. However, it remains unclear how momentary PEP following social interactions changes over the course of treatment for social anxiety disorder. The purpose of the present study was to examine how both momentary and general PEP change over the course of treatment, and how such changes predict treatment outcome. METHOD Participants (N = 60) with social anxiety disorder were enrolled in group cognitive behavioural therapy. All participants completed measures of PEP and social anxiety symptom severity at five time points over treatment. A subset (N = 33) also completed repeated experience sampling measurements of PEP following social interactions across the course of treatment. RESULTS Both general and momentary PEP decreased over the course of treatment. Decreases in both types of PEP predicted lower social anxiety symptom severity following treatment. CONCLUSION The results of the study demonstrate that momentary experiences of PEP can be influenced by treatment, and can in turn impact treatment outcome. The findings have significant clinical and theoretical implications.
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Affiliation(s)
- Danielle E Katz
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Stephanie Cassin
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Rashmi Weerasinghe
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Neil A Rector
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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Mathieson F, Stanley J, Collings C(S, Tester R, Dowell A. Cluster randomised controlled trial of a guided self-help mental health intervention in primary care. BMJ Open 2019; 9:e023481. [PMID: 30819700 PMCID: PMC6398763 DOI: 10.1136/bmjopen-2018-023481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 01/16/2019] [Accepted: 01/28/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To ascertain whether an ultrabrief intervention (UBI) improves mental health outcomes for patients in general practice with mild-to-moderate mental health concerns. TRIAL DESIGN Two-arm cluster randomised controlled trial. METHODS Participants: general practitioners (GPs) were invited based on working in a participating general practice. Patients were eligible to participate if aged 18-65 years, scored ≤35 on the Kessler-10 (K10) and if meeting local mental health access criteria (based on age, low income or ethnic group). INTERVENTIONS intervention arm GPs were trained on the UBI approach, with participating patients receiving three structured appointments over 5 weeks. GPs randomised to practice as usual (PAU) did not receive training, and delivered support following their existing practice approaches. OUTCOME MEASURES primary outcome was patient-level K10 score at 6 months postrecruitment.Randomisation: GP practices were randomised to UBI training or PAU at the start of the study.Blinding: GPs were not blinded to group assignment. RESULTS Numbers randomised: 62 GPs (recruiting 85 patients) were randomised to UBI, and 50 to PAU (recruiting 75 patients).Numbers analysed: 31 GPs recruited at least one patient in the UBI arm (70 patients analysed), and 21 GPs recruited at least one patient in the PAU arm (69 patients analysed). OUTCOME K10 scores from an intention-to-treat analysis were similar in UBI and PAU arms, with a wide CI (mean adjusted K10 difference=1.68 points higher in UBI arm, 95% CI -1.18 to 4.55; p=0.255). Secondary outcomes were also similar in the two groups. CONCLUSIONS the UBI intervention did not lead to better outcomes than practice as usual, although the study had lower than planned power due to poor recruitment. The study results can still contribute to the continuing debate about brief psychological therapy options for primary care and their development. TRIAL REGISTRATION NUMBER ACTRN12613000041752; Pre-results.
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Affiliation(s)
- Fiona Mathieson
- Department of Psychological Medicine, University of Otago, Wellington, Wellington, New Zealand
| | - James Stanley
- Public Health, University of Otago, Wellington, Wellington, New Zealand
- University of Otago, Wellington, Wellington, New Zealand
| | | | - Rachel Tester
- Primary Health Care and General Practice, University of Otago, Wellington, Wellington, New Zealand
| | - Anthony Dowell
- General Practice, Wellington School of Medicine and Health Sciences, Wellington South, New Zealand
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30
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Loughnan SA, Sie A, Hobbs MJ, Joubert AE, Smith J, Haskelberg H, Mahoney AEJ, Kladnitski N, Holt CJ, Milgrom J, Austin MP, Andrews G, Newby JM. A randomized controlled trial of 'MUMentum Pregnancy': Internet-delivered cognitive behavioral therapy program for antenatal anxiety and depression. J Affect Disord 2019; 243:381-390. [PMID: 30266030 DOI: 10.1016/j.jad.2018.09.057] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/12/2018] [Accepted: 09/16/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Anxiety and depression are common during pregnancy and associated with adverse outcomes for the mother and infant if left untreated. Despite the need to improve treatment accessibility and uptake in this population, no studies have investigated internet-delivered cognitive behavioural therapy (iCBT) for antenatal anxiety and depression. In a randomised controlled trial, we examined the efficacy and acceptability of a brief, unguided iCBT intervention - the MUMentum Pregnancy program - in pregnant women with anxiety and/or depression. METHODS Participants meeting clinical threshold on validated self-report measures of generalised anxiety and/or depression were recruited online and randomised to iCBT (n = 43) or a treatment as usual (TAU) control (n = 44). Outcomes were assessed at baseline, post-treatment and four-week follow-up; and included anxiety, depression, psychological distress, antenatal bonding, quality of life, and treatment acceptability. RESULTS Of the 36 women who started iCBT, 26 completed all three lessons of treatment (76% adherence rate). iCBT produced moderate to large effect size reductions for anxiety on the GAD-7 (Hedges' g = 0.76) and psychological distress on the Kessler-10 (g = 0.88) that were superior to TAU. Only small nonsignificant differences were found for depression outcomes (g = < 0.35). Participants reported that iCBT was an acceptable treatment for antenatal anxiety and/or depression. LIMITATIONS Lack of an active control condition and long-term postpartum follow-up. CONCLUSIONS This is the first study to evaluate brief unguided iCBT for antenatal anxiety and depression. While our findings are promising, particularly for anxiety reduction, additional RCTs are required to establish treatment efficacy.
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Affiliation(s)
- Siobhan A Loughnan
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent's Hospital, Sydney, Australia; School of Psychiatry, University of New South Wales, Sydney, Australia.
| | - Amanda Sie
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent's Hospital, Sydney, Australia
| | - Megan J Hobbs
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent's Hospital, Sydney, Australia; School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Amy E Joubert
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent's Hospital, Sydney, Australia; School of Psychology, University of New South Wales, Sydney, Australia
| | - Jessica Smith
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent's Hospital, Sydney, Australia
| | - Hila Haskelberg
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent's Hospital, Sydney, Australia
| | - Alison E J Mahoney
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent's Hospital, Sydney, Australia
| | - Natalie Kladnitski
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent's Hospital, Sydney, Australia
| | - Christopher J Holt
- Parent-Infant Research Institute (PIRI), Australia and Melbourne School of Psychological Science, University of Melbourne, Australia
| | - Jeannette Milgrom
- Parent-Infant Research Institute (PIRI), Australia and Melbourne School of Psychological Science, University of Melbourne, Australia
| | - Marie-Paule Austin
- School of Psychiatry, University of New South Wales, Sydney, Australia; Perinatal & Women's Mental Health Unit, c/o St John of God Hospital, Australia and Royal Hospital for Women, Sydney, Australia
| | - Gavin Andrews
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent's Hospital, Sydney, Australia; School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Jill M Newby
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent's Hospital, Sydney, Australia; School of Psychology, University of New South Wales, Sydney, Australia
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31
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Kladnitski N, Smith J, Allen A, Andrews G, Newby JM. Online mindfulness-enhanced cognitive behavioural therapy for anxiety and depression: Outcomes of a pilot trial. Internet Interv 2018; 13:41-50. [PMID: 30206518 PMCID: PMC6112099 DOI: 10.1016/j.invent.2018.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/30/2018] [Accepted: 06/07/2018] [Indexed: 01/13/2023] Open
Abstract
Transdiagnostic internet-delivered cognitive behavioural therapies (iCBT) are effective for treating anxiety and depression, but there is room for improvement. In this study we developed a new Mindfulness-Enhanced iCBT intervention by incorporating formal and informal mindfulness exercises within an existing transdiagnostic iCBT program for mixed depression and anxiety. We examined the acceptability, feasibility, and outcomes of this new program in a sample of 22 adults with anxiety disorders and/or major depression. Participants took part in the 7-lesson clinician-guided online intervention over 14 weeks, and completed measures of distress (K-10), anxiety (GAD-7), depression (PHQ-9), mindfulness (FFMQ) and well-being (WEMBWS) at pre-, mid-, post-treatment, and three months post-treatment. Treatment engagement, satisfaction, and side-effects were assessed. We found large, significant reductions in distress (Hedges g = 1.55), anxiety (g = 1.39), and depression (g = 1.96), and improvements in trait mindfulness (g = 0.98) and well-being (g = 1.26) between baseline and post-treatment, all of which were maintained at follow-up. Treatment satisfaction was high for treatment-completers, with minimal side-effects reported, although adherence was lower than expected (59.1% completed). These findings show that it is feasible to integrate online mindfulness training with iCBT for the treatment of anxiety and depression, but further research is needed to improve adherence. A randomised controlled trial is needed to explore the efficacy of this program.
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Affiliation(s)
- Natalie Kladnitski
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent’s Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia
| | - Jessica Smith
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent’s Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia
| | - Adrian Allen
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent’s Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia
| | - Gavin Andrews
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent’s Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia
| | - Jill M. Newby
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW 2052, Australia
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Evaluation of a brief unguided psychological online intervention for depression: A controlled trial including exploratory moderator analyses. Internet Interv 2018; 13:73-81. [PMID: 30206522 PMCID: PMC6112098 DOI: 10.1016/j.invent.2018.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/23/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Psychological online interventions (POIs) reduce depression but we know little about factors influencing their effectiveness. We evaluated a new, brief POI for depression and conducted exploratory moderator analyses. METHODS In this online trial (German Clinical Trials Register; DRKS00011045), we allocated participants to treatment as usual (TAU; n = 67) or POI (n = 65). At first, we randomized participants; later we allocated participants based on depression severity in order to counter baseline differences. The unguided POI addressed behavioral activation and depressive thinking in a single module with 25 webpages (including a smartphone application). We did one assessment at baseline and a post-assessment four weeks later. RESULTS At post-assessment, depression (p = .586), behavioral activation (p = .332), and dysfunctional attitudes (p = .499) did not differ between groups. When concurrent treatments (medication/psychotherapy) remained constant/decreased, the POI outperformed TAU (p = .031). POI-participants with lower willingness to change (p = .030) or higher education (p = .017) were less likely to worsen (i.e., experience increased depressive symptoms) compared to TAU. DISCUSSION The targeted sample size was not reached, measurements were self-reported, and randomization failed. The POI's content may have been too limited. Concurrent treatments, which were more often sought out by TAU participants, diminished group differences and should be considered in future studies. Brief POIs may protect against worsening of depressive symptoms among highly educated participants or those with low willingness to change.
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Firth J, Torous J, Carney R, Newby J, Cosco TD, Christensen H, Sarris J. Digital Technologies in the Treatment of Anxiety: Recent Innovations and Future Directions. Curr Psychiatry Rep 2018; 20:44. [PMID: 29779065 PMCID: PMC7006989 DOI: 10.1007/s11920-018-0910-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW This review aims to provide a comprehensive overview of the efficacy, limitations, and future of e-health treatments for anxiety. Within this, we provide detail on "first-generation" e-health approaches, such as computerized therapies. Additionally, we assess the emergence and early efficacy of newer methods of treatment delivery, including smartphone apps and virtual reality interventions, discussing the potential and pitfalls for each. RECENT FINDINGS There is now substantial clinical research demonstrating the efficacy of internet-delivered cognitive behavioral therapy in the treatment of anxiety. However, the ability of these interventions for engaging patients in "real-world" settings is unclear. Recently, smartphone apps for anxiety have presented a more popular and ubiquitous method of intervention delivery, although the evidence base supporting these newer approaches drastically falls behind the extensive marketing and commercialization efforts currently driving their development. Meanwhile, the increasing availability of novel technologies, such as "virtual reality" (VR), introduces further potential of e-health treatments for generalized anxiety and anxiety-related disorders such as phobias and obsessive compulsive disorder, while also creating additional challenges for research. Although still in its infancy, e-health research is already presenting several promising avenues for delivering effective and scalable treatments for anxiety. Nonetheless, several important steps must be taken in order for academic research to keep pace with continued technological advances.
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Affiliation(s)
- Joseph Firth
- NICM Health Research Institute, University of Western Sydney, Campbelltown, Sydney, NSW, 2560, Australia. .,Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - John Torous
- Department of Psychiatry and Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Rebekah Carney
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK,Youth Mental Health Research Unit, Greater Manchester West Mental Health Foundation Trust, Manchester, UK
| | - Jill Newby
- School of Psychology, Faculty of Science, UNSW Sydney, Sydney, Australia
| | - Theodore D. Cosco
- Gerontology Research Centre, Simon Fraser University, Vancouver, Canada,Oxford Institute of Population Ageing, University of Oxford, Oxford, UK
| | - Helen Christensen
- Black Dog Institute, UNSW Sydney, Sydney, Australia,School of Psychiatry, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Jerome Sarris
- NICM Health Research Institute, University of Western Sydney, Campbelltown, Sydney, NSW 2560, Australia,Department of Psychiatry, University of Melbourne, Professorial Unit, The Melbourne Clinic, Melbourne, Australia
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Loughnan SA, Newby JM, Haskelberg H, Mahoney A, Kladnitski N, Smith J, Black E, Holt C, Milgrom J, Austin MP, Andrews G. Internet-based cognitive behavioural therapy (iCBT) for perinatal anxiety and depression versus treatment as usual: study protocol for two randomised controlled trials. Trials 2018; 19:56. [PMID: 29357918 PMCID: PMC5778736 DOI: 10.1186/s13063-017-2422-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 12/18/2017] [Indexed: 11/16/2022] Open
Abstract
Background We aimed to evaluate the acceptability and efficacy of two brief, Internet-delivered cognitive behavioural therapy interventions—MUMentum Pregnancy (study 1) and MUMentum Postnatal (study 2)—in reducing maternal symptoms of anxiety, depression and overall psychological distress compared to usual care in the perinatal period. Methods/Design Women who are pregnant (study 1) or < 12 months postpartum (study 2) with current clinically elevated symptoms of anxiety and/or depression according to validated self-report measures, will be recruited via the research arm of a not-for-profit clinical and research unit in Australia and randomised to the intervention group or treatment as usual control group. The minimum sample size for each study (alpha 0.05; power 0.80 for a g of 0.80) was identified as 50 with at least 10% more to be recruited to account for expected attrition. The co-primary outcome measures are the Patient Health Questionnaire 9-item scale and Generalised Anxiety Disorder 7-item scale to measure depression and anxiety symptom severity, respectively, and will be administered at the following primary time-points: baseline; post treatment; and at one-month follow-up. Psychological distress will be measured according to the Kessler-10 psychological distress scale at each primary time-point and will also be completed before each lesson for those in the intervention group. The total trial period nine weeks for study 1 and 11 weeks for study 2. Program efficacy will be determined using intent-to-treat mixed models. Maintenance of gains will be assessed at one-month follow-up. Discussion The current randomised controlled trial seeks to extend the literature by evaluating the efficacy of a self-help intervention for women in the perinatal period. If efficacious, the MUMentum programs have the potential to be easily disseminated via https://thiswayup.org.au/ to large numbers of women across Australia as an intervention for women screening positive for anxiety, depressive or distress symptoms during pregnancy or postpartum. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12616000560493; ACTRN12616000559415. Registered on 2nd May 2016. Electronic supplementary material The online version of this article 10.1186/s13063-017-2422-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Siobhan A Loughnan
- Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW School of Psychiatry at St Vincent's Hospital, Level 4, O'Brien Centre, St Vincent's Hospital, 394 Victoria Street, Sydney, NSW, 2010, Australia.
| | - Jill M Newby
- School of Psychology, Faculty of Science, UNSW Sydney, 1302 Mathews Building, Kensington, NSW, 2052, Australia
| | - Hila Haskelberg
- Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW School of Psychiatry at St Vincent's Hospital, Level 4, O'Brien Centre, St Vincent's Hospital, 394 Victoria Street, Sydney, NSW, 2010, Australia
| | - Alison Mahoney
- Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW School of Psychiatry at St Vincent's Hospital, Level 4, O'Brien Centre, St Vincent's Hospital, 394 Victoria Street, Sydney, NSW, 2010, Australia
| | - Natalie Kladnitski
- Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW School of Psychiatry at St Vincent's Hospital, Level 4, O'Brien Centre, St Vincent's Hospital, 394 Victoria Street, Sydney, NSW, 2010, Australia
| | - Jessica Smith
- Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW School of Psychiatry at St Vincent's Hospital, Level 4, O'Brien Centre, St Vincent's Hospital, 394 Victoria Street, Sydney, NSW, 2010, Australia
| | - Emma Black
- Perinatal & Women's Mental Health Unit, c/o St John of God Hospital, 13 Grantham Street, Burwood, NSW, 2134, Australia
| | - Christopher Holt
- Parent-Infant Research Institute (PIRI) and Melbourne School of Psychological Science, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, VIC, 3081, Australia
| | - Jeannette Milgrom
- Parent-Infant Research Institute (PIRI) and Melbourne School of Psychological Science, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, VIC, 3081, Australia
| | - Marie-Paule Austin
- Perinatal & Women's Mental Health Unit, c/o St John of God Hospital, 13 Grantham Street, Burwood, NSW, 2134, Australia
| | - Gavin Andrews
- Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW School of Psychiatry at St Vincent's Hospital, Level 4, O'Brien Centre, St Vincent's Hospital, 394 Victoria Street, Sydney, NSW, 2010, Australia
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Schröder J, Berger T, Westermann S, Klein JP, Moritz S. Internet interventions for depression: new developments. DIALOGUES IN CLINICAL NEUROSCIENCE 2017. [PMID: 27489460 PMCID: PMC4969707 DOI: 10.31887/dcns.2016.18.2/jschroeder] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A wide range of Internet interventions, mostly grounded in methods of cognitive behavioral therapy, have been developed and tested for several mental disorders. The evidence to date shows that these interventions are effective in reducing symptoms of depression. Metaanalyses report small-to-medium effect sizes when Internet interventions are delivered as stand-alone self-help interventions (d=0.25-0.36), and medium-to-large effect sizes when delivered as therapist-guided interventions (d=0.58-0.78), both compared with usual care. Only a minority of people suffering from depression receive adequate treatment, and Internet interventions might help bridge the large treatment gap. This review summarizes the current body of evidence and highlights pros and cons of Internet interventions. It also outlines how they could be implemented in mental health care systems and points out unresolved questions, as well as future directions, in this research field.
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Affiliation(s)
- Johanna Schröder
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Stefan Westermann
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, University of Lübeck, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
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Murphy MJ, Newby JM, Butow P, Kirsten L, Allison K, Loughnan S, Price MA, Shaw J, Shepherd H, Smith J, Andrews G. iCanADAPT Early protocol: randomised controlled trial (RCT) of clinician supervised transdiagnostic internet-delivered cognitive behaviour therapy (iCBT) for depression and/or anxiety in early stage cancer survivors -vs- treatment as usual. BMC Cancer 2017; 17:193. [PMID: 28298187 PMCID: PMC5353884 DOI: 10.1186/s12885-017-3182-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/08/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND This RCT with two parallel arms will evaluate the efficacy of an internet-delivered transdiagnostic cognitive behavioural therapy (iCBT) intervention for the treatment of clinical depression and/or anxiety in early stage cancer survivors. METHODS/DESIGN Early stage cancer survivors will be recruited via the research arm of a not-for-profit clinical research unit and randomised to an intervention (iCBT) group or a 'treatment as usual' (TAU) control group. The minimum sample size for each group is 45 people (assuming effect size > 0.6, power of 80%, and alpha at .05), but 10% more will be recruited to account for attrition. A solitary or cumulative diagnosis(es) of Major Depressive Episode (current), Generalised Anxiety Disorder, Illness Anxiety Disorder, Panic Disorder, Agoraphobia, and/or Adjustment disorder will be determined using modules from the Anxiety Disorders Interview Schedule for DSM-5. Depression and anxiety levels with be measured via the total score of the Hospital Anxiety and Depression scale (HADS-T), the primary outcome measure. Secondary measures will include the Kessler 10 to measure general distress, the Fear of Cancer Recurrence Inventory (FCRI) to measure the specific fear of cancer recurrence and the Functional Assessment of Cancer Therapy, General Version 4 (FACT-G) for self-report of physical, social, emotional and functional well-being. iCBT participants will complete the measures before lessons 1 and 5, at post-treatment and at 3-month follow-up. The TAU group will complete similar measures at weeks 1, 8 and 16 of the waiting period. Program efficacy will be determined using intent-to-treat mixed models. Maintenance of gains will be assessed at 3-month follow-up. Mediation analyses using PROCESS will be used to examine the association between change in depressive and anxious symptoms over time and changes in FCRI and FACT-G QOL in separate analysis. DISCUSSION This is the first RCT looking at iCBT specifically for clinical depression and/or anxiety in a cancer population. Findings will help to direct the role of iCBT in streamlined psycho-social care pathways. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12616000231448, registered 19th February 2016 ( www.anzctr.org.au ). This trial protocol is in compliance with the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines.
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Affiliation(s)
- M. J. Murphy
- Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW School of Psychiatry at St Vincent’s Hospital, Level 4, O’Brien Centre, St Vincent’s Hospital, 394 Victoria Street, Sydney, NSW 2010 Australia
| | - J. M. Newby
- Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW School of Psychiatry at St Vincent’s Hospital, Level 4, O’Brien Centre, St Vincent’s Hospital, 394 Victoria Street, Sydney, NSW 2010 Australia
- School of Psychology, Faculty of Science, UNSW Australia, Mathews Building, Kensington, NSW 2052 Australia
| | - P. Butow
- Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Level 6, Chris O’Brien Lifehouse (C39Z), The University of Sydney, Sydney, NSW 2006 Australia
| | - L. Kirsten
- Nepean Cancer Care Centre, Sydney West Cancer Network, Kingswood, NSW 2747 Australia
- Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Level 6, Chris O’Brien Lifehouse (C39Z), The University of Sydney, Sydney, NSW 2006 Australia
| | - K. Allison
- Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Level 6, Chris O’Brien Lifehouse (C39Z), The University of Sydney, Sydney, NSW 2006 Australia
| | - S. Loughnan
- Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW School of Psychiatry at St Vincent’s Hospital, Level 4, O’Brien Centre, St Vincent’s Hospital, 394 Victoria Street, Sydney, NSW 2010 Australia
| | - M. A. Price
- Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Level 6, Chris O’Brien Lifehouse (C39Z), The University of Sydney, Sydney, NSW 2006 Australia
| | - J. Shaw
- Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Level 6, Chris O’Brien Lifehouse (C39Z), The University of Sydney, Sydney, NSW 2006 Australia
| | - H. Shepherd
- Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Level 6, Chris O’Brien Lifehouse (C39Z), The University of Sydney, Sydney, NSW 2006 Australia
| | - J. Smith
- Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Level 6, Chris O’Brien Lifehouse (C39Z), The University of Sydney, Sydney, NSW 2006 Australia
| | - G. Andrews
- Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW School of Psychiatry at St Vincent’s Hospital, Level 4, O’Brien Centre, St Vincent’s Hospital, 394 Victoria Street, Sydney, NSW 2010 Australia
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Drozd F, Vaskinn L, Bergsund HB, Haga SM, Slinning K, Bjørkli CA. The Implementation of Internet Interventions for Depression: A Scoping Review. J Med Internet Res 2016; 18:e236. [PMID: 27608548 PMCID: PMC5034149 DOI: 10.2196/jmir.5670] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/23/2016] [Accepted: 08/21/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Depression is one of the most common mental health problems among adults, but effective treatments are not widely accessible. The Internet holds promise as a cost-effective and convenient delivery platform of interventions for depression. However, studies suggest that Internet interventions are not widely available in routine settings. OBJECTIVE The aim of this study was to review the literature and examine whether there are systematic differences in reporting of the various implementation components on Internet interventions for depression, and then to examine what is known about and is characteristic of the implementation of these Internet interventions in regular care settings. METHODS We performed a scoping review, drawing upon a broad range of the literature on Internet interventions for depression in regular care, and used the active implementation framework to extract data. RESULTS Overall, the results suggested that knowledge about the implementation of Internet interventions for depression in regular care is limited. However, guided support from health professionals emphasizing program adherence and recruitment of end users to the interventions emerged as 2 main themes. We identified 3 additional themes among practitioners, including their qualifications, training, and supervision, but these were scarcely described in the literature. The competency drivers (ie, staff and user selection, training, and supervision) have received the most attention, while little attention has been given to organizational (ie, decision support, administration, and system intervention) and leadership drivers. CONCLUSIONS Research has placed little emphasis on reporting on the implementation of interventions in practice. Leadership and organizational drivers, in particular, have been largely neglected. The results of this scoping review have implications for future research and efforts to successfully implement Internet interventions for depression in regular care.
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Affiliation(s)
- Filip Drozd
- National Network for Infant Mental Health, Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.
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Santacana M, Arias B, Mitjans M, Bonillo A, Montoro M, Rosado S, Guillamat R, Vallès V, Pérez V, Forero CG, Fullana MA. Predicting Response Trajectories during Cognitive-Behavioural Therapy for Panic Disorder: No Association with the BDNF Gene or Childhood Maltreatment. PLoS One 2016; 11:e0158224. [PMID: 27355213 PMCID: PMC4927091 DOI: 10.1371/journal.pone.0158224] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 06/13/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Anxiety disorders are highly prevalent and result in low quality of life and a high social and economic cost. The efficacy of cognitive-behavioural therapy (CBT) for anxiety disorders is well established, but a substantial proportion of patients do not respond to this treatment. Understanding which genetic and environmental factors are responsible for this differential response to treatment is a key step towards "personalized medicine". Based on previous research, our objective was to test whether the BDNF Val66Met polymorphism and/or childhood maltreatment are associated with response trajectories during exposure-based CBT for panic disorder (PD). METHOD We used Growth Mixture Modeling to identify latent classes of change (response trajectories) in patients with PD (N = 97) who underwent group manualized exposure-based CBT. We conducted logistic regression to investigate the effect on these trajectories of the BDNF Val66Met polymorphism and two different types of childhood maltreatment, abuse and neglect. RESULTS We identified two response trajectories ("high response" and "low response"), and found that they were not significantly associated with either the genetic (BDNF Val66Met polymorphism) or childhood trauma-related variables of interest, nor with an interaction between these variables. CONCLUSIONS We found no evidence to support an effect of the BDNF gene or childhood trauma-related variables on CBT outcome in PD. Future studies in this field may benefit from looking at other genotypes or using different (e.g. whole-genome) approaches.
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Affiliation(s)
- Martí Santacana
- Department of Mental Health, Consorci Sanitari de Terrassa, Terrassa, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Bárbara Arias
- Anthropology Unit, Department of Animal Biology, Universitat de Barcelona, Barcelona, Spain
- CIBERSAM (Centro de Investigaciones Biomédicas en Red de Salud Mental), Instituto de Salud Carlos III, Madrid, Spain
| | - Marina Mitjans
- CIBERSAM (Centro de Investigaciones Biomédicas en Red de Salud Mental), Instituto de Salud Carlos III, Madrid, Spain
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - Albert Bonillo
- Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - María Montoro
- Department of Mental Health, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Sílvia Rosado
- Institute of Neuropsychiatry and Addictions, Hospital del Mar, Barcelona, Spain
| | - Roser Guillamat
- Department of Mental Health, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Vicenç Vallès
- Department of Mental Health, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Víctor Pérez
- CIBERSAM (Centro de Investigaciones Biomédicas en Red de Salud Mental), Instituto de Salud Carlos III, Madrid, Spain
- Institute of Neuropsychiatry and Addictions, Hospital del Mar, Barcelona, Spain
| | - Carlos G. Forero
- CIBERESP (Centro de Investigaciones Biomédicas en Red, Epidemiología y Salud Pública), Instituto de Salud Carlos III, Madrid, Spain
- Health Services Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain
- Department of Experimental and Life Sciences (DCEXS), Universitat Pompeu Fabra, Barcelona, Spain
| | - Miquel A. Fullana
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Institute of Neuropsychiatry and Addictions, Hospital del Mar, Barcelona, Spain
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Tebbs J. Letter regarding 'characteristics of the relationship that develops from nurse-caregiver communication during telecare'. J Clin Nurs 2016; 25:2678-9. [PMID: 27240039 DOI: 10.1111/jocn.13404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Jeffrey Tebbs
- Department of Biobehavioral Nursing and Health Systems, Univeristy of Washington, Seattle, WA, USA
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Brière FN, Rohde P, Stice E, Morizot J. GROUP-BASED SYMPTOM TRAJECTORIES IN INDICATED PREVENTION OF ADOLESCENT DEPRESSION. Depress Anxiety 2016; 33:444-51. [PMID: 26457813 PMCID: PMC4835266 DOI: 10.1002/da.22440] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 09/04/2015] [Accepted: 09/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescent depression prevention research has focused on mean intervention outcomes, but has not considered heterogeneity in symptom course. Here, we empirically identify subgroups with distinct trajectories of depressive symptom change among adolescents enrolled in two indicated depression prevention trials and examine how cognitive-behavioral (CB) interventions and baseline predictors relate to trajectory membership. METHODS Six hundred thirty-one participants were assigned to one of three conditions: CB group intervention, CB bibliotherapy, and brochure control. We used group-based trajectory modeling to identify trajectories of depressive symptoms from pretest to 2-year follow-up. We examined associations between class membership and conditions using chi-square tests and baseline predictors using multinomial regressions. RESULTS We identified four trajectories in the full sample. Qualitatively similar trajectories were found in each condition separately. Two trajectories of positive symptom course (low-declining, high-declining) had declining symptoms and were distinguished by baseline symptom severity. Two trajectories of negative course (high-persistent, resurging), respectively, showed no decline in symptoms or decline followed by symptom reappearance. Participants in the brochure control condition were significantly more likely to populate the high-persistent trajectory relative to either CB condition and were significantly less likely to populate the low-declining trajectory relative to CB group. Several baseline factors predicted trajectory classes, but gender was the most informative prognostic factor, with males having increased odds of membership in a high-persistent trajectory relative to other trajectories. CONCLUSIONS Findings suggest that CB preventive interventions do not alter the nature of trajectories, but reduce the risk that adolescents follow a trajectory of chronically elevated symptoms.
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Affiliation(s)
- Frédéric N. Brière
- École de Psychoéducation, Université de Montréal, Montréal, Québec, Canada
| | - Paul Rohde
- Oregon Research Institute, Eugene, Oregon, United States
| | - Eric Stice
- Oregon Research Institute, Eugene, Oregon, United States
| | - Julien Morizot
- École de Psychoéducation, Université de Montréal, Montréal, Québec, Canada
,University of Montreal Public Health Research Institute (IRSPUM)
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Rosnick CB, Wetherell JL, White KS, Andreescu C, Dixon D, Lenze EJ. Cognitive-behavioral therapy augmentation of SSRI reduces cortisol levels in older adults with generalized anxiety disorder: A randomized clinical trial. J Consult Clin Psychol 2016; 84:345-52. [PMID: 26881447 DOI: 10.1037/a0040113] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Elevated cortisol in stress and aging, such as has been seen in late-life anxiety disorders, is postulated to accelerate cognitive and physiological decline in this large and increasing population. Selective serotonin-reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT) are both effective treatments for generalized anxiety disorder (GAD) in older adults. On the other hand, there is very little research examining the effect of combining these therapies on peak cortisol levels. For the current analyses, we examined the effectiveness of CBT augmentation on peak cortisol levels in older adults diagnosed with GAD. METHODS The sample consisted of 42 individuals with late-life GAD who received an acute course of the SSRI escitalopram and then entered a 16-week randomized phase. Twenty-one participants were randomized to receive 16 sessions of CBT in addition to continuing escitalopram and the remaining 21 participants continued on escitalopram without CBT. Generalized estimating equations were performed to assess the effectiveness of CBT augmentation on peak cortisol levels (30 min after waking). RESULTS Older adults with GAD who received both escitalopram and CBT demonstrated a significant reduction in peak cortisol levels at posttreatment compared to the group who received escitalopram without CBT augmentation. CONCLUSIONS CBT augmentation of SSRI treatment reduced peak cortisol levels for older adults with GAD. Since persistently high cortisol levels in aging are thought to increase age-related cognitive and medical problems, our findings suggest that there may be a benefit to health and cognition of CBT augmentation for late-life anxiety disorders.
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Affiliation(s)
| | | | - Kamila S White
- Department of Psychology, University of Missouri-St. Louis
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - David Dixon
- Department of Psychiatry, Washington University School of Medicine
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine
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Allen AR, Newby JM, Smith J, Andrews G. Internet-based cognitive behavioural therapy (iCBT) for posttraumatic stress disorder versus waitlist control: study protocol for a randomised controlled trial. Trials 2015; 16:544. [PMID: 26628268 PMCID: PMC4666048 DOI: 10.1186/s13063-015-1059-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 11/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This randomised controlled trial (RCT) with two parallel arms will evaluate the efficacy of an internet-delivered six-lesson 10-week cognitive behavioural therapy (iCBT) intervention for posttraumatic stress disorder (PTSD). It will also investigate the association between changes in PTSD symptoms, intolerance of uncertainty (IU) and emotion regulation. METHODS/DESIGN Patients with PTSD will be recruited via the research arm of a not-for-profit clinical and research unit in Australia and randomised to a treatment group or waitlist control group. The minimum sample size for each group (alpha 0.05, power 0.80 for a g of 0.47) was identified as 72, but 10 % more will be recruited to hedge against expected attrition. PTSD diagnosis will be determined using the PTSD module from the Mini International Neuropsychiatric Interview version 5.0.0. The PTSD Checklist - Civilian version (PCL-C) will be used to measure PTSD symptoms (the primary outcome measure), with the Intolerance of Uncertainty Scale 12-item version (IUS-12) and the Emotion Regulation Questionnaire (ERQ) used to measure intolerance of uncertainty and emotion regulation, respectively. The PCL-C will be administered to the treatment group before each lesson of the PTSD program and at 3-month follow-up. The IUS-12 and ERQ will be administered before lessons 1 and 4, at post-treatment and at 3-month follow-up. The waitlist control group will complete these measures at week 1, week 5 and week 11 of the waitlist period. PTSD program efficacy will be determined using intent-to-treat mixed models. Maintenance of gains will be assessed at 3-month follow-up. Mediation analyses using PROCESS will be used to examine the association between change in PTSD symptoms over treatment and change in each of IU and emotion regulation ability in separate analyses. DISCUSSION The current RCT seeks to replicate previous efficacy findings of iCBT for PTSD in a formally assessed PTSD sample from the general population. Findings may point to future lines of enquiry for the role of IU and emotion regulation in the mechanism of PTSD symptom change during CBT. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12614001213639 , registered 18 November 2014. This trial protocol is written in compliance with the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines.
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Affiliation(s)
- Adrian R Allen
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Level 4, O'Brien Centre, St. Vincent's Hospital, 394-404 Victoria Street, Darlinghurst, NSW, Australia.
| | - Jill M Newby
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Level 4, O'Brien Centre, St. Vincent's Hospital, 394-404 Victoria Street, Darlinghurst, NSW, Australia.
| | - Jessica Smith
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Level 4, O'Brien Centre, St. Vincent's Hospital, 394-404 Victoria Street, Darlinghurst, NSW, Australia.
| | - Gavin Andrews
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Level 4, O'Brien Centre, St. Vincent's Hospital, 394-404 Victoria Street, Darlinghurst, NSW, Australia.
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Gratzer D, Khalid-Khan F. Internet-delivered cognitive behavioural therapy in the treatment of psychiatric illness. CMAJ 2015; 188:263-272. [PMID: 26527829 DOI: 10.1503/cmaj.150007] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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The efficacy of internet-delivered treatment for generalized anxiety disorder: A systematic review and meta-analysis. Internet Interv 2015. [DOI: 10.1016/j.invent.2015.07.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Vallury KD, Jones M, Oosterbroek C. Computerized Cognitive Behavior Therapy for Anxiety and Depression in Rural Areas: A Systematic Review. J Med Internet Res 2015; 17:e139. [PMID: 26048193 PMCID: PMC4526901 DOI: 10.2196/jmir.4145] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 04/15/2015] [Accepted: 04/27/2015] [Indexed: 11/21/2022] Open
Abstract
Background People living in rural and remote communities have greater difficulty accessing mental health services and evidence-based therapies, such as cognitive behavior therapy (CBT), than their urban counterparts. Computerized CBT (CCBT) can be used to effectively treat depression and anxiety and may be particularly useful in rural settings where there are a lack of suitably trained practitioners. Objective To systematically review the global evidence regarding the clinical effectiveness and acceptability of CCBT interventions for anxiety and/or depression for people living in rural and remote locations. Methods We searched seven online databases: Medline, Embase Classic and Embase, PsycINFO, CINAHL, Web of Science, Scopus, and the Cochrane Library. We also hand searched reference lists, Internet search engines, and trial protocols.
Two stages of selection were undertaken. In the first, the three authors screened citations. Studies were retained if they reported the efficacy, effectiveness or acceptability of CCBT for depression and/or anxiety disorders, were peer reviewed, and written in English. The qualitative data analysis software, NVivo 10, was then used to run automated text searches for the word “rural,” its synonyms, and stemmed words. All studies identified were read in full and were included in the study if they measured or meaningfully discussed the efficacy or acceptability of CCBT among rural participants. Results A total of 2594 studies were identified, of which 11 met the selection criteria and were included in the review. The studies that disaggregated efficacy data by location of participant reported that CCBT was equally effective for rural and urban participants. Rural location was found to both positively and negatively predict adherence across studies. CCBT may be more acceptable among rural than urban participants—studies to date showed that rural participants were less likely to want more face-to-face contact with a practitioner and found that computerized delivery addressed confidentiality concerns. Conclusions CCBT can be effective for addressing depression and anxiety and is acceptable among rural participants. Further work is required to confirm these results across a wider range of countries, and to determine the most feasible model of CCBT delivery, in partnership with people who live and work in rural and remote communities.
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Affiliation(s)
- Kari Dee Vallury
- Department of Rural Health (DRH), Division of Health Sciences, University of South Australia, Whyalla Norrie, Australia.
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Hadjistavropoulos HD, Pugh NE, Nugent MM, Hesser H, Andersson G, Ivanov M, Butz CG, Marchildon G, Asmundson GJG, Klein B, Austin DW. Therapist-assisted Internet-delivered cognitive behavior therapy for depression and anxiety: translating evidence into clinical practice. J Anxiety Disord 2014; 28:884-93. [PMID: 25445078 DOI: 10.1016/j.janxdis.2014.09.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/23/2014] [Accepted: 09/22/2014] [Indexed: 11/19/2022]
Abstract
This dissemination study examined the effectiveness of therapist-assisted Internet-delivered Cognitive Behavior Therapy (ICBT) when offered in clinical practice. A centralized unit screened and coordinated ICBT delivered by newly trained therapists working in six geographically dispersed clinical settings. Using an open trial design, 221 patients were offered 12 modules of ICBT for symptoms of generalized anxiety (n=112), depression (n=83), or panic (n=26). At baseline, midpoint and post-treatment, patients completed self-report measures. On average, patients completed 8 of 12 modules. Latent growth curve modeling identified significant reductions in depression, anxiety, stress and impairment (d=.65-.78), and improvements in quality of life (d=.48-.66). Improvements in primary symptoms were large (d=.91-1.25). Overall, therapist-assisted ICBT was effective when coordinated across settings in clinical practice, but further attention should be given to strategies to improve completion of treatment modules.
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Affiliation(s)
- H D Hadjistavropoulos
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, Canada S4S 6J4.
| | - N E Pugh
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, Canada S4S 6J4.
| | - M M Nugent
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, Canada S4S 6J4.
| | - H Hesser
- Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden.
| | - G Andersson
- Department of Behavioural Sciences and Learning, Linköping University and Department of Clinical Neuroscience, Karolinska Institute, SE-581 83 Linköping, Sweden.
| | - M Ivanov
- Department of Computer Science, University of Regina, 3737 Wascana Parkway, Regina, SK, Canada S4S 6J4.
| | - C G Butz
- Department of Computer Science, University of Regina, 3737 Wascana Parkway, Regina, SK, Canada S4S 6J4.
| | - G Marchildon
- Johnson-Shoyama Graduate School of Public Policy, 3737 Wascana Parkway, Department of Psychology, University of Regina, Regina, SK, Canada S4S 6J4.
| | - G J G Asmundson
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, Canada S4S 6J4.
| | - B Klein
- School of Health Sciences and DVC-Research Portfolio, Federation University Australia, Victoria, Australia; Centre of Mental Health Research, The Australian National University, Canberra, Australia; The National eTherapy Centre, Swinburne University of Technology, Lydiard St S, Ballarat, VIC 3350, Australia.
| | - D W Austin
- Centre for Mental Health and Wellbeing Research, School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia.
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The effectiveness of internet cognitive behaviour therapy (iCBT) for social anxiety disorder across two routine practice pathways. Internet Interv 2014. [DOI: 10.1016/j.invent.2014.11.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Newby JM, Mewton L, Williams AD, Andrews G. Effectiveness of transdiagnostic Internet cognitive behavioural treatment for mixed anxiety and depression in primary care. J Affect Disord 2014; 165:45-52. [PMID: 24882176 DOI: 10.1016/j.jad.2014.04.037] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/16/2014] [Accepted: 04/16/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Internet-delivered cognitive behavioural treatment (iCBT) has been shown to be effective for the combined treatment of depression and anxiety in randomised controlled trials. The degree to which these findings generalise to patients in primary care awaits further investigation. METHODS Using an open-trial design, we investigated adherence to, and effectiveness of a 6-lesson therapist-assisted iCBT program for mixed anxiety and depression for patients (n = 707) who completed the program under the supervision of primary care clinicians (general practitioners, psychologists and other allied health professionals). Primary outcome measures were the PHQ-9 (depression), GAD-7 (generalised anxiety), K-10 (distress), WHODAS-II (disability), mini-SPIN (social anxiety) and panic disorder severity scale self-report version (PDSS). RESULTS Adherence to the iCBT program was modest (47.3%), but within-subjects effect sizes ranged from medium (0.51 for PDSS) to large (1.20 for PHQ-9). LIMITATIONS The lack of control group, limited post-treatment data due to drop-out, and short follow-up period. CONCLUSIONS iCBT is an effective treatment for mixed depression and anxiety when delivered in primary care settings. Methods to increase adherence are needed to optimise the benefits to patients.
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Affiliation(s)
- Jill M Newby
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St. Vincent׳s Hospital, Darlinghurst, NSW, Australia.
| | - Louise Mewton
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St. Vincent׳s Hospital, Darlinghurst, NSW, Australia
| | - Alishia D Williams
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St. Vincent׳s Hospital, Darlinghurst, NSW, Australia
| | - Gavin Andrews
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St. Vincent׳s Hospital, Darlinghurst, NSW, Australia
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Mewton L, Smith J, Rossouw P, Andrews G. Current perspectives on Internet-delivered cognitive behavioral therapy for adults with anxiety and related disorders. Psychol Res Behav Manag 2014; 7:37-46. [PMID: 24511246 PMCID: PMC3913603 DOI: 10.2147/prbm.s40879] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aim of the current review is to provide a summary of research into Internet-delivered cognitive behavioral therapy (iCBT) for anxiety disorders. We include 37 randomized controlled trials that examined the efficacy of iCBT programs in adults (aged over 18 years), as compared with waiting list or active control. The included studies were identified from Medline searches and from reference lists, and only published data were included. Several trials of iCBT for generalized anxiety disorder, panic disorder, and social phobia were identified. Two trials of iCBT for obsessive-compulsive disorder were identified, whilst one trial each was identified for hypochondriasis, specific phobia (spiders), and post-traumatic stress disorder. Finally, there were five trials that focused on transdiagnostic therapy for either a range of comorbid anxiety disorders or comorbid anxiety and depression. Between-group effect sizes were moderate to large for all disorders, and ranged from 0.30 to 2.53. iCBT was found to be commensurate with face-to-face cognitive behavioral therapy whether delivered individually or in group format. Guidance may not be necessary for iCBT to be effective for immediate gains, but may be more important in longer-term maintenance of symptom improvement and maximizing patient adherence. The clinical experience of the individual providing guidance does not appear to impact treatment outcomes. Future research needs to focus on the optimal level of guidance required to generate maximum patient benefits, whilst balancing the efficient use of clinician time and resources. Evidence-based contraindications to iCBT should also be developed so that the choice of treatment modality accurately reflects patients' needs. Further research should be conducted into the effective elements of iCBT, as well as the extent to which therapy enhancers and advancing technology can be accommodated into established iCBT frameworks.
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Affiliation(s)
- Louise Mewton
- Clinical Research Unit for Anxiety and Depression, St Vincent’s Hospital, Sydney, NSW, Australia
| | - Jessica Smith
- Clinical Research Unit for Anxiety and Depression, St Vincent’s Hospital, Sydney, NSW, Australia
| | - Pieter Rossouw
- Clinical Research Unit for Anxiety and Depression, St Vincent’s Hospital, Sydney, NSW, Australia
| | - Gavin Andrews
- Clinical Research Unit for Anxiety and Depression, St Vincent’s Hospital, Sydney, NSW, Australia
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