1
|
Garneau J, Savard J, Dang-Vu TT, Gouin JP. Predicting response to stepped-care cognitive behavioral therapy for insomnia using pre-treatment heart rate variability in cancer patients. Sleep Med 2024; 121:160-170. [PMID: 38991424 DOI: 10.1016/j.sleep.2024.06.021] [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: 02/29/2024] [Revised: 06/04/2024] [Accepted: 06/21/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE This study examined whether high frequency heart-rate variability (HF-HRV) and HF-HRV reactivity to worry moderate response to cognitive behavioural therapy for insomnia (CBT-I) within both a standard and stepped-care framework among cancer patients with comorbid insomnia. Biomarkers such as HF-HRV may predict response to CBT-I, a finding which could potentially inform patient allocation to different treatment intensities within a stepped-care framework. METHODS 177 participants (86.3 % female; Mage = 55.3, SD = 10.4) were randomized to receive either stepped-care or standard CBT-I. 145 participants had their HRV assessed at pre-treatment during a rest and worry period. Insomnia symptoms were assessed using the Insomnia Severity Index (ISI) and daily sleep diary across five timepoints from pre-treatment to a 12-month post-treatment follow-up. RESULTS Resting HF-HRV was significantly associated with pre-treatment sleep efficiency and sleep onset latency but not ISI score. However, resting HF-HRV did not predict overall changes in insomnia across treatment and follow-up. Similarly, resting HF-HRV did not differentially predict changes in sleep diary parameters across standard or stepped-care groups. HRV reactivity was not related to any of the assessed outcome measures in both cross-sectional and longitudinal analyses. CONCLUSION Although resting HF-HRV was related to initial daily sleep parameters, HF-HRV measures did not significantly predict longitudinal responses to CBT-I. These findings suggest that HF-HRV does not predict treatment responsiveness to CBT-I interventions of different intensity in cancer patients.
Collapse
Affiliation(s)
- James Garneau
- Department of Psychology, Concordia University, 7141 Sherbrooke St. W, Montréal, H4B 1R6, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), CIUSSS Centre-Sud-de-l'île-de-Montréal, 4565 Queen Mary Rd, Montréal, H3W 1W5, Canada.
| | - Josée Savard
- School of Psychology, Université Laval, 2325 Rue des Bibliothèques, Québec, G1V 0A6, Canada; CHU de Québec-Université Laval Research Center, 2705 Bd Laurier, Québec, G1V 4G2, Canada; Université Laval Cancer Research Center, 9 Rue McMahon, Québec, G1R 3S3, Canada.
| | - Thien Thanh Dang-Vu
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), CIUSSS Centre-Sud-de-l'île-de-Montréal, 4565 Queen Mary Rd, Montréal, H3W 1W5, Canada; Department of Health, Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke St. W, Montréal, H4B 1R6, Canada.
| | - Jean-Philippe Gouin
- Department of Psychology, Concordia University, 7141 Sherbrooke St. W, Montréal, H4B 1R6, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), CIUSSS Centre-Sud-de-l'île-de-Montréal, 4565 Queen Mary Rd, Montréal, H3W 1W5, Canada.
| |
Collapse
|
2
|
Storch EA, Schneider SC, Olsen SM, Ramirez AC, Berry LN, Goin-Kochel RP, McNeel M, Candelari AE, Guzick AG, Cepeda SL, Weinzimmer S, Voigt RG, Quast T, Goodman WK, Salloum A. Stepped-Care Cognitive Behavioral Therapy in Children on the Autism Spectrum with Co-occurring Anxiety. J Autism Dev Disord 2024; 54:93-108. [PMID: 36239830 PMCID: PMC9561323 DOI: 10.1007/s10803-022-05775-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2022] [Indexed: 01/27/2023]
Abstract
This trial examined stepped-care cognitive-behavioral treatment (CBT) among 96 autistic youth with co-occurring anxiety. Step 1 included an open trial of parent-led, therapist-guided bibliotherapy. Step 2 was family-based CBT for those who did not respond to Step 1 or maintenance for those who did. Eighteen participants (28%) who completed Step 1 responded. Responders reported significantly lower pre-treatment anxiety, internalizing symptoms, and functional impairment than non-responders. After Steps 1 and 2, 80% of completers (55% intent-to-treat) were responders. Anxiety, impairment, and ASD-related impairments significantly improved. Youth in maintenance experienced faster improvement through post-treatment, though there were no group differences at 3-month-follow-up. A stepped approach may help some individuals in Step 1, particularly those who are less anxious.
Collapse
Affiliation(s)
- Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Suite 4-400, Houston, TX, 77030, USA.
| | - Sophie C Schneider
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Sean M Olsen
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Ana C Ramirez
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Leandra N Berry
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | | | - Morgan McNeel
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Abigail E Candelari
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Andrew G Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Sandra L Cepeda
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Saira Weinzimmer
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Robert G Voigt
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Troy Quast
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Wayne K Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Alison Salloum
- School of Social Work, University of South Florida, Tampa, FL, USA
| |
Collapse
|
3
|
Franken K, ten Klooster P, Bohlmeijer E, Westerhof G, Kraiss J. Predicting non-improvement of symptoms in daily mental healthcare practice using routinely collected patient-level data: a machine learning approach. Front Psychiatry 2023; 14:1236551. [PMID: 37817829 PMCID: PMC10560743 DOI: 10.3389/fpsyt.2023.1236551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
Objectives Anxiety and mood disorders greatly affect the quality of life for individuals worldwide. A substantial proportion of patients do not sufficiently improve during evidence-based treatments in mental healthcare. It remains challenging to predict which patients will or will not benefit. Moreover, the limited research available on predictors of treatment outcomes comes from efficacy RCTs with strict selection criteria which may limit generalizability to a real-world context. The current study evaluates the performance of different machine learning (ML) models in predicting non-improvement in an observational sample of patients treated in routine specialized mental healthcare. Methods In the current longitudinal exploratory prediction study diagnosis-related, sociodemographic, clinical and routinely collected patient-reported quantitative outcome measures were acquired during treatment as usual of 755 patients with a primary anxiety, depressive, obsessive compulsive or trauma-related disorder in a specialized outpatient mental healthcare center. ML algorithms were trained to predict non-response (< 0.5 standard deviation improvement) in symptomatic distress 6 months after baseline. Different models were trained, including models with and without early change scores in psychopathology and well-being and models with a trimmed set of predictor variables. Performance of trained models was evaluated in a hold-out sample (30%) as a proxy for unseen data. Results ML models without early change scores performed poorly in predicting six-month non-response in the hold-out sample with Area Under the Curves (AUCs) < 0.63. Including early change scores slightly improved the models' performance (AUC range: 0.68-0.73). Computationally-intensive ML models did not significantly outperform logistic regression (AUC: 0.69). Reduced prediction models performed similar to the full prediction models in both the models without (AUC: 0.58-0.62 vs. 0.58-0.63) and models with early change scores (AUC: 0.69-0.73 vs. 0.68-0.71). Across different ML algorithms, early change scores in psychopathology and well-being consistently emerged as important predictors for non-improvement. Conclusion Accurately predicting treatment outcomes in a mental healthcare context remains challenging. While advanced ML algorithms offer flexibility, they showed limited additional value compared to traditional logistic regression in this study. The current study confirmed the importance of taking early change scores in both psychopathology and well-being into account for predicting longer-term outcomes in symptomatic distress.
Collapse
Affiliation(s)
- Katinka Franken
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | | | | | | | | |
Collapse
|
4
|
Atik E, Schückes M, Apolinário-Hagen J. Patient and Therapist Expectations for a Blended Cognitive Behavioral Therapy Program for Depression: Qualitative Exploratory Study. JMIR Ment Health 2022; 9:e36806. [PMID: 36583934 PMCID: PMC9840101 DOI: 10.2196/36806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 10/24/2022] [Accepted: 11/16/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Blended cognitive behavioral therapy (bCBT)-the combination of digital elements and face-to-face psychotherapy-has been proposed to alleviate challenges that patients and therapists face in conventional cognitive behavioral therapy. There is growing evidence that adding digital elements to face-to-face psychotherapy can contribute to better treatment outcomes. However, bCBT programs still show considerable shortcomings, and knowledge on how to improve digital apps using a bCBT protocol is limited. OBJECTIVE This study aimed to inductively identify functions and qualities that are expected from a bCBT treatment for depression in the eyes of patients and psychotherapists who were not currently receiving or practicing bCBT treatment. METHODS We used a qualitative exploratory study design and conducted 3 focus group interviews (n=6 in each) and 5 semistructured in-depth interviews with therapists as well as 11 individual interviews with patients with a primary diagnosis of depression and currently undergoing cognitive behavioral therapy treatment in Germany. Themes and categories were established inductively from transcribed interview records based on a rigorous coding method. RESULTS Both therapists and patients expected a digital app to provide patients with the opportunity to track their mood, work on therapeutic homework activities, easily access an intervention set for harder moments, and efficiently facilitate administrative tasks. The desire to be able to customize bCBT protocols to individual patient circumstances was evident in both patient and therapist interviews. Patients differed with respect to what content and the amount of material the app should focus on as well as the method of recording experiences. Therapists viewed digital apps as potentially aiding in their documentation work outside of sessions. Different attitudes surfaced on the topic of data security, with patients not as concerned as therapists. CONCLUSIONS Both patients and therapists had substantially positive attitudes toward the option of an integrated bCBT treatment. Our study presents novel findings on the expectations and attitudes of patients and therapists.
Collapse
Affiliation(s)
- Ece Atik
- Ruhr University Bochum, Bochum, Germany
| | - Magnus Schückes
- Institute for SME Research and Entrepreneurship, University of Mannheim, Mannheim, Germany
| | - Jennifer Apolinário-Hagen
- Institute of Occupational, Social and Environmental Medicine, Faculty of Medicine, Centre for Health and Society, Heinrich Heine University Dusseldorf, Dusseldorf, Germany
| |
Collapse
|
5
|
Nordh M, Serlachius E, Hesser H, Mataix-Cols D, Högström J. Clinical, demographic and theory-derived maintaining factors as moderators of treatment outcome in internet-delivered cognitive behavioural therapy for children and adolescents with social anxiety disorder. Behav Res Ther 2022; 159:104230. [PMID: 36423412 DOI: 10.1016/j.brat.2022.104230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/30/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
Internet-delivered cognitive behavioural therapy (ICBT) is an efficacious treatment for social anxiety disorder (SAD) in youth. However, we have limited knowledge about patient characteristics that may be associated with better (or worse) treatment outcome. Particularly concerning factors suggested to be involved in the maintenance of SAD (e.g., anticipatory anxiety and post-event processing). The aim of the current study was to evaluate possible predictors and moderators of the effect of ICBT in a randomised controlled trial where children and adolescents (N = 103; 10-17 years) with SAD received either ICBT or internet-delivered supportive therapy, ISUPPORT. Examined variables were pre-treatment levels of social anxiety, depression symptoms, putative maintaining factors as well as demographic variables like age and gender. Latent growth curve models were used to examine predictors and moderators of changes in youth and clinician rated social anxiety symptoms, from pre-treatment to 3-month follow-up. Baseline depression symptoms moderated the outcome, with higher depression scores being associated with greater reduction of SAD symptoms in ICBT compared to ISUPPORT. More difficulties at baseline with anticipatory anxiety, post-event processing, focus of attention and safety behaviours predicted greater reduction of SAD symptoms, regardless of treatment condition. No other clinical or demographic variable predicted or moderated the outcome. In summary, baseline depression severity may be an important moderator of ICBT, but the preliminary finding needs replication in sufficiently powered trials.
Collapse
Affiliation(s)
- Martina Nordh
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Eva Serlachius
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
| | - Hugo Hesser
- School of Law, Psychology and Social Work, Center for Health and Medical Psychology, Örebro University, Örebro, Sweden; Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Jens Högström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| |
Collapse
|
6
|
Schønning A, Nordgreen T. Predicting Treatment Outcomes in Guided Internet-Delivered Therapy for Anxiety Disorders-The Role of Treatment Self-Efficacy. Front Psychol 2021; 12:712421. [PMID: 34744872 PMCID: PMC8566333 DOI: 10.3389/fpsyg.2021.712421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022] Open
Abstract
Aim: Guided Internet-delivered therapy has shown to be an effective treatment format for anxiety disorders. However, not all patients experience improvement, and although predictors of treatment outcome have been identified, few are consistent over time and across studies. The current study aimed to examine whether treatment self-efficacy (self-efficacy regarding the mastery of obstacles during treatment) in guided Internet-delivered therapy for anxiety disorders in adults could be a predictor of lower dropout rates and greater symptom reduction. Method: The analyzed data comes from an open effectiveness study including 575 patients receiving guided Internet-delivered therapy for panic disorder or social anxiety disorder. Treatment self-efficacy was measured at pre-treatment. Symptom reduction was measured at 10 measurement points, including a 6-month follow-up. A mixed linear model was applied in the analysis. Results: The results showed that high treatment self-efficacy was a predictor of both lower dropout rates and greater symptom reduction. Significant interaction effects between time and treatment self-efficacy were found for several of the nine modules that constitutes the treatment program, suggesting that treatment self-efficacy could be a moderator of symptom reduction. Three of nine modules in the panic disorder treatment and six of nine in the social anxiety disorder treatment showed significant interaction effects. Conclusion: The results suggest that measuring treatment self-efficacy may be a valuable tool to identify patients at risk of dropping out, and that treatment self-efficacy could be a predictor and moderator of symptom reduction in guided Internet-delivered therapy. The implications of the results are discussed.
Collapse
Affiliation(s)
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
7
|
Rozen N, Aderka IM. The effect of depression on treatment outcome in social anxiety disorder: an individual-level meta-analysis. Cogn Behav Ther 2021; 51:185-216. [PMID: 34617874 DOI: 10.1080/16506073.2021.1966089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Social anxiety disorder (SAD) is highly comorbid with depression. In the present meta-analysis, we conducted the first individual-level examination of the association between pre-treatment depression and improvement in social anxiety symptoms during treatment. We identified eligible studies on cognitive behavior therapy (CBT) and pharmacotherapy for SAD and contacted authors to obtain individual-level data. We obtained these data from 41 studies, including 46 treatment conditions (n = 4,381). Our results showed that individuals who had high levels of depression at pre-treatment experienced greater decreases in social anxiety symptoms from pre- to post-treatment, but not at follow-up. When analyzing treatment modalities (individual CBT, group CBT, internet-delivered CBT, and pharmacotherapy), we found that depressive symptoms were associated with better post-treatment outcomes for individual CBT and internet-delivered CBT, but not for pharmacotherapy or group CBT. Our findings suggest that depression does not negatively affect treatment outcome in SAD and may even lead to improved outcomes in some treatment formats. Clinical implications of these findings are discussed.
Collapse
Affiliation(s)
- Naama Rozen
- School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Idan M Aderka
- School of Psychological Sciences, University of Haifa, Haifa, Israel
| |
Collapse
|
8
|
Mohr DC, Kwasny MJ, Meyerhoff J, Graham AK, Lattie EG. The effect of depression and anxiety symptom severity on clinical outcomes and app use in digital mental health treatments: Meta-regression of three trials. Behav Res Ther 2021; 147:103972. [PMID: 34600398 DOI: 10.1016/j.brat.2021.103972] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
A large number of trials have consistently shown that guided digital mental health treatments (DMHTs) are effective for depression and anxiety. As DMHTs are adopted by healthcare organizations, payers, and employers, they are often considered most appropriate for people with mild-to-moderate levels of symptom severity. Thus, the aim of this study was to examine the effects of symptom severity on depression and anxiety outcomes and app use across three trials of a guided DMHT, IntelliCare. Participants were categorized into mild, moderate, moderately severe, and severe symptom severity groups on depression and anxiety. All symptom severity groups showed significant reductions in depression and anxiety in a clear ordinal pattern, with the mild symptom severity group showing the smallest changes and the severe symptom group showing the largest improvements. Those with the lowest levels of educational attainment showed the largest symptom improvement. Baseline symptom severity was not significantly related to app use. App use was significantly related to depression and anxiety outcomes. These findings suggest that depression and anxiety symptom severity is not useful in determining who should be referred to a guided DMHT.
Collapse
Affiliation(s)
- David C Mohr
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA.
| | - Mary J Kwasny
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA
| | - Jonah Meyerhoff
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA
| | - Andrea K Graham
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA
| | - Emily G Lattie
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA
| |
Collapse
|
9
|
Salehi A, Salehi E, Mosadeghi-Nik M, Sargeant S, Fatehi F. Strengthening positive social pathways via digital social applications in individuals with social skills deficits: A scoping review. Int J Soc Psychiatry 2021; 67:779-787. [PMID: 33076755 DOI: 10.1177/0020764020963354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Effective digital social capital interventions have great potential to establish trusted social pathways to access supportive services and to enable talking about issues contributing to distress. AIM This review explores the digital social capital interventions used in individuals with social skills deficits, and the best social health outcomes achieved. METHOD Four databases (PubMed, CINAHL, PsychINFO, and Web of Science) were used with no time limitation, and 33 papers were included. RESULTS A diverse range of digital social programs was used for social capital improvement based on individuals' characteristics (e.g. age range and illnesses). Programs ranged from digitally-enhanced self-help or self-guided treatment (to enhance the self-efficacy of individuals), to group treatments and/or web-based caregiver support services. They comprised mobile social apps, video blogging, video-communication system/video-conferencing, and online social communication, to more advanced techniques such as virtual reality. All of these modalities were shown to be beneficial for improving the social health of individuals. Interventions targeted two aspects of social capital: (1) cognitive social capital, focusing on enhancing trust and control, self-efficacy on life. Some examples were cognitive behavioural therapy, and increasing the received and more importantly perceived social support. (2) structural social capital, focusing on individuals' relationships with family/carers, friends, peers to other connections at the macro level, such as health care providers and their community as a whole. The two interconnected aspects of social capital play a role in decreasing fears of being judged by others, general fears in social interactions and interpersonal problems. CONCLUSION Guided digital social support interventions result in open and flexible access to various resources through supportive social networks, for patients and their family members/carers.
Collapse
Affiliation(s)
- Asiyeh Salehi
- School of Health and Human Sciences, Southern Cross University, Lismore, New South Wales, Australia
| | - Elham Salehi
- Department of Computer Engineering, Islamic Azad University, Shiraz, Iran
| | | | - Sally Sargeant
- School of Health and Human Sciences, Southern Cross University, Lismore, New South Wales, Australia
| | - Farhad Fatehi
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia.,School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Polak M, Tanzer NK, Bauernhofer K, Andersson G. Disorder-specific internet-based cognitive-behavioral therapy in treating panic disorder, comorbid symptoms and improving quality of life: A meta-analytic evaluation of randomized controlled trials. Internet Interv 2021; 24:100364. [PMID: 33643852 PMCID: PMC7889983 DOI: 10.1016/j.invent.2021.100364] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 12/15/2020] [Accepted: 12/21/2020] [Indexed: 02/08/2023] Open
Abstract
Compared to conventional face-to-face psychological treatments, internet-based cognitive-behavioral therapy (iCBT) presents an innovative alternative that has been found to be effective in the treatment of anxiety disorders. The current study provides a meta-analysis investigating the efficacy of disorder-specific guided self-help (Gsh) iCBT compared to various active and inactive control conditions, with focus on adult panic disorder sufferers with or without agoraphobia (PD/A). Systematic literature search yielded 13 randomized controlled trials (RCTs) (N = 1214) that met the eligibility criteria for this study. We found no statistically significant differences between Gsh iCBT and various active CBT interventions in reducing PD/A symptoms at both post-test (g = 0.015, k = 10) and follow-up (g = 0.113, k = 6) levels. Also, comorbid anxiety and depression were reduced equivalently at post-test (g = 0.004, k = 6) and follow-up (g = 0.004, k = 6). Quality of life was equally improved at post-test (g = -0.100, k = 5) and follow-up (g = 0.074, k = 2). When compared to inactive controls, we found large effect sizes in PD/A (g = -0.892, k = 9) and comorbid anxiety and depression (g = -0.723, k = 9) symptoms, and moderate change in quality of life (g = -0.484, k = 3) at post-test. There was no difference between Guided self-help iCBT and Self-help iCBT in PD/A (g = -0.025, k = 3) and comorbid anxiety and depression (g = -0.025, k = 3) at post-test. Baseline severity, country of original research and adherence to the treatment in form of initial uptake were identified as statistically significant moderators of the iCBT treatment.
Collapse
Affiliation(s)
- Martin Polak
- Department of Psychology, University of Graz, Austria
| | | | | | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Sweden
| |
Collapse
|
11
|
Stech EP, Chen AZ, Sharrock MJ, Grierson AB, Upton EL, Mahoney AEJ, Grisham JR, Newby JM. Internet-delivered exposure therapy versus internet-delivered cognitive behavioral therapy for panic disorder: A pilot randomized controlled trial. J Anxiety Disord 2021; 79:102382. [PMID: 33774558 DOI: 10.1016/j.janxdis.2021.102382] [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: 07/19/2020] [Revised: 02/11/2021] [Accepted: 03/01/2021] [Indexed: 11/19/2022]
Abstract
AIM To compare the efficacy and acceptability of internet-delivered exposure therapy for panic disorder, to multi-component internet-delivered cognitive behavioral therapy (iCBT) that included controlled breathing, cognitive restructuring and exposure. METHODS Participants with panic disorder, with or without agoraphobia, were randomized to internet-delivered exposure therapy (n = 35) or iCBT (n = 34). Both programs were clinician guided, with six lessons delivered over eight weeks. Outcomes included panic disorder and agoraphobia symptom severity, as well as depression symptom severity, functional impairment and days out of role. RESULTS Participants in both conditions displayed a large reduction in panic disorder symptom severity (ds >1.30) from pre- to post-treatment. Participants in both conditions displayed medium to large reduction in agoraphobia and depression symptom severity, functional impairment and days out of role. Effects were maintained at three- and six-month follow-up. There was no significant difference between the interventions in clinical outcomes, adherence or treatment satisfaction. CONCLUSIONS Internet-delivered exposure therapy appeared to be as acceptable and efficacious as more established iCBT, despite including less strategies. However, a fully powered replication is now needed to compare the two approaches.
Collapse
Affiliation(s)
- Eileen P Stech
- School of Psychology, University of New South Wales Sydney, NSW 2052, Australia; Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW 2010, Australia.
| | - Aileen Z Chen
- School of Psychiatry, University of New South Wales Sydney, NSW 2052, Australia; Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW 2010, Australia
| | - Maria J Sharrock
- School of Psychiatry, University of New South Wales Sydney, NSW 2052, Australia; Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW 2010, Australia
| | - Ashlee B Grierson
- School of Psychiatry, University of New South Wales Sydney, NSW 2052, Australia; Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW 2010, Australia
| | - Emily L Upton
- School of Psychology, University of New South Wales Sydney, NSW 2052, Australia
| | - Alison E J Mahoney
- School of Psychiatry, University of New South Wales Sydney, NSW 2052, Australia; Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW 2010, Australia
| | - Jessica R Grisham
- School of Psychology, University of New South Wales Sydney, NSW 2052, Australia
| | - Jill M Newby
- School of Psychology, University of New South Wales Sydney, NSW 2052, Australia; Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW 2010, Australia; Black Dog Institute, University of New South Wales Sydney, NSW 2052, Australia
| |
Collapse
|
12
|
Niles AN, Axelsson E, Andersson E, Hedman-Lagerlöf E, Carlbring P, Andersson G, Johansson R, Widén S, Driessen J, Santoft F, Ljótsson B. Internet-based cognitive behavior therapy for depression, social anxiety disorder, and panic disorder: Effectiveness and predictors of response in a teaching clinic. Behav Res Ther 2021; 136:103767. [DOI: 10.1016/j.brat.2020.103767] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 12/11/2022]
|
13
|
Weineland S, Ribbegårdh R, Kivi M, Bygdell A, Larsson A, Vernmark K, Lilja JL. Transitioning from face-to-face treatment to iCBT for youths in primary care - therapists' attitudes and experiences. Internet Interv 2020; 22:100356. [PMID: 33318951 PMCID: PMC7724368 DOI: 10.1016/j.invent.2020.100356] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 11/05/2020] [Accepted: 11/10/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND To address the increasing mental health problems among young people, health care needs to broaden the spectrum of interventions and increase access to care. One particularly promising first-line intervention is cognitive behavioral therapy (CBT) delivered via the Internet (iCBT). The outbreak of the Coronavirus disease -2019 (COVID -19) has made the need for solid digital mental health care systems clear. This is the first published study exploring the transition among therapists of working with face-to-face treatment to using iCBT for youths suffering from anxiety treated in primary care. METHODS Fourteen primary care therapists were included in the study. Semi-structured interviews (n = 26) were conducted on two occasions: before starting to use iCBT for youths, and at a subsequent follow-up after gaining treatment experience. Data was summarized into thematic categories. RESULTS The overarching themes that were identified were: Attitudes to iCBT before and after implementation; Experiences of treatment delivery; Characteristics of "the right patient;" and The role of the digital therapist. CONCLUSION The participants generally had positive attitudes to iCBT for youths and saw it as a valuable alternative to face-to-face treatments. However, they identified challenges related to patient selection, and to motivating patients and maintaining a therapeutic relationship through mainly written communication. The participants appreciated the increase in variety that iCBT brought to their schedules, and also experienced iCBT as a relief from common challenges of therapeutic work, such as emotional stress and high cognitive demands. The participating therapists' positive experiences support the introduction of iCBT for youths in routine primary care.
Collapse
Affiliation(s)
- Sandra Weineland
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden,R&D Primary Health Care, Västra Götaland, Sweden,Corresponding author at: Department of Psychology, University of Gothenburg, Haraldsgatan 1, 413 14 Gothenburg, Sweden.
| | - Rasmus Ribbegårdh
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Marie Kivi
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Andreas Bygdell
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Anna Larsson
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Kristofer Vernmark
- Department of Behavioral Sciences and Learning (IBL), Linköping University, Linköping, Sweden
| | - Josefine L. Lilja
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden,R&D Primary Health Care, Västra Götaland, Sweden
| |
Collapse
|
14
|
Prefrontal cortex hypoactivity distinguishes severe from mild-to-moderate social anxiety as revealed by a palm-sized near-infrared spectroscopy system. J Neural Transm (Vienna) 2020; 127:1305-1313. [PMID: 32638118 DOI: 10.1007/s00702-020-02228-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/02/2020] [Indexed: 12/17/2022]
|
15
|
O'Kearney R, Kim S, Dawson RL, Calear AL. Are claims of non-inferiority of Internet and computer-based cognitive-behavioural therapy compared with in-person cognitive-behavioural therapy for adults with anxiety disorders supported by the evidence from head-to-head randomised controlled trials? A systematic review. Aust N Z J Psychiatry 2019; 53:851-865. [PMID: 31339342 DOI: 10.1177/0004867419864433] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This review examines the evidence from head-to-head randomised controlled trials addressing whether the efficacy of cognitive-behavioural therapy for anxiety disorders, obsessive-compulsive disorder and post-traumatic stress disorders in adults delivered by computer or online (computer- and Internet-delivered cognitive-behavioural therapy) is not inferior to in-person cognitive-behavioural therapy for reducing levels of symptoms and producing clinically significant gains at post-treatment and at follow-up. A supplementary aim is to examine the evidence for severity as a moderator of the relative efficacy of computer- and Internet-delivered cognitive-behavioural therapy and in-person cognitive-behavioural therapy. METHOD PubMed, PsycINFO, Embase and Cochrane database of randomised trials were searched for randomised controlled trials of cognitive-behavioural therapy for these disorders with at least an in-person cognitive-behavioural therapy and Internet or computer cognitive-behavioural therapy arm. RESULTS A total of 14 randomised controlled trials (9 Internet, 5 computer) of cognitive-behavioural therapy for social anxiety disorder, panic disorder and specific phobia and 3 reports of effect moderators were included. One study showed a low risk of bias when assessed against risk of bias criteria for non-inferiority trials. The remaining studies were assessed as high or unclear risk of bias. One study found that Internet-delivered cognitive-behavioural therapy was superior and non-inferior at post-treatment and follow-up to group in-person cognitive-behavioural therapy for social anxiety disorder. One study of Internet-delivered cognitive-behavioural therapy for panic disorder showed non-inferiority to individual in-person cognitive-behavioural therapy for responder status at post-treatment and one of Internet cognitive-behavioural therapy for panic disorder for symptom severity at follow-up. Other comparisons (22 Internet, 13 computer) and for estimates pooled for Internet cognitive-behavioural therapy for social anxiety disorder, Internet cognitive-behavioural therapy for panic disorder and computer-delivered cognitive-behavioural therapy studies did not support non-inferiority. Evidence of effect moderation by severity and co-morbidity was mixed. CONCLUSION There is limited evidence from randomised controlled trials which supports claims that computer- or Internet-delivered cognitive-behavioural therapy for anxiety disorders is not inferior to in-person delivery. Randomised controlled trials properly designed to test non-inferiority are needed before conclusions about the relative benefits of in-person and Internet- and computer-delivered cognitive-behavioural therapy can be made. PROSPERO CRD420180961655-6.
Collapse
Affiliation(s)
- Richard O'Kearney
- 1 Research School of Psychology, The Australian National University, Canberra, ACT, Australia
| | - Sheri Kim
- 1 Research School of Psychology, The Australian National University, Canberra, ACT, Australia
| | - Rachelle L Dawson
- 1 Research School of Psychology, The Australian National University, Canberra, ACT, Australia
| | - Alison L Calear
- 2 Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| |
Collapse
|
16
|
Pfammatter AF, Nahum-Shani I, DeZelar M, Scanlan L, McFadden HG, Siddique J, Hedeker D, Spring B. SMART: Study protocol for a sequential multiple assignment randomized controlled trial to optimize weight loss management. Contemp Clin Trials 2019; 82:36-45. [PMID: 31129369 PMCID: PMC6624080 DOI: 10.1016/j.cct.2019.05.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 05/14/2019] [Accepted: 05/22/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Stepped care is a rational resource allocation approach to reduce population obesity. Evidence is lacking to guide decisions on use of low cost treatment components such as mobile health (mHealth) tools without compromising weight loss of those needing more expensive traditional treatment components (e.g., coaching, meal replacement). A sequential multiple assignment randomization trial (SMART) will be conducted to inform the development of an empirically based stepped care intervention that incorporates mHealth and traditional treatment components. OBJECTIVE The primary aim tests the non-inferiority of app alone, compared to app plus coaching, as first line obesity treatment, measured by weight change from baseline to 6 months. Secondary aims are to identify the best tactic to address early treatment non-response and the optimal treatment sequence for resource efficient weight loss. STUDY DESIGN Four hundred participants, 18-60 years old with Body Mass Index between 27 and 45 kg/m2 will be randomized to receive a weight loss smartphone app (APP) or the app plus weekly coaching (APP + C) for a 12 week period. Those achieving <0.5 lb. weight loss on average per week, assessed by wireless scale at 2, 4, and 8 weeks, will be classified as non-responders and re-randomized once to step-up modestly (adding another mHealth component) or vigorously (adding mHealth and traditional treatment components) for the remaining treatment period. Weight will be assessed in person at baseline, 3, 6, and 12 months. SIGNIFICANCE Results will inform construction of an obesity treatment algorithm that balances weight loss outcomes with resource consumption.
Collapse
Affiliation(s)
- Angela Fidler Pfammatter
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States.
| | - Inbal Nahum-Shani
- Survey Research Center, Institute for Social Research, University of Michigan Ann Arbor, Ann Arbor, MI, United States
| | - Margaret DeZelar
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Laura Scanlan
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - H Gene McFadden
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Juned Siddique
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Donald Hedeker
- University of Chicago, Department of Public Health Sciences, Chicago, IL, United States
| | - Bonnie Spring
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| |
Collapse
|
17
|
Candlish J, Teare MD, Cohen J, Bywater T. Statistical design and analysis in trials of proportionate interventions: a systematic review. Trials 2019; 20:151. [PMID: 30819224 PMCID: PMC6396459 DOI: 10.1186/s13063-019-3206-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 01/17/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In proportionate or adaptive interventions, the dose or intensity can be adjusted based on individual need at predefined decision stages during the delivery of the intervention. The development of such interventions may require an evaluation of the effectiveness of the individual stages in addition to the whole intervention. However, evaluating individual stages of an intervention has various challenges, particularly the statistical design and analysis. This review aimed to identify the use of trials of proportionate interventions and how they are being designed and analysed in current practice. METHODS We searched MEDLINE, Web of Science and PsycINFO for articles published between 2010 and 2015 inclusive. We considered trials of proportionate interventions in all fields of research. For each trial, its aims, design and analysis were extracted. The data synthesis was conducted using summary statistics and a narrative format. RESULTS Our review identified 44 proportionate intervention trials, comprising 28 trial results, 13 protocols and three secondary analyses. These were mostly described as stepped care (n=37) and mainly focussed on mental health research (n=30). The other studies were aimed at finding an optimal adaptive treatment strategy (n=7) in a variety of therapeutic areas. Further terminology used included adaptive intervention, staged intervention, sequentially multiple assignment trial or a two-phase design. The median number of decision stages in the interventions was two and only one study explicitly evaluated the effect of the individual stages. CONCLUSIONS Trials of proportionate staged interventions are being used predominantly within the mental health field. However, few studies consider the different stages of the interventions, either at the design or the analysis phase, and how they may interact with one another. There is a need for further guidance on the design, analyses and reporting across trials of proportionate interventions. TRIAL REGISTRATION Prospero, CRD42016033781. Registered on 2 February 2016.
Collapse
Affiliation(s)
- Jane Candlish
- ScHARR, University of Sheffield, 30 Regent Court, Sheffield, S1 4DA, UK.
| | - M Dawn Teare
- ScHARR, University of Sheffield, 30 Regent Court, Sheffield, S1 4DA, UK
| | - Judith Cohen
- ScHARR, University of Sheffield, 30 Regent Court, Sheffield, S1 4DA, UK
- Hull Health Trials Unit, University of Hull/Hull York Medical School, York, UK
| | - Tracey Bywater
- Department of Health Sciences, University of York, Area 2, Seebohm, Rowntree Building, York, Y010 5DD, UK
| |
Collapse
|
18
|
Apolinário-Hagen J. Internet-Delivered Psychological Treatment Options for Panic Disorder: A Review on Their Efficacy and Acceptability. Psychiatry Investig 2019; 16:37-49. [PMID: 30122031 PMCID: PMC6354039 DOI: 10.30773/pi.2018.06.26] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/26/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Internet-delivered psychological treatments have been suggested as a chance to expand the access to professional help. However, little is known about the usefulness of different support formats and approaches of digital treatments for panic disorder among clinicians. OBJECTIVE This narrative review aimed to explore the recent evidence base on the efficacy and acceptability of different internet-delivered treatments for adults with panic disorder. METHODS A systematic search in electronic databases (Pubmed/Medline, PSYNDEX) and a hand search were performed to identify articles on randomized controlled trials published within the past five years (2012/12/10-2017/12/12) in English peer-reviewed journals. RESULTS Eight studies (1,013 participants) involving 10 interventions met the inclusion criteria. Nine interventions were primarly based on Cognitive Behavioral Therapy principles. Most interventions were effective, when compared to a control condition (6 of 8 comparisons). Minimal guidance was associated with improved outcomes in one study and adherence in two studies (3 comparisons). Furthermore, no differences were found based on treatment approach (2 comparisons). Regarding acceptability, the attrition rates were moderate to high, ranging from 9.8% to 42.1% of randomized participants. Adherence rates also varied largely (7.8-75%), whereas participant satisfaction of program completers was assessed overall high (5 studies). CONCLUSION Diverse effective internet-delivered treatments are available for the self-management of panic symptoms. Especially selfguided and transdiagnostic Cognitive Behavioral Therapy approaches appear being efficient options for the dissemination in routine care. However, due to the limited evidence base, further efforts are required to improve the actual uptake of internet-delivered treatments and identify moderators of outcomes.
Collapse
|
19
|
Salomonsson S, Santoft F, Lindsäter E, Ejeby K, Ljótsson B, Öst LG, Ingvar M, Lekander M, Hedman-Lagerlöf E. Stepped care in primary care - guided self-help and face-to-face cognitive behavioural therapy for common mental disorders: a randomized controlled trial. Psychol Med 2018; 48:1644-1654. [PMID: 29095133 DOI: 10.1017/s0033291717003129] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Common mental disorders (CMD) cause large suffering and high societal costs. Cognitive behavioural therapy (CBT) can effectively treat CMD, but access to treatment is insufficient. Guided self-help (GSH) CBT, has shown effects comparable with face-to-face CBT. However, not all patients respond to GSH, and stepping up non-responders to face-to-face CBT, could yield larger response rates. The aim was to test a stepped care model for CMD in primary care by first evaluating the effects of GSH-CBT and secondly, for non-responders, evaluating the additional effect of face-to-face CBT. METHODS Consecutive patients (N = 396) with a principal disorder of depression, anxiety, insomnia, adjustment or exhaustion disorder were included. In Step I, all patients received GSH-CBT. In Step II, non-responders were randomized to face-to-face CBT or continued GSH. The primary outcome was remission status, defined as a score below a pre-established cutoff on a validated disorder-specific scale. RESULTS After GSH-CBT in Step I, 40% of patients were in remission. After Step II, 39% of patients following face-to-face CBT were in remission compared with 19% of patients after continued GSH (p = 0.004). Using this stepped care model required less than six therapy sessions per patient and led to an overall remission rate of 63%. CONCLUSIONS Stepped care can be effective and resource-efficient to treat CMD in primary care, leading to high remission rates with limited therapist resources. Face-to-face CBT speeded up recovery compared with continued GSH. At follow-ups after 6 and 12 months, remission rates were similar in the two groups.
Collapse
Affiliation(s)
- Sigrid Salomonsson
- Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden
| | - Fredrik Santoft
- Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden
| | - Elin Lindsäter
- Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden
| | - Kersti Ejeby
- Department of Neurobiology,Care Sciences and Society (NVS),H1, Division of Family Medicine,Karolinska Institutet,Stockholm,Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden
| | - Lars-Göran Öst
- Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden
| | - Martin Ingvar
- Department of Clinical Neuroscience,Osher Center for Integrative Medicine, Karolinska Institutet,Stockholm,Sweden
| | - Mats Lekander
- Department of Clinical Neuroscience,Osher Center for Integrative Medicine, Karolinska Institutet,Stockholm,Sweden
| | - Erik Hedman-Lagerlöf
- Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden
| |
Collapse
|
20
|
Erbe D, Eichert HC, Riper H, Ebert DD. Blending Face-to-Face and Internet-Based Interventions for the Treatment of Mental Disorders in Adults: Systematic Review. J Med Internet Res 2017; 19:e306. [PMID: 28916506 PMCID: PMC5622288 DOI: 10.2196/jmir.6588] [Citation(s) in RCA: 258] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 06/06/2017] [Accepted: 07/27/2017] [Indexed: 12/16/2022] Open
Abstract
Background Many studies have provided evidence for the effectiveness of Internet-based stand-alone interventions for mental disorders. A newer form of intervention combines the strengths of face-to-face (f2f) and Internet approaches (blended interventions). Objective The aim of this review was to provide an overview of (1) the different formats of blended treatments for adults, (2) the stage of treatment in which these are applied, (3) their objective in combining face-to-face and Internet-based approaches, and (4) their effectiveness. Methods Studies on blended concepts were identified through systematic searches in the MEDLINE, PsycINFO, Cochrane, and PubMed databases. Keywords included terms indicating face-to-face interventions (“inpatient,” “outpatient,” “face-to-face,” or “residential treatment”), which were combined with terms indicating Internet treatment (“internet,” “online,” or “web”) and terms indicating mental disorders (“mental health,” “depression,” “anxiety,” or “substance abuse”). We focused on three of the most common mental disorders (depression, anxiety, and substance abuse). Results We identified 64 publications describing 44 studies, 27 of which were randomized controlled trials (RCTs). Results suggest that, compared with stand-alone face-to-face therapy, blended therapy may save clinician time, lead to lower dropout rates and greater abstinence rates of patients with substance abuse, or help maintain initially achieved changes within psychotherapy in the long-term effects of inpatient therapy. However, there is a lack of comparative outcome studies investigating the superiority of the outcomes of blended treatments in comparison with classic face-to-face or Internet-based treatments, as well as of studies identifying the optimal ratio of face-to-face and Internet sessions. Conclusions Several studies have shown that, for common mental health disorders, blended interventions are feasible and can be more effective compared with no treatment controls. However, more RCTs on effectiveness and cost-effectiveness of blended treatments, especially compared with nonblended treatments are necessary.
Collapse
Affiliation(s)
- Doris Erbe
- Department of Special Education and Rehabilitation, University of Cologne, Cologne, Germany
| | - Hans-Christoph Eichert
- Department of Special Education and Rehabilitation, University of Cologne, Cologne, Germany
| | - Heleen Riper
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| |
Collapse
|
21
|
Castelnuovo G, Pietrabissa G, Cattivelli R, Manzoni GM, Molinari E. Not Only Clinical Efficacy in Psychological Treatments: Clinical Psychology Must Promote Cost-Benefit, Cost-Effectiveness, and Cost-Utility Analysis. Front Psychol 2016; 7:563. [PMID: 27242562 PMCID: PMC4860399 DOI: 10.3389/fpsyg.2016.00563] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/05/2016] [Indexed: 01/17/2023] Open
Affiliation(s)
- Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilano, Italy
| | - Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilano, Italy
| | - Roberto Cattivelli
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilano, Italy
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCSVerbania, Italy; Faculty of Psychology, eCampus UniversityNovedrate, Italy
| | - Enrico Molinari
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilano, Italy
| |
Collapse
|
22
|
Nordgreen T, Haug T, Öst LG, Andersson G, Carlbring P, Kvale G, Tangen T, Heiervang E, Havik OE. Stepped Care Versus Direct Face-to-Face Cognitive Behavior Therapy for Social Anxiety Disorder and Panic Disorder: A Randomized Effectiveness Trial. Behav Ther 2016; 47:166-83. [PMID: 26956650 DOI: 10.1016/j.beth.2015.10.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/07/2015] [Accepted: 10/08/2015] [Indexed: 11/15/2022]
Abstract
The aim of this study was to assess the effectiveness of a cognitive behavioral therapy (CBT) stepped care model (psychoeducation, guided Internet treatment, and face-to-face CBT) compared with direct face-to-face (FtF) CBT. Patients with panic disorder or social anxiety disorder were randomized to either stepped care (n=85) or direct FtF CBT (n=88). Recovery was defined as meeting two of the following three criteria: loss of diagnosis, below cut-off for self-reported symptoms, and functional improvement. No significant differences in intention-to-treat recovery rates were identified between stepped care (40.0%) and direct FtF CBT (43.2%). The majority of the patients who recovered in the stepped care did so at the less therapist-demanding steps (26/34, 76.5%). Moderate to large within-groups effect sizes were identified at posttreatment and 1-year follow-up. The attrition rates were high: 41.2% in the stepped care condition and 27.3% in the direct FtF CBT condition. These findings indicate that the outcome of a stepped care model for anxiety disorders is comparable to that of direct FtF CBT. The rates of improvement at the two less therapist-demanding steps indicate that stepped care models might be useful for increasing patients' access to evidence-based psychological treatments for anxiety disorders. However, attrition in the stepped care condition was high, and research regarding the factors that can improve adherence should be prioritized.
Collapse
Affiliation(s)
- Tine Nordgreen
- Anxiety Disorders Research Network, Haukeland University Hospital; University of Bergen.
| | - Thomas Haug
- Anxiety Disorders Research Network, Haukeland University Hospital
| | - Lars-Göran Öst
- Anxiety Disorders Research Network, Haukeland University Hospital; University of Bergen; Stockholm University; Karolinska Institutet
| | | | | | - Gerd Kvale
- Anxiety Disorders Research Network, Haukeland University Hospital; University of Bergen
| | - Tone Tangen
- Anxiety Disorders Research Network, Haukeland University Hospital; University of Bergen
| | - Einar Heiervang
- Anxiety Disorders Research Network, Haukeland University Hospital; Institute of Clinical Medicine, University of Oslo
| | - Odd E Havik
- Anxiety Disorders Research Network, Haukeland University Hospital; University of Bergen
| |
Collapse
|
23
|
Haug T, Nordgreen T, Öst LG, Tangen T, Kvale G, Hovland OJ, Heiervang ER, Havik OE. Working alliance and competence as predictors of outcome in cognitive behavioral therapy for social anxiety and panic disorder in adults. Behav Res Ther 2016; 77:40-51. [DOI: 10.1016/j.brat.2015.12.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 12/05/2015] [Accepted: 12/08/2015] [Indexed: 11/30/2022]
|
24
|
Ciuca AM, Berger T, Crişan LG, Miclea M. Internet-based treatment for Romanian adults with panic disorder: protocol of a randomized controlled trial comparing a Skype-guided with an unguided self-help intervention (the PAXPD study). BMC Psychiatry 2016; 16:6. [PMID: 26769021 PMCID: PMC4714451 DOI: 10.1186/s12888-016-0709-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 01/06/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Efficacy of self-help internet-based cognitive behavior therapy (ICBT) for anxiety disorders has been confirmed in several randomized controlled trials. However, the amount and type of therapist guidance needed in ICBT are still under debate. Previous studies have shown divergent results regarding the role of therapist guidance and its impact on treatment outcome. This issue is central to the development of ICBT programs and needs to be addressed directly. The present study aims to compare the benefits of regular therapist guidance via online real-time audio-video communication (i.e. Skype) to no therapist guidance during a 12-week Romanian self-help ICBT program for Panic Disorder. Both treatments are compared to a waiting-list control group. METHODS/DESIGN A parallel group randomized controlled trial is proposed. The participants, 192 Romanian adults fulfilling diagnostic criteria for panic disorder according to a diagnostic interview, conducted via secured Skype or telephone, are randomly assigned to one of the three conditions: independent use of the internet-based self-help program PAXonline, the same self-help treatment with regular therapist support via secured Skype, and waiting-list control group. The primary outcomes are severity of self-report panic symptoms (PDSS-SR) and diagnostic status (assessors are blind to group assignment), at the end of the intervention (12 weeks) and at follow-up (months 3 and 6). The secondary measures address symptoms of comorbid anxiety disorders, depression, quality of life, adherence and satisfaction with ICBT. Additional measures of socio-demographic characteristics, personality traits, treatment expectancies, catastrophic cognitions, body vigilance and working alliance are considered as potential moderators and/ or mediators of treatment outcome. DISCUSSION To the best of our knowledge, the present study is the first effort to investigate the efficacy of a self-help internet-based intervention with therapist guidance via real-time video communication. A direct comparison between therapist guided versus unguided self-directed intervention for panic disorder will also be addressed for the first time. Findings from this study will inform researchers and practitioners about the added value of online video-therapy guidance sessions and the type of patients who may benefit the most from guided and unguided ICBT for Panic disorder. TRIAL REGISTRATION ACTRN12614000547640 (Australian New Zealand Clinical Trials Registry). Registered 22/05/2014.
Collapse
Affiliation(s)
- Amalia Maria Ciuca
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland. .,Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania.
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
| | | | - Mircea Miclea
- Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania.
| |
Collapse
|