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Eylem-van Bergeijk O, Poulter S, Ashcroft K, Robinson T, Mane P, Islam M, Condell J, Leavey G. Cerina: cognitive-behavioural therapy-based mobile application for managing GAD symptoms among Ulster University Students in Northern Ireland - a protocol for a pilot feasibility randomised controlled trial. BMJ Open 2024; 14:e083554. [PMID: 38950994 PMCID: PMC11218020 DOI: 10.1136/bmjopen-2023-083554] [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: 12/21/2023] [Accepted: 05/30/2024] [Indexed: 07/03/2024] Open
Abstract
INTRODUCTION University students are one of the most vulnerable populations for anxiety disorders worldwide. In Northern Ireland, anxiety disorders appear to be more common among the university student population due to the population demographics across the region. Despite the need, these students show less inclination to access the widely available on-campus well-being services and other external professional services. Digital cognitive-behavioural therapy (CBT) aims to bridge this gap between the need for psychological help and access to it. However, challenges such as limited reach, low adoption, implementation barriers and poor long-term maintenance are mainstay issues resulting in reduced uptake of digital CBT. As a result, the potential impact of digital CBT is currently restricted. The proposed intervention 'Cerina' is a scalable CBT-based mobile app with an interactive user interface that can be implemented in university settings if found to be feasible and effective. METHODS AND ANALYSIS The study is a single-blind pilot feasibility randomised controlled trial aiming to test the feasibility and preliminary effects of Cerina in reducing Generalised Anxiety Disorder (GAD) symptoms. Participants are 90 Ulster University students aged 18 and above with self-reported GAD symptoms. They will be allocated to two conditions: treatment (ie, access to Cerina for 6 weeks) and a wait-list control group (ie, optional on-campus well-being services for 6 weeks). Participants in the wait-list will access Cerina 6 weeks after their randomisation and participants in both conditions will be assessed at baseline, at 3 (mid-assessment) and 6 weeks (postassessment). The primary outcome is the feasibility of Cerina (ie, adherence to the intervention, its usability and the potential to deliver a full trial in the future). The secondary outcomes include generalised anxiety, depression, worry and quality of life. Additionally, participants in both conditions will be invited to semistructured interviews for process evaluation. ETHICS AND DISSEMINATION Ethical approval for the study has been granted by the Ulster University Research Ethics Committee (ID: FCPSY-22-084). The results of the study will be disseminated through publications in scientific articles and presentations at relevant conferences and/or public events. TRIAL REGISTRATION NUMBER NCT06146530.
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Affiliation(s)
- Ozlem Eylem-van Bergeijk
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Siobhan Poulter
- School of Computing, Engineering & Intelligent Systems, Ulster University, Coleraine, UK
| | - Kurtis Ashcroft
- School of Computing, Engineering & Intelligent Systems, Ulster University, Coleraine, UK
| | - Tony Robinson
- School of Computing, Engineering & Intelligent Systems, Ulster University, Coleraine, UK
| | | | | | - Joan Condell
- Centre for Personalised Medicine, Ulster University Faculty of Life and Health Sciences, Derry, UK
| | - Gerard Leavey
- Department of Psychology, Ulster University, Derry, UK
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Dominguez-Rodriguez A, Herdoiza-Arroyo PE, González-Ramírez LP, Martínez-Arriaga RJ, Villarreal-Zegarra D, Santos da Silva AC, González-Cantero JO, Vargas Salinas VS, S. Mensorio M, Cisneros Hernández AA, Lourenço dos Santos R, Nieto Ramos EG, Albán-Terán MG, Mateu-Mollá J, Ramírez-Martínez FR, Colmenero Guadián AM, Martínez-Rubio D, Langer ÁI, Araya C, Castellanos-Vargas RO. Internet-based self-administered intervention to reduce anxiety and depression symptomatology and improve well-being in 7 countries: protocol of a randomized control trial. Front Psychol 2024; 15:1279847. [PMID: 38774723 PMCID: PMC11107906 DOI: 10.3389/fpsyg.2024.1279847] [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: 08/18/2023] [Accepted: 04/01/2024] [Indexed: 05/24/2024] Open
Abstract
Background Online psychological interventions have emerged as a treatment alternative because they are accessible, flexible, personalized, and available to large populations. The number of Internet interventions in Latin America is limited, as are Randomized Controlled Trials (RCTs) of their effectiveness and a few studies comparing their effectiveness in multiple countries at the same time. We have developed an online intervention, Well-being Online, which will be available to the public free of charge in 7 countries: Mexico, Ecuador, Peru, Chile, Brazil, Spain, and the Netherlands. We expect a reduction in depression and anxiety symptoms and an increase in well-being of the participants. Methods A multi-country, randomized controlled trial will be conducted. The intervention is multicomponent (Cognitive Behavioral Therapy, Behavioral Activation Therapy, Mindfulness, Acceptance and Commitment Therapy, and Positive Psychology), with 10 sessions. In each country, eligible participants will be randomized to one of three groups: Enriched Intervention (interactive web design with videos, infographics, text, audio, and forum), Text Intervention (text on the website), and Wait List (control group). Repeated measures will be obtained at 5-time points. Our primary outcomes will be anxiety symptomatology, depressive symptomatology, and mental well-being. MANOVA analysis will be used for our main analysis. Discussion This protocol describes the design of a randomized trial to evaluate the efficacy of a web-based intervention to reduce anxiety and depression symptomatology and increase subjective well-being. The intervention will be made available in four languages (Spanish, Portuguese, Dutch, and English). Its results will contribute to the evidence of effectiveness in terms of randomized trials and Internet interventions, mainly in Latin America and Europe.
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Affiliation(s)
| | - Paulina Erika Herdoiza-Arroyo
- Faculty of Medicine, Health and Life Sciences, School of Psychology, Universidad Internacional del Ecuador, Quito, Ecuador
| | | | - Reyna Jazmín Martínez-Arriaga
- Departamento de Clínicas de Salud Mental, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - David Villarreal-Zegarra
- Instituto Peruano de Orientación Psicológica, Lima, Peru
- Escuela de Psicología, Universidad Continental, Lima, Peru
| | | | - Joel Omar González-Cantero
- Departamento de Ciencias del Comportamiento, Centro Universitario de los Valles, Universidad de Guadalajara, Ameca, Mexico
| | | | | | - Adrián Antonio Cisneros Hernández
- Departamento de Clínicas de Salud Mental, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | | | - Emilia Gabriela Nieto Ramos
- Faculty of Medicine, Health and Life Sciences, School of Psychology, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Margarita Gabriela Albán-Terán
- Faculty of Medicine, Health and Life Sciences, School of Psychology, Universidad Internacional del Ecuador, Quito, Ecuador
| | | | | | | | - David Martínez-Rubio
- Department of Psychology, European University of Valencia, Valencia, Spain
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
| | - Álvaro I. Langer
- Faculty of Psychology and Humanities, University San Sebastián, Valdivia, Chile
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago, Chile
| | - Claudio Araya
- School of Psychology, University Adolfo Ibañez, Santiago, Chile
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Zarski AC, Weisel KK, Berger T, Krieger T, Schaub MP, Berking M, Görlich D, Jacobi C, Ebert DD. Efficacy of an Internet- and Mobile-Based Intervention for Subclinical Anxiety and Depression (ICare Prevent) with Two Guidance Formats: Results from a Three-Armed Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2024; 93:155-168. [PMID: 38688243 PMCID: PMC11151970 DOI: 10.1159/000536149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/29/2023] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Limited research exists on intervention efficacy for comorbid subclinical anxiety and depressive disorders, despite their common co-occurrence. Internet- and mobile-based interventions (IMIs) are promising to reach individuals facing subclinical symptoms. OBJECTIVE This study aimed to evaluate the efficacy of a transdiagnostic and self-tailored IMI in reducing subclinical anxiety and depressive symptom severity with either individualized (IG-IMI) or automated (AG-IMI) guidance compared to a waitlist control group with care-as-usual access (WLC). METHODS Participants included 566 adults with subclinical anxiety (GAD-7 ≥ 5) and/or depressive (CES-D ≥16) symptoms, who did not meet criteria for a full-syndrome depressive or anxiety disorder. In a three-arm randomized clinical trial, participants were randomized to a cognitive behavioral 7-session IMI plus booster session with IG-IMI (n = 186) or AG-IMI (n = 189) or WLC (n = 191). Primary outcomes included observer-rated anxiety (HAM-A) and depressive (QIDS) symptom severity 8 weeks after randomization assessed by blinded raters via telephone. Follow-up outcomes at 6 and 12 months are reported. RESULTS Symptom severity was significantly lower with small to medium effects in IG-IMI (anxiety: d = 0.45, depression: d = 0.43) and AG-IMI (anxiety: d = 0.31, depression: d = 0.32) compared to WLC. No significant differences emerged between guidance formats in primary outcomes. There was a significant effect in HAM-A after 6 months favoring AG-IMI. On average, participants completed 85.38% of IG-IMI and 77.38% of AG-IMI. CONCLUSIONS A transdiagnostic, self-tailored IMI can reduce subclinical anxiety and depressive symptom severity, but 12-month long-term effects were absent. Automated guidance holds promise for enhancing the scalability of IMIs in broad prevention initiatives.
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Affiliation(s)
- Anna-Carlotta Zarski
- Division of eHealth in Clinical Psychology, Department of Clinical Psychology, Philipps University of Marburg, Marburg, Germany
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Kiona K. Weisel
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Tobias Krieger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael P. Schaub
- Swiss Research Institute for Public Health and Addiction (ISGF), Associated to the University of Zurich, Zurich, Switzerland
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Corinna Jacobi
- Institute for Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany
| | - David D. Ebert
- Professorship Psychology and Digital Mental Health Care, Technical University of Munich, Munich, Germany
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Berman AH, Topooco N, Lindfors P, Bendtsen M, Lindner P, Molander O, Kraepelien M, Sundström C, Talebizadeh N, Engström K, Vlaescu G, Andersson G, Andersson C. Transdiagnostic and tailored internet intervention to improve mental health among university students: Research protocol for a randomized controlled trial. Trials 2024; 25:158. [PMID: 38429834 PMCID: PMC10908025 DOI: 10.1186/s13063-024-07986-1] [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: 08/11/2023] [Accepted: 02/15/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Emerging adulthood is often associated with mental health problems. About one in three university students report symptoms of depression and anxiety that can negatively affect their developmental trajectory concerning work, intimate relationships, and health. This can interfere with academic performance, as mood and anxiety disorders are key predictors of dropout from higher education. A treatment gap exists, where a considerable proportion of students do not seek help for mood and anxiety symptoms. Offering internet interventions to students with mental health problems could reduce the treatment gap, increase mental health, and improve academic performance. A meta-analysis on internet interventions for university students showed small effects for depression and none for anxiety. Larger trials are recommended to further explore effects of guidance, transdiagnostic approaches, and individual treatment components. METHODS This study will offer 1200 university students in Sweden participation in a three-armed randomized controlled trial (RCT) evaluating a guided or unguided transdiagnostic internet intervention for mild to moderate depression and anxiety, where the waitlist control group accesses the intervention at 6-month follow-up. Students reporting suicidal ideation/behaviors will be excluded and referred to treatment within the existing healthcare system. An embedded study within the trial (SWAT) will assess at week 3 of 8 whether participants in the guided and unguided groups are at higher risk of failing to benefit from treatment. Those at risk will be randomized to an adaptive treatment strategy, or to continue the treatment as originally randomized. Primary outcomes are symptoms of depression and anxiety. Follow-ups will occur at post-treatment and at 6-, 12-, and 24-month post-randomization. Between-group outcome analyses will be reported, and qualitative interviews about treatment experiences are planned. DISCUSSION This study investigates the effects of a transdiagnostic internet intervention among university students in Sweden, with an adaptive treatment strategy employed during the course of treatment to minimize the risk of treatment failure. The study will contribute knowledge about longitudinal trajectories of mental health and well-being following treatment, taking into account possible gender differences in responsiveness to treatment. With time, effective internet interventions could make treatment for mental health issues more widely accessible to the student group.
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Affiliation(s)
- Anne H Berman
- Department of Psychology, Uppsala University, Uppsala, Sweden.
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Naira Topooco
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Petra Lindfors
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Philip Lindner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Olof Molander
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Martin Kraepelien
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Christopher Sundström
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | | | - Karin Engström
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - George Vlaescu
- Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Gerhard Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Claes Andersson
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Department of Criminology, Malmö University, Malmö, Sweden
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Vivas-Fernandez M, Garcia-Lopez LJ, Piqueras JA, Muela-Martinez JA, Canals-Sans J, Espinosa-Fernandez L, Jimenez-Vazquez D, Diaz-Castela MDM, Morales-Hidalgo P, Rivera M, Ehrenreich-May J. Randomized controlled trial for selective preventive transdiagnostic intervention for adolescents at risk for emotional disorders. Child Adolesc Psychiatry Ment Health 2023; 17:77. [PMID: 37353831 PMCID: PMC10290361 DOI: 10.1186/s13034-023-00616-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/15/2023] [Indexed: 06/25/2023] Open
Abstract
Significant evidence does exist on the effectiveness of transdiagnostic interventions to improve emotional problems in clinical populations, and their application as universal and indicated prevention programs. However, no randomized controlled trials (RCT) studying selective transdiagnostic prevention intervention have been published. This is the first known RCT to evaluate the efficacy/effectiveness of an evidence-based selective prevention transdiagnostic program for emotional problems in adolescents. The impact of three different interventions was evaluated: (1) PROCARE (Preventive transdiagnostic intervention for Adolescents at Risk for Emotional disorders), which is a group-based, abbreviated version of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A), along with adding a booster session to reduce risk of onset of anxiety and depression, (2) PROCARE + , which includes the PROCARE protocol along with personalized add-on modules tailored to match adolescents' risk factors, and (3) an active control condition (ACC) based on emotional psychoeducation. In total, 208 adolescents (48.5% girls) evidencing high risk and low protective factors were randomized and allocated to PROCARE, PROCARE + or ACC. Data from 153 adolescents who completed all assessments in the different phases of the study were analyzed. Self- and parent-reported measures were taken at baseline, as well as after the intervention, a 6 month follow-up was carried out, together with a 1 month follow-up after the booster session. Differences between conditions were significant on most of the outcome measures, with superior effect sizes for PROCARE + in the short and long term. Interventions were acceptable in terms of acceptability, with good satisfaction rates. Tailored targeted selective transdiagnostic interventions focused on mitigating risk factors and promoting protective factors in vulnerable adolescents are promising.
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Affiliation(s)
| | - Luis-Joaquin Garcia-Lopez
- University of Jaen, Jaen, Spain
- Division of Clinical Psychology, Department of Psychology, University of Jaen, Campus de las Lagunillas s/n, C-5., Jaen, Spain
| | | | | | | | | | | | | | - Paula Morales-Hidalgo
- Universitat Rovira I Virgili, Tortosa, Spain
- Universitat Oberta de Catalunya, Barcelona, Spain
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García-Batista ZE, Cantisano-Guzmán LM, Guerra-Peña K, Alvarez A, Moretti L, Cano-Vindel A, Muñoz-Navarro R, Medrano LA, Baltra RA. PsicAP transdiagnostic protocol of group cognitive-behavioral training for emotional disorders in Dominican Republic: a randomized controlled trial protocol. BMC Psychiatry 2023; 23:363. [PMID: 37226144 DOI: 10.1186/s12888-023-04771-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 04/11/2023] [Indexed: 05/26/2023] Open
Abstract
Emotional disorders (ED) such as anxiety, depression and somatization are extremely prevalent disorders that can affect an individual's quality of life and functionality. Primary Health Care (PHC) is the first place to identify most patients with these conditions. Mental health services in the Dominican Republic, as well as in Latin America and the Caribbean in general, are unable to provide appropriate care for most people with mental disorders. Using evidence-based treatment protocols is also crucial to make progress in helping people with ED. The PsicAP project is a group intervention that uses a transdiagnostic approach and is grounded in cognitive-behavioral techniques. The program is implemented in 7 group sessions, each lasting for one and a half hours. The program has been shown to be effective in reducing clinical symptoms, dysfunction, and in improving quality of life. It is also a non-time-intensive, low-cost treatment that is helpful for addressing EDs in a PHC context. The objective is to bring psychological treatments into PHC facilities of Dominican Republic, making them more accessible for a larger amount of the population.
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Affiliation(s)
- Zoilo Emilio García-Batista
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic.
- Escuela de Psicología, Pontificia Universidad Católica Madre y Maestra, Av. Autopista Duarte Km. 1 1/2, Santiago, 51000, Dominican Republic.
| | | | - Kiero Guerra-Peña
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - Adriana Alvarez
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - Luciana Moretti
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
- Universidad Siglo 21, Córdoba, Argentina
| | | | | | - Leonardo Adrián Medrano
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
- Universidad Siglo 21, Córdoba, Argentina
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Vivas-Fernandez M, Garcia-Lopez LJ, Piqueras JA, Muela-Martinez JA, Canals-Sans J, Espinosa-Fernandez L, Jimenez-Vazquez D, Diaz-Castela MDM, Morales-Hidalgo P, Rivera M, Ehrenreich-May J. Randomized controlled trial for selective preventive transdiagnostic intervention for adolescents at risk for emotional disorders. Child Adolesc Psychiatry Ment Health 2023; 17:7. [PMID: 36635735 PMCID: PMC9835742 DOI: 10.1186/s13034-022-00550-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/19/2022] [Indexed: 01/14/2023] Open
Abstract
Significant evidence does exist on the effectiveness of transdiagnostic interventions to improve emotional problems in clinical populations, and their application as universal and indicated prevention programs. However, no randomized controlled trials (RCT) studying selective transdiagnostic prevention intervention have been published. This is the first known RCT to evaluate the efficacy/effectiveness of an evidence-based selective prevention transdiagnostic program for emotional problems in adolescents. The impact of three different interventions was evaluated: (1) PROCARE (Preventive transdiagnostic intervention for Adolescents at Risk for Emotional disorders), which is a group-based, online-delivered, abbreviated version of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A), along with adding a booster session, to reduce risk of onset of anxiety and depression, (2) PROCARE + , which includes the PROCARE protocol along with personalized add-on modules tailored to match adolescents' risk factors, and (3) an active control condition (ACC) based on emotional psychoeducation. In total, 286 adolescents (53.3% girls) evidencing high risk and low protective factors were randomized and allocated to PROCARE, PROCARE + or ACC. Self- and parent-reported measures were taken at baseline, as well as after the intervention, a 6-month follow-up was carried out, together with a 1-month follow-up after the booster session. Differences between conditions were significant on most of the outcome measures, with superior effect sizes for PROCARE +. Interventions were excellent in terms of acceptability, with good satisfaction rates. Tailored selective transdiagnostic interventions focused on mitigating risk factors and promoting protective factors in vulnerable adolescents are promising.
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Affiliation(s)
| | - Luis-Joaquin Garcia-Lopez
- University of Jaen, Jaen, Spain
- Department of Psychology, Division of Clinical Psychology, University of Jaen, Campus de Las Lagunillas S/N, C-5 Jaen, Spain
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Mavragani A, Kleiboer A, Neijenhuijs K, Karyotaki E, Wiers R, de Koning L, Jacobi C, Zarski AC, Weisel KK, Cuijpers P, Riper H. Challenges in Recruiting University Students for Web-Based Indicated Prevention of Depression and Anxiety: Results From a Randomized Controlled Trial (ICare Prevent). J Med Internet Res 2022; 24:e40892. [PMID: 36515986 PMCID: PMC9798269 DOI: 10.2196/40892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/02/2022] [Accepted: 09/13/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Depression and anxiety are common mental health conditions in college and university student populations. Offering transdiagnostic, web-based prevention programs such as ICare Prevent to those with subclinical complaints has the potential to reduce some barriers to receiving help (eg, availability of services, privacy considerations, and students' desire for autonomy). However, uptake of these interventions is often low, and accounts of recruitment challenges are needed to complement available effectiveness research in student populations. OBJECTIVE The aims of this study were to describe recruitment challenges together with effective recruitment strategies for ICare Prevent and provide basic information on the intervention's effectiveness. METHODS A 3-arm randomized controlled trial was conducted in a student sample with subclinical symptoms of depression and anxiety on the effectiveness of an individually guided (human support and feedback on exercises provided after each session, tailored to each participant) and automatically guided (computer-generated messages provided after each session, geared toward motivation) version of ICare Prevent, a web-based intervention with transdiagnostic components for the indicated prevention of depression and anxiety. The intervention was compared with care as usual. Descriptive statistics were used to outline recruitment challenges and effective web-based and offline strategies as well as students' use of the intervention. A basic analysis of intervention effects was conducted using a Bayesian linear mixed model, with Bayes factors reported as the effect size. RESULTS Direct recruitment through students' email addresses via the central student administration was the most effective strategy. Data from 35 participants were analyzed (individually guided: n=14, 40%; automatically guided: n=8, 23%; care as usual: n=13, 37%). Use of the intervention was low, with an average of 3 out of 7 sessions (SD 2.9) completed. The analyses did not suggest any intervention effects other than anecdotal evidence (all Bayes factors10≤2.7). CONCLUSIONS This report adds to the existing literature on recruitment challenges specific to the student population. Testing the feasibility of recruitment measures and the greater involvement of the target population in their design, as well as shifting from direct to indirect prevention, can potentially help future studies in the field. In addition, this report demonstrates an alternative basic analytical strategy for underpowered randomized controlled trials. TRIAL REGISTRATION International Clinical Trials Registry Platform NTR6562; https://tinyurl.com/4rbexzrk. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-018-2477-y.
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Affiliation(s)
| | - Annet Kleiboer
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Koen Neijenhuijs
- Department of Research and Business Development, HumanTotalCare, Utrecht, Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Reinout Wiers
- Department of Psychology and Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
| | - Lisa de Koning
- Department of Psychology and Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
| | - Corinna Jacobi
- Department of Clinical Psychology and Psychotherapy, Technical University Dresden, Dresden, Germany
| | - Anna-Carlotta Zarski
- Department of Sport and Health Science, Technical University Munich, Munich, Germany
| | - Kiona K Weisel
- Department of Clinical Psychology and Psychotherapy, Friedrich Alexander University, Erlangen-Nuremberg, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,International Institute for Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Heleen Riper
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam UMC, location VUmc, Amsterdam, Netherlands
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Paredes-Mealla M, Martínez-Borba V, Miragall M, García-Palacios A, Baños RM, Suso-Ribera C. Is there evidence that emotional reasoning processing underlies emotional disorders in adults? A systematic review. CURRENT PSYCHOLOGY 2022; 42:1-17. [PMID: 36406838 PMCID: PMC9644006 DOI: 10.1007/s12144-022-03884-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 11/11/2022]
Abstract
The prevalence of emotional disorders has increased in recent times. Emotional Reasoning (ER), which is a transdiagnostic process, occurs when feelings, rather than objective evidence, are used as a source of information to make judgements about the valence of a situation. Differences in ER may explain the existence and maintenance of emotional disorders. The objective is to systematically review the role of ER in the occurrence and severity of emotional disorders. Following PRISMA guidelines, we searched through: PubMed, PsycInfo, Scopus and The Cochrane Library. Search terms were "Emotional Reasoning", "ex-consequentia reasoning", "Affect-as-information"; and "emotional disorders", "anxiety", "depression", "depressive". Nine articles were included. An association was demonstrated between ER and a greater degree of anxious symptomatological severity. In depressive symptomatology, no significant differences were found. One study reported the effect of Cognitive Behavioural Therapy on ER bias, finding no changes after the intervention. Finally, another study evaluated the efficacy of computerised experiential training in reducing ER bias, showing significant differences. There are few studies on ER and its evolution in research has not been uniform over time. Encouragingly, though, research to date suggests that ER is a transdiagnostic process involved in several anxiety disorders. More investigation is needed to dilucidate whether ER also underlies the onset and maintenance of depressive disorders.
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Affiliation(s)
- Macarena Paredes-Mealla
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, 12071 Castellon de la Plana, Spain
| | - Verónica Martínez-Borba
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, 12071 Castellon de la Plana, Spain
| | - Marta Miragall
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
- CIBER Fisiopatología Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, 12071 Castellon de la Plana, Spain
- CIBER Fisiopatología Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain
| | - Rosa Mª Baños
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
- CIBER Fisiopatología Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain
- Instituto Polibienestar, University of Valencia, Valencia, Spain
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, 12071 Castellon de la Plana, Spain
- CIBER Fisiopatología Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain
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10
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Sierra MA, Ruiz FJ. Content validity and perceived utility of a self-help online acceptance and commitment therapy program focused on repetitive negative thinking. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022; 26:1-10. [PMID: 35990417 PMCID: PMC9381937 DOI: 10.1016/j.jcbs.2022.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022]
Abstract
Telehealth strategies have become essential for responding to the sanitary emergency due to the COVID-19 pandemic. In this context, developing online psychological interventions (OPIs) that can treat and prevent psychological difficulties is gaining more relevance. This article describes an acceptance and commitment therapy (ACT) based OPI focused on repetitive negative thinking (RNT). This OPI is called Disentangled, Aware, and Committed (DAC) and represents an attempt to adapt previous RNT-focused ACT protocols to this format type. Study 1 evaluated content validity through the assessment of four experts in ACT regarding clarity, utility, pertinence, conceptual adjustment, and therapeutic goal fulfillment for each component of the DAC program. In Study 2, forty-one undergraduate clinical psychology trainees rated the components of the DAC program according to its clarity and perceived utility. These participants were enrolled in a randomized controlled trial that analyzed the efficacy of the DAC to prevent the usually observed increase in emotional symptoms and RNT among this population. Expert reviewers in Study 1 rated all DAC components as clear and useful for potential users, following a logical order, theoretically coherent with the ACT model, and successfully fulfilling its stated goals. In Study 2, the participants also rated the DAC components as clear and potentially useful for their lives. In conclusion, the DAC appears to be a feasible transdiagnostic OPI for treating and preventing emotional symptoms, which warrants further studies analyzing its efficacy.
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Affiliation(s)
- Marge A Sierra
- Fundación Universitaria Konrad Lorenz, Carrera 9 Bis, Nº 62-43, Bogotá, Colombia
| | - Francisco J Ruiz
- Fundación Universitaria Konrad Lorenz, Carrera 9 Bis, Nº 62-43, Bogotá, Colombia
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11
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Volz HP, Saliger J, Kasper S, Möller HJ, Seifritz E. Subsyndromal generalised anxiety disorder: operationalisation and epidemiology - a systematic literature survey. Int J Psychiatry Clin Pract 2022; 26:277-286. [PMID: 34314295 DOI: 10.1080/13651501.2021.1941120] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The diagnosis of anxiety disorders, like other psychiatric disorders also, is operationalised since the introduction of diagnostic manuals. The diagnostic criteria of Generalised Anxiety Disorder (GAD) have been tightened in the last decades. This leads to the exclusion of patients with a high level of anxiety, but not fulfilling certain of the GAD-criteria, from effective treatment. Such so-called subsyndromal, subthreshold or subclinical GAD-states, however, often exhibit a comparable burden of disease like the full syndromal disorder and often tend to develop into the full syndromal disorder. The purpose of this review is - beside systematically reporting the papers found in respective data bases from 2013 onwards - to summarise the relevant data regarding definitions, epidemiology and consequences of subsyndromal anxiety states in order to give a comprehensive review.
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Affiliation(s)
- Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | - Julia Saliger
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | | | - Hans-Jürgen Möller
- Clinic and Policlinic for Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
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12
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Koelen J, Vonk A, Klein A, de Koning L, Vonk P, de Vet S, Wiers R. Man vs. machine: A meta-analysis on the added value of human support in text-based internet treatments (“e-therapy”) for mental disorders. Clin Psychol Rev 2022; 96:102179. [DOI: 10.1016/j.cpr.2022.102179] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 04/28/2022] [Accepted: 06/04/2022] [Indexed: 11/03/2022]
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Volz HP, Stirnweiß J, Kasper S, Möller HJ, Seifritz E. Subthreshold depression - concept, operationalisation and epidemiological data. A scoping review. Int J Psychiatry Clin Pract 2022; 27:92-106. [PMID: 35736807 DOI: 10.1080/13651501.2022.2087530] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose: In diagnostic systems (e.g., DSM-5, ICD-10), depression is defined categorically. However, the concept of subthreshold depression (SD) has gained increasing interest in recent years. The purpose of the present paper was to review, based on a scoping review, the relevant papers in this field published between October 2011 and September 2020.Materials and methods: Of the 1,160 papers identified, 64 records could be included in further analysis. The scoping review was conducted using both electronic and manual methods.Results: The main result of the analysis is that the operationalisation criteria used are highly heterogeneous, which also leads to very heterogenous epidemiological data.Conclusions: Clear conclusions are not possible scrutinising the reported results. Most definitions seem to be arbitrary, with considerable overlap (e.g., between SD and minor depression). The review also revealed that the impact of SD on quality of life and related parameters appear to be in the range of the respective impact of major depression (MD) and therapeutic approaches might be helpful for SD and also for the prevention of conversion from SD to MD. Keeping the presented difficulties in mind, a proposal for the definition of SD is made in the present paper in order to facilitate the discussion leading to more homogeneous criteria.
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Affiliation(s)
- Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy und Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | - Johanna Stirnweiß
- Hospital for Psychiatry, Psychotherapy und Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | - Siegfried Kasper
- Center of Brain Research, Medical University of Vienna, Vienna, Austria
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy, and Psychosomatics. Psychiatric Hospital, University of Zürich, Zürich, Switzerland
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Karyotaki E, Klein AM, Ciharova M, Bolinski F, Krijnen L, de Koning L, de Wit L, van der Heijde CM, Ebert DD, Riper H, Batelaan N, Vonk P, Auerbach RP, Kessler RC, Bruffaerts R, Struijs S, Wiers RW, Cuijpers P. Guided internet-based transdiagnostic individually tailored Cognitive Behavioral Therapy for symptoms of depression and/or anxiety in college students: A randomized controlled trial. Behav Res Ther 2022; 150:104028. [DOI: 10.1016/j.brat.2021.104028] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 12/17/2021] [Accepted: 12/27/2021] [Indexed: 12/22/2022]
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Lin J, Zou L, Lin W, Becker B, Yeung A, Cuijpers P, Li H. Does gender role explain a high risk of depression? A meta-analytic review of 40 years of evidence. J Affect Disord 2021; 294:261-278. [PMID: 34304081 DOI: 10.1016/j.jad.2021.07.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 07/11/2021] [Accepted: 07/13/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND This meta-analytic review aimed to systematically evaluate associations of depression with multiple gender role dimensions (masculinity, femininity, androgyny, and undifferentiated traits) and to determine potential moderators (participant characteristics, study instruments and sociocultural factors) of the relationship. METHODS Of 4481 initially identified records in three electronic databases, 58 studies published 1978 to 2021 were included for meta-analysis. RESULTS (1) Association of depression and gender role is moderated by study year and human development indices. (2) Masculinity is a protective factor for depression, while this dominance has declined as life expectancy increases. (3) A negative, weak but significant association between depression and femininity is observed in women, and college students, which starts to emerge with the gradual increase in the national education and income index from 1990 to 2019. (4) Androgynous individuals reported the lowest level of depression as compared with other gender role orientations (masculine, feminine, and undifferentiated trait group). This disparity is becoming more extreme with life expectancy and per capita income index increases. LIMITATIONS English-language studies were only included in this review. CONCLUSIONS Androgyny might be the most ideal gender role protecting both women and men from depression.
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Affiliation(s)
- Jingyuan Lin
- Center for Brain Function and Psychological Science, Shenzhen University; Shenzhen Institute of Neuroscience, Shenzhen 518060, Guangdong, China; Center for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Key Laboratory of Brain Cognition and Educational Science, Ministry of Education; School of Psychology, South China Normal University, Guangzhou 510631, Guangdong, China; Institute for Brain and Psychological Sciences, Sichuan Normal University, Chengdu 610054, Sichuan, China
| | - Liye Zou
- Exercise Psychophysiology Laboratory; Institute of KEEP Collaborative Innovation, School of Psychology, Shenzhen University, 518060, China
| | - Wuji Lin
- Center for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Key Laboratory of Brain Cognition and Educational Science, Ministry of Education; School of Psychology, South China Normal University, Guangzhou 510631, Guangdong, China; Institute for Brain and Psychological Sciences, Sichuan Normal University, Chengdu 610054, Sichuan, China
| | - Benjamin Becker
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 610054, Sichuan, China
| | - Albert Yeung
- Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, Amsterdam 1081 BT, the Netherlands
| | - Hong Li
- Center for Brain Function and Psychological Science, Shenzhen University; Shenzhen Institute of Neuroscience, Shenzhen 518060, Guangdong, China; Center for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Key Laboratory of Brain Cognition and Educational Science, Ministry of Education; School of Psychology, South China Normal University, Guangzhou 510631, Guangdong, China; Institute for Brain and Psychological Sciences, Sichuan Normal University, Chengdu 610054, Sichuan, China.
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Bőthe B, Baumgartner C, Schaub MP, Demetrovics Z, Orosz G. Hands-off: Feasibility and preliminary results of a two-armed randomized controlled trial of a web-based self-help tool to reduce problematic pornography use. J Behav Addict 2021; 10:1015-1035. [PMID: 34727088 PMCID: PMC8987418 DOI: 10.1556/2006.2021.00070] [Citation(s) in RCA: 8] [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: 07/01/2021] [Revised: 09/14/2021] [Accepted: 10/04/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Despite problematic pornography use (PPU) being prevalent, no previous study has examined the effectiveness of evidence-based interventions for PPU, using rigorous methods. Using a two-armed randomized controlled trial study design, we examined the feasibility and initial effectiveness of a six-week online PPU intervention. METHODS We recruited 264 participants (3.8% women, M age = 33.2, SD = 10.6) who were randomized and assigned to either the self-help intervention (n = 123) or waitlist control condition (n = 141), and completed self-report questionnaires at baseline and after the end of the intervention (six-week follow-up). Multivariable linear regression models were generated and tested on a complete case basis to investigate possible treatment effects. Participants provided quantitative and qualitative feedback regarding the intervention's content and appearance. RESULTS Participants evaluated all modules positively in the intervention in general. There were differential dropout rates (89.4% in intervention vs. 44.7% in control group) with an overall follow-up rate of 34.5%. The intervention group reported significantly lower levels of PPU (P < 0.001, d = 1.32) at the six-week follow-up. Moreover, they reported lower pornography use frequency (P < 0.001, d = 1.65), self-perceived pornography addiction (P = 0.01, d = 0.85), pornography craving (P = 0.02, d = 0.40), and higher pornography avoidance self-efficacy (P = 0.001, d = 0.87) at the six-week follow-up. DISCUSSION AND CONCLUSIONS The present study was only a first step in rigorous treatment studies for PPU, but the findings are promising and suggest that online interventions for PPU might help reduce PPU in some cases, even without the guidance of therapists, by reducing treatment barriers.
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Affiliation(s)
- Beáta Bőthe
- Département de Psychologie, Université de Montréal, Montréal, Canada
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Christian Baumgartner
- Swiss Research Institute for Public Health and Addiction ISGF, Associated to the University of Zurich, Zurich, Switzerland
| | - Michael P. Schaub
- Swiss Research Institute for Public Health and Addiction ISGF, Associated to the University of Zurich, Zurich, Switzerland
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
| | - Gábor Orosz
- Université d’Artois, Université de Lille, Université Littoral Côte d’Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Atelier Sherpas, F-62800, Liévin, France
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17
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Doets JJR, Topper M, Nugter AM. A systematic review and meta-analysis of the effect of whole body cryotherapy on mental health problems. Complement Ther Med 2021; 63:102783. [PMID: 34655758 DOI: 10.1016/j.ctim.2021.102783] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/26/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To give an overview of the nature and methodological quality of studies on whole body cryotherapy (WBC) as add-on intervention for mental health problems. METHODS A meta-analysis according to PRISMA guidelines was conducted (Prospero registration: CRD42020167443). Databases MEDLINE, PsycINFO and the Cochrane Library were searched. Risk of bias was scored according to the Cochrane ROBINS-I-tool to which an extra bias-dimension of allegiance bias was added. Within and between Hedges' g pooled effect sizes were calculated for the main aspect of mental health measured. Treatment efficacy was examined using a random effects model. Heterogeneity was examined through identification of visual outliers and by I2 statistics. RESULTS Out of 196 articles coming up from the search, ten studies met all inclusion criteria, six of which were (randomized) controlled trials. Together these studies report on a total of 294 participants receiving WBC. The within-group pooled effect size for mental health problems is large (Hedges' g = 1.63, CI: 1.05-2.21), with high heterogeneity (I2 = 93%). Subgroup analyses on depressive symptoms and quality of life (QOL) showed a diminution of heterogeneity to moderate. Effect sizes for depressive symptoms are very large (Hedges' g = 2.95, CI: 2.44-3.45) and for QOL medium (Hedges' g = 0.70, CI: 0.15-1.24). The between-group pooled effect size is medium (Hedges' g = 0.76, CI: 0.17-1.36). CONCLUSIONS Results indicate preliminary evidence for WBC as efficacious add-on intervention for mental health problems, especially depressive symptoms. Further research in the form of RCTs with larger numbers of participants is needed.
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Affiliation(s)
- Julia J R Doets
- Department of Anxiety Disorders, Mental Health Service Organization 'GGZ Noord-Holland-Noord', Alkmaar, The Netherlands.
| | - Maurice Topper
- Department of Research, Mental Health Service Organization 'GGZ Noord-Holland-Noord', Heerhugowaard, The Netherlands
| | - Annet M Nugter
- Department of Research, Mental Health Service Organization 'GGZ Noord-Holland-Noord', Heerhugowaard, The Netherlands
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Gericke F, Ebert DD, Breet E, Auerbach RP, Bantjes J. A qualitative study of university students' experience of Internet‐based CBT for depression. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Franco Gericke
- Institute for Life Course Health Research Department of Global Health Faculty of Medicine and Health Sciences Stellenbosch University Stellenbosch South Africa
| | - David D. Ebert
- Psychology & Digital Mental Health Care, Department of Sport and Health Sciences Technical University Munich Munich Germany
| | - Elsie Breet
- Institute for Life Course Health Research Department of Global Health Faculty of Medicine and Health Sciences Stellenbosch University Stellenbosch South Africa
| | | | - Jason Bantjes
- Institute for Life Course Health Research Department of Global Health Faculty of Medicine and Health Sciences Stellenbosch University Stellenbosch South Africa
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19
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Kuso S, Nitsch M, Zeiler M, Simek M, Adamcik T, Dey M, Berger T, Krieger T, Weisel KK, Zarski AC, Ebert DD, Schaub MP, Moser CT, Botella C, Baños R, Herrero R, Etchemendy E, Nacke B, Beintner I, Vollert B, Schmidt-Hantke J, Hütter K, Jacobi C, Waldherr K. Stakeholders' views on online interventions to prevent common mental health disorders in adults implemented into existing healthcare systems in Europe. Eur J Public Health 2021; 31:i55-i63. [PMID: 34240157 PMCID: PMC8495679 DOI: 10.1093/eurpub/ckab043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Online preventive interventions can help to reduce the incidence of mental disorders. Whereas knowledge on stakeholders' attitudes and factors relevant for successfully integrating online treatment into existing healthcare systems is available, knowledge is scarce for online prevention. METHODS Stakeholders from Germany, Switzerland, Austria and Spain were surveyed. Potential facilitators/delivery staff (e.g. psychologists, psychotherapists) completed an online questionnaire (n = 183), policy makers (i.e. from the governing sector or health insurance providers) participated in semi-structured interviews (n = 16) and target groups/potential users of mental illness prevention (n = 49) participated in ten focus groups. Thematic analysis was used to identify their experiences with and attitudes and needs regarding online programmes to prevent mental disorders. Additionally, it was examined which groups they consider underserved and which factors they consider as fostering and hindering for reach, adoption, implementation and maintenance (cf. RE-AIM model) when integrating online prevention into existing healthcare systems. RESULTS Main advantages of online mental illness prevention are perceived in low structural and psychological barriers. Lack of personal contact, security, privacy and trust concerns were discussed as disadvantages. Relevant needs are high usability and target group appropriateness, evidence for effectiveness and the use of motivational tools. CONCLUSIONS Positive attitudes among stakeholders are the key for successful integration of online mental illness prevention into existing healthcare systems. Potential facilitators/delivery staff must receive training and support to implement these programmes; the programmes must be attractive and continuously evaluated, updated and promoted to ensure ongoing reach; and existing infrastructure and contextual factors must be considered.
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Affiliation(s)
- Stefanie Kuso
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt 2700, Austria
| | - Martina Nitsch
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt 2700, Austria
| | - Michael Zeiler
- Department for Child and Adolescent Psychiatry, Medical University of Vienna, Vienna 1090, Austria
| | - Monika Simek
- Department for Child and Adolescent Psychiatry, Medical University of Vienna, Vienna 1090, Austria
| | - Tanja Adamcik
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt 2700, Austria
| | - Michelle Dey
- Swiss Research Institute for Public Health and Addiction ISGF, Associated to the University of Zurich, Zurich, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Tobias Krieger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kiona K Weisel
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Anna-Carlotta Zarski
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - David D Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction ISGF, Associated to the University of Zurich, Zurich, Switzerland
| | - Christian T Moser
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christina Botella
- Jaume I University, Castellón, Spain.,CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain
| | - Rosa Baños
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain.,Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Rocio Herrero
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain.,Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Ernestina Etchemendy
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain.,Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Barbara Nacke
- Department of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Ina Beintner
- Department of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Bianka Vollert
- Department of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | | | - Kristian Hütter
- Department of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Corinna Jacobi
- Department of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Karin Waldherr
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt 2700, Austria
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Nitsch M, Waldherr K, Zeiler M, Klesges L, Jacobi C. Stakeholder consultation to facilitate implementation of interventions for prevention and promotion in mental health in Europe: introducing the design of the ICare Stakeholder Survey. Eur J Public Health 2021; 31:i48-i54. [PMID: 34240158 PMCID: PMC8266536 DOI: 10.1093/eurpub/ckab045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Online interventions to prevent mental health problems have proven to be effective. However, knowledge about their implementation in real-world practice as well as for dissemination to the target groups in different settings is scarce. The goal of the 'ICare' network is to establish a comprehensive model of eMental-health service delivery in and across different European countries. Since implementation and dissemination are influenced by many contextual factors, in the first phase of ICare a stakeholder survey was conducted. The survey aim was to explore stakeholders' experiences, needs and attitudes regarding Internet-based prevention of mental health problems and hindering and fostering factors for implementation and dissemination. This article is part of a supplement and describes the design of the stakeholder survey. Survey results are published in separate articles in the same supplement. METHODS Based on a literature review and the individual characteristics of the ICare interventions, stakeholder groups were identified in different settings across six European countries. The RE-AIM framework guided the development of the research questions and survey instruments. A concurrent mixed methods design was applied comprising focus groups with the intended target groups of ICare interventions, an online questionnaire with potential facilitators/delivery staff and semi-structured interviews with policy makers. CONCLUSION The challenge was to develop a design that allowed flexibility but at the same did not jeopardize the validity of the study. Implications drawn from this survey are not restricted to specific preventive interventions but will provide general information on how online mental illness prevention can be best implemented in various settings.
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Affiliation(s)
- Martina Nitsch
- Ferdinand Porsche FernFH—Distance-Learning University of Applied Sciences, Vienna, Austria
| | - Karin Waldherr
- Ferdinand Porsche FernFH—Distance-Learning University of Applied Sciences, Vienna, Austria
| | - Michael Zeiler
- Department for Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Lisa Klesges
- School of Public Health, University of Memphis, Memphis, TN, USA
| | - Corinna Jacobi
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany
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Bendig E, Bauereiß N, Buntrock C, Habibović M, Ebert DD, Baumeister H. Lessons learned from an attempted randomized-controlled feasibility trial on "WIDeCAD" - An internet-based depression treatment for people living with coronary artery disease (CAD). Internet Interv 2021; 24:100375. [PMID: 33732627 PMCID: PMC7941156 DOI: 10.1016/j.invent.2021.100375] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 01/12/2021] [Accepted: 02/17/2021] [Indexed: 12/22/2022] Open
Abstract
Despite the high prevalence of comorbid depression in people living with coronary artery disease (CAD), uptake of psychological treatment is generally low. This study was designed to investigate the feasibility of an internet-based cognitive-behavioral (iCBT) depression intervention for people with CAD and depressive symptoms. METHODS People with CAD and depressive symptoms (PHQ-9 ≥ 5) were randomly assigned to the eight modules comprising iCBT (N = 18), or waitlist-control (N = 16). Measures were taken at baseline (t1) and at post-treatment (eight weeks after randomization, t2). Feasibility-related outcomes were recruitment strategy, study attrition, intervention dropout, satisfaction, negative effects as well as the potential of the intervention to affect likely outcomes in a future full-scale trial (depression, anxiety, quality of life, fear of progression). Data analyses were based on intention-to-treat principles. Linear regression models were used to detect between group differences. Linear Mixed Models were used to model potential changes over time. RESULTS This trial was terminated prior to a-priori defined sample size has been reached given low recruitment success as well as high intervention dropout (88%) and study attrition (23%). On average, participants in the intervention group completed M = 2.78 (SD = 3.23) modules. Participants in the waitlist control group barely started one module (M = 0.82, SD = 1.81). The satisfaction with the intervention was low (M = 20.6, SD = 0.88). Participants reported no negative effects attributed to the iCBT. Differences between groups with regard to depression, anxiety, fear of progression and quality of life remained non-significant (p > 0.05). CONCLUSION This trial failed to recruit a sufficient number of participants. Future work should explore potential pitfalls with regards to the reach and persuasiveness of internet interventions for people living with CAD. The study gives important indications for future studies with regard to the need for new ideas to reach and treat people with CAD and depression.
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Key Words
- APOI, Attitudes towards Psychological Online Interventions Questionnaire
- AQoL-8D, Inventory for the Assessment of Quality of Life
- CAD, Coronary artery disease
- CBT, Cognitive Behavioral Therapy
- CG, waitlist control group
- CSQ, Client Satisfaction Questionnaire
- Cognitive behavioral therapy
- Coronary artery disease
- Depression
- EG, intervention group
- FOP-Q-SF, Fear of Progression Questionnaire
- GAD-7, Generalized Anxiety Disorder 7-item Scale
- HADS, Hospital Anxiety and Depression Scale
- INEP, Inventory for the assessment of negative effects of psychotherapy
- ITT, intention-to-treat
- Internet and mobile-based intervention
- PHQ-9, Patient Health Questionnaire
- Psychological intervention
- SMS, short message service
- WIDeCAD, Web- and mobile-based Intervention for DEpression in people with CAD
- iCBT, internet-based cognitive behavioral therapy
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Affiliation(s)
- Eileen Bendig
- Department of Clinical Psychology and Psychotherapy, University Ulm, Ulm, Germany
| | - Natalie Bauereiß
- Department of Clinical Psychology and Psychotherapy, University Ulm, Ulm, Germany
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen-Nürnberg, Germany
| | - Mirela Habibović
- Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Netherlands
| | - David Daniel Ebert
- Faculty of Behavioral and Movement Sciences, Clinical Psychology, Vrije University Amsterdam, Netherlands
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, University Ulm, Ulm, Germany
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22
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Shapira S, Yeshua-Katz D, Cohn-Schwartz E, Aharonson-Daniel L, Sarid O, Clarfield AM. A pilot randomized controlled trial of a group intervention via Zoom to relieve loneliness and depressive symptoms among older persons during the COVID-19 outbreak. Internet Interv 2021; 24:100368. [PMID: 33527072 PMCID: PMC7839498 DOI: 10.1016/j.invent.2021.100368] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 12/19/2022] Open
Abstract
While effective in reducing infections, social distancing during the COVID-19 outbreak may carry ill effects on the mental health of older adults. The present study explored the efficacy of a short-term digital group intervention aimed at providing seniors with the tools and skills necessary for improving their coping ability during these stressful times. A total of 82 community-dwelling adults aged between 65 aged 90 (Mage = 72 years, SD = 5.63) were randomized to either an intervention group (n = 64) or a wait-list control group (n = 18). The intervention comprised online guided sessions in small groups in which behavioral and cognitive techniques were learned and practiced via the ZOOM videoconferencing platform. Loneliness and depression levels were measured pre- and post-participation. The results demonstrated a significant improvement in the intervention group in terms of both loneliness and depressive symptoms, compared with the control group. Results of mixed effect models indicated a medium ameliorative effect on loneliness (d = 0.58), while that for depressive symptoms was only marginally significant and smaller in size (d = 0.43). Our intervention presents a relatively simple and effective technique that can be efficiently utilized to support older adults both during emergencies such as the COVID-19 outbreak, as well as in more routine times for older adults who live alone or reside in remote areas.
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Affiliation(s)
- Stav Shapira
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 653, Beer Sheva, Israel
- PREPARD Center for Emergency Response Research, Ben Gurion University of the Negev, P.O. Box 653, Beer Sheva, Israel
| | - Daphna Yeshua-Katz
- Department of Communication Studies, Faculty of Humanities and Social Sciences, Ben Gurion University of the Negev, P.O. Box 653, Beer Sheva, Israel
| | - Ella Cohn-Schwartz
- The Department of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 653, Beer Sheva, Israel
| | - Limor Aharonson-Daniel
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 653, Beer Sheva, Israel
- PREPARD Center for Emergency Response Research, Ben Gurion University of the Negev, P.O. Box 653, Beer Sheva, Israel
| | - Orly Sarid
- The Spitzer Department of Social Work, Faculty of Humanities and Social Sciences, Ben Gurion University of the Negev, P.O. Box 653, Beer Sheva, Israel
| | - A. Mark Clarfield
- Medical School for International Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer Sheva, Israel
- The Department of Geriatrics, McGill University, Montreal, QC, Canada
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23
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Domhardt M, Cuijpers P, Ebert DD, Baumeister H. More Light? Opportunities and Pitfalls in Digitalized Psychotherapy Process Research. Front Psychol 2021; 12:544129. [PMID: 33815184 PMCID: PMC8017120 DOI: 10.3389/fpsyg.2021.544129] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 02/27/2021] [Indexed: 12/23/2022] Open
Abstract
While the evidence on the effectiveness of different psychotherapies is often strong, it is not settled whereby and how these therapies work. Knowledge on the causal factors and change mechanisms is of high clinical and public relevance, as it contributes to the empirically informed advancement of psychotherapeutic interventions. Here, digitalized research approaches might possess the potential to generate new insights into human behavior change, contributing to augmented interventions and mental healthcare practices with better treatment outcomes. In this perspective article, we describe recent findings of research into change mechanisms that were only feasible with digital tools and outline important future directions for this rather novel branch of research. Furthermore, we indicate several challenges and pitfalls that are to be solved, in order to advance digitalized psychotherapy process research, both methodologically and technologically.
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Affiliation(s)
- Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - David Daniel Ebert
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
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24
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Rahmadiana M, Karyotaki E, Schulte M, Ebert DD, Passchier J, Cuijpers P, Berger T, van Ballegooijen W, Wimbarti S, Riper H. Transdiagnostic Internet Intervention for Indonesian University Students With Depression and Anxiety: Evaluation of Feasibility and Acceptability. JMIR Ment Health 2021; 8:e20036. [PMID: 33666553 PMCID: PMC7980121 DOI: 10.2196/20036] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 11/12/2020] [Accepted: 12/07/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND University students with depression and anxiety do not easily receive or seek treatment; therefore, internet-based interventions have been suggested to be a promising way to improve treatment accessibility and availability. However, it has not been examined whether a guided, culturally adapted, transdiagnostic, internet-based intervention is effective for treating symptoms of depression, anxiety, or both among university students in Indonesia. OBJECTIVE This study aims to investigate the feasibility (acceptability and satisfaction, usability, and uptake) of a guided, culturally adapted, transdiagnostic, internet-based intervention among university students with symptoms of depression, anxiety, or both in Indonesia. METHODS Students from Universitas Gadjah Mada, Yogyakarta, Indonesia, were screened for symptoms of depression, anxiety, or both, and filled online informed consent, demographic questionnaires, and a quality of life measure at pretreatment assessment (T0). Subsequently, the participants started the intervention. Seven weeks after T0, the primary outcomes of this feasibility study were analyzed at posttreatment assessment (T1) using the 8-item Client Satisfaction Questionnaire (CSQ-8) and the System Usability Scale (SUS). Mean and SDs for the CSQ-8 and SUS were calculated to examine feasibility. Within-group secondary outcomes (depression, anxiety, and quality of life) were inspected for outliers and normal distribution. Paired-sample t tests were used to investigate differences between time points of secondary outcomes. A mixed-method approach of quantitative and qualitative analyses was adopted. Both the primary and secondary outcomes were additionally explored with an individual semistructured interview and synthesized descriptively. RESULTS A total of 50 participants completed the intervention. We found a moderate to high level of satisfaction and acceptability, a slightly below-average level of desirable usability (≥70), and an adherence rate of 52% which was higher than expected given the novelty of the intervention. Results for the secondary outcomes indicated a decrease in depression and anxiety. For depression, the overall mean difference between the 2 time points for depression was 3.92 (95% CI 2.75-5.1; Hedges g 1.15; P<.001). For anxiety, the overall mean difference between the 2 time points was 3.34 (95% CI 2.06-4.61; Hedges g 1.02; P<.001). Further, a moderate effect in improving quality of life was found (g=0.50). Overall, participants were positive about the online intervention and ECoaches (online guidance), and they found the intervention to be culturally appropriate. CONCLUSIONS A culturally adapted, transdiagnostic, internet-based intervention appears to be acceptable and feasible for reducing symptoms of depression, anxiety, or both, and increasing quality of life in university students in Indonesia. Future studies should include a randomized controlled trial to assess the effectiveness of such interventions as they may supplement existing counseling services in universities, reduce the treatment costs, and maximize treatment accessibility in low-resourced settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1016/j.invent.2018.11.002.
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Affiliation(s)
- Metta Rahmadiana
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Mieke Schulte
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - David Daniel Ebert
- Division of Online Health Training, Innovation Incubator, Leuphana University of Lueneburg, Lueneburg, Germany.,Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Department of Clinical Psychology and EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jan Passchier
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Wouter van Ballegooijen
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Department of Psychiatry, Vrije Universiteit Medical Centre/GGZ inGeest, Amsterdam, Netherlands
| | - Supra Wimbarti
- Faculty of Psychology, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Department of Psychiatry, Vrije Universiteit Medical Centre/GGZ inGeest, Amsterdam, Netherlands
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25
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Use of a personalised depression intervention in primary care to prevent anxiety: a secondary study of a cluster randomised trial. Br J Gen Pract 2021; 71:e95-e104. [PMID: 33495203 PMCID: PMC7846354 DOI: 10.3399/bjgp20x714041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/12/2020] [Indexed: 01/10/2023] Open
Abstract
Background In the predictD-intervention, GPs used a personalised biopsychosocial programme to prevent depression. This reduced the incidence of major depression by 21.0%, although the results were not statistically significant. Aim To determine whether the predictD-intervention is effective at preventing anxiety in primary care patients without depression or anxiety. Design and setting Secondary study of a cluster randomised trial with practices randomly assigned to either the predictD-intervention or usual care. This study was conducted in seven Spanish cities from October 2010 to July 2012. Method In each city, 10 practices and two GPs per practice, as well as four to six patients every recruiting day, were randomly selected until there were 26–27 eligible patients for each GP. The endpoint was cumulative incidence of anxiety as measured by the PRIME-MD screening tool over 18 months. Results A total of 3326 patients without depression and 140 GPs from 70 practices consented and were eligible to participate; 328 of these patients were removed because they had an anxiety syndrome at baseline. Of the 2998 valid patients, 2597 (86.6%) were evaluated at the end of the study. At 18 months, 10.4% (95% CI = 8.7% to 12.1%) of the patients in the predictD-intervention group developed anxiety compared with 13.1% (95% CI = 11.4% to 14.8%) in the usual-care group (absolute difference = −2.7% [95% CI = −5.1% to −0.3%]; P = 0.029). Conclusion A personalised intervention delivered by GPs for the prevention of depression provided a modest but statistically significant reduction in the incidence of anxiety.
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26
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Domhardt M, Steubl L, Boettcher J, Buntrock C, Karyotaki E, Ebert DD, Cuijpers P, Baumeister H. Mediators and mechanisms of change in internet- and mobile-based interventions for depression: A systematic review. Clin Psychol Rev 2020; 83:101953. [PMID: 33422841 DOI: 10.1016/j.cpr.2020.101953] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/09/2020] [Accepted: 11/23/2020] [Indexed: 01/05/2023]
Abstract
The efficacy of Internet- and mobile-based interventions (IMIs) for depression in adults is well established. Yet, comprehensive knowledge on the mediators responsible for therapeutic change in these interventions is pending. Therefore, we conducted the first systematic review on mediators in IMIs for depression, investigating mechanisms of change in interventions with different theoretical backgrounds and delivery modes (PROSPERO CRD42019130301). Two independent reviewers screened references from five databases (i.e., Cochrane Library, Embase, MEDLINE/PubMed, PsycINFO and ICTRP), selected studies for inclusion and extracted data from eligible studies. We included 26 RCTs on mediators in IMIs for depression (6820 participants), rated their risk of bias and adherence to methodological quality criteria for psychotherapy process research. Primary studies examined 64 mediators, with cognitive variables (e.g., perceived control, rumination or interpretation bias) being the largest group of both examined (m = 28) and significant mediators (m = 22); followed by a range of other mediators, including mindfulness, acceptance and behavioral activation. Our findings might contribute to the empirically-informed advancement of interventions and mental health care practices, enabling optimized treatment outcomes for patients with depression. Furthermore, we discuss implications for future research and provide methodological recommendations for forthcoming mediation studies with more pertinent designs, allowing for inferences with higher causal specificity.
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Affiliation(s)
- Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany.
| | - Lena Steubl
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany
| | - Johanna Boettcher
- Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Germany
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Germany
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands; Department of Global Health and Social Medicine, Harvard Medical School, United States
| | - David D Ebert
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands; Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany
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27
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Domhardt M, Letsch J, Kybelka J, Koenigbauer J, Doebler P, Baumeister H. Are Internet- and mobile-based interventions effective in adults with diagnosed panic disorder and/or agoraphobia? A systematic review and meta-analysis. J Affect Disord 2020; 276:169-182. [PMID: 32697696 DOI: 10.1016/j.jad.2020.06.059] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/20/2020] [Accepted: 06/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is no meta-analysis that specifically evaluates the effectiveness of Internet- and mobile-based interventions (IMIs) in adults with diagnosed panic disorder and/or agoraphobia (PD/A) so far. The current meta-analysis aims to fill this gap (PROSPERO CRD 42016034016). METHODS Systematic literature searches in six databases for randomised and controlled clinical trials investigating IMIs in adults, who met diagnostic criteria for PD/A. Study selection and data extraction were conducted independently by two reviewers. Random-effects meta-analyses, pre-planned subgroup and sensitivity analyses were conducted when appropriate. Primary outcomes were PD and A symptom severity. In addition, adherence, response, remission, quality of life, anxiety and depression symptom severity were examined. RESULTS A total of 16 trials (1015 patients), with 21 comparisons (9 IMI vs. waitlist; 7 IMI vs. IMI; 5 IMI vs. active treatment condition), were included. IMIs revealed beneficial effects on panic (Hedges' g range -2.61 to -0.25) and agoraphobia symptom severity when compared to waitlist (pooled g = -1.15, [95%-CI = -1.56; -0.74]). Studies comparing IMIs to active controls (i.e., face-to-face CBT and applied relaxation) did not find significant differences for reductions in panic (g = -0.02, [95%-CI = -0.25; 0.21]) and agoraphobia symptom severity (g = -0.10, [95%-CI = -0.39; 0.19]). Furthermore, IMIs were superior to waitlist controls regarding anxiety and depression symptom severity and quality of life. LIMITATIONS Tests for publication bias were not feasible due to the limited number of trials per comparison, and the risk of bias assessment indicated some methodological shortcomings. CONCLUSIONS Findings from this meta-analytic review provide support for the effectiveness of IMIs in patients with verified PD/A. However, before IMIs can be included in treatment guidelines for PD/A, future high quality research is needed that substantiates and extends the evidence base, especially in regard to intervention safety.
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Affiliation(s)
- Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Ulm University, Albert-Einstein-Allee-47, 89081 Ulm, Germany.
| | - Josefine Letsch
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Ulm, Germany
| | - Jonas Kybelka
- Department of Clinical Psychology and Psychotherapy, Ulm University, Albert-Einstein-Allee-47, 89081 Ulm, Germany
| | - Josephine Koenigbauer
- Department of Clinical Psychology and Psychotherapy, Ulm University, Albert-Einstein-Allee-47, 89081 Ulm, Germany
| | - Philipp Doebler
- Statistical Methods in the Social Sciences, Department of Statistics, TU Dortmund University, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Albert-Einstein-Allee-47, 89081 Ulm, Germany
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28
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Rigabert A, Motrico E, Moreno-Peral P, Resurrección DM, Conejo-Cerón S, Cuijpers P, Martín-Gómez C, López-Del-Hoyo Y, Bellón JÁ. Effectiveness of online psychological and psychoeducational interventions to prevent depression: Systematic review and meta-analysis of randomized controlled trials. Clin Psychol Rev 2020; 82:101931. [PMID: 33137611 DOI: 10.1016/j.cpr.2020.101931] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 08/16/2020] [Accepted: 10/13/2020] [Indexed: 02/08/2023]
Abstract
Although evidence exists for the efficacy of interventions to prevent depression, little is known about its prevention through online interventions. We aim to assess the effectiveness of online psychological and psychoeducational interventions to prevent depression in heterogeneous populations. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted based on literature searches in eight electronic data bases and other sources from inception to 22 July 2019. Of the 4181 abstracts reviewed, 501 were selected for full-text review, and 21 RCTs met the inclusion criteria, representing 10,134 participants from 11 countries and four continents. The pooled SMD was -0·26 (95%CI: -0·36 to -0·16; p < 0.001) and sensitivity analyses confirmed the robustness of this result. We did not find publication bias but there was substantial heterogeneity (I2 = 72%; 95%CI, 57% to 82%). A meta-regression including three variables explained 81% of the heterogeneity. Indicated prevention and interactive website delivery were statistically associated with higher effectiveness, and no association was observed with risk of bias. Online psychological and psychoeducational interventions have a small effect in reducing depressive symptoms in non-depressed and varied populations, and the quality of evidence is moderate. Given that these types of interventions are very accessible and can be applied on a wide scale, they should be further developed and implemented. Registration details: Registration number (PROSPERO): CRD42014014804.
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Affiliation(s)
- Alina Rigabert
- Department of Psychology, Universidad Loyola Andalucía, Seville, Spain; Fundación Andaluza Beturia para la Investigación en Salud, Huelva, Spain
| | - Emma Motrico
- Department of Psychology, Universidad Loyola Andalucía, Seville, Spain; Prevention and Health Promotion Research Network (redIAPP), ISCIII, Spain.
| | - Patricia Moreno-Peral
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Spain; Institute of Biomedical Research in Málaga (IBIMA), Málaga, Spain; Research Unit, Primary Care District of Málaga-Guadalhorce, Málaga, Spain
| | | | - Sonia Conejo-Cerón
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Spain; Institute of Biomedical Research in Málaga (IBIMA), Málaga, Spain; Research Unit, Primary Care District of Málaga-Guadalhorce, Málaga, Spain
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | | | - Yolanda López-Del-Hoyo
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Spain; Instituto de Investigación Sanitaria de Aragón, Universidad de Zaragoza, Spain
| | - Juan Ángel Bellón
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Spain; Institute of Biomedical Research in Málaga (IBIMA), Málaga, Spain; Research Unit, Primary Care District of Málaga-Guadalhorce, Málaga, Spain; El Palo Health Center, Andalusian Health Service (SAS), Málaga, Spain; Department of Public Health and Psychiatry, University of Málaga (UMA), Spain
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29
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Weisel KK, Zarski AC, Berger T, Krieger T, Moser CT, Schaub MP, Görlich D, Berking M, Ebert DD. User Experience and Effects of an Individually Tailored Transdiagnostic Internet-Based and Mobile-Supported Intervention for Anxiety Disorders: Mixed-Methods Study. J Med Internet Res 2020; 22:e16450. [PMID: 32936085 PMCID: PMC7527916 DOI: 10.2196/16450] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/20/2020] [Accepted: 06/22/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Internet interventions have been shown to be effective in treating anxiety disorders. Most interventions to date focus on single disorders and disregard potential comorbidities. OBJECTIVE The aim of this mixed-methods study was to investigate feasibility, user experience, and effects of a newly developed individually tailored transdiagnostic guided internet intervention for anxiety disorders. METHODS This study is an uncontrolled, within-group, baseline, postintervention pilot trial with an embedded qualitative and quantitative process and effect evaluation. In total, 49 adults with anxiety disorders (generalized anxiety disorder n=20, social phobia n=19, agoraphobia without panic n=12, panic with agoraphobia n=6, panic without agoraphobia n=4, subclinical depression n=41) received access to the 7-session intervention. We examined motivation and expectations, intervention use, user experience, impact, and modification requests. Qualitative data were assessed using semistructured interviews and analyzed by qualitative content analysis. Quantitative outcomes included symptom severity of anxiety and depression (Hamilton Anxiety Rating Scale [HAM-A], Quick Item Inventory of Depressive Symptomatology clinician rating [QIDS-C]), diagnostic status in clinical interviews (Mini International Neuropsychiatric Interview [MINI]), and web-based self-reports (Generalized Anxiety Disorder-7 [GAD-7], Center for Epidemiological Studies Depression Scale [CES-D], Beck Anxiety Inventory [BAI], Panic and Agoraphobia Scale [PAS], Social Phobia Scale [SPS], Patient Health Questionnaire-9 [PHQ-9]) at baseline and postassessment. Quantitative data was analyzed by comparing within-group means expressed as Cohen d. RESULTS Anxiety symptom severity (HAM-A d=1.19) and depressive symptoms (QIDS-C d=0.42) improved significantly, and 54% (21/39) no longer were diagnosed as having any anxiety disorder. The main positive effects were the general improvement of disease burden and attentiveness to feelings and risk situations while the main negative effects experienced were lack of change in disease burden and symptom deterioration. The most prevalent reasons for participation were the advantages of online treatment, symptom burden, and openness toward online treatment. Helpful factors included support, psychoeducation and practicing strategies in daily life; the main hindering factors were too little individualization and being overwhelmed by the content and pace. CONCLUSIONS The intervention was found to be feasible and results show preliminary data indicating potential efficacy for improving anxiety and depression. The next step should be the evaluation within a randomized controlled trial. Concerning intervention development, it was found that future interventions should emphasize individualization even more in order to further improve the fit to individual characteristics, preferences, and needs.
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Affiliation(s)
- Kiona K Weisel
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Anna-Carlotta Zarski
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Tobias Krieger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christian T Moser
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael P Schaub
- Swiss Research Institute of Public Health and Addiction ISGF, Associated to the University of Zurich, Zurich, Switzerland
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - David D Ebert
- Clinical, Neuro- & Development Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Saruhanjan K, Zarski AC, Schaub MP, Ebert DD. Design of a Guided Internet- and Mobile-Based Intervention for Internet Use Disorder-Study Protocol for a Two-Armed Randomized Controlled Trial. Front Psychiatry 2020; 11:190. [PMID: 32256409 PMCID: PMC7092751 DOI: 10.3389/fpsyt.2020.00190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 02/26/2020] [Indexed: 12/12/2022] Open
Abstract
Context: Internet Use Disorder (IUD), characterized as the inability to control one's internet use, is emerging as an increasing societal concern as it is associated with reduced quality of life and mental health comorbidities. Evidence-based treatment options are, however, scarce due to the novelty of the diagnosis. Internet- and mobile-based interventions may be an effective means to deliver psychological treatment to individuals with IUD as they address individuals affected in their online setting. The aim of the study is to evaluate the efficacy of a newly developed, guided internet- and mobile-based intervention for IUD. Methods: In a two-armed randomized controlled trial (N = 130), individuals showing problematic internet use patterns (Internet Addiction Test ≥ 49) will be randomly allocated to the internet- and mobile-based intervention or a waiting control group. Assessments will take place at baseline, 7 weeks, 6- and 12 months after randomization. The primary outcome is internet addiction symptom severity (IAT) at 7 weeks. Secondary outcomes include quality of life, depressive symptoms, anxiety, and other psychosocial variables associated with IUD. Intervention: The intervention consists of seven sessions: Goal setting and motivational interviewing, impulse control, problem solving, cognitive restructuring, self-worth, relapse prevention, and a booster session. Participants are supported by an eCoach who provides individual feedback after completion of each session. Participants can choose between several elective sessions based on individual need. Conclusions: This is the first study to evaluate an internet- and mobile-based intervention for IUD, which could be a promising first step to reduce individuals' disease burden. Trial Registration: DRKS00015314. The study is currently ongoing. First participants were enrolled in the study on September 14th 2018. Recruitment will continue approximately through March 2020.
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Affiliation(s)
- Karina Saruhanjan
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Anna-Carlotta Zarski
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Patrick Schaub
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - David Daniel Ebert
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Clough BA, Rowland DP, Casey LM. Development of the eTAP-T: A measure of mental health professionals' attitudes and process towards e-interventions. Internet Interv 2019; 18:100288. [PMID: 31890635 PMCID: PMC6926282 DOI: 10.1016/j.invent.2019.100288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The development of technological applications within psychotherapy has opened up new opportunities for mental health professionals (MHPs) to address client need. Despite the clinical efficacy and utility of evidence-based electronic interventions, MHPs' engagement with these interventions remains poorly understood. OBJECTIVE The aim of the current study was to develop and conduct a preliminary psychometric investigation of the measurement properties of the electronic-therapy attitudes and process questionnaire - therapist version (eTAP-T). Based upon the theory of planned behaviour (TPB), the eTAP-T measures factors related to MHPs' engagement with e-interventions for clients' mental health concerns. METHODS Participants were 222 practicing MHPs who reported being in direct contact with clients. Participants completed the eTAP-T and related measures with a subsample of 40 participants completing a two-week follow up questionnaire. RESULTS Exploratory factor analysis with item reduction resulted in a 12-item eTAP-T, with four factors accounting for 82% of variance. The four factors (subjective norms, perceived behavioural control, attitudes and intentions) were consistent with the four TPB domains. The eTAP-T demonstrated satisfactory validity and reliability as per the consensus-based standards for the selection of health measurement instruments. CONCLUSIONS The development and preliminary psychometric investigation supported the validity and reliability of the eTAP-T. Further research is required for confirmatory analyses. The eTAP-T may be useful in identifying the training needs of MHPs and evaluating training programs. Specific areas for intervention, such as attitudes or perceived credibility may be identified and targetted, with the measure then also used to evaluate change across these domains. It is anticipated that the eTAP-T may useful tool in improving uptake of digital interventions by MHPs.
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Affiliation(s)
- Bonnie A. Clough
- Corresponding author at: School of Applied Psychology, Griffith University, Parklands Drive, Southport 4215, Queensland, Australia.
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Karyotaki E, Klein AM, Riper H, de Wit L, Krijnen L, Bol E, Bolinski F, Burger S, Ebert DD, Auerbach RP, Kessler RC, Bruffaerts R, Batelaan N, van der Heijde CM, Vonk P, Kleiboer A, Wiers RW, Cuijpers P. Examining the effectiveness of a web-based intervention for symptoms of depression and anxiety in college students: study protocol of a randomised controlled trial. BMJ Open 2019; 9:e028739. [PMID: 31092668 PMCID: PMC6530301 DOI: 10.1136/bmjopen-2018-028739] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION The college years are a peak period for the onset of common mental disorders. Poor mental health is associated with low academic attainment, physical, interpersonal and cognitive impairments. Universities can use online approaches to screen students for mental disorders and treat those in need. The present study aims to assess the effectiveness of a guided web-based transdiagnostic individually tailored intervention to treat students with symptoms of depression and/or anxiety. METHODS and analysis : The present study is a randomised controlled trial. Participants are Dutch college students (≥18 years) with mild to moderate depression and/or anxiety symptoms. The intervention is a guided web-based transdiagnostic individually tailored intervention that targets symptoms of depression and/or anxiety. The intervention consists of seven online sessions with a duration ranging from 4 to 7 weeks depending on individual progress. A booster session is administered 4 weeks after the completion of the seventh session. Primary outcome measures are the Patient Health Questionnaire for depression and the Generalised Anxiety Disorder 7-item scale for anxiety. These scales are administered at screening, post-treatment and follow-up assessments (6 and 12 months post-randomisation). : E THICS AND DISSEMINATION: The Medical Ethics Committee of the Vrije Universiteit Medical Centre has approved the protocol (registration number 2016.583, A2017.362andA2018.421). Results of the trial will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NTR6797; Pre-results.
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Affiliation(s)
- Eirini Karyotaki
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anke M Klein
- Addiction, Development, and Psychopathology Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Leonore de Wit
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lisa Krijnen
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eline Bol
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Addiction, Development, and Psychopathology Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Felix Bolinski
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Simone Burger
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - David D Ebert
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Randy P Auerbach
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum, Centre for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Neeltje Batelaan
- Department of Psychiatry and Department of Epidemiology and Biostatistics, VU University Medical Centre Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical Centre Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Claudia M van der Heijde
- Department of Research, Development and Prevention, Student Health Service University of Amsterdam, Amsterdam, The Netherlands
| | - Peter Vonk
- Department of Research, Development and Prevention, Student Health Service University of Amsterdam, Amsterdam, The Netherlands
| | - Annet Kleiboer
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Reinout W Wiers
- Addiction, Development, and Psychopathology Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Ebert DD, Buntrock C, Mortier P, Auerbach R, Weisel KK, Kessler RC, Cuijpers P, Green JG, Kiekens G, Nock MK, Demyttenaere K, Bruffaerts R. Prediction of major depressive disorder onset in college students. Depress Anxiety 2019; 36:294-304. [PMID: 30521136 PMCID: PMC6519292 DOI: 10.1002/da.22867] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/16/2018] [Accepted: 08/19/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) in college students is associated with substantial burden. AIMS To assess 1-year incidence of MDD among incoming freshmen and predictors of MDD-incidence in a representative sample of students. METHOD Prospective cohort study of first-year college students (baseline: n = 2,519, 1-year follow-up: n = 958) RESULTS: The incidence of MDD within the first year of college was 6.9% (SE = 0.8). The most important individual-level predictors of onset were prior suicide plans and/or attempts (OR = 9.5). The strongest population-level baseline predictors were history of childhood-adolescent trauma, stressful experience in the past 12 months, parental psychopathology, and other 12-month mental disorder. Multivariate cross-validated prediction (cross-validated AUC = 0.73) suggest that 36.1% of incident MDD cases in a replication sample would occur among the 10% of students at highest predicted risk (24.5% predicted incidence in this highest-risk subgroup). CONCLUSIONS Screening at college entrance is a promising strategy to identify students at risk of MDD onset, which may improve the development and deployment of targeted preventive interventions.
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Affiliation(s)
- David D. Ebert
- Department of Clinical Psychology and PsychotherapyFriedrich–Alexander University Erlangen–NüurembergErlangenGermany
| | - Claudia Buntrock
- Department of Clinical Psychology and PsychotherapyFriedrich–Alexander University Erlangen–NüurembergErlangenGermany
| | - Philippe Mortier
- Department of NeurosciencesUniversitair Psychiatrisch Centrum KU LeuvenBelgium
| | - Randy Auerbach
- Department of PsychiatryHarvard Medical SchoolBostonMAUSA
- Center for Depression, Anxiety and Stress Research, McLean HospitalBelmontMAUSA
| | - Kiona K. Weisel
- Department of Clinical Psychology and PsychotherapyFriedrich–Alexander University Erlangen–NüurembergErlangenGermany
| | | | - Pim Cuijpers
- EMGO Institute for Health and Care Research, VU University AmsterdamAmsterdamthe Netherlands
| | | | - Glenn Kiekens
- Department of NeurosciencesUniversitair Psychiatrisch Centrum KU LeuvenBelgium
| | | | - Koen Demyttenaere
- Department of PsychiatryHarvard Medical SchoolBostonMAUSA
- Center for Depression, Anxiety and Stress Research, McLean HospitalBelmontMAUSA
| | - Ronny Bruffaerts
- Department of PsychiatryHarvard Medical SchoolBostonMAUSA
- Center for Depression, Anxiety and Stress Research, McLean HospitalBelmontMAUSA
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Lorenzo-Luaces L, Johns E, Keefe JR. The Generalizability of Randomized Controlled Trials of Self-Guided Internet-Based Cognitive Behavioral Therapy for Depressive Symptoms: Systematic Review and Meta-Regression Analysis. J Med Internet Res 2018; 20:e10113. [PMID: 30413400 PMCID: PMC6251981 DOI: 10.2196/10113] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 07/11/2018] [Accepted: 07/19/2018] [Indexed: 01/23/2023] Open
Abstract
Background Self-guided internet-based cognitive behavioral therapies (iCBTs) for depressive symptoms may substantially increase accessibility to mental health treatment. Despite this, questions remain as to the generalizability of the research on self-guided iCBT. Objective We sought to describe the clinical entry criteria used in studies of self-guided iCBT, explore the criteria’s effects on study outcomes, and compare the frequency of use of these criteria with their use in studies of face-to-face psychotherapy and antidepressant medications. We hypothesized that self-guided iCBT studies would use more stringent criteria that would bias the sample toward those with a less complex clinical profile, thus inflating treatment outcomes. Methods We updated a recently published meta-analysis by conducting a systematic literature search in PubMed, MEDLINE, PsycINFO, and EMBASE. We conducted a meta-regression analysis to test the effect of the different commonly used psychiatric entry criteria on the treatment-control differences. We also compared the frequency with which exclusion criteria were used in the self-guided iCBT studies versus studies of face-to-face psychotherapy and antidepressants from a recently published review. Results Our search yielded 5 additional studies, which we added to the 16 studies identified by Karyotaki and colleagues in 2017. Few self-guided iCBT studies excluded patients with severe depressive symptoms (6/21, 29%), but self-guided iCBT studies were more likely than antidepressant (14/170, 8.2%) studies to use this criterion. However, self-guided iCBT studies did not use this criterion more frequently than face-to-face psychotherapy studies (6/16, 38%). Beyond this, we found no evidence that self-guided iCBTs used more stringent entry criteria. Strong evidence suggested that they were actually less likely to use most entry criteria, especially exclusions on the basis of substance use or personality pathology. None of the entry criteria used had an effect on outcomes. Conclusions A conservative interpretation of our findings is that the patient population sampled in the literature on self-guided iCBT is relatively comparable with that of studies of antidepressants or face-to-face psychotherapy. Alternatively, studies of unguided cognitive behavioral therapy may sample from a more heterogeneous and representative patient population. Until evidence emerges to suggest otherwise, the patient population sampled in self-guided iCBT studies cannot be considered as less complex than the patient population from face-to-face psychotherapy or antidepressant studies.
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Affiliation(s)
- Lorenzo Lorenzo-Luaces
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN, United States
| | - Emily Johns
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN, United States
| | - John R Keefe
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States
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