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Lo HKY, Ho FYY, Yeung JWF, Ng STW, Wong EYT, Chung KF. Self-help interventions for the prevention of relapse in mood disorder: a systematic review and meta-analysis. Fam Pract 2024:cmae036. [PMID: 39016242 DOI: 10.1093/fampra/cmae036] [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] [Indexed: 07/18/2024] Open
Abstract
INTRODUCTION Self-help interventions may offer a scalable adjunct to traditional care, but their effectiveness in relapse prevention is not well-established. Objectives: This review aimed to assess their effectiveness in preventing relapses among individuals with mood disorders. METHODS We systematically reviewed the pertinent trial literature in Web of Science, EMBASE, PubMed, PsycINFO, and Cochrane databases until May 2024. Randomized controlled trials that examined the self-help interventions among individuals diagnosed with major depressive disorder (MDD) or bipolar disorder (BD) were included. The random-effects model computed the pooled risk ratios of relapse, with subgroup analyses and meta-regression analyses to explore heterogeneity sources. RESULTS Fifteen papers and 16 comparisons of randomized trials involving 2735 patients with mood disorders were eligible for this meta-analysis. Adjunct self-help interventions had a small but significant effect on reducing the relapse rates of major depressive disorder (pooled risk ratio: 0.78, 95% confidence interval (CI): 0.66-0.92, P = 0.0032, NNT = 11), and were marginally better in bipolar disorder (pooled risk ratio: 0.62, 95% CI: 0.40-0.97, P = .0344, NNT = 12), as compared to treatment as usual (TAU). No subgroup difference was found based on intervention components, settings, delivery method, or guidance levels. The average dropout rate for self-help interventions (18.9%) did not significantly differ from TAU dropout rates. The examination of treatment adherence was highly variable, precluding definitive conclusions. CONCLUSIONS Self-help interventions demonstrate a modest preventative effect on relapse in mood disorders, despite low to very low certainty. Future research is essential to identify which elements of self-help interventions are most effective.
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Affiliation(s)
- Heidi Ka-Ying Lo
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Fiona Yan-Yee Ho
- Department of Psychology, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jerry Wing-Fai Yeung
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Stephy Tim-Wai Ng
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Eva Yuen-Ting Wong
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Ka-Fai Chung
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
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Terhorst Y, Kaiser T, Brakemeier EL, Moshe I, Philippi P, Cuijpers P, Baumeister H, Sander LB. Heterogeneity of Treatment Effects in Internet- and Mobile-Based Interventions for Depression: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e2423241. [PMID: 39023887 PMCID: PMC11258589 DOI: 10.1001/jamanetworkopen.2024.23241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/21/2024] [Indexed: 07/20/2024] Open
Abstract
Importance While the effects of internet- and mobile-based interventions (IMIs) for depression have been extensively studied, no systematic evidence is available regarding the heterogeneity of treatment effects (HTEs), indicating to what extent patient-by-treatment interactions exist and personalized treatment models might be necessary. Objective To investigate the HTEs in IMIs for depression as well as their efficacy and effectiveness. Data Sources A systematic search in Embase, MEDLINE, Central, and PsycINFO for randomized clinical trials and supplementary reference searches was conducted on October 13, 2019, and updated March 25, 2022. The search string included various terms related to digital psychotherapy, depression, and randomized clinical trials. Study Selection Titles, abstracts, and full texts were reviewed by 2 independent researchers. Studies of all populations with at least 1 intervention group receiving an IMI for depression and at least 1 control group were eligible, if they assessed depression severity as a primary outcome and followed a randomized clinical trial (RCT) design. Data Extraction and Synthesis This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Risk of bias was evaluated using the Cochrane Risk of Bias Tool. HTE was investigated using logarithmic variance ratios (lnVR) and effect sizes using Hedges g. Three-level bayesian meta-regressions were conducted. Main Outcomes and Measures Heterogeneity of treatment effects was the primary outcome of this study; magnitudes of treatment effect sizes were the secondary outcome. Depression severity was measured by different self-report and clinician-rated scales in the included RCTs. Results The systematic review of 102 trials included 19 758 participants (mean [SD] age, 39.9 [10.58] years) with moderate depression severity (mean [SD] in Patient Health Questionnaire-9 score, 12.81 [2.93]). No evidence for HTE in IMIs was found (lnVR = -0.02; 95% credible interval [CrI], -0.07 to 0.03). However, HTE was higher in more severe depression levels (β̂ = 0.04; 95% CrI, 0.01 to 0.07). The effect size of IMI was medium (g = -0.56; 95% CrI, -0.46 to -0.66). An interaction effect between guidance and baseline severity was found (β̂ = -0.24, 95% CrI, -0.03 to -0.46). Conclusions and Relevance In this systematic review and meta-analysis of RCTs, no evidence for increased patient-by-treatment interaction in IMIs among patients with subthreshold to mild depression was found. Guidance did not increase effect sizes in this subgroup. However, the association of baseline severity with HTE and its interaction with guidance indicates a more sensitive, guided, digital precision approach would benefit individuals with more severe symptoms. Future research in this population is needed to explore personalization strategies and fully exploit the potential of IMI.
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Affiliation(s)
- Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
- Department of Psychology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Tim Kaiser
- Methods and Evaluation/Quality Assurance, Freie Universität Berlin, Berlin, Germany
| | - Eva-Lotta Brakemeier
- Department of Clinical Psychology and Psychotherapy, University Greifswald, Greifswald, Germany
| | - Isaac Moshe
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Paula Philippi
- Department of Clinical Child and Adolescent Psychology and Psychotherapy, Bergische Universität Wuppertal, Wuppertal, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
| | - Lasse Bosse Sander
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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Gu Y, Andargoli AE, Mackelprang JL, Meyer D. Design and implementation of clinical decision support systems in mental health helpline Services: A systematic review. Int J Med Inform 2024; 186:105416. [PMID: 38552266 DOI: 10.1016/j.ijmedinf.2024.105416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 02/27/2024] [Accepted: 03/17/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Clinical Decision Support Systems (CDSSs) are electronic systems used to conduct assessments based on patient characteristics and to offer treatment recommendations for clinicians to consider during their decision-making processes. CDSSs are needed by mental health helpline services to optimise service delivery for clients and counsellors, while also collecting the data needed for the administration of the service. The aim of this systematic review was to provide a comprehensive overview of the design and implementation of CDSSs in mental health helpline services, to identify current issues in their design and implementation, and to provide recommendations that may address any identified issues. MATERIALS AND METHODS Keywords related to mental health, helplines and CDSS were searched in three databases in April 2022 and September 2023. In total, 21 articles published between 1987 and 2023 met the inclusion criteria. RESULTS The objectives of the mental health helplines services included in this study included suicide risk reduction, diagnosis, treatment and monitoring of mental health disorders, and support of clinicians or counsellors in making better and more accurate decisions by incorporating real-time data analysis. All included studies demonstrated co-design activities, however, the level and degree of end-user involvement differed across the studies. The factors that impact CDSS implementation success depend on the design and implementation approach, user experience and context. CDSS evaluations in the included studies assessed reliability, utility, user friendlessness, cost-effectivenessand participant satisfaction. Few studies considered data privacy and integration issues. CONCLUSION More interactive methods should be adopted during the design of CDSSs for mental health helpline services. Increased frequency and intensity of user participation in system design, that goes beyond providing feedback on research materials, enables user opinions to be fully understood and addressed. Comprehensive frameworks should be developed to guide requirements gathering, system design and system evaluation practices. These factors are interrelated and may impact implementation success. From the outset therefore, the design of a CDSS in the mental health helpline domain should consider the full system development cycle.
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Affiliation(s)
- Yueming Gu
- Swinburne University of Technology, Melbourne, Australia.
| | | | | | - Denny Meyer
- Swinburne University of Technology, Melbourne, Australia
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Henrique MG, de Paula Couto MCP, Araya R, Mendes AV, Nakamura CA, Hollingworth W, van de Ven P, Peters TJ, Scazufca M. Acceptability and fidelity of a psychosocial intervention (PROACTIVE) for older adults with depression in a basic health unit in São Paulo, Brazil: a qualitative study. BMC Public Health 2021; 21:2278. [PMID: 34903192 PMCID: PMC8670151 DOI: 10.1186/s12889-021-12402-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 11/30/2021] [Indexed: 11/18/2022] Open
Abstract
Background Depression is a common condition in older adults, being often detected and treated initially in primary care. Collaborative care models including, for example, task-shifting and stepped-care approaches have been investigated to overcome the current scarcity of strategies and trained mental health professionals to treat depression. The PROACTIVE study developed a psychosocial intervention, which makes extensive use of technology in an intervention delivered mainly by non-specialists to treat older adults with depression. The aim of this qualitative study is to assess: 1. Health workers’ fidelity to the intervention protocol; 2. Acceptability of the psychosocial intervention from the viewpoint of older adult participants; and 3. Perceptions of the psychosocial intervention by the health workers. Methods Qualitative methods were used to achieve our aims. The sample included participants (N = 31) receiving the intervention in the pilot trial and health workers (N = 11) working in a Basic Health Unit in the northern area of São Paulo, Brazil. Focus group, non-participant observation and structured interviews were used. Data were analysed using a thematic analysis approach. Results 1. Health workers’ fidelity to the intervention protocol: training, supervision and the structured intervention were crucial and guaranteed health workers’ fidelity to the protocol. 2. Acceptability of the psychosocial intervention from the viewpoint of older adult participants: Collaborative care, task-shifting, and stepped-care approaches were well accepted. The structured protocol of the intervention including different activities and videos was important to adherence of older adult participants 3. Perceptions of the psychosocial intervention by the health workers: It was feasible to have the home psychosocial sessions conducted by health workers, who are non-mental health specialists and received 3-day training. Training and supervision were perceived as crucial to support health workers before and during the intervention. Technology served as a tool to structure the sessions, obtain and store patient data, present multi-media content, guarantee fidelity to the protocol and facilitate communication among members of the team. However, extra burden was mentioned by the health workers indicating the need of adjustments in their daily duties. Conclusions The PROACTIVE intervention was demonstrated to be feasible and accepted by both health workers and older adult participants. The qualitative assessments suggested improvements in training and supervision to ensure fidelity to protocol. To assess effectiveness a randomised controlled trial of the intervention will be conducted with the addition of improvements suggested by this qualitative study. Trial registration The pilot study of which the present study gives support to was registered at the Brazilian Clinical Trials, UTN code: U1111-1218-6717 on 26/09/2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12402-3.
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Affiliation(s)
- Maiara Garcia Henrique
- LIM-23, Instituto de Psiquiatria, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | | | - Ricardo Araya
- Centre of Global Mental Health, Institute of Psychiatry, Psychology, and Neurosciences, King's College, London, UK
| | - Ana Vilela Mendes
- LIM-23, Instituto de Psiquiatria, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Carina Akemi Nakamura
- LIM-23, Instituto de Psiquiatria, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - William Hollingworth
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Pepijn van de Ven
- Health Research Institute, University of Limerick, Limerick, IE, Ireland
| | - Tim J Peters
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcia Scazufca
- LIM-23, Instituto de Psiquiatria, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Kueper JK, Terry AL, Zwarenstein M, Lizotte DJ. Artificial Intelligence and Primary Care Research: A Scoping Review. Ann Fam Med 2020; 18:250-258. [PMID: 32393561 PMCID: PMC7213996 DOI: 10.1370/afm.2518] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/11/2019] [Accepted: 11/21/2019] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Rapid increases in technology and data motivate the application of artificial intelligence (AI) to primary care, but no comprehensive review exists to guide these efforts. Our objective was to assess the nature and extent of the body of research on AI for primary care. METHODS We performed a scoping review, searching 11 published or gray literature databases with terms pertaining to AI (eg, machine learning, bayes* network) and primary care (eg, general pract*, nurse). We performed title and abstract and then full-text screening using Covidence. Studies had to involve research, include both AI and primary care, and be published in Eng-lish. We extracted data and summarized studies by 7 attributes: purpose(s); author appointment(s); primary care function(s); intended end user(s); health condition(s); geographic location of data source; and AI subfield(s). RESULTS Of 5,515 unique documents, 405 met eligibility criteria. The body of research focused on developing or modifying AI methods (66.7%) to support physician diagnostic or treatment recommendations (36.5% and 13.8%), for chronic conditions, using data from higher-income countries. Few studies (14.1%) had even a single author with a primary care appointment. The predominant AI subfields were supervised machine learning (40.0%) and expert systems (22.2%). CONCLUSIONS Research on AI for primary care is at an early stage of maturity. For the field to progress, more interdisciplinary research teams with end-user engagement and evaluation studies are needed.
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Affiliation(s)
- Jacqueline K Kueper
- Departments of Epidemiology & Biostatistics and Computer Science, Western University, London, Ontario, Canada
| | - Amanda L Terry
- Departments of Epidemiology & Biostatistics, Family Medicine, Schulich Interfaculty Program in Public Health, Western University, London, Ontario, Canada
| | - Merrick Zwarenstein
- Departments of Epidemiology & Biostatistics and Family Medicine, Western University, London, Ontario, Canada
| | - Daniel J Lizotte
- Departments of Epidemiology & Biostatistics, Computer Science, Schulich Interfaculty Program in Public Health, Statistical & Actuarial Sciences, Western University, London, Ontario, Canada
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Abstract
Advances in digital technology have a profound impact on conventional healthcare systems. We examine the trailblazing use of online interventions to enable autonomous psychological care which can greatly enhance individual- and population-level access to services. There is strong evidence supporting online cognitive-behavioural therapy and more engaging programmes are now appearing so as to reduce user 'attrition'. The next generation of autonomous psychotherapy programmes will implement adaptive and personalised responses, moving beyond impersonalised advice on cognitive and behavioural techniques. This will be a more authentic form of psychotherapy that integrates therapy with the actual relationship experiences of the individual user.
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Affiliation(s)
| | | | - Sanaz Fallahkhair
- School of Computing Engineering and Maths, University of Brighton, UK
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7
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McCashin D, Coyle D, O'Reilly G. Qualitative Synthesis of Young People's Experiences With Technology-Assisted Cognitive Behavioral Therapy: Systematic Review. J Med Internet Res 2019; 21:e13540. [PMID: 31714251 PMCID: PMC6880234 DOI: 10.2196/13540] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/12/2019] [Accepted: 05/29/2019] [Indexed: 12/14/2022] Open
Abstract
Background Cognitive behavioral therapy (CBT) for young people is increasingly being provided using technology-assisted formats. Although there is increasing evidence regarding the efficacy of such approaches, as illustrated by quantitative systematic reviews, the literature has also highlighted challenges with implementation factors, including high attrition rates and variable user engagement. Qualitative review methods can help to address the factors that impact young peoples’ experience of technology-assisted cognitive behavioral therapy (tech-assisted CBT) and, thus, enable us to better understand such implementation factors. To date, no such qualitative synthesis exists. Objective The primary aim of this review was to systematically identify and synthesize the qualitative literature concerning the experiences of young people who have used tech-assisted CBT. Methods This systematic review applied Thomas and Harden’s 2008 qualitative thematic synthesis approach. This involved line-by-line coding of the results sections of included studies and an inductive analysis on identified themes, followed by the generation of analytical themes through a process of iteration and interpretation of the descriptive themes. PsycINFO, ACM Digital Library, PubMed, EMBASE, and JMIR Publications databases were searched. The inclusion criteria were (1) studies involving school-aged young people over preschool age (6 years) but under the age of 18 years, (2) use of any form of tech-assisted CBT for any time period, (3) a stated focus of qualitative data to document the experiences of participants, and (4) studies published in English. The exclusion criteria were (1) interventions only provided face-to-face with no technological component, (2) only focused on the performance of the technology rather than participant experience, and (3) numerical data that sought to represent qualitative data. Results A total of 14 studies were included in this review. Overall, these studies represented interventions for low mood and anxiety (n=10), trauma or self-harm (n=2), and physical difficulties (n=2). Overall, 5 analytical themes emerged on young people’s experiences with tech-assisted CBT: (1) helpfulness, (2) therapeutic process, (3) transferability, (4) gameplay experience, and (5) limitations. In addition, these analytical themes contained the following subthemes: positive experiences, tech-assisted CBT versus face-to-face CBT, understanding of a CBT model, process of change, skills development, application to everyday life settings, parental involvement, character relatedness, playability, negative experiences, and broad content. Conclusions Overall, young people’s experiences with tech-assisted CBT were mostly positive. The use of gaming environments, relatable characters, concrete metaphors, and age-appropriate narratives contributed to these positive experiences. Evidence suggests that technology can help to mediate face-to-face relationships with therapists and help young people to understand the CBT model. Clear barriers also emerged, including over-reliance on reading and writing skills and dissatisfaction with overly generalized content and comparison with commercial technologies. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42018103388; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018103388
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Affiliation(s)
- Darragh McCashin
- School of Psychology, University College Dublin, Dublin, Ireland
| | - David Coyle
- School of Computer Science, University College Dublin, Dublin, Ireland
| | - Gary O'Reilly
- School of Psychology, University College Dublin, Dublin, Ireland
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8
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Dai Q, Hu L, Feng Z. Attentional bias modification reduces clinical depression and enhances attention toward happiness. J Psychiatr Res 2019; 109:145-155. [PMID: 30551021 DOI: 10.1016/j.jpsychires.2018.11.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/30/2018] [Accepted: 11/30/2018] [Indexed: 02/04/2023]
Abstract
Difficulty in clinical antidepressant treatment leads to the pursuit of alternative treatments, such as cognitive-behavior therapy (CBT). CBT combined with regular antidepressants have indicated an optimal therapeutic effect in clinic. Attentional bias is important in the occurrence and remission of depression, however, few studies have explored the effect of attentional bias modification (ABM) on depression, and inconsistent results have been obtained due to the heterogeneity in the targeted populations, training tasks, strategies, and materials. Hence, the current study aimed to explore the therapeutic effect of ABM on depression in clinical depression. Study I was designed to explore the optimal training methods regarding task (dot-probe vs. cue-target), material (faces vs. self-referent words), and strategy (mixed ABM toward positive and away from negative stimuli vs. positive ABM toward positive stimuli) in unselected undergraduates once daily for 10 days (N = 309). Study II was carried out to observe the effect of 10 days ABM toward positive and away from negative faces (based on Study I) on clinical depression (N = 32). Depression level was assessed via a self-reporting questionnaire and a structured interview, while attentional bias was tested by cue-target task and attention to positive and negative inventory (APNI). In unselected undergraduates (Study I), two strategies significantly reduced the self-reporting depression scores: mixed ABM toward positive stimuli and away from negative stimuli with emotional faces, and positive ABM toward positive materials only with self-referent words. In patients with major depressive disorder (MDD) (Study II), the mixed ABM with emotional faces resulted in enhanced attentional bias toward happy materials in the cue-target task and APNI, which predicted a delayed depression reduction in clinical depression at the one-month follow-up investigation. Our finding confirms the literature and broadens the knowledge with the evidence of the optimal therapeutic effect of ABM combined with regular antidepressants in clinical depression. The findings that a quick enhancement in positive attentional bias, predicting a later therapeutic effect on clinical depression reduction, indicate a potential mechanism that could underlie the therapeutic process of ABM in depression. The findings that two training strategies are effective in depression reduction suggest that different strategies should be utilized to treat different types of depression. This study offers a potential way to cure depression and could be further practiced in clinic.
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Affiliation(s)
- Qin Dai
- Department of Nursing Psychology, The Third Military Medical University, Chongqing, 400038, China; Department of Psychology, The Third Military Medical University, Chongqing, 400038, China.
| | - Lidan Hu
- Department of Psychiatry, Geleshan Psychiatric Hospital, Chongqing, China
| | - Zhengzhi Feng
- Department of Psychology, The Third Military Medical University, Chongqing, 400038, China
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Sogomonjan M, Kerikmäe T, Ööpik P, Ross P. A report on the survey. Attitudes of Estonian healthcare professionals to internet-delivered cognitive behavioural therapy. COGENT PSYCHOLOGY 2019. [DOI: 10.1080/23311908.2019.1637623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Melita Sogomonjan
- Department of Law, Tallinn University of Technology, Tallinn, Estonia
| | - Tanel Kerikmäe
- Department of Law, Tallinn University of Technology, Tallinn, Estonia
| | - Pille Ööpik
- Department of Family Medicine, University of Tartu, Tartu, Estonia
| | - Peeter Ross
- Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia
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10
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Dai Q, Yin X, Li H, Feng Z. Orbito-frontal cortex mechanism of inhibition of return in current and remitted depression. Hum Brain Mapp 2018; 39:2941-2954. [PMID: 29575563 PMCID: PMC6866481 DOI: 10.1002/hbm.24051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 03/09/2018] [Indexed: 12/17/2022] Open
Abstract
Deficient inhibition of return (IOR) for emotional materials is an important cognitive biomarker of depression. However, its neural mechanism and role in depression remission remain largely unknown. Using functional magnetic resonance imaging (fMRI), this study observed the neural foundation of inhibition of return in individuals with current (n = 30) and remitted (n = 27) depression and in healthy controls (n = 33), by using a cue-target task. The results showed that individuals with remitted depression (RMD) possessed a nonavoidant attention model for sad faces, which indicated a cue validity and was correlated with enhanced task- and resting-state activation and function connectivity in orbitofrontal cortex (OFC). The patients with major depressive disorder (MDD), in contrast, displayed an IOR effect for all faces, which indicated a strategy of attention avoidance due to the high cognitive burden in the cue-target task, and was correlated with decreased resting-state activation and function connectivity in OFC. Moreover, the hippocampus, a less-known cortex in IOR, showed a contrary model, that is, lower activation in depression remission and higher task- and resting-state activation in depressive episodes. The results suggest the OFC mechanism of the IOR effect in remitted depression and the hippocampus mechanism of the IOR effect in depressive episodes, which offer potential biomarkers for the clinical treatment of depression.
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Affiliation(s)
- Qin Dai
- College of Psychology and SociologyShenzhen UniversityShenzhenChina
- Department of PsychologyThe Third Military Medical UniversityChong QingChina
- Department of NursingThe Third Military Medical UniversityChong QingChina
| | - Xuntao Yin
- Radiological DepartmentThe Southwest Hospital of the Third Military Medical UniversityChong QingChina
| | - Hong Li
- College of Psychology and SociologyShenzhen UniversityShenzhenChina
| | - Zhengzhi Feng
- Department of PsychologyThe Third Military Medical UniversityChong QingChina
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Ahern E, Kinsella S, Semkovska M. Clinical efficacy and economic evaluation of online cognitive behavioral therapy for major depressive disorder: a systematic review and meta-analysis. Expert Rev Pharmacoecon Outcomes Res 2018; 18:25-41. [PMID: 29145746 DOI: 10.1080/14737167.2018.1407245] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/16/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Leading cause of disability worldwide, depression is the most prevalent mental disorder with growing societal costs. As mental health services demand often outweighs provision, accessible treatment options are needed. Our systematic review and meta-analysis evaluated the clinical efficacy and economic evidence for the use of online cognitive behavioral therapy (oCBT) as an accessible treatment solution for depression. AREAS COVERED Electronic databases were searched for controlled trials published between 2006 and 2016. Of the reviewed 3,324 studies, 29 met the criteria for inclusion in the efficacy meta-analysis. The systematic review identified five oCBT economic evaluations. Therapist-supported oCBT was equivalent to face-to-face CBT at improving depressive symptoms and superior to treatment-as-usual, waitlist control, and attention control. Depression severity, number of sessions, or support did not affect efficacy. From a healthcare provider perspective, oCBT tended to show greater costs with greater benefits in the short term, relative to comparator treatments. EXPERT COMMENTARY Although efficacious, further economic evidence is required to support the provision of oCBT as a cost-effective treatment for depression. Economic evaluations that incorporate a societal perspective will better account for direct and indirect treatment costs. Nevertheless, oCBT shows promise of effectively improving depressive symptoms, considering limited mental healthcare resources.
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Affiliation(s)
- Elayne Ahern
- a Department of Psychology , University of Limerick , Limerick , Ireland
- b Department of Economics , Kemmy Business School, University of Limerick , Limerick , Ireland
| | - Stephen Kinsella
- b Department of Economics , Kemmy Business School, University of Limerick , Limerick , Ireland
| | - Maria Semkovska
- a Department of Psychology , University of Limerick , Limerick , Ireland
- c Health Research Institute , University of Limerick , Limerick , Ireland
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12
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Backenstrass M, Wolf M. Internetbasierte Therapie in der Versorgung von Patienten mit depressiven Störungen: Ein Überblick. ACTA ACUST UNITED AC 2018. [DOI: 10.1024/1661-4747/a000339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Internet- und mobilbasierten Interventionen wird großes Potenzial in der Behandlung von Menschen mit depressiver Symptomatik zugeschrieben. Diese Einschätzung hat sich in den letzten Jahren vor dem Hintergrund mehrerer Programmentwicklungen und einer Vielzahl von Studien zur Wirksamkeitsprüfung der zumeist auf der kognitiven Verhaltenstherapie basierten Angebote etabliert. Ziel der vorliegenden Übersichtsarbeit ist es, zu prüfen, inwieweit sich aus der empirischen Befundlage wissenschaftlich fundierte Empfehlungen für die Versorgungsbereiche Prävention, Primärversorgung, ambulante Psychotherapie, fachärztliche Versorgung sowie die stationäre Behandlung ableiten lassen. Hierfür werden die Ergebnisse ausgewählter Studien, die in den genannten Versorgungsbereichen angesiedelt sind und die Erhebung der Diagnose depressive Störung auf ein Expertenurteil stützen, kritisch bewertet. In der Schlussfolgerung ermöglicht die gegenwärtige Studienlage keine eindeutige Empfehlung zum Einsatz von internetbasierten Behandlungsprogrammen in den genannten Versorgungsbereichen.
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Affiliation(s)
- Matthias Backenstrass
- Institut für Klinische Psychologie, Klinikum Stuttgart, Deutschland, und Psychologisches Institut, Arbeitseinheit für Klinische Psychologie und Psychotherapie, Universität Heidelberg, Deutschland
| | - Markus Wolf
- Psychologisches Institut, Klinische Psychologie mit Schwerpunkt Psychotherapieforschung, Universität Zürich, Schweiz
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Time to remission from mild to moderate depressive symptoms: One year results from the EVIDENT-study, an RCT of an internet intervention for depression. Behav Res Ther 2017; 97:154-162. [DOI: 10.1016/j.brat.2017.07.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 11/24/2022]
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Castro A, López-Del-Hoyo Y, Peake C, Mayoral F, Botella C, García-Campayo J, Baños RM, Nogueira-Arjona R, Roca M, Gili M. Adherence predictors in an Internet-based Intervention program for depression. Cogn Behav Ther 2017; 47:246-261. [PMID: 28871896 DOI: 10.1080/16506073.2017.1366546] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Internet-delivered psychotherapy has been demonstrated to be effective in the treatment of depression. Nevertheless, the study of the adherence in this type of the treatment reported divergent results. The main objective of this study is to analyze predictors of adherence in a primary care Internet-based intervention for depression in Spain. A multi-center, three arm, parallel, randomized controlled trial was conducted with 194 depressive patients, who were allocated in self-guided or supported-guided intervention. Sociodemographic and clinical characteristics were gathered using a case report form. The Mini international neuropsychiatric interview diagnoses major depression. Beck Depression Inventory was used to assess depression severity. The visual analogic scale assesses the respondent's self-rated health and Short Form Health Survey was used to measure the health-related quality of life. Age results a predictor variable for both intervention groups (with and without therapist support). Perceived health is a negative predictor of adherence for the self-guided intervention when change in depression severity was included in the model. Change in depression severity results a predictor of adherence in the support-guided intervention. Our findings demonstrate that in our sample, there are differences in sociodemographic and clinical variables between active and dropout participants and we provide adherence predictors in each intervention condition of this Internet-based program for depression (self-guided and support-guided). It is important to point that further research in this area is essential to improve tailored interventions and to know specific patients groups can benefit from these interventions.
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Affiliation(s)
- Adoración Castro
- a IUNICS-IDISBA , University of Balearic Islands , Palma de Mallorca , Spain.,b Primary Care Prevention and Health Promotion Research Network , RedIAPP , Madrid , Spain
| | - Yolanda López-Del-Hoyo
- b Primary Care Prevention and Health Promotion Research Network , RedIAPP , Madrid , Spain.,c Department of Psychiatry, Hospital Miguel Servet , University of Zaragoza , Zaragoza , Spain
| | - Christian Peake
- d Facultad de Educación, Departamento de Fundamentos de la Pedagogía , Universidad Católica de la Santísima Concepción , Concepción , Chile
| | - Fermín Mayoral
- e Mental Health Department, Institute of Biomedicine of Málaga , University Regional Hospital of Málaga , Málaga , Spain
| | - Cristina Botella
- f Faculty of Health Sciences, Department of Clinical and Basic Psychology and Biopsychology , University Jaume I , Castellon , Spain.,g CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III , Madrid , Spain
| | - Javier García-Campayo
- b Primary Care Prevention and Health Promotion Research Network , RedIAPP , Madrid , Spain.,c Department of Psychiatry, Hospital Miguel Servet , University of Zaragoza , Zaragoza , Spain
| | - Rosa María Baños
- g CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III , Madrid , Spain.,h Department of Psychological, Personality, Evaluation and Treatment , University of Valencia , Valencia , Spain
| | - Raquel Nogueira-Arjona
- i Faculty of Psychology, Department of Personality, Assessment and Psychological Treatments , University of Malaga, Malaga, Spain of Malaga , Malaga , Spain
| | - Miquel Roca
- a IUNICS-IDISBA , University of Balearic Islands , Palma de Mallorca , Spain.,b Primary Care Prevention and Health Promotion Research Network , RedIAPP , Madrid , Spain
| | - Margalida Gili
- a IUNICS-IDISBA , University of Balearic Islands , Palma de Mallorca , Spain.,b Primary Care Prevention and Health Promotion Research Network , RedIAPP , Madrid , Spain
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Zhao D, Lustria MLA, Hendrickse J. Systematic review of the information and communication technology features of web- and mobile-based psychoeducational interventions for depression. PATIENT EDUCATION AND COUNSELING 2017; 100:1049-1072. [PMID: 28126383 DOI: 10.1016/j.pec.2017.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 12/10/2016] [Accepted: 01/07/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To examine the information and communication technology (ICT) features of psychoeducational interventions for depression delivered via the Internet or via mobile technology. METHODS Web- and mobile-based psychoeducational intervention studies published from 2004 to 2014 were selected and reviewed by two independent coders. RESULTS A total of 55 unique studies satisfied the selection criteria. The review revealed a diverse range of ICTs used to support the psychoeducational programs. Most interventions used websites as their main mode of delivery and reported greater use of communication tools compared to effective approaches like tailoring or interactive technologies games, videos, and self-monitoring tools. Many of the studies relied on medium levels of clinician involvement and only a few were entirely self-guided. CONCLUSION Programs that reported higher levels of clinician involvement also reported using more communication tools, and reported greater compliance to treatment. Future experimental studies may help unpack the effects of technology features and reveal new ways to automate aspects of clinician input. PRACTICAL IMPLICATIONS There is a need to further examine ways ICTs can be optimized to reduce the burden on clinicians whilst enhancing the delivery of proven effective therapeutic approaches.
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Affiliation(s)
- Danyang Zhao
- School of Communication, Florida State University, Tallahassee, USA.
| | | | - Joshua Hendrickse
- School of Communication, Florida State University, Tallahassee, USA.
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Mogoașe C, Cobeanu O, David O, Giosan C, Szentagotai A. Internet-Based Psychotherapy for Adult Depression: What About the Mechanisms of Change? J Clin Psychol 2016; 73:5-64. [DOI: 10.1002/jclp.22326] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Karyotaki E, Kleiboer A, Smit F, Turner DT, Pastor AM, Andersson G, Berger T, Botella C, Breton JM, Carlbring P, Christensen H, de Graaf E, Griffiths K, Donker T, Farrer L, Huibers MJH, Lenndin J, Mackinnon A, Meyer B, Moritz S, Riper H, Spek V, Vernmark K, Cuijpers P. Predictors of treatment dropout in self-guided web-based interventions for depression: an 'individual patient data' meta-analysis. Psychol Med 2015; 45:2717-2726. [PMID: 25881626 DOI: 10.1017/s0033291715000665] [Citation(s) in RCA: 204] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND It is well known that web-based interventions can be effective treatments for depression. However, dropout rates in web-based interventions are typically high, especially in self-guided web-based interventions. Rigorous empirical evidence regarding factors influencing dropout in self-guided web-based interventions is lacking due to small study sample sizes. In this paper we examined predictors of dropout in an individual patient data meta-analysis to gain a better understanding of who may benefit from these interventions. METHOD A comprehensive literature search for all randomized controlled trials (RCTs) of psychotherapy for adults with depression from 2006 to January 2013 was conducted. Next, we approached authors to collect the primary data of the selected studies. Predictors of dropout, such as socio-demographic, clinical, and intervention characteristics were examined. RESULTS Data from 2705 participants across ten RCTs of self-guided web-based interventions for depression were analysed. The multivariate analysis indicated that male gender [relative risk (RR) 1.08], lower educational level (primary education, RR 1.26) and co-morbid anxiety symptoms (RR 1.18) significantly increased the risk of dropping out, while for every additional 4 years of age, the risk of dropping out significantly decreased (RR 0.94). CONCLUSIONS Dropout can be predicted by several variables and is not randomly distributed. This knowledge may inform tailoring of online self-help interventions to prevent dropout in identified groups at risk.
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Affiliation(s)
- E Karyotaki
- Department of Clinical psychology,Vu University Amsterdam,Amsterdam,The Netherlands
| | - A Kleiboer
- Department of Clinical psychology,Vu University Amsterdam,Amsterdam,The Netherlands
| | - F Smit
- Department of Clinical psychology,Vu University Amsterdam,Amsterdam,The Netherlands
| | - D T Turner
- Department of Clinical psychology,Vu University Amsterdam,Amsterdam,The Netherlands
| | - A M Pastor
- Department of Psychology and Technology,Jaume University,Castellon,Spain
| | - G Andersson
- Department of Behavioural Sciences and Learning,Sweden Institute for Disability Research,Linköping; University,Sweden
| | - T Berger
- Department of Clinical Psychology and Psychotherapy,University of Bern,Bern,Switzerland
| | - C Botella
- Department of Psychology and Technology,Jaume University,Castellon,Spain
| | - J M Breton
- Department of Psychology and Technology,Jaume University,Castellon,Spain
| | - P Carlbring
- Department of Psychology,Stockholm University,Stockholm,Sweden
| | - H Christensen
- Black Dog Institute and University of New South Wales,Prince of Wales Hospital,Sydney,Australia
| | - E de Graaf
- Department of Clinical Psychological Science,Faculty of Psychology,Maastricht University,The Netherlands
| | - K Griffiths
- National Institute of Mental Health Research,The Australian National University,Sydney,Australia
| | - T Donker
- Department of Clinical psychology,Vu University Amsterdam,Amsterdam,The Netherlands
| | - L Farrer
- National Institute of Mental Health Research,The Australian National University,Sydney,Australia
| | - M J H Huibers
- Department of Clinical psychology,Vu University Amsterdam,Amsterdam,The Netherlands
| | - J Lenndin
- Department of Behavioural Sciences and Learning,Linkoping University,Linkoping,Sweden
| | - A Mackinnon
- Centre for Youth Mental Health Research,University of Melbourne,Melbourne,Australia
| | - B Meyer
- Research Department,Gaia AG,Hamburg,Germany
| | - S Moritz
- Department of Psychiatry and Psychotherapy,University Medical Centre Hamburg-Eppendorf,Hamburg,Germany
| | - H Riper
- Department of Clinical psychology,Vu University Amsterdam,Amsterdam,The Netherlands
| | - V Spek
- Avans Hogeschool,University of Tilburg,Tilburg,The Netherlands
| | - K Vernmark
- Department of Behavioural Sciences and Learning,Linkoping University,Linkoping,Sweden
| | - P Cuijpers
- Department of Clinical psychology,Vu University Amsterdam,Amsterdam,The Netherlands
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Interventions for preventing relapse or recurrence of depression in primary health care settings: A systematic review. Prev Med 2015; 76 Suppl:S16-21. [PMID: 25192769 DOI: 10.1016/j.ypmed.2014.07.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 07/04/2014] [Accepted: 07/23/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE A systematic review was conducted to assess the efficacy of pharmacological and psychological interventions for preventing relapse or recurrence of depression in adults with depression in primary care. METHOD Papers published from inception to January 28th 2014 were identified searching the electronic databases MEDLINE, EMBASE, PsycINFO, and CENTRAL. Randomized controlled trials of any pharmacological, psychological or psychosocial intervention or combination of interventions delivered in primary care settings were included, with relapse or recurrence of a depressive disorder as a main outcome. The Cochrane Collaboration risk of bias tool was used to assess study quality. RESULTS Only three studies with a small number of patients fulfilled the inclusion criteria. None of the three randomized controlled trials included in our review showed a statistically significant superiority of an intervention for the prevention of depression relapse or recurrence. CONCLUSIONS There is limited evidence to inform relapse or recurrence prevention strategies specifically in primary care.
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Abstract
A rather large body of literature now exists on the use of telemental health services in the diagnosis and management of various psychiatric conditions. This review aims to provide an up-to-date assessment of telemental health, focusing on four main areas: computerized CBT (cCBT), Internet-based CBT (iCBT), virtual reality exposure therapy (VRET), and mobile therapy (mTherapy). Four scientific databases were searched and, where possible, larger, better-designed meta-analyses and controlled trials were highlighted. Taken together, published studies support an expanded role for telepsychiatry tools, with advantages that include increased care access, enhanced efficiency, reduced stigma associated with visiting mental health clinics, and the ability to bypass diagnosis-specific obstacles to treatment, such as when social anxiety prevents a patient from leaving the house. Of technology-mediated therapies, cCBT and iCBT possess the most efficacy evidence, with VRET and mTherapy representing promising but less researched options that have grown in parallel with virtual reality and mobile technology advances. Nonetheless, telepsychiatry remains challenging because of the need for specific computer skills, the difficulty in providing patients with a deep understanding or support, concerns about the "therapeutic alliance", privacy fears, and the well documented problem of patient attrition. Future studies should further test the efficacy, advantages and limitations of technology-enabled CBT, as well as explore the online delivery of other psychotherapeutic and psychopharmacological modalities.
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Affiliation(s)
- Elias Aboujaoude
- OCD Clinic, Stanford University School of MedicineStanford, CA, USA
| | - Wael Salame
- Department of Psychiatry, Lebanese American UniversityBeirut, Lebanon
| | - Lama Naim
- Department of Psychiatry, Lebanese American UniversityBeirut, Lebanon
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Overholser JC. Technology-Assisted Psychotherapy (TAP): Adapting Computerized Treatments into Traditional Psychotherapy for Depression. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2013. [DOI: 10.1007/s10879-013-9241-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Richards D, Richardson T. Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev 2012; 32:329-42. [PMID: 22466510 DOI: 10.1016/j.cpr.2012.02.004] [Citation(s) in RCA: 913] [Impact Index Per Article: 76.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 02/03/2012] [Accepted: 02/16/2012] [Indexed: 11/18/2022]
Abstract
The aim of the paper was to systematically review the literature on computer-based psychological treatments for depression and conduct a meta-analysis of the RCT studies, including examining variables which may effect outcomes. Database and hand searches were made using specific search terms and inclusion criteria. The review included a total of 40 studies (45 published papers), and 19 RCTs (23 published papers) were included in a standard meta-analysis. The review describes the different computer-based treatments for depression, their design, communication types employed: synchronous, asynchronous, and face-to-face (F:F); alongside various types and frequency of support delivered. The evidence supports their effectiveness and highlights participant satisfaction. However, pertinent limitations are noted. Across 19 studies the meta-analysis revealed a moderate post-treatment pooled effect size d=.56 (95% confidence interval [CI] -.71, -.41), Z=7.48, p<.001). Supported interventions yielded better outcomes, along with greater retention. The results reported statistically significant clinical improvement and recovery post-treatment. The review and meta-analysis support the efficacy and effectiveness of computer-based psychological treatments for depression, in diverse settings and with different populations. Further research is needed, in particular to investigate the influence of therapist factors in supported treatments, the reasons for dropout, and the maintenance of gains post-treatment.
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Gerhards SAH, Huibers MJH, Theunissen KATM, de Graaf LE, Widdershoven GAM, Evers SMAA. The responsiveness of quality of life utilities to change in depression: a comparison of instruments (SF-6D, EQ-5D, and DFD). VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:732-9. [PMID: 21839412 DOI: 10.1016/j.jval.2010.12.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 10/11/2010] [Accepted: 12/14/2010] [Indexed: 05/25/2023]
Abstract
BACKGROUND Utilities are often a main outcome parameter in economic evaluations. Because depression has a large influence on quality of life, it is expected that utilities are responsive to changes in depression. OBJECTIVE To evaluate the change in utility derived from different instruments in depression, including the Short Form 6D (SF-6D), the Euroqol based on the UK (EQ-5D(UK)), the Euroqol based on the Dutch tariff (EQ-5D(NL)), and utilities derived from Beck Depression Inventory Second Edition (BDI-II) using the Depression-Free-Day method. METHOD This study evaluated the responsiveness, the minimally important difference, and the agreement in utility change derived from the different instruments. RESULTS The SF-6D, EQ-5D(UK), and EQ-5D(NL) were responsive. The minimally important difference values are in line with previous studies, about 0.3. The Depression-Free-Day method nearly always resulted in positive utility changes, even for subgroups that had no change or deterioration in health status or depression. There was poor agreement between utility changes of the SF-6D, EQ-5D (either EQ-5D(UK) or EQ-5D(NL)), and DFDu. CONCLUSIONS The SF-6D, EQ-5D(UK), and EQ-5D(NL) seem responsive and thus adequate for estimating utility in depression treatment. We do not recommend the use of the Depression-Fee-Day method. The low agreement between utility changes indicates that outcomes of the different instruments are incomparable.
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Affiliation(s)
- Sylvia A H Gerhards
- Department of Clinical Psychological Science, Faculty of Psychology, Maastricht University, The Netherlands.
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Gerhards SAH, Abma TA, Arntz A, de Graaf LE, Evers SMAA, Huibers MJH, Widdershoven GAM. Improving adherence and effectiveness of computerised cognitive behavioural therapy without support for depression: a qualitative study on patient experiences. J Affect Disord 2011; 129:117-25. [PMID: 20889214 DOI: 10.1016/j.jad.2010.09.012] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 09/14/2010] [Accepted: 09/14/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Several studies have evaluated the efficacy and effectiveness of computerized cognitive behavioural therapy (CCBT) for depression, but research on the patient perspective is limited. AIMS To gain knowledge on patient experiences with the online self-help CCBT program Colour Your Life (CYL) for depression, and find explanations for the low treatment adherence and effectiveness. METHOD Qualitative data were collected through semi-structured interviews with 18 patients. Interviewees were selected from a CCBT trial. An inductive, content analysis of the interviews was performed. RESULTS The main theme throughout the interviews concerns barriers and motivators experienced with CCBT. The most important barriers included experiences of a lack of identification with and applicability of CCBT-CYL, lack of support to adhere with the program or to gain deeper understanding, and inadequate computer/Internet skills, equipment, or location. Confusion between CCBT and Internet questionnaires resulted in no CCBT uptake of some study participants. Motivators included experiencing self-identification and improvement through CCBT-CYL, participating in a scientific study, and the freedom and anonymity associated with online computer self-help. The addition of support to CCBT was suggested as an improvement towards adherence and the course content. CONCLUSION The CCBT program CYL in its current form does not work for a large group of people with depressive symptoms. More tailoring, the provision of support (professional or lay) and good computer conditions could improve CCBT.
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Affiliation(s)
- S A H Gerhards
- Department of Clinical Psychological Science, Faculty of Psychology, Maastricht University, The Netherlands.
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