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Lyons GA, Zettle RD, Petts RA. Investigating Determinants of Client Psychotherapy Preference: An Analog Study. J Cogn Psychother 2024; 38:227-242. [PMID: 38991741 DOI: 10.1891/jcp-2022-0041] [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] [Indexed: 07/13/2024]
Abstract
Increased emphasis has been placed on elucidating the contribution of client variables, such as treatment preference, to optimize evidence-based practice. This analog study sought to better understand variables associated with treatment preference using a convenience sample of college students (n = 54) who read brief descriptions of three interventions for negative thoughts-defusion, noticing, and restructuring. They rated each on acceptability and practicality and completed measures of cognitive fusion, emotional distress, and experiential avoidance as possible moderating variables. Restructuring was overwhelmingly preferred and rated as more acceptable than the two alternatives by both the overall sample and a distressed subsample. Preference for defusion or noticing was not predicted by ratings of acceptability or practicality but by elevated levels of cognitive fusion and emotional distress consistent with a compensation model. Limitations of the study and its implications for further research on psychotherapy preference and its integration within evidence-based practice are discussed.
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Affiliation(s)
- Grace A Lyons
- Department of Psychology, Wichita State University, Wichita, KS, USA
| | - Robert D Zettle
- Department of Psychology, Wichita State University, Wichita, KS, USA
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Dworschak C, Heim E, Kuhn N, Schwager J, Tröster A, Maercker A. User-centered development of an internet-based CBT intervention for the treatment of loneliness in older individuals. Internet Interv 2024; 35:100720. [PMID: 38328277 PMCID: PMC10847952 DOI: 10.1016/j.invent.2024.100720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/18/2023] [Accepted: 01/30/2024] [Indexed: 02/09/2024] Open
Abstract
Background Loneliness is a widespread phenomenon associated with a number of negative health outcomes. Older individuals may constitute one important target group with a need for effective interventions. However, despite evidence showing that addressing maladaptive social cognition (e.g., via cognitive behavioral therapy [CBT]) is the most effective intervention strategy for reducing loneliness, most existing programs aimed at older individuals do not use that method. Further, in terms of mental health service use, older individuals have been found to be an extremely undertreated population. When developing interventions, active involvement of end users in the development process is essential to increase later uptake. Objective The aim of the present study was to develop an internet-based CBT intervention for loneliness in older individuals (i.e., aged ≥65 years) applying a user-centered design. The present report provides an in-depth description of the development process. Methods Two phases of qualitative data collection were conducted in parallel with intervention development using a sample of N = 12 participants including both potential end users (i.e., older adults) as well as experts (i.e., psychotherapists). Measures included semi-structured interviews and usability testing. Results In Phase 1 interviews, participants indicated that they were predominantly positive about the idea of an internet-based program for loneliness targeting older individuals. Individualization and interactivity were named as crucial features. In Phase 2, usability testing of a prototype program provided important insights into technical barriers to intervention use. Further, participants reported that they were missing content on philosophy/theology and the role of descendants/relatives. Valuable insights from Phase 1 and Phase 2 were incorporated into the intervention program resulting in a 7-module internet-based self-help CBT intervention. Discussion Findings of this study highlight the significance of including relevant stakeholders in the development process of an intervention. Additionally, results emphasize the high acceptance of internet-based interventions in this population, but also underline the need for considering age-specific aspects when developing treatments.
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Affiliation(s)
- Christine Dworschak
- University of Zurich, Department of Psychology, Binzmühlestrasse 14/17, 8050 Zurich, Switzerland
- University Research Priority Program “Dynamics of Healthy Aging”, University of Zurich, Switzerland
| | - Eva Heim
- University of Lausanne, Department of Psychology, Quartier UNIL-Mouline, 1015 Lausanne, Switzerland
| | - Nadine Kuhn
- University of Zurich, Department of Psychology, Binzmühlestrasse 14/17, 8050 Zurich, Switzerland
| | - Jessica Schwager
- University of Zurich, Department of Psychology, Binzmühlestrasse 14/17, 8050 Zurich, Switzerland
| | - Alicia Tröster
- University of Zurich, Department of Psychology, Binzmühlestrasse 14/17, 8050 Zurich, Switzerland
| | - Andreas Maercker
- University of Zurich, Department of Psychology, Binzmühlestrasse 14/17, 8050 Zurich, Switzerland
- University Research Priority Program “Dynamics of Healthy Aging”, University of Zurich, Switzerland
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3
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Olagoke A, Hebert-Beirne J, Floyd B, Caskey R, Boyd A, Molina Y. The effectiveness of a religiously framed HPV vaccination message among Christian parents of unvaccinated adolescents in the United States. JOURNAL OF COMMUNICATION IN HEALTHCARE 2023; 16:215-224. [PMID: 37401883 DOI: 10.1080/17538068.2023.2171613] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND The uptake of the human papillomavirus (HPV) vaccines has been controversial among religious parents due to beliefs that their children are expected to practice sexual purity and so do not need protection from a sex-related infection. Also, if at all they get infected in the future, God can protect them from sickness without a vaccine. Yet, most HPV vaccination messages are secular, lacking spiritual themes. This study compared the effectiveness of the Centers for Disease Control and Prevention (CDC) Vaccine Information Statement (VIS) on HPV with our intervention message- a scripture-embedded HPV vaccination message (using a randomized controlled trial design) on vaccination intention. METHODS The study was conducted online. Participants were 342 Christian parents (from any denomination) of unvaccinated adolescents aged 11-17 years. The intervention message used the Cognitive Metaphor Theory to map the constructs of the Biblical story of Noah and the Ark to HPV vaccination. We framed Noah as the parents, the flood as HPV, and the ark as the vaccination. Multiple linear regression was used to analyze the changes in vaccination intention before and after the intervention. RESULTS Our findings showed that parents who received the scripture-embedded message reported a higher intention to vaccinate their children than those who received the CDC VIS (β= 0.31, 95% confidence interval [95%CI] = 0.11-0.52; p=0.003). CONCLUSION Our findings support the need for equitable messaging regarding HPV vaccination. Faith-based messaging interventions that seek to increase HPV vaccination should be framed to address religious anti-vaccination beliefs.
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Affiliation(s)
- Ayokunle Olagoke
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA
| | | | - Brenikki Floyd
- Division of Community Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Rachel Caskey
- Division of Community Health Sciences, University of Illinois Chicago, Chicago, IL, USA
- Sections of General Internal Medicine and Pediatrics, University of Illinois, Chicago, IL, USA
- University of Illinois, Chicago Cancer Center, Chicago, IL, USA
| | - Andrew Boyd
- Department of Biomedical and Health Information Science, University of Illinois, Chicago, IL, USA
| | - Yamilé Molina
- Division of Community Health Sciences, University of Illinois Chicago, Chicago, IL, USA
- University of Illinois, Chicago Cancer Center, Chicago, IL, USA
- Center for Research on Women and Gender, College of Medicine, University of Illinois, Chicago, IL, USA
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Inhibitory Learning-Based Exposure Therapy for Patients With Pathological Health Anxiety: Results From a Single Case Series Study. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Do You Mind? Examining the Impact of Psychoeducation Specificity on Perceptions of Mindfulness-Based Programs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159621. [PMID: 35954975 PMCID: PMC9368431 DOI: 10.3390/ijerph19159621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/21/2022] [Accepted: 07/29/2022] [Indexed: 12/10/2022]
Abstract
Objective: Mindfulness-based programs (MBPs) cultivate the capacity for mindfulness, defined as nonjudgmental acceptance and awareness of present-moment experience. Mindfulness has been associated with a host of benefits for users, such as improved indices of mental well-being. We examined public perceptions of acceptability (i.e., how appropriate the treatment is for a given problem) and credibility (i.e., how logical and convincing a treatment seems) of MBPs as a form of mental health intervention. The main objective of this study was to examine whether higher specificity of psychoeducational content improved perceptions of the acceptability and credibility of MBPs. Methods: Participants (n = 188; female% = 39.4) were recruited online and randomly assigned to one of two conditions. In one condition, participants received balanced and evidence-based psychoeducation specific to MBPs for mental health. In the other condition, participants received general information about psychological treatments for mental health. Acceptability and credibility perceptions were measured by questionnaires across time (pre-and post-psychoeducation) and across specificity conditions (specific vs. general psychoeducation). Results: Participants randomized to the general, but not the specific, psychoeducation-endorsed higher scores of acceptability of MBPs post-psychoeducation. Further, participants endorsed higher scores of MBP credibility post-psychoeducation, regardless of the specificity of psychoeducation provided. Conclusions: Perceptions of the acceptability of MBPs were improved following exposure to general psychoeducation, and perceptions of the credibility of MBPs were improved following psychoeducation, regardless of specificity. Examining public perceptions of MBPs is important for informing strategies to support access to and use of MBPs.
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Olagoke AA, Floyd B, Caskey R, Hebert-Beirne J, Boyd AD, Molina Y. Disentangling the Role of Religiosity in Human Papillomavirus Vaccination Amidst COVID-19 Pandemic. JOURNAL OF RELIGION AND HEALTH 2022; 61:1734-1749. [PMID: 35112233 PMCID: PMC8810213 DOI: 10.1007/s10943-021-01490-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
Religion is a complex and sociocultural driver of human papillomavirus (HPV) vaccination decisions, but its exact role has been mixed/unclear. We used a cross-sectional study of 342 Christian parents to examine the associations between the three domains of religiosity (organizational, non-organizational, and intrinsic) and the intention to (i) seek HPV information and (ii) receive the HPV vaccine. Organizational religiosity was the only domain that was positively associated with information-seeking intention regardless of the type of covariates included. Mixed findings in the association between religiosity and HPV vaccination decisions may depend on the religiosity domain being assessed.
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Affiliation(s)
- Ayokunle A Olagoke
- Health Communication Research Laboratory, The Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA.
| | - Brenikki Floyd
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Rachel Caskey
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Jennifer Hebert-Beirne
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Andrew D Boyd
- Department of Biomedical and Health Information Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Yamile Molina
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
- Center for Research on Women and Gender, College of Medicine, University of Illinois, Chicago, IL, USA
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Seewer N, Skoko A, Käll A, Andersson G, Luhmann M, Berger T, Krieger T. Evaluation of the Efficacy of Two Internet-based Self-help Interventions for Chronic Loneliness: Study Protocol for a Three-arm Randomized Controlled Trial (Preprint). JMIR Res Protoc 2022; 11:e36358. [PMID: 35867403 PMCID: PMC9356337 DOI: 10.2196/36358] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Loneliness, or perceived social isolation, is prevalent in both the general population and clinical practice. Although loneliness has repeatedly been associated with mental and physical health, research on interventions that reduce loneliness effectively is still rather scarce. Objective This study aims to evaluate the efficacy of a guided and an unguided version of the same internet-based cognitive behavioral self-help program for loneliness (SOLUS-D) for adults. Methods A total of 250 participants will be randomly assigned to 1 of 2 intervention groups (SOLUS-D with guidance or SOLUS-D without guidance) or a wait-list control group (2:2:1 allocation ratio). Adult participants experiencing high levels of loneliness will be recruited from the general population. Individuals currently experiencing at least moderately severe depressive symptoms, an ongoing severe substance use disorder, previous or current bipolar or psychotic disorder, or acute suicidality will be excluded from the trial. Assessments will take place at baseline, 5 weeks (midassessment), and 10 weeks (postassessment). The primary outcome is loneliness assessed using the 9-item University of California, Los Angeles Loneliness Scale at the posttreatment time point. Secondary outcomes include depressive symptoms, symptoms of social anxiety, satisfaction with life, social network size, and variables assessing cognitive bias and social behavior. The maintenance of potentially achieved gains will be assessed and compared at 6 and 12 months after randomization in the 2 active conditions. Potential moderators and mediators will be tested exploratorily. Data will be analyzed on an intention-to-treat basis. Results Recruitment and data collection started in May 2021 and are expected to be completed by 2022, with the 12-month follow-up to be completed by 2023. As of the time of submission of the manuscript, 134 participants were randomized. Conclusions This 3-arm randomized controlled trial will add to the existing research on the efficacy of loneliness interventions. Furthermore, it will shed light on the role of human guidance in internet-based treatments for individuals with increased levels of loneliness and the possible mechanisms of change. If SOLUS-D proves effective, it could provide a low-threshold, cost-efficient method of helping and supporting individuals with increased levels of loneliness. Trial Registration ClinicalTrials.gov NCT04655196; https://clinicaltrials.gov/ct2/show/NCT04655196 International Registered Report Identifier (IRRID) DERR1-10.2196/36358
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Affiliation(s)
- Noëmi Seewer
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Andrej Skoko
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Anton Käll
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Maike Luhmann
- Faculty of Psychology, Ruhr University Bochum, Bochum, 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
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Goonesekera Y, Donkin L. A Cognitive Behavior Therapy Chatbot (Otis) for Health Anxiety Management: A Mixed-Methods Pilot Study (Preprint). JMIR Form Res 2022; 6:e37877. [PMID: 36150049 PMCID: PMC9586257 DOI: 10.2196/37877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 09/01/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background An increase in health anxiety was observed during the COVID-19 pandemic. However, due to physical distancing restrictions and a strained mental health system, people were unable to access support to manage health anxiety. Chatbots are emerging as an interactive means to deliver psychological interventions in a scalable manner and provide an opportunity for novel therapy delivery to large groups of people including those who might struggle to access traditional therapies. Objective The aim of this mixed methods pilot study was to investigate the feasibility, acceptability, engagement, and effectiveness of a cognitive behavioral therapy (CBT)–based chatbot (Otis) as an early health anxiety management intervention for adults in New Zealand during the COVID-19 pandemic. Methods Users were asked to complete a 14-day program run by Otis, a primarily decision tree–based chatbot on Facebook Messenger. Health anxiety, general anxiety, intolerance of uncertainty, personal well-being, and quality of life were measured pre-intervention, postintervention, and at a 12-week follow-up. Paired samples t tests and 1-way ANOVAs were conducted to investigate the associated changes in the outcomes over time. Semistructured interviews and written responses in the self-report questionnaires and Facebook Messenger were thematically analyzed. Results The trial was completed by 29 participants who provided outcome measures at both postintervention and follow-up. Although an average decrease in health anxiety did not reach significance at postintervention (P=.55) or follow-up (P=.08), qualitative analysis demonstrated that participants perceived benefiting from the intervention. Significant improvement in general anxiety, personal well-being, and quality of life was associated with the use of Otis at postintervention and follow-up. Anthropomorphism, Otis’ appearance, and delivery of content facilitated the use of Otis. Technical difficulties and high performance and effort expectancy were, in contrast, barriers to acceptance and engagement of Otis. Conclusions Otis may be a feasible, acceptable, and engaging means of delivering CBT to improve anxiety management, quality of life, and personal well-being but might not significantly reduce health anxiety.
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Affiliation(s)
- Yenushka Goonesekera
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Liesje Donkin
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
- Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
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Perski O, Short CE. Acceptability of digital health interventions: embracing the complexity. Transl Behav Med 2021; 11:1473-1480. [PMID: 33963864 PMCID: PMC8320880 DOI: 10.1093/tbm/ibab048] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Acceptability is a core concept in digital health. Available frameworks have not clearly articulated why and how researchers, practitioners and policy makers may wish to study the concept of acceptability. Here, we aim to discuss (i) the ways in which acceptability might differ from closely related concepts, including user engagement; (ii) the utility of the concept of acceptability in digital health research and practice; (iii) social and cultural norms that influence acceptability; and (iv) pragmatic means of measuring acceptability, within and beyond the research process. Our intention is not to offer solutions to these open questions but to initiate a debate within the digital health community. We conducted a narrative review of theoretical and empirical examples from the literature. First, we argue that acceptability may usefully be considered an emergent property of a complex, adaptive system of interacting components (e.g., affective attitude, beliefs), which in turn influences (and is influenced by) user engagement. Second, acceptability is important due to its ability to predict and explain key outcomes of interest, including user engagement and intervention effectiveness. Third, precisely what people find acceptable is deeply contextualized and interlinked with prevailing social and cultural norms. Understanding and designing for such norms (e.g., through drawing on principles of user centered design) is therefore key. Finally, there is a lack of standard acceptability measures and thresholds. Star ratings coupled with free-text responses may provide a pragmatic means of capturing acceptability. Acceptability is a multifaceted concept, which may usefully be studied with a complexity science lens.
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Affiliation(s)
- Olga Perski
- Department of Behavioural Science and Health, University College London, London, UK
| | - Camille E Short
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
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Johnsen HM, Haddeland K. User evaluation of a therapist-guided internet-delivered treatment program for anxiety disorders: A qualitative study. Internet Interv 2021; 25:100389. [PMID: 33996506 PMCID: PMC8091870 DOI: 10.1016/j.invent.2021.100389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/27/2021] [Accepted: 04/12/2021] [Indexed: 11/25/2022] Open
Abstract
Therapist-guided internet-based cognitive behaviour therapy (ICBT) has been proposed as a potential means to increase individuals' access to quality mental health care and effective treatment. Guided ICBT aims to increase a patient's knowledge and competence to better cope with their disorder. Despite the growing evidence supporting the effects of guided ICBT, there is remarkably little research on the different factors that are important for patients to achieve effects from using such digital treatment interventions. Thus, the aim of this study was to conduct a user evaluation of a therapist-guided ICBT program using the updated DeLone and McLean (D&M) model for measuring information systems (IS) success or effectiveness. This model includes the following six dimensions: system quality, information quality, service quality, intention to use and use, user satisfaction, and net benefits (impacts or effect). Ten users of a Norwegian therapist-guided ICBT program for treating anxiety disorders named 'Assisted Self-Help' (Assistert Selvhjelp) participated in phone-based individual interviews. Data were analysed using directed content analysis. Results showed that the participants were quite satisfied with the program's system quality and information quality. However, participants suggested improvements, including in-program instruction, improved visibility of system status, more flexibility regarding automated measurement surveys, and the inclusion of more videos with patient stories. Further, the results indicated a need for improvement in the service quality of guided ICBT introduction, instruction, follow-up, guidance, and support from therapists. The results showed that user friendliness and high educational content might not be sufficient for a therapist-guided ICBT program to be perceived as effective. It might also be necessary for therapists to provide follow-up, guidance, and support that are more in line with individual patient needs. Thus, the results suggest that guided ICBT requires active participation from all involved in the process, including the therapist.
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Affiliation(s)
- Hege Mari Johnsen
- Corresponding author at: Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, PO Box 509, 4898 Grimstad, Norway.
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Evoy KE, Covvey JR, Peckham AM, Reveles KR. Gabapentinoid misuse, abuse and non-prescribed obtainment in a United States general population sample. Int J Clin Pharm 2021; 43:1055-1064. [PMID: 33387188 DOI: 10.1007/s11096-020-01217-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/08/2020] [Indexed: 11/24/2022]
Abstract
Background Reports of gabapentinoid (gabapentin and pregabalin) misuse are on the rise, but few studies have assessed this within the general US population. Objective Describe lifetime misuse/abuse/non-prescribed obtainment of gabapentinoids and descriptive characteristics associated with such actions in a US general population sample. Setting This cross-sectional questionnaire was administered online by Qualtrics® research panel aggregator via quota-based sampling. Methods Data were collected from a sample of respondents that mirrored the general US population aged 18-59 years with regards to age, geographic region, ethnicity, income, and education level, based on most recent census data. Misuse/abuse/non-prescribed obtainment was collectively defined as use of a gabapentinoid for reasons other than a diagnosed medical condition, using with the intention of altering one's state of consciousness, or obtaining without a prescription. A multivariable logistic regression model was created to predict misuse/abuse/non-prescribed obtainment of gabapentinoids, incorporating relevant covariates. Main outcome measure Proportion of sample indicating lifetime misuse/abuse/non-prescribed obtainment of gabapentinoids. Results Among 1,843 respondents, 121 (6.6%) reported gabapentinoid misuse/abuse/non-prescribed obtainment. Specifically, 2.1% (n = 39) and 1.5% (n = 27) of respondents for gabapentin and pregabalin, respectively, met study criteria for abuse. Opioids were the most common medication co-administered with gabapentinoids (among 50-70% of respondents) for misuse/abuse. Previous treatment for addiction (OR: 2.61, 95% CI: 1.32-5.14, p = 0.005) and the total attitudinal risk score (OR: 1.14, 95% CI: 1.09-1.19, p < 0.001) were associated with gabapentinoid misuse/abuse/non-prescribed obtainment. Conclusion Among those surveyed, 6.6% reported previous gabapentinoid misuse/abuse/non-prescribed obtainment, providing one of the first estimates within a nationally distributed, US general population sample.
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Affiliation(s)
- Kirk E Evoy
- The University of Texas At Austin College of Pharmacy, 7703 Floyd Curl Dr. - MC 6220, San Antonio, TX, 78229, USA. .,University Health System, San Antonio, TX, USA. .,The University of Texas Health San Antonio School of Medicine, 7703 Floyd Curl Dr. MC - 6220, San Antonio, TX, 78229, USA.
| | - Jordan R Covvey
- Duquesne University School of Pharmacy, 600 Forbes Avenue, 418 Mellon Hall, Pittsburgh, PA, 15282, USA
| | - Alyssa M Peckham
- School of Pharmacy, Northeastern University, Bouvé College of Health Sciences, 360 Huntington Ave, Boston, MA, R218 TF02115, USA.,Department of Pharmacy, Massachusetts General Hospital, 360 Huntington Ave, Boston, MA, R218 TF02115, USA
| | - Kelly R Reveles
- The University of Texas At Austin College of Pharmacy, 7703 Floyd Curl Dr. - MC 6220, San Antonio, TX, 78229, USA.,The University of Texas Health San Antonio School of Medicine, 7703 Floyd Curl Dr. MC - 6220, San Antonio, TX, 78229, USA
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12
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Treatment barriers, preferences and histories of individuals with symptoms of body dysmorphic disorder. Behav Cogn Psychother 2020; 49:582-595. [PMID: 33161929 DOI: 10.1017/s1352465820000843] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Individuals with mental health concerns face many barriers when accessing psychological treatment. Even when patients overcome these barriers, they often do not receive an evidence-based treatment. Although the current literature highlights these issues clearly across psychological disorders, the research is limited in relation to body dysmorphic disorder (BDD). AIM The aim of this study was to examine psychological treatment barriers, treatment delivery preferences and treatment histories of individuals with symptoms of BDD. METHOD A total of 122 participants with clinically significant BDD symptoms (94% female; mean age = 34.19 years, SD = 10.86) completed the cross-sectional study. RESULTS The most frequently reported barriers to accessing psychological treatment for individuals with BDD symptoms were the cost of treatment (41%) and the belief that the symptoms did not warrant treatment (36%). Although 69% of treatment-seeking participants reported previously receiving cognitive behavioural therapy (CBT) for BDD, only 13% of participants appeared to receive best-practice CBT. The preferred modality of future psychological treatment delivery was face-to-face treatment with a therapist once a week (63%), rather than accelerated or remote treatment approaches. CONCLUSIONS The study suggests that there are significant barriers to accessing CBT for BDD. Reducing these barriers, as well as increasing consumer mental health literacy, is required to improve treatment access and treatment outcomes for individuals with BDD.
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McCall HC, Sison AP, Burnett JL, Beahm JD, Hadjistavropoulos HD. Exploring Perceptions of Internet-Delivered Cognitive Behaviour Therapy among Public Safety Personnel: Informing Dissemination Efforts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176026. [PMID: 32824994 PMCID: PMC7503620 DOI: 10.3390/ijerph17176026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 11/16/2022]
Abstract
Background Public safety personnel (PSP) experience high rates of mental health disorders but have limited access to treatment. To improve treatment access, there is a growing interest in offering internet-delivered cognitive behaviour therapy (ICBT) to PSP. As attitudes towards ICBT can both impact and inform ICBT implementation efforts, this study examines perceptions of ICBT among PSP who viewed a poster (a commonly used method of advertising ICBT) or a poster supplemented with a story of a PSP who benefitted from ICBT. Methods Participants (N = 132) from various PSP sectors were randomly assigned to view a poster or a poster and a story. Participants then completed an online survey assessing their perceptions of ICBT using both qualitative and quantitative questions. We used a mixed-methods approach to analyze the data. Results No differences in perceptions of ICBT were identified between the conditions. Ratings of credibility, treatment expectancy, anticipated treatment adherence, and acceptability suggested that PSP had positive perceptions of ICBT. Most participants (93%) reported that they would access ICBT if they needed help with mental health concerns. Participants ranked therapist-guided ICBT as their second most preferred treatment, with psychologists ranked first. Female participants found ICBT more credible than male participants. More experienced PSP reported lower acceptability and anticipated adherence to ICBT. Conclusions The findings suggest that many PSP are likely to be receptive to ICBT even when a simple poster is used as a method of informing PSP of this treatment option. Further attention to improving the perceptions of ICBT among certain groups may be warranted.
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Affiliation(s)
- Hugh C. McCall
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; (H.C.M.); (A.P.S.); (J.L.B.); (J.D.B.)
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Angelo P. Sison
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; (H.C.M.); (A.P.S.); (J.L.B.); (J.D.B.)
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Jody L. Burnett
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; (H.C.M.); (A.P.S.); (J.L.B.); (J.D.B.)
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Janine D. Beahm
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; (H.C.M.); (A.P.S.); (J.L.B.); (J.D.B.)
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Heather D. Hadjistavropoulos
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; (H.C.M.); (A.P.S.); (J.L.B.); (J.D.B.)
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
- Correspondence:
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14
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Covvey JR, Vogel SM, Peckham AM, Evoy KE. Prevalence and characteristics of self-reported kratom use in a representative US general population sample. J Addict Dis 2020; 38:506-513. [PMID: 32657217 DOI: 10.1080/10550887.2020.1788914] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Reports of kratom (Mitragyna speciosa) use, a medicinal plant widely found in Southeast Asia, are on the rise in the US. However, the prevalence and characteristics of individuals who use kratom in the US is unknown. OBJECTIVE To estimate lifetime prevalence of, and descriptive characteristics associated with, kratom use in a sample of the US general population. METHODS A cross-sectional survey was administered online by Qualtrics® research panel aggregator. Utilizing quota-based sampling, data was collected from a US sample aged 18-59 years, representative to age, geographic region, ethnicity, income, and education level. Data was collected regarding respondent demographic/clinical characteristics, as well as frequency/patterns of kratom and other drug use. RESULTS Among 1,842 respondents, 112 (6.1%) reported use of kratom within their lifetime. Respondents who used kratom were largely between 25-44 years old, male, employed, and at higher educational levels. A total of 24.1% to 47.3% of respondents indicated self-reported diagnoses for addiction, and 42.9% reported having previously received treatment for addiction. A total of 71.4% to 92% of respondents who used kratom also reported use of other drugs, including nicotine, cannabis, cocaine, ecstasy, methamphetamine, and heroin. CONCLUSIONS To our knowledge, this analysis provides the first estimate of kratom use in the general US population, providing insight on demographic/clinical characteristics of individuals reporting use.
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Affiliation(s)
- Jordan R Covvey
- Division of Pharmaceutical, Administrative and Social Sciences, School of Pharmacy, Duquesne University, Pittsburgh, PA, USA
| | - Samantha M Vogel
- Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA.,Dell Medical School, UT Health Austin, Austin, TX, USA
| | - Alyssa M Peckham
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA.,Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Kirk E Evoy
- Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA.,Southeast Clinic, University Health System, San Antonio, TX, USA.,Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA
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15
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Käll A, Jägholm S, Hesser H, Andersson F, Mathaldi A, Norkvist BT, Shafran R, Andersson G. Internet-Based Cognitive Behavior Therapy for Loneliness: A Pilot Randomized Controlled Trial. Behav Ther 2020; 51:54-68. [PMID: 32005340 DOI: 10.1016/j.beth.2019.05.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/30/2019] [Accepted: 05/01/2019] [Indexed: 01/08/2023]
Abstract
Loneliness has been described as a common source of discomfort based on a subjective discrepancy between the actual and desired social situation. For some people this feeling may become a sustained state that is associated with a wide range of psychiatric and psychosocial problems. While there are few existing treatment protocols, interventions based on cognitive behavioral therapy (CBT) have shown positive effects. The current study investigated the efficacy of an 8-week internet-based treatment containing CBT components aimed at reducing feelings of loneliness. Seventy-three participants were recruited from the general public and randomly allocated to treatment or a wait-list control condition. Participants were assessed with standardized self-report measures of loneliness, depression, social anxiety, worry, and quality of life at pretreatment and posttreatment. Robust linear regression analysis of all randomized participants showed significant treatment effects on the primary outcome measure of loneliness (between group Cohen's d = 0.77), and on secondary outcomes measuring quality of life and social anxiety relative to control at postassessment. The results suggest the potential utility of internet-based CBT in alleviating loneliness but more research on the long-term effects and the mechanisms underlying the effects is needed.
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16
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Elson TD, Heinrich SR, Richards JF, Wirawan RY, Shepard DS. Cost-benefit analysis of an employee assistance program for a geographically dispersed workforce in South Australia. JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 2019. [DOI: 10.1080/15555240.2019.1676161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Tony D. Elson
- Public Policy Program, Carnegie Mellon University, Adelaide, Australia
| | - Susan R. Heinrich
- Public Policy Program, Carnegie Mellon University, Adelaide, Australia
| | - Jane F. Richards
- People and Culture Division, South Australia Department for Education, Adelaide, Australia
| | - Rama Y. Wirawan
- Public Policy Program, Carnegie Mellon University, Adelaide, Australia
| | - Donald S. Shepard
- Public Policy Program, Carnegie Mellon University, Adelaide, Australia
- American Studies, Flinders University, Adelaide, Australia
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
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17
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Tuazon VE, Gonzalez E, Gutierrez D, Nelson L. Colonial Mentality and Mental Health Help‐Seeking of Filipino Americans. JOURNAL OF COUNSELING AND DEVELOPMENT 2019. [DOI: 10.1002/jcad.12284] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Edith Gonzalez
- School Psychology and Counselor Education, College of William & Mary
- Now at Department of Counseling, Texas A&M University–Commerce
| | - Daniel Gutierrez
- School Psychology and Counselor Education, College of William & Mary
| | - Lotes Nelson
- Clinical Mental Health Counseling Department, Southern New Hampshire University
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18
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What do you really need? Self- and partner-reported intervention preferences within cognitive behavioural therapy for reassurance seeking behaviour. Behav Cogn Psychother 2019; 48:25-37. [DOI: 10.1017/s135246581900050x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Reassurance seeking (RS) in obsessive compulsive disorder (OCD) is commonly addressed in cognitive behavioural therapy (CBT) using a technique called reducing accommodation. Reducing accommodation is a behaviourally based CBT intervention that may be effective; however, there is a lack of controlled research on its use and acceptability to clients/patients, and case studies suggest that it can be associated with negative emotional/behavioural consequences. Providing support to encourage coping with distress is a cognitively based CBT intervention that may be an effective alternative, but lacks evidence regarding its acceptability.Aims:This study aimed to determine whether support provision may be a more acceptable/endorsed CBT intervention for RS than a strict reducing accommodation approach.Method:Participants and familiar partners (N = 179) read vignette descriptions of accommodation reduction and support interventions, and responded to measures of perceived intervention acceptability/adhereability and endorsement, before completing a forced-choice preference task.Results:Overall, findings suggested that participants and partners gave significantly higher ratings for the support than the accommodation reduction intervention (partial η2 = .049 to .321). Participants and partners also both selected the support intervention more often than the traditional reducing accommodation intervention when given the choice.Conclusions:Support provision is perceived as an acceptable CBT intervention for RS by participants and their familiar partners. These results have implications for cognitive behavioural theory and practice related to RS.
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19
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Hoffmann D, Rask CU, Hedman-Lagerlöf E, Eilenberg T, Frostholm L. Accuracy of self-referral in health anxiety: comparison of patients self-referring to internet-delivered treatment versus patients clinician-referred to face-to-face treatment. BJPsych Open 2019; 5:e80. [PMID: 31496462 PMCID: PMC6737511 DOI: 10.1192/bjo.2019.54] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 06/28/2019] [Accepted: 06/28/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Severe health anxiety is a chronic and costly disorder if untreated. Patient self-referral may lower barriers to treatment and decrease diagnostic delay. AIMS This study evaluated the accuracy of self-referral for severe health anxiety and compared characteristics of patients self-referred to internet-delivered treatment with patients referred by a clinician to face-to-face treatment. METHOD Two trials in the same clinic employed different referral methods for health anxiety, namely self-referral and clinician-referral (trial registration: clinicaltrials.gov: NCT01158430 and NCT02735434). The trials were conducted at different time points but with largely comparable eligibility criteria. The accuracy of the recruitment methods was compared by looking at the number of eligible patients in the two trials. Patients completed a baseline questionnaire and subsequently underwent a diagnostic interview by experienced clinicians. Mean differences in self-report and clinical data explored between-group demographic and clinical characteristics. RESULTS In total, 101/151 (67%) self-referred patients were eligible compared with 126/254 (50%) clinician-referred patients (P = 0.001). Self-referred patients were 3.4 years older (P = 0.008) and had a somewhat higher educational level (P = 0.030). Patients who self-referred reported significantly higher levels of health anxiety, emotional distress and somatic symptoms compared with clinician-referred patients. Yet, they had less clinician-assessed comorbid anxiety disorders (P<0.001) and better physical health-related quality of life (P<0.001) suggesting a more distinct symptom profile. CONCLUSIONS Self-referral was found to be an accurate method to recruit highly relevant patients with treatment-demanding health anxiety. Thus, both self-referral and clinician-referral seem feasible and valid referral methods, but they may recruit patients with slightly different characteristics. DECLARATION OF INTEREST None.
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Affiliation(s)
- Ditte Hoffmann
- Postdoctoral Researcher, The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - Charlotte Ulrikka Rask
- Professor, Child and Adolescent Psychiatric Centre, Risskov, Aarhus University Hospital, Denmark
| | - Erik Hedman-Lagerlöf
- Associate Professor, Department of Clinical Neuroscience, Karolinska Institute, Sweden
| | - Trine Eilenberg
- Clinical Psychologist, Department of Occupational Medicine, Aarhus University Hospital, Denmark
| | - Lisbeth Frostholm
- Associate Professor, The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
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20
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Zauszniewski JA, Bekhet A, Herbell K. Comprehensive evaluation of interventions: eight vital parameters. Nurse Res 2018; 26:20-25. [PMID: 30474362 DOI: 10.7748/nr.2018.e1603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND It is critically important to determine the effectiveness of an intervention before it can be translated into clinical practice. However, the future implementation and sustainability of the intervention may be diminished if other intervention parameters are not assessed. This requires obtaining feedback from intervention recipients so interventions will be perceived as appealing, relevant, meaningful and beneficial to them; otherwise recipients may be unlikely to perform them over time, resulting in unsuccessful health outcomes. AIM To propose the addition of two intervention parameters to the existing six-parameter model and provide examples from recent research of how each parameter can be tested. DISCUSSION Definitions of the eight parameters are provided and methods for analysing each of them explained. While some studies show necessity, fidelity and cost have unique distinguishing characteristics, other studies indicate feasibility, acceptability and safety have common features, and efficacy and effectiveness are closely associated. CONCLUSION Researchers frequently examine one or two parameters, but few simultaneously apply the six-parameter model. This model is also missing two vital parameters - efficacy and cost. IMPLICATIONS FOR PRACTICE Comprehensive and systematic evaluation of all eight intervention parameters is recommended before researchers begin randomised controlled trials and translate them into practice.
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Affiliation(s)
| | - Abir Bekhet
- Marquette University, Milwaukee, Wisconsin, United States
| | - Kayla Herbell
- Sinclair School of Nursing, University of Missouri, United States
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21
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Internet-delivered cognitive behaviour therapy for chronic health conditions: a systematic review and meta-analysis. J Behav Med 2018; 42:169-187. [DOI: 10.1007/s10865-018-9984-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/25/2018] [Indexed: 01/08/2023]
Abstract
AbstractThis systematic review and meta-analysis aims to evaluate the effectiveness of internet-delivered cognitive behavioural therapy (ICBT) on anxiety and depression among persons with chronic health conditions. A systematic database search was conducted of MEDLINE, CINAHL, PsycInfo, EMBASE, and Cochrane for relevant studies published from 1990 to September 2018. A study was included if the following criteria were met: (1) randomized controlled trial involving an ICBT intervention; (2) participants experienced a chronic health condition; (3) participants ≥ 18 years of age; and (4) effects of ICBT on anxiety and/or depression were reported. The Cochrane Risk of Bias tool was used to assess the risk of bias on the included studies. Pooled analysis was conducted on the primary and condition specific secondary outcomes. Twenty-five studies met inclusion criteria and investigated the following chronic health conditions: tinnitus (n = 6), fibromyalgia (n = 3), pain (n = 7), rheumatoid arthritis (n = 3), cardiovascular disease (n = 2), diabetes (n = 1), cancer (n = 1), heterogeneous chronic disease population (n = 1), and spinal cord injury (n = 1). Pooled analysis demonstrated small effects of ICBT in improving anxiety and depression. Moderate effects of therapist-guided approach were seen for depression and anxiety outcomes; while, self-guided approaches resulted in small effects for depression and moderate effects in anxiety outcomes. ICBT shows promise as an alternative to traditional face-to-face interventions among persons with chronic health conditions. Future research on long-term effects of ICBT for individuals with chronic health conditions is needed.Trial Registration PROSPERO registration number: CRD42018087292.
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22
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Berman AH, Kolaas K, Petersén E, Bendtsen P, Hedman E, Linderoth C, Müssener U, Sinadinovic K, Spak F, Gremyr I, Thurang A. Clinician experiences of healthy lifestyle promotion and perceptions of digital interventions as complementary tools for lifestyle behavior change in primary care. BMC FAMILY PRACTICE 2018; 19:139. [PMID: 30131057 PMCID: PMC6103870 DOI: 10.1186/s12875-018-0829-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 08/14/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Evidence-based practice for healthy lifestyle promotion in primary health care is supported internationally by national policies and guidelines but implementation in routine primary health care has been slow. Referral to digital interventions could lead to a larger proportion of patients accessing structured interventions for healthy lifestyle promotion, but such referral might have unknown implications for clinicians with patients accessing such interventions. This qualitative study aimed to explore the perceptions of clinicians in primary care on healthy lifestyle promotion with or without digital screening and intervention. METHODS Focus group interviews were conducted at 10 primary care clinics in Sweden with clinicians from different health professions. Transcribed interviews were analyzed using content analysis, with inspiration from a phenomenological-hermeneutic method involving naïve understanding, structural analysis and comprehensive understanding. RESULTS Two major themes captured clinicians' perceptions on healthy lifestyle promotion: 1) the need for structured professional practice and 2) deficient professional practice as a hinder for implementation. Sub-themes in theme 1 were striving towards professionalism, which for participants meant working in a standardized fashion, with replicable routines regardless of clinic, as well as being able to monitor statistics on individual patient and group levels; and embracing the future with critical optimism, meaning expecting to develop professionally but also being concerned about the consequences of integrating digital tools into primary care, particularly regarding the importance of personal interaction between patient and provider. For theme 2, sub-themes were being in an unmanageable situation, meaning not being able to do what is perceived as best for the patient due to lack of time and resources; and following one's perception, meaning working from a gut feeling, which for our participants also meant deviating from clinical routines. CONCLUSIONS In efforts to increase evidence-based practice and lighten the burden of clinicians in primary care, decision- and policy-makers planning the introduction of digital tools for healthy lifestyle promotion will need to explicitly define their role as complements to face-to-face encounters. Our overriding hope is that this study will contribute to maintaining meaningfulness in the patient-clinician encounter, when digital tools are added to facilitate patient behavior change of unhealthy lifestyle behaviors.
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Affiliation(s)
- Anne H. Berman
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Healthcare Services, Stockholm County Council, Norra Stationsgatan 69, SE-11364 Stockholm, Sweden
- Stockholm Center for Dependency Disorders, Box 17914, 118 95 Stockholm, Sweden
| | - Karoline Kolaas
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Healthcare Services, Stockholm County Council, Norra Stationsgatan 69, SE-11364 Stockholm, Sweden
- Gustavsberg Primary Care Clinic, Odelbergs väg 19, Gustavsberg, Sweden
| | - Elisabeth Petersén
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Healthcare Services, Stockholm County Council, Norra Stationsgatan 69, SE-11364 Stockholm, Sweden
- Stockholm Center for Dependency Disorders, Box 17914, 118 95 Stockholm, Sweden
| | - Preben Bendtsen
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Erik Hedman
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Healthcare Services, Stockholm County Council, Norra Stationsgatan 69, SE-11364 Stockholm, Sweden
- Gustavsberg Primary Care Clinic, Odelbergs väg 19, Gustavsberg, Sweden
| | - Catharina Linderoth
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Ulrika Müssener
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Kristina Sinadinovic
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Healthcare Services, Stockholm County Council, Norra Stationsgatan 69, SE-11364 Stockholm, Sweden
- Stockholm Center for Dependency Disorders, Box 17914, 118 95 Stockholm, Sweden
| | - Fredrik Spak
- Chalmers Technological University, Gothenburg, Sweden
| | - Ida Gremyr
- Department of Public Health and Community Medicine, Section for Epidemiology and Social Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Thurang
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Healthcare Services, Stockholm County Council, Norra Stationsgatan 69, SE-11364 Stockholm, Sweden
- Stockholm Center for Dependency Disorders, Box 17914, 118 95 Stockholm, Sweden
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