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Hadjistavropoulos HD, McCall HC, Dear BF, Beahm JD, Carleton RN, Titov N. Outcomes of transdiagnostic internet-delivered cognitive behavioural therapy tailored to public safety personnel: A longitudinal observational study. J Anxiety Disord 2024; 104:102861. [PMID: 38640867 DOI: 10.1016/j.janxdis.2024.102861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 01/07/2024] [Accepted: 04/09/2024] [Indexed: 04/21/2024]
Abstract
First responders and other public safety personnel (PSP) experience high rates of mental health problems and face barriers to accessing mental healthcare. Internet-delivered cognitive behavioural therapy (ICBT) is an effective and accessible treatment for various mental health concerns. Canadian PSP report favorable attitudes toward ICBT, and preliminary outcomes demonstrate that they benefit from it. Expanding on this research, the current study consisted of a longitudinal observational study of 560 Canadian PSP who participated in ICBT. It was designed to assess the longer term effectiveness of ICBT and moderators of outcomes by gender, linguistic and occupational group, and years of occupational experience. We evaluated symptom change at 8, 26, and 52 weeks post-enrollment, and results among PSP who had elevated clinical scores, showed large reductions (Hedges' g) in symptoms of depression (g = 1.3), anxiety (g =1.48), posttraumatic stress (g =1.24), panic (g =1.19), and anger (g =1.07) and moderate reductions in symptoms of social anxiety (g =.48-.56). Moderator analyses revealed modest differences in pre-treatment symptoms among certain groups but no group differences in symptom change over time. Clients showed good completion of treatment materials and reported high treatment satisfaction. The results suggest further study of ICBT tailored to PSP is warranted, including evaluating ICBT tailored for PSP in other countries.
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Affiliation(s)
- Heather D Hadjistavropoulos
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada; Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada.
| | - Hugh C McCall
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada; Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Blake F Dear
- School of Psychological Sciences, Macquarie University, Balaclava Rd, Macquarie Park, NSW 2109, Australia; eCentreClinic, Macquarie University, Balaclava Rd, Macquarie Park, NSW 2109, Australia
| | - Janine D Beahm
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada; Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - R Nicholas Carleton
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada; Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Nickolai Titov
- School of Psychological Sciences, Macquarie University, Balaclava Rd, Macquarie Park, NSW 2109, Australia; eCentreClinic, Macquarie University, Balaclava Rd, Macquarie Park, NSW 2109, Australia
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Limpächer C, Kindt T, Hoyer J. Counteract Anhedonia! Introducing an Online-Training to Enhance Reward Experiencing - A Pilot Study. CLINICAL PSYCHOLOGY IN EUROPE 2024; 6:e13751. [PMID: 39119054 PMCID: PMC11303914 DOI: 10.32872/cpe.13751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/01/2024] [Indexed: 08/10/2024] Open
Abstract
Background Anhedonia is a risk factor for a severe course of depression but is often not adequately addressed in psychotherapy. This study presents the Training to Enhance Reward Experience (T-REx), a novel self-help approach that uses savoring and mental imagery to target impairments in reward experience associated with anhedonia. We aimed to examine feasibility and acceptability of T-REx and exploratively investigated its effects on anhedonia and other clinical variables. Method In an online, randomized controlled trial, 79 subjects participated for five days in T-REx or the active control condition Gratitude Writing (GW). We assessed changes in anhedonia, depression, and active behavior at inclusion, after the waiting period, post-intervention and at follow-up. The intervention effects were examined for the full sample and an anhedonic sub-sample. Results T-REx and GW were equally feasible and clearly accepted by the sample. Both interventions significantly reduced depressive symptoms and increased behavioral activation. Although there was no significant main effect of the interventions, between-group differences were observed for depressive symptoms and active behavior at post-intervention and follow-up, favoring T-REx. Further, within-group changes for T-REx were larger than for GW. The observed effects had a greater magnitude in the anhedonic sub-sample, suggesting that individuals with more pronounced anhedonic symptoms derived greater benefit from the interventions. Discussion This first study of T-REx provides promising results that should prompt further investigations of T-REx in clinical samples. The results suggest that T-REx has a positive effect on depression symptoms and active behavior. Further, its potential as a valuable adjunct to behavioral activation interventions is discussed.
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Affiliation(s)
- Cara Limpächer
- Behavioral Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Tordis Kindt
- University Clinic and Outpatient Clinic for Psychiatry, Psychotherapy and Psychosomatics, University Hospital Halle (Saale), Halle, Germany
| | - Jürgen Hoyer
- Behavioral Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
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Kolaas K, Berman AH, Hedman-Lagerlöf E, Lindsäter E, Hybelius J, Axelsson E. Internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety or both: a systematic review with meta-analysis of randomised controlled trials. BMJ Open 2024; 14:e075796. [PMID: 38569713 PMCID: PMC11015301 DOI: 10.1136/bmjopen-2023-075796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 02/26/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE Depression and anxiety are major public health problems. This study evaluated the effects of internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety, or both. DESIGN Systematic review with meta-analysis. DATA SOURCES Medline (Ovid), Cochrane Library (Wiley), the Web of Science Core Collection (Clarivate), and PsycInfo (EBSCO) were searched on 24 May 2021, with an update on 6 February 2023. ELIGIBILITY CRITERIA Randomised controlled trials of internet-delivered transdiagnostic psychological treatments, open to both participants with primary depression and participants with primary anxiety. This review concerned all treatment frameworks, both guided and unguided formats and all age groups. DATA EXTRACTION AND SYNTHESIS In random-effects meta-analysis, we estimated pooled effects on depression symptoms and anxiety in terms of Hedges' g with 95% CIs. Absolute and relative heterogeneity was quantified as the τ2 and I 2. RESULTS We included 57 trials with 21 795 participants. Nine trials (16%) recruited exclusively from routine care, and three (5%) delivered treatment via video. For adults, large within-group reductions were seen in depression (g=0.90; 95% CI 0.81 to 0.99) and anxiety (g=0.87; 95% CI 0.78 to 0.96). Compared with rudimentary passive controls, the added effects were moderate (depression: g=0.52; 95% CI 0.42 to 0.63; anxiety: g=0.45; 95% CI 0.34 to 0.56) and larger in trials that required all participants to meet full diagnostic criteria for depression or an anxiety disorder. Compared with attention/engagement controls, the added effects were small (depression: g=0.30; 95% CI 0.07 to 0.53; anxiety: g=0.21; 95% CI 0.01 to 0.42). Heterogeneity was substantial, and the certainty of the evidence was very low. Two trials concerned adolescents and reported mixed results. One trial concerned older adults and reported promising results. CONCLUSION Internet-delivered transdiagnostic treatments for depression and anxiety show small-to-moderate added effects, varying by control condition. Research is needed regarding routine care, the video format, children and adolescents and older adults. PROSPERO REGISTRATION NUMBER CRD42021243172.
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Affiliation(s)
- Karoline Kolaas
- Centre for Psychiatry Research, Karolinska Institute Department of Clinical Neuroscience, Stockholm, Stockholm, Sweden
- Liljeholmen University Primary Health Care Center, Region Stockholm, Academic Primary Care Centre, Stockholm, Stockholm, Sweden
| | - Anne H Berman
- Centre for Psychiatry Research, Karolinska Institute Department of Clinical Neuroscience, Stockholm, Stockholm, Sweden
- Department of Psychology, Uppsala Universitet, Uppsala, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Karolinska Institute Department of Clinical Neuroscience, Stockholm, Stockholm, Sweden
- Gustavsberg University Primary Health Care Center, Academic Primary Care Centre, Stockholm, Stockholm, Sweden
| | - Elin Lindsäter
- Division of Psychology, Karolinska Institute Department of Clinical Neuroscience, Stockholm, Stockholm, Sweden
- Gustavsberg University Primary Health Care Center, Academic Primary Care Centre, Stockholm, Stockholm, Sweden
| | - Jonna Hybelius
- Liljeholmen University Primary Health Care Center, Region Stockholm, Academic Primary Care Centre, Stockholm, Stockholm, Sweden
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Stockholm, Sweden
| | - Erland Axelsson
- Liljeholmen University Primary Health Care Center, Region Stockholm, Academic Primary Care Centre, Stockholm, Stockholm, Sweden
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Stockholm, Sweden
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Okatsu A, Kanie A, Kataoka Y. Evaluation of the effect of a midwife-led online program using cognitive behavioral therapy for pregnant women at risk for anxiety disorder in Japan: A pilot randomized controlled trial. PLoS One 2023; 18:e0281632. [PMID: 37163508 PMCID: PMC10171600 DOI: 10.1371/journal.pone.0281632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 01/25/2023] [Indexed: 05/12/2023] Open
Abstract
AIM This study aimed to conduct a pilot randomized controlled trial (RCT) to examine the appropriateness and feasibility of a midwife-led cognitive behavioral therapy (CBT)-based, three-session program delivered remotely to pregnant women at risk for anxiety disorders. METHODS The study design was a pilot RCT. Outcome was the difference between the two groups in the change in generalized anxiety disorder-7 (GAD-7), Kessler6 (K6) and Edinberg Postnatal Depression Scale (EPDS) etc. Recruitment was conducted from August 2020 to July 2021 in clinics and web-based survey monitors in Japan, with follow-up through November 2021. RESULTS This program involving 63 pregnant women were administered. Although the intervention was remote, a total of three sessions was completed during pregnancy. The change in GAD-7 scores from pre- to 1 month postpartum, was mean -1.77 in the intervention group and mean -0.97 in the control group, with a p-value of .521, indicating no significant difference between the two groups, although GAD-7 scores were lower in the intervention group. The change in K6 score from pre- to 1 month postpartum, was mean -3.55 in the intervention group and mean -1.62 in the control group, with a p-value of .168, indicating no significant difference between the two groups, although the intervention group showed a greater decrease. In particular, in primiparas, the change in GAD-7 scores in the intervention group was large, and some expressed a desire for a postpartum session, suggesting that a follow-up session after delivery may be effective. In multiparas, the control group showed an increase in both GAD-7 and K6 scores from late pregnancy to 1 month postpartum, while the intervention group showed a decrease in scores. CONCLUSION The program was implemented using CBT conducted by midwife, anxiety decreased in primiparas. In future RCTs, it was suggested that additional postpartum sessions may be effective. TRIAL REGISTRATION UMIN Clinical trial registry ID: UMIN000040304.
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Affiliation(s)
- Aiko Okatsu
- Midwifery, School of Nursing, St. Luke's International University, Akashi-cho, Tokyo, Japan
- Center for Cognitive Behavioral Therapy, National Center of Neurology and Psychiatry, Kodaira-Shi, Tokyo, Japan
| | - Ayako Kanie
- Center for Cognitive Behavioral Therapy, National Center of Neurology and Psychiatry, Kodaira-Shi, Tokyo, Japan
- Psychiatry, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yaeko Kataoka
- Midwifery, School of Nursing, St. Luke's International University, Akashi-cho, Tokyo, Japan
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Zhang W, Du Y, Yang X, Wang E, Fang J, Liu Z, Wu S, Liu Q, Hu Y. Comparative efficacy of face-to-face and internet-based cognitive behavior therapy for generalized anxiety disorder: A meta-analysis of randomized controlled trial. Front Psychiatry 2022; 13:832167. [PMID: 35966496 PMCID: PMC9366007 DOI: 10.3389/fpsyt.2022.832167] [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: 12/09/2021] [Accepted: 07/11/2022] [Indexed: 11/19/2022] Open
Abstract
Objective The study aimed to ascertain the comparative efficacy of these two forms on reducing anxiety scores of scales in patients with a generalized anxiety disorder (GAD) by examining the available evidence for face-to-face cognitive behavior therapy (CBT) and internet-based cognitive behavior therapy (ICBT). Moreover, this study attempted to determine whether ICBT can obtain similar benefits as CBT for GAD patients during coronavirus disease 2019 (COVID-19) due to the quarantine policy and the requirement of social distance. Methods This meta-analysis was registered with the International Prospective Register of Systematic Reviews (PROSPERO) according to the guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement (registration number CRD42021241938). Therefore, a meta-analysis of randomized controlled trials (RCTs) examining CBT or ICBT was conducted in this study to treat GAD patients diagnosed with DMS-IV. The researchers searched PubMed, MEDLINE, Embase, PsycINFO, and the Cochrane Database of Systematic Reviews for relevant studies published from 2000 to July 5, 2022. Evidence from RCTs was synthesized by Review Manager 5.4 as mean difference (MD) for change in scores of scales through a random-effects meta-analysis. Results A total of 26 trials representing 1,687 participants were pooled. The results demonstrated that ICBT and CBT were very close in the effect size of treating GAD (MD = -2.35 vs. MD = -2.79). Moreover, they still exhibited a similar response (MD = -3.45 vs. MD = -2.91) after studies with active control were removed. Conclusion Regarding the treatment of GAD, ICBT can achieve a similar therapeutic effect as CBT and could be CBT's candidate substitute, especially in the COVID-19 pandemic era, since the internet plays a crucial role in handling social space constraints. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=241938, identifier CRD42021241938.
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Affiliation(s)
- Wenle Zhang
- Department of Psychological Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Department of Clinical Psychology, Capital Medical University, Beijing, China
| | - Yun Du
- Department of Psychological Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Department of Clinical Psychology, Capital Medical University, Beijing, China
| | - Xiangyun Yang
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Encong Wang
- Department of Psychological Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jiexin Fang
- Department of Psychological Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ziqi Liu
- School of Foreign Languages, Shanghai University, Shanghai, China
| | - Shanqian Wu
- Beijing Anding Hospital, Capital Medical University, Beijing, China
- Department of Psychiatry, Capital Medical University, Beijing, China
| | - Qinqin Liu
- Department of Clinical Psychology, Capital Medical University, Beijing, China
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yongdong Hu
- Department of Psychological Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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LeBlanc J, Talbot F, Fournier V, Titov N, Dear BF. Lessons learned from two feasibility trials of a translated and minimally monitored iCBT program for young adults among community and university samples. Internet Interv 2022; 28:100529. [PMID: 35371925 PMCID: PMC8971854 DOI: 10.1016/j.invent.2022.100529] [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: 05/29/2021] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 11/27/2022] Open
Abstract
Young adults are less likely to use traditional mental health services than adults. iCBT may be more youth friendly, but its access remains limited in several countries. This study aims to evaluate the feasibility of a minimally monitored transdiagnostic iCBT program translated from English to French and offered in Canada for the treatment of anxiety and depression among young adults. The impact of the program on resilience was also assessed. Twenty-five participants from community and university samples were included in the analyses in two separate single-group feasibility trials with a 3-month follow-up. Feasibility outcomes were attrition, adherence, treatment acceptability and treatment gains. Outcome measures included the Patient Health Questionnaire 9-item (PHQ-9), Generalized Anxiety Disorder 7-item (GAD-7) and Connor-Davidson Resilience Scale (CD-RISC). In Trial 1 (N = 10), recruiting among the general population proved to be challenging. Low adherence (20%) and high attrition (80%) rates were observed. Methodological changes to recruitment were made and a second trial was conducted among university students using incentives (N = 15). About half of the participants completed treatment (55%, n = 8/15), 12/15 provided post-treatment data and 8/15 provided 3-month follow-up data. All study completers (100%; n = 14) reported they would recommend the program. Mixed effects model analyses revealed significant and large pre-post treatment reductions on the PHQ-9 and GAD-7 (Cohen's d = 1.09 and 1.64 respectively) with treatment gains maintained at follow-up. Moderate improvements were found on the CD-RISC post-treatment with further gains at follow-up (ds = 0.55 and 1.10 respectively). These finding suggest that future research on this French-Canadian version of the Mood Mechanic Course is feasible with appropriate attention to recruitment. Translating existing iCBT interventions and using minimal monitoring may be an optimal first step to initiate the cross-cultural dissemination of iCBT while increasing access to treatments among young adults. Lessons learned are discussed.
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Affiliation(s)
| | - France Talbot
- Université de Moncton, Canada,Corresponding author at: Université de Moncton, Moncton E1A 3E9, N.-B., Canada.
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Basque D, Talbot F, French D. Increasing access to pain management: Feasibility of a self-compassion psychoeducational website using a minimally monitored delivery model. Internet Interv 2021; 26:100458. [PMID: 34745907 PMCID: PMC8551074 DOI: 10.1016/j.invent.2021.100458] [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: 07/16/2021] [Revised: 09/11/2021] [Accepted: 09/15/2021] [Indexed: 10/27/2022] Open
Abstract
Self-compassion has been associated with several positive pain-related outcomes. However, little is known about the impact of targeting self-compassion on pain management. This study assesses the feasibility of a self-compassion psychoeducation website among adults with chronic pain using a minimally monitored delivery model. Participants (N = 26) were recruited online and a single group pre-test and post-test design with a 3-month follow-up was used. The intervention was a 6-week program comprised of a video, writing exercises, guided meditations and automated emails. Feasibility outcome measures were grouped into the following categories: study engagement (ease of recruitment, attrition, adherence, satisfaction), pain vulnerability variables (intensity, interference, catastrophizing, mood) and protective pain variables (self-compassion, resilience and acceptance). Challenges pertaining to uptake were encountered. Attrition was higher (n = 11/26; 42%) and adherence to the full treatment protocol lower (n = 6/26; 23%) than expected. Treatment satisfaction was high with nearly all study completers (93%) reporting that they would recommend the program to a friend. Intent-to-treat mixed effects models showed a significant and large increase of self-compassion (d = 0.92) and a significant impact on several outcome variables (ds from 0.24 to 1.15) with most gains either maintained or increased at follow-up. The recruitment strategy may have negatively impacted participant engagement. Methodological modifications are proposed to improve the feasibility of the program. Minimally monitored web-based programs targeting self-compassion may benefit adults with chronic pain who may have limited access to traditional psychological services or who prefer online-based interventions.
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Affiliation(s)
- D. Basque
- Université de Moncton, New Brunswick, Canada
| | - F. Talbot
- Université de Moncton, New Brunswick, Canada,Corresponding author.
| | - D.J. French
- The Atlantic Pain Clinic, New Brunswick, Canada
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Talbot F, Fournier JS, Hendriks M. Life goal reconstruction for people with chronic health conditions: Feasibility of a brief internet-based writing intervention using a minimally monitored delivery. Internet Interv 2021; 25:100431. [PMID: 34401390 PMCID: PMC8350599 DOI: 10.1016/j.invent.2021.100431] [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: 04/16/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 11/11/2022] Open
Abstract
Examination of people's narratives after significant life changes revealed that engaging in current and future goal reconstruction was associated with higher levels of well-being while a failure to disengage from "what might have been" was associated with lower levels of well-being. This work led to the development of a life goal writing intervention that has received empirical support with most studies conducted among nonclinical populations. This study aims to assess the feasibility of a brief and minimally monitored internet-delivered writing therapy developed to facilitate life goal reconstruction among adults diagnosed with various chronic health conditions. Sixteen adults showing mild to moderate levels of anxiety or depression were recruited and a single group pretest/post-test design used. The 5-week program is comprised of psychoeducation, five weekly 30-min writing sessions, automated emails and symptom monitoring. Feasibility outcome measures included attrition, treatment adherence, acceptability and preliminary effectiveness. Primary outcome measures were The Patient Health Questionnaire -9 (PHQ-9) and the Generalized Anxiety Disorder -7 (GAD-7). Attrition was low (12%) and adherence high (93%). All but one study completer reported they would recommend the program. Mixed effects models revealed a significant and large reduction from pre-treatment to post-treatment on the PHQ-9 and GAD-7 and remission rates of 67% and 64% respectively. These findings suggest that it would be feasible to proceed to a larger trial. The brief duration of the intervention combined to a minimally monitored delivery may lend itself to implementation in routine clinical care milieus such as hospital settings.
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Affiliation(s)
- France Talbot
- Corresponding author at: School of Psychology, Université de Moncton, 18 Antonine Maillet Ave, Moncton, New-Brunswick E1A 3E9, Canada.
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