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Wen X, Gou M, Chen H, Kishimoto T, Qian M, Margraf J, Berger T. The Efficacy of Web-Based Cognitive Behavioral Therapy With a Shame-Specific Intervention for Social Anxiety Disorder: Randomized Controlled Trial. JMIR Ment Health 2024; 11:e50535. [PMID: 39115189 PMCID: PMC11331269 DOI: 10.2196/50535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 03/29/2024] [Accepted: 05/25/2024] [Indexed: 08/21/2024] Open
Abstract
Background Social anxiety disorder (SAD) is one of the most prevalent psychological disorders and generally co-occurs with elevated shame levels. Previous shame-specific interventions could significantly improve outcomes in social anxiety treatments. Recent review suggests that integrating a more direct shame intervention could potentially increase the effectiveness of cognitive behavioral therapy. Web-based cognitive behavioral therapy (WCBT) has proven efficacy, sustaining benefits for 6 months to 4 years. Previous evidence indicated that shame predicted the reduction of social anxiety and mediated between engagements in exposure and changes in social anxiety during WCBT. Objective This study aimed to design a shame intervention component through a longitudinal study and conduct a randomized controlled trial to investigate the effectiveness of a shame intervention component in reducing social anxiety symptoms and shame experience in a clinical sample of people with SAD. Methods The development of a shame intervention component was informed by cognitive behavioral principles and insights from longitudinal data that measured the Experience of Shame Scale (ESS), the Coping Styles Questionnaire, and the Social Interaction Anxiety Scale (SIAS) in 153 participants. The psychoeducation, cognitive construct, and exposure sections were tailored to focus more on shame-related problem-solving and self-blame. A total of 1220 participants were recruited to complete questionnaires, including the ESS, the SIAS, the Social Phobia Scale (SPS), and diagnostic interviews. Following a 2-round screening process, 201 participants with SAD were randomly assigned into a shame WCBT group, a normal WCBT group, and a waiting group. After the 8-week WCBT intervention, the participants were asked to complete posttest evaluations, including the ESS, SIAS and SPS. Results Participants in the shame WCBT group experienced significant reductions in shame levels after the intervention (ESS: P<.001; ηp2=0.22), and the reduction was greater in the shame intervention group compared to normal WCBT (P<.001; mean deviation -12.50). Participants in both the shame WCBT and normal WCBT groups experienced significant reductions in social anxiety symptoms (SIAS: P<.001; ηp2=0.32; SPS: P<.001; ηp2=0.19) compared to the waiting group after intervention. Furthermore, in the experience of social interaction anxiety (SIAS), the shame WCBT group showed a higher reduction compared to the normal WCBT group (P<.001; mean deviation -9.58). Problem-solving (SE 0.049, 95% CI 0.025-0.217) and self-blame (SE 0.082, 95% CI 0.024-0.339) mediated the effect between ESS and SIAS. Conclusions This is the first study to design and incorporate a shame intervention component in WCBT and to validate its efficacy via a randomized controlled trial. The shame WCBT group showed a significant reduction in both shame and social anxiety after treatment compared to the normal WCBT and waiting groups. Problem-solving and self-blame mediated the effect of shame on social anxiety. In conclusion, this study supports previous findings that a direct shame-specific intervention component could enhance the efficacy of WCBT.
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Affiliation(s)
- Xu Wen
- Department of Clinical Psychology and Psychotherapy, Ruhr University Bochum, Bochum, Germany
- School of Psychological and Cognitive Science, Peking University, Beijing, China
| | - Mengke Gou
- School of Psychological and Cognitive Science, Peking University, Beijing, China
| | - Huijing Chen
- School of Sociology and Political Science, Shanghai University, Shanghai, China
| | - Tomoko Kishimoto
- Department of Social Psychology, Nankai University School of Sociology, Tianjin, China
| | - Mingyi Qian
- School of Psychological and Cognitive Science, Peking University, Beijing, China
| | - Jürgen Margraf
- Department of Clinical Psychology and Psychotherapy, Ruhr University Bochum, Bochum, Germany
| | - Thomas Berger
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
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Shinno S, Matsumoto K, Hamatani S, Inaba Y, Ozawa Y, Kawasaki Y, Ikai T, Sutoh C, Hayashi H, Shimizu E. Feasibility of Guided Internet-Based Cognitive Behavioral Therapy for Panic Disorder and Social Anxiety Disorder in Japan: Pilot Single-Arm Trial. JMIR Form Res 2024; 8:e53659. [PMID: 38421717 PMCID: PMC10940979 DOI: 10.2196/53659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) is effective in treating anxiety disorders. Accessibility to CBT has been limited in Japan due to the shortage of therapists. While an open-source e-learning system can be used to create a simple internet-based cognitive behavioral therapy (ICBT) program, the safety and outpatient acceptance of this treatment approach have not been explored in Japan. OBJECTIVE The aim of this study was to investigate whether outpatients with anxiety disorders could accept and successfully complete the ICBT program with guidance by CBT therapists when implementing therapeutic modules and CBT tasks. Due to being in the initial phase of a novel treatment in Japan, this study was intended for verification with a small sample size. METHODS In total, 6 adults, including 4 male participants and 2 female participants, were enrolled in a single-arm trial. The intervention involved guided ICBT comprising 12 sessions, including CBT text, comprehension confirmation tests, and explanatory videos about cognitive behavioral models, accessible through a website. The therapist guided the participants in accessing the ICBT program and answering their questions using a chat tool. The primary outcome was anxiety severity assessed using the State-Trait Anxiety Inventory-Trait. Secondary outcomes included the Panic Disorder Severity Scale, Liebowitz Social Anxiety Scale (LSAS), Beck Anxiety Inventory (BAI), Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Working Alliance Inventory-Short Form (WAI-SF). Statistical analyses were performed using paired 2-tailed t tests to assess the changes in clinical symptoms. The total WAI-SF score at the final session was used to evaluate the therapeutic alliance. For statistical analyses, mean changes for total State-Trait Anxiety Inventory-Trait, BAI, Panic Disorder Severity Scale, LSAS, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 scores were analyzed using the paired 2-tailed t test. The 2-sided significance level for hypothesis testing was set at 5%, and 2-sided 95% CIs were calculated. RESULTS Most participants diligently engaged with the ICBT program. No adverse events were reported. The mean total scores for the primary outcome decreased by 11.0 (SD 9.6) points (95% CI -22.2 to 0.20; Hedges g=0.95), but it was not statistically significant. The mean total scores for the secondary outcomes that assess clinical symptoms decreased, with a significant reduction observed in the BAI of 15.7 (SD 12.1) points (95% CI -28.4 to -3.0; P=.03; Hedges g=1.24). The mean total scores for PDSS and LSAS decreased significantly, by 12.0 (SD 4.24) points (95% CI -50.1 to 26.1; P=.16; Hedges g=1.79) and 32.4 (SD 11.1) points (95% CI -59.7 to -4.3; P=.04; Hedges g=1.38), respectively. Of the participants, 67% (n=4) showed treatment response, and 50% (n=3) achieved remission after the intervention. The therapeutic alliance, measured using the WAI-SF, was moderate. CONCLUSIONS Guided ICBT may be feasible for the treatment of outpatients with panic disorder and social anxiety disorder in Japan. TRIAL REGISTRATION University Hospital Medical Information Network Clinical Trials Registry UMIN0000038118; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000043439.
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Affiliation(s)
- Seina Shinno
- Department of Integrated Medical Sciences, Graduate School of Medicine, University of Fukui, Fukui, Japan
| | - Kazuki Matsumoto
- Division of Clinical Psychology, Kagoshima University Medical and Dental Hospital, Kagoshima, Japan
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Sayo Hamatani
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
| | - Yosuke Inaba
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yoshihito Ozawa
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Tomoki Ikai
- Faculty of Medical Sciences, Division of Medicine Primary Health Care, University of Fukui, Fukui, Japan
| | - Chihiro Sutoh
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Hiroyuki Hayashi
- Department of Integrated Medical Sciences, Graduate School of Medicine, University of Fukui, Fukui, Japan
- Department of Emergency and General Medicine, Fukui University Hospital, Fukui, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Wen X, Margraf J, Qian M, Berger T, Zhao N, Gou M, Wei S. Pathological network changes in patients with social anxiety disorder before and after an Internet-based CBT. Internet Interv 2023; 34:100691. [PMID: 38034862 PMCID: PMC10684799 DOI: 10.1016/j.invent.2023.100691] [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: 06/27/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 12/02/2023] Open
Abstract
A network perspective may shed light on the understanding of Internet-based CBT efficacy for social anxiety disorder. Previous cross-sectional evidence revealed a densely interconnected network for individuals with social anxiety. Yet, longitudinal network changes before and after ICBT are lacking. This study aimed to investigate pathological network changes with Graphical Gaussian Model among patients with social anxiety disorder (n = 249). Social phobia scale (SPS) and Social interaction anxiety scale (SIAS) were measured before and after 8 weeks Internet-based CBT. Results revealed the connection between symptom tension when speaking and symptom awkward when being watched was the most robust edges during ICBT interventions. The pathological network benefited from ICBT and exhibited modification in several prominent interconnections. The overall network connectivity continues to exhibit comparable strength after ICBT. This study represents the first examination of social anxiety network changes after patients with SAD completed a systematic ICBT. Changes in critical edges and nodes provide valuable insights for the design and efficacy assessment of ICBT interventions.
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Affiliation(s)
- Xu Wen
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr University Bochum, Germany
- Peking University, School of Psychological and Cognitive Sciences, Beijing, China
| | - Juergen Margraf
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr University Bochum, Germany
| | - Mingyi Qian
- Peking University, School of Psychological and Cognitive Sciences, Beijing, China
| | - Thomas Berger
- Department of Psychology, Clinical Psychology and Psychotherapy, Bern, Switzerland
| | - Nan Zhao
- Peking University, School of Psychological and Cognitive Sciences, Beijing, China
| | - Mengke Gou
- Peking University, School of Psychological and Cognitive Sciences, Beijing, China
| | - Shijuan Wei
- Peking University, School of Psychological and Cognitive Sciences, Beijing, China
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Zha Y, Tang Q, Jin X, Cai X, Gong W, Shao Y, Weng X. Development of social anxiety cognition scale for college students: Basing on Hofmann's model of social anxiety disorder. Front Psychol 2023; 14:1080099. [PMID: 36743247 PMCID: PMC9892844 DOI: 10.3389/fpsyg.2023.1080099] [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: 10/25/2022] [Accepted: 01/05/2023] [Indexed: 01/21/2023] Open
Abstract
Introduction To develop the Chinese version of the Social Anxiety Cognition Scale for College Students (SACS-CS) based on Hofmann's model of social anxiety disorder and examine its reliability and validity. Methods Based on literature analysis and structured interviews, a theoretical model was constructed and behavioral examples were collected. According to the results of participants' and experts' evaluations, the initial SACS-CS was developed. The study data were collected from a total of 500 valid participants, randomly divided into two samples. Sample 1 (n = 200) and sample 2 (n = 300) were considered for exploratory factor analysis and confirmatory factor analysis (CFA), respectively. Internal reliability and validity were examined using all 500 participants, and temporal reliability was established using sample 3 (n = 70), who completed the scale again after 4 weeks. Results The SACS-CS consists of 21 items, grouped under four factors: self-perception, social skills, emotional control, and cost estimation. The four-factor model fits well. The internal consistency coefficient of the scale and the four factors ranged from 0.87 to 0.96, and the test-retest reliability ranged from 0.76 to 0.84. The scores of the scale and the four factors were significantly correlated with the score of the Interaction Anxiousness Scale (r = 0.54-0.64). Discussion The SACS-CS possesses good reliability and validity and can be applied in the cognitive assessment of college students' social anxiety. The scale could help people with different social anxiety disorder conditions receive more personalized interventions.
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Affiliation(s)
- Yuxin Zha
- School of Psychology, Beijing Sport University, Beijing, China
| | - Qin Tang
- School of Psychology, Beijing Sport University, Beijing, China
| | - Xiaoru Jin
- School of Psychology, Beijing Sport University, Beijing, China
| | - Xinfei Cai
- School of Psychology, Beijing Sport University, Beijing, China
| | - Wen Gong
- School of Psychology, Beijing Sport University, Beijing, China
| | - Yongcong Shao
- School of Psychology, Beijing Sport University, Beijing, China,*Correspondence: Yongcong Shao, ✉
| | - Xiechuan Weng
- Department of Neuroscience, Beijing Institute of Basic Medical Sciences, Beijing, China,Xiechuan Weng, ✉
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Factors Associated With Treatment Response in an Internet-Based Intervention for Prolonged Grief Disorder After Cancer Bereavement. Behav Ther 2023; 54:119-131. [PMID: 36608969 DOI: 10.1016/j.beth.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 06/01/2022] [Accepted: 07/24/2022] [Indexed: 01/11/2023]
Abstract
Internet-based psychological interventions have proven effective in the treatment of prolonged grief disorder (PGD). Yet, some patients do not benefit from treatment in a clinically significant way. We aimed to examine predictors of symptom reduction in an Internet-based intervention for PGD after cancer bereavement, in order to identify possible treatment mechanisms and discern directions for future intervention design. A secondary analysis of data from a randomized wait-list controlled trial on an Internet-based intervention for PGD after cancer bereavement was conducted. Multiple regression models were used (1) to test for the influence of pretreatment PGD, working alliance, avoidance and gender on PGD symptom reduction; and (2) to explore further predictors of treatment success with a best subset selection protocol. The regression models explained 18% (Model 1) and 34% (Model 2) of variance in symptom reduction. Participants with more favorable symptom change had more severe pretreatment PGD scores and better working alliance. Those with lower social support and less posttraumatic growth experienced more PGD symptom change. In conclusion, therapeutic alliance is an important factor that should be monitored and fostered. Findings regarding social support and posttraumatic growth need further replication and clarification.
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Binet É, Ouellet MC, Lebel J, Békés V, Morin CM, Belleville G. Gender Differences in Usage and Subjective Appreciation of an Online Cognitive Behavioral Therapy for Wildfire Evacuees: Descriptive Study. J Clin Med 2022; 11:6649. [PMID: 36431126 PMCID: PMC9699434 DOI: 10.3390/jcm11226649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Based on the most common psychological difficulties of the evacuees from the 2016 Fort McMurray wildfires in Alberta, Canada, a therapist-guided cognitive behavioral self-treatment was developed. This study aimed to explore how gender influences the usage and subjective appreciation of the RESILIENT online treatment. METHODS Our study included 81 English-speaking evacuees with significant posttraumatic symptoms, or with some posttraumatic symptoms accompanied by at least mild depression symptoms or subclinical insomnia, and who logged into the platform at least once. Various usage and subjective appreciation variables were analyzed, including number of completed sessions, number of logins, number of words per session, perceived efforts, perception of usefulness and intention to continue using the different strategies. RESULTS No difference was detected in most objective usage indicators. The number of words written in sessions 7 and 10 was significantly greater for women than for men. Regarding subjective appreciation, men had a greater perception of having put strong efforts in the cognitive restructuring strategy, while women reported in a greater proportion that they wanted to continue using physical exercise as a behavioral activation strategy. CONCLUSIONS Our study offers a first look into how women and men use online treatments, and what their preferences are.
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Affiliation(s)
- Émilie Binet
- School of Psychology, Laval University, 2325 Rue de l’Université, Quebec, QC G1V 0A6, Canada
| | - Marie-Christine Ouellet
- School of Psychology, Laval University, 2325 Rue de l’Université, Quebec, QC G1V 0A6, Canada
| | - Jessica Lebel
- School of Psychology, Laval University, 2325 Rue de l’Université, Quebec, QC G1V 0A6, Canada
| | - Vera Békés
- Ferkauf Graduate School, Yeshiva University, 1165 Morris Park Ave, The Bronx, New York, NY 10461, USA
| | - Charles M. Morin
- School of Psychology, Laval University, 2325 Rue de l’Université, Quebec, QC G1V 0A6, Canada
| | - Geneviève Belleville
- School of Psychology, Laval University, 2325 Rue de l’Université, Quebec, QC G1V 0A6, Canada
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Musiat P, Johnson C, Atkinson M, Wilksch S, Wade T. Impact of guidance on intervention adherence in computerised interventions for mental health problems: a meta-analysis. Psychol Med 2022; 52:229-240. [PMID: 34802474 DOI: 10.1017/s0033291721004621] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Web-based interventions are increasingly used for the prevention, treatment and aftercare of mental disorders. A crucial factor to the efficacy of such online programmes is adherence to the intervention content and procedure. It has been frequently suggested that adherence in web-based interventions is low and little is known about which factors influence adherence. To increase intervention uptake and completion, studies increasingly include interventions with some form of guidance. Guided interventions have been shown to have higher efficacy, however, evidence for the impact on adherence is limited and mixed. This meta-analysis explored the impact of human guidance on intervention completion in web-based mental health interventions. A total of 22 studies were included with interventions primarily targeting symptoms of depression and anxiety disorders. Results showed that guidance significantly increases the average amount of intervention completion [g = 0.29, 95% confidence interval (CI) 0.18-0.40] and the proportion of intervention completers [log odds ratio (OR) = 0.50, 95% CI 0.34-0.66] with small effects. On average, full completion rates were 12% higher in guided intervention groups. This meta-analysis demonstrated that guidance in web-based mental health interventions does increase adherence, but more research is required to better understand the specific mechanisms between guidance, adherence and outcomes.
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Affiliation(s)
- Peter Musiat
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia, Australia
| | - Catherine Johnson
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia, Australia
| | | | - Simon Wilksch
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia, Australia
| | - Tracey Wade
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia, Australia
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Lopes RC, Šipka D, Krieger T, Klein JP, Berger T. Optimizing cognitive-behavioral therapy for social anxiety disorder and understanding the mechanisms of change: Study protocol for a randomized factorial trial. Internet Interv 2021; 26:100480. [PMID: 34824982 PMCID: PMC8605076 DOI: 10.1016/j.invent.2021.100480] [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: 08/12/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Social anxiety disorder (SAD) is characterized by a marked fear of negative evaluation in social situations and significant impairments. Even with the most effective treatments, remission rates are around 50%. An important reason for the limited effectiveness of treatments is the lack of evidence-based explanation of how treatments work and what their active ingredients might be. An approach to unpack the active ingredients and mechanisms of treatment is the factorial design. OBJECTIVES The study is a factorial trial aiming (1) to examine the main effects and interactions for the four main treatment components of internet-based cognitive-behavioral therapy (ICBT) for SAD (i.e., psychoeducation, cognitive restructuring, attentional training, and exposure) and (2) to examine whether and which change mechanisms mediate the relationship between treatment components and symptom reduction. METHODS A total of 464 adults diagnosed with SAD will be randomized to one of 16 conditions containing combinations of the treatment components. The primary endpoint is SAD symptomatology at eight weeks. Secondary endpoints include symptoms of depression and anxiety, quality of life, and negative effects. Hypothesized change mechanisms are the increase of knowledge about SAD, the decrease of dysfunctional cognitions, the decrease of self-focused attention, and the decrease of avoidance and safety behaviors. DISCUSSION A better understanding of the differential efficacy of treatment components and mechanisms of treatment underlying ICBT for SAD might inform clinicians and researchers to plan more potent and scalable treatments. TRIAL REGISTRATION clinicaltrials.gov (NCT04879641) on June, 11th 2021. https://clinicaltrials.gov/ct2/show/NCT04879641.
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Affiliation(s)
- Rodrigo C.T. Lopes
- Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse, 8, 3012 Bern, Switzerland,Corresponding author at: Universität Bern, Institut für Psychologie, Klinische Psychologie und Psychotherapie, Fabrikstrasse 8, 3012 Bern, Switzerland.
| | - Dajana Šipka
- Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse, 8, 3012 Bern, Switzerland
| | - Tobias Krieger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse, 8, 3012 Bern, Switzerland
| | - Jan Philipp Klein
- Department of Psychiatry, Psychosomatics and Psychotherapy, Luebeck University, Luebeck, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse, 8, 3012 Bern, Switzerland
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Zhang X, Lewis S, Firth J, Chen X, Bucci S. Digital mental health in China: a systematic review. Psychol Med 2021; 51:2552-2570. [PMID: 34581263 PMCID: PMC8579156 DOI: 10.1017/s0033291721003731] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 01/24/2023]
Abstract
Mental health problems are highly prevalent in China; however, China's mental health services lack resources to deliver high-quality care to people in need. Digital mental health is a promising solution to this short-fall in view of the population's digital literacy. In this review, we aim to: (i) investigate the effectiveness, acceptability, usability, and safety of digital health technologies (DHTs) for people with mental health problems in China; (ii) critically appraise the literature; and (iii) make recommendations for future research directions. The databases MEDLINE, PsycINFO, EMBASE, Web of Science, CNKI, WANFANG, and VIP were systemically searched for English and Chinese language articles evaluating DHTs for people with mental health problems in mainland China. Eligible studies were systematically reviewed. The heterogeneity of studies included precluded a meta-analysis. In total, 39 articles were retrieved, reporting on 32 DHTs for various mental health problems. Compared with the digital mental health field in the West, the Chinese studies targeted schizophrenia and substance use disorder more often and investigated social anxiety mediated by shame and culturally specific variants, DHTs were rarely developed in a co-production approach, and methodology quality was less rigorous. To our knowledge, this is the first systematic review focused on digital mental health in the Chinese context including studies published in both English and the Chinese language. DHTs were acceptable and usable among Chinese people with mental health problems in general, similar to findings from the West. Due to heterogeneity across studies and a paucity of robust control trial research, conclusions about the efficacy of DHTs are lacking.
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Affiliation(s)
- Xiaolong Zhang
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Shôn Lewis
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Joseph Firth
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NICM Health Research Institute, Western Sydney University, Westmead, Australia
| | - Xu Chen
- The National Clinical Research Center for Mental Disorders & 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
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Schønning A, Nordgreen T. Predicting Treatment Outcomes in Guided Internet-Delivered Therapy for Anxiety Disorders-The Role of Treatment Self-Efficacy. Front Psychol 2021; 12:712421. [PMID: 34744872 PMCID: PMC8566333 DOI: 10.3389/fpsyg.2021.712421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022] Open
Abstract
Aim: Guided Internet-delivered therapy has shown to be an effective treatment format for anxiety disorders. However, not all patients experience improvement, and although predictors of treatment outcome have been identified, few are consistent over time and across studies. The current study aimed to examine whether treatment self-efficacy (self-efficacy regarding the mastery of obstacles during treatment) in guided Internet-delivered therapy for anxiety disorders in adults could be a predictor of lower dropout rates and greater symptom reduction. Method: The analyzed data comes from an open effectiveness study including 575 patients receiving guided Internet-delivered therapy for panic disorder or social anxiety disorder. Treatment self-efficacy was measured at pre-treatment. Symptom reduction was measured at 10 measurement points, including a 6-month follow-up. A mixed linear model was applied in the analysis. Results: The results showed that high treatment self-efficacy was a predictor of both lower dropout rates and greater symptom reduction. Significant interaction effects between time and treatment self-efficacy were found for several of the nine modules that constitutes the treatment program, suggesting that treatment self-efficacy could be a moderator of symptom reduction. Three of nine modules in the panic disorder treatment and six of nine in the social anxiety disorder treatment showed significant interaction effects. Conclusion: The results suggest that measuring treatment self-efficacy may be a valuable tool to identify patients at risk of dropping out, and that treatment self-efficacy could be a predictor and moderator of symptom reduction in guided Internet-delivered therapy. The implications of the results are discussed.
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Affiliation(s)
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
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Lebel J, Flores-Tremblay T, Binet É, Ouellet MC, Belleville G. Données d’utilisation d’un autotraitement guidé en ligne pour promouvoir la résilience après une catastrophe naturelle. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1081516ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectifs Malgré l’existence de plusieurs traitements en ligne pour les personnes avec un trouble de stress posttraumatique (TSPT), peu d’études se sont penchées sur les données d’utilisation d’une telle intervention. Étant donné le potentiel de la modalité en ligne à pallier les obstacles limitant l’accès à l’aide psychologique, il importe de documenter les interactions des usagers avec ces outils en lien avec l’amélioration des symptômes ciblés. L’objectif de cette étude est de documenter les données d’utilisation de la plateforme de traitement en ligne RESILIENT par les personnes évacuées des feux de Fort McMurray, Alberta (Canada), et d’examiner leur association avec l’efficacité du traitement sur les symptômes de trouble de stress posttraumatique (TSPT), d’insomnie et de dépression, et l’adhésion au traitement, mesurée par le nombre de modules consultés par les participants.
Méthode Quatre-vingt-dix-sept personnes évacuées des feux de Fort McMurray présentant des symptômes de TSPT, d’insomnie et de dépression sont incluses dans la présente étude. Les participants étaient invités à utiliser la plateforme RESILIENT, un autotraitement en ligne guidé par un thérapeute qui cible les symptômes de TSPT, le sommeil et l’humeur, et comprend 12 modules offrant des stratégies de thérapies cognitives et comportementales (TCC) basées sur les données probantes. Des données d’utilisation objectives (p. ex. nombre de modules consultés) et subjectives (p. ex. niveau d’efforts investis) ont été recueillies.
Résultats Afin de prédire la réduction des symptômes de TSPT, de dépression et d’insomnie, ainsi que le nombre de modules consultés par les participants, des modèles de régressions séquentielles ont été effectués, avec un contrôle statistique pour les symptômes prétraitement, l’âge et le genre. Les modèles finaux ont révélé qu’une réduction des symptômes de TSPT, de dépression et d’insomnie était prédite significativement par le nombre de modules consultés (β = - 0,41 ; - 0,53 ; - 0,49 respectivement, tous p < 0,001) ainsi que par le niveau d’efforts moyen autorapporté au module 7 (mi-parcours) (β = - 0,43 ; p < 0,001 ; β = - 0,38 ; p = 0,005 et β = - 0,36 ; p = 0,007 respectivement). Le nombre de modules consultés, par ailleurs, était prédit significativement par le nombre de mots dans le 4e module (β = 0,34 ; p < 0,001) et dans le 7e module (β = 0,44 ; p < 0,001), ainsi que par le nombre d’entrées dans le journal du sommeil (β = 0,28 ; p < 0,001).
Conclusion Les résultats ont confirmé qu’une plus grande interaction avec la plateforme influence positivement l’efficacité du traitement et qu’une utilisation accrue en début de traitement semble être un bon prédicteur de l’achèvement de celui-ci. Cette étude confirme l’importance de soutenir l’engagement des participants envers le traitement en ligne afin d’optimiser son efficacité.
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Affiliation(s)
- Jessica Lebel
- École de Psychologie, Université Laval, Québec, QC, Canada
| | | | - Émilie Binet
- École de Psychologie, Université Laval, Québec, QC, Canada
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Spanhel K, Balci S, Feldhahn F, Bengel J, Baumeister H, Sander LB. Cultural adaptation of internet- and mobile-based interventions for mental disorders: a systematic review. NPJ Digit Med 2021; 4:128. [PMID: 34433875 PMCID: PMC8387403 DOI: 10.1038/s41746-021-00498-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 08/03/2021] [Indexed: 02/07/2023] Open
Abstract
Providing accessible and effective healthcare solutions for people living in low- and middle-income countries, migrants, and indigenous people is central to reduce the global mental health treatment gap. Internet- and mobile-based interventions (IMI) are considered scalable psychological interventions to reduce the burden of mental disorders and are culturally adapted for implementation in these target groups. In October 2020, the databases PsycInfo, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were systematically searched for studies that culturally adapted IMI for mental disorders. Among 9438 screened records, we identified 55 eligible articles. We extracted 17 content, methodological, and procedural components of culturally adapting IMI, aiming to consider specific situations and perspectives of the target populations. Adherence and effectiveness of the adapted IMI seemed similar to the original IMI; yet, no included study conducted a direct comparison. The presented taxonomy of cultural adaptation of IMI for mental disorders provides a basis for future studies investigating the relevance and necessity of their cultural adaptation.PROSPERO registration number: CRD42019142320.
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Affiliation(s)
- Kerstin Spanhel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany.
| | - Sumeyye Balci
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Felicitas Feldhahn
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Juergen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Lasse B Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
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Rodrigo H, Beukes EW, Andersson G, Manchaiah V. Internet-based cognitive-behavioural therapy for tinnitus: secondary analysis to examine predictors of outcomes. BMJ Open 2021; 11:e049384. [PMID: 34417217 PMCID: PMC8381319 DOI: 10.1136/bmjopen-2021-049384] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The current study examined predictors of outcomes of internet-based cognitive-behavioural therapy (ICBT) for individuals with tinnitus. DESIGN Secondary analysis of intervention studies. SETTING Internet-based guided tinnitus intervention provided in the UK. PARTICIPANTS 228 individuals who underwent ICBT. INTERVENTIONS ICBT. PRIMARY AND SECONDARY OUTCOME MEASURES The key predictor variables included demographic, tinnitus, hearing-related and treatment-related variables as well as clinical factors (eg, anxiety, depression, insomnia), which can have an impact on the treatment outcome. A 13-point reduction in Tinnitus Functional Index (TFI) scores has been defined as a successful outcome. RESULTS Of the 228 subjects who were included in the study, 65% had a successful ICBT outcome. As per the univariate analysis, participants with a master's degree or above had the highest odds of having a larger reduction in tinnitus severity (OR 3.47; 95% CI 1.32 to 12.51), compared with the participants who had education only up to high school or less. Additionally, the baseline tinnitus severity was found to be a significant variable (OR 2.65; 95% CI 1.50 to 4.67) contributing to a successful outcome with the intervention. Both linear and logistic regression models have identified education level and baseline tinnitus severity to be significant predictor variables contributing to a reduction in tinnitus severity post-ICBT. As per the linear regression model, participants who had received disability allowance had shown a 25.3-point lower TFI reduction compared with those who did not experience a decrease in their workload due to tinnitus after adjusting for baseline tinnitus severity and their education level. CONCLUSIONS Predictors of intervention outcome can be used as a means of triaging patients to the most suited form of treatment to achieve optimal outcomes and to make healthcare savings. Future studies should consider including a heterogeneous group of participants as well as other predictor variables not included in the current study.ClinicalTrial.gov Registration: NCT02370810 (completed); NCT02665975 (completed).
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Affiliation(s)
- Hansapani Rodrigo
- School of Mathematical and Statistical Sciences, The University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Eldré W Beukes
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, Texas, USA
- Department of Vision and Hearing Sciences, Anglia Ruskin University, Chelmsford, UK
| | - Gerhard Andersson
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institute, Stockholm, Sweden
| | - Vinaya Manchaiah
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, Texas, USA
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, Karnataka, India
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Elison-Davies S, Wardell JD, Quilty LC, Ward J, Davies G. Examining correlates of cannabis users' engagement with a digital intervention for substance use disorder: An observational study of clients in UK services delivering Breaking Free Online. J Subst Abuse Treat 2021; 123:108261. [PMID: 33612195 DOI: 10.1016/j.jsat.2020.108261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 11/09/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cannabis is among the most widely used drugs, with the literature demonstrating that cannabis use disorder (CUD) may be more prevalent than previously thought. Research should explore novel approaches to behavioral support to meet treatment need, including computer-assisted therapies such as Breaking Free Online (BFO). This study aimed to understand how participants' baseline sociodemographic and clinical characteristics are associated with engagement with BFO, and how both participants' characteristics and their engagement may be associated with cannabis use and biopsychosocial functioning at follow-up. METHODS An observational study with 1830 individuals presenting to UK-based publicly funded treatment services who reported cannabis as their primary problem substance and engaged with BFO as a self-directed intervention. RESULTS Moderate-severe depression/anxiety (51%) and elevated severity of cannabis dependence scores (39%) characterized the baseline sample. Women demonstrated greater clinical complexity at baseline than men. Baseline mental health and biopsychosocial functioning were associated with whether participants completed a follow-up assessment. Among 460 participants who completed a follow-up assessment, intervention engagement was positively associated with self-reported quality of life and biopsychosocial functioning at follow-up. CONCLUSIONS Cannabis users demonstrated substantial clinical complexity at baseline, with depression/anxiety and biopsychosocial functioning being associated with BFO engagement. Greater BFO engagement was also associated with better quality of life and biopsychosocial functioning at follow-up. Some groups, including those with greater mental health and biopsychosocial impairment at baseline and women, may require support to engage with BFO to maximize clinical benefits.
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Affiliation(s)
- Sarah Elison-Davies
- Breaking Free Group, Williams House, Manchester Science Park, Lloyd Street North, Manchester M15 6SE, UK.
| | - Jeffrey D Wardell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1L8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1L8, Canada
| | - Lena C Quilty
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1L8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1L8, Canada
| | - Jonathan Ward
- Breaking Free Group, Williams House, Manchester Science Park, Lloyd Street North, Manchester M15 6SE, UK
| | - Glyn Davies
- Breaking Free Group, Williams House, Manchester Science Park, Lloyd Street North, Manchester M15 6SE, UK
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