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Kaiser T, Brakemeier EL, Herzog P. What if we wait? Using synthetic waiting lists to estimate treatment effects in routine outcome data. Psychother Res 2023; 33:1043-1057. [PMID: 36857510 DOI: 10.1080/10503307.2023.2182241] [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: 07/01/2022] [Accepted: 02/14/2023] [Indexed: 03/03/2023] Open
Abstract
Objective: Due to the lack of randomization, pre-post routine outcome data precludes causal conclusions. We propose the "synthetic waiting list" (SWL) control group to overcome this limitation. Method: First, a step-by-step introduction illustrates this novel approach. Then, this approach is demonstrated using an empirical example with data from an outpatient cognitive-behavioral therapy (CBT) clinic (N = 139). We trained an ensemble machine learning model ("Super Learner") on a data set of patients waiting for treatment (N = 311) to make counterfactual predictions of symptom change during this hypothetical period. Results: The between-group treatment effect was estimated to be d = 0.42. Of the patients who received CBT, 43.88% achieved reliable and clinically significant change, while this probability was estimated to be 14.54% in the SWL group. Counterfactual estimates suggest a clear net benefit of psychotherapy for 41% of patients. In 32%, the benefit was unclear, and 27% would have improved similarly without receiving CBT. Conclusions: The SWL is a viable new approach that provides between-group outcome estimates similar to those reported in the literature comparing psychotherapy with high-intensity control interventions. It holds the potential to mitigate common limitations of routine outcome data analysis.
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Affiliation(s)
- Tim Kaiser
- Department of Psychology, University of Greifswald, Greifswald, Germany
| | | | - Philipp Herzog
- Department of Psychology, Harvard University, Cambridge, MA, USA
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2
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Vivas-Fernandez M, Garcia-Lopez LJ, Piqueras JA, Muela-Martinez JA, Canals-Sans J, Espinosa-Fernandez L, Jimenez-Vazquez D, Diaz-Castela MDM, Morales-Hidalgo P, Rivera M, Ehrenreich-May J. Randomized controlled trial for selective preventive transdiagnostic intervention for adolescents at risk for emotional disorders. Child Adolesc Psychiatry Ment Health 2023; 17:77. [PMID: 37353831 PMCID: PMC10290361 DOI: 10.1186/s13034-023-00616-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/15/2023] [Indexed: 06/25/2023] Open
Abstract
Significant evidence does exist on the effectiveness of transdiagnostic interventions to improve emotional problems in clinical populations, and their application as universal and indicated prevention programs. However, no randomized controlled trials (RCT) studying selective transdiagnostic prevention intervention have been published. This is the first known RCT to evaluate the efficacy/effectiveness of an evidence-based selective prevention transdiagnostic program for emotional problems in adolescents. The impact of three different interventions was evaluated: (1) PROCARE (Preventive transdiagnostic intervention for Adolescents at Risk for Emotional disorders), which is a group-based, abbreviated version of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A), along with adding a booster session to reduce risk of onset of anxiety and depression, (2) PROCARE + , which includes the PROCARE protocol along with personalized add-on modules tailored to match adolescents' risk factors, and (3) an active control condition (ACC) based on emotional psychoeducation. In total, 208 adolescents (48.5% girls) evidencing high risk and low protective factors were randomized and allocated to PROCARE, PROCARE + or ACC. Data from 153 adolescents who completed all assessments in the different phases of the study were analyzed. Self- and parent-reported measures were taken at baseline, as well as after the intervention, a 6 month follow-up was carried out, together with a 1 month follow-up after the booster session. Differences between conditions were significant on most of the outcome measures, with superior effect sizes for PROCARE + in the short and long term. Interventions were acceptable in terms of acceptability, with good satisfaction rates. Tailored targeted selective transdiagnostic interventions focused on mitigating risk factors and promoting protective factors in vulnerable adolescents are promising.
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Affiliation(s)
| | - Luis-Joaquin Garcia-Lopez
- University of Jaen, Jaen, Spain
- Division of Clinical Psychology, Department of Psychology, University of Jaen, Campus de las Lagunillas s/n, C-5., Jaen, Spain
| | | | | | | | | | | | | | - Paula Morales-Hidalgo
- Universitat Rovira I Virgili, Tortosa, Spain
- Universitat Oberta de Catalunya, Barcelona, Spain
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van Dijk DA, Meijer RM, van den Boogaard TM, Spijker J, Ruhé HG, Peeters FPML. Worse off by waiting for treatment? The impact of waiting time on clinical course and treatment outcome for depression in routine care. J Affect Disord 2023; 322:205-211. [PMID: 36372129 DOI: 10.1016/j.jad.2022.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/31/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Long-term untreated major depressive disorder (MDD) is associated with a less favorable clinical course. Waiting time, defined as the interval between diagnostic workup and treatment initiation, may be clinically relevant given the prolongation of the pre-existing duration of untreated MDD. However, it is currently unknown whether and to what extent waiting time affects treatment course in routine outpatient care. METHODS Retrospectively extracted data from 715 outpatients with MDD who received naturalistic outpatient MDD treatment were examined. Treatment outcome was defined as the difference in depression severity at the start of treatment and six months thereafter. Clinical course during waiting time was defined by the difference in severity at diagnostic workup and at treatment initiation. We analyzed the association between waiting time and treatment outcome and between waiting time and clinical course during this waiting time using multivariable regression analyses. We adjusted for severity and suicidality as potential confounders. RESULTS An increased duration of the waiting time was associated with a less favorable treatment outcome (B = 0.049, SE = 0.019, p = 0.01). This association persisted after adjustment for potential confounders (B = 0.053, SE = 0.02, p = 0.01). No association was found between length of waiting time and clinical course during waiting time. LIMITATIONS Strict definitions resulted in smaller sample sizes for the final analyses. The uncontrolled design may be questionable to definitively establish the impact of waiting time on treatment outcome. CONCLUSIONS A prolonged waiting time is significantly associated with less favorable treatment outcome. Reduction of waiting time deserves priority in depression treatment planning to improve clinical outcomes.
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Affiliation(s)
- D A van Dijk
- Department of Clinical Psychological Science, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, the Netherlands; Parnassia Group, PsyQ Haaglanden, Department of Mood Disorders, The Hague, the Netherlands.
| | - R M Meijer
- Antes/Parnassia Psychiatric Institute, Rotterdam, the Netherlands
| | - Th M van den Boogaard
- Parnassia Group, PsyQ Haaglanden, Department of Mood Disorders, The Hague, the Netherlands
| | - J Spijker
- Pro Persona Mental Healthcare, Nijmegen, the Netherlands; Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - H G Ruhé
- Department of Psychiatry, Radboudumc, Nijmegen, the Netherlands; Donders Institute for Brain and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - F P M L Peeters
- Department of Clinical Psychological Science, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, the Netherlands
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Vivas-Fernandez M, Garcia-Lopez LJ, Piqueras JA, Muela-Martinez JA, Canals-Sans J, Espinosa-Fernandez L, Jimenez-Vazquez D, Diaz-Castela MDM, Morales-Hidalgo P, Rivera M, Ehrenreich-May J. Randomized controlled trial for selective preventive transdiagnostic intervention for adolescents at risk for emotional disorders. Child Adolesc Psychiatry Ment Health 2023; 17:7. [PMID: 36635735 PMCID: PMC9835742 DOI: 10.1186/s13034-022-00550-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/19/2022] [Indexed: 01/14/2023] Open
Abstract
Significant evidence does exist on the effectiveness of transdiagnostic interventions to improve emotional problems in clinical populations, and their application as universal and indicated prevention programs. However, no randomized controlled trials (RCT) studying selective transdiagnostic prevention intervention have been published. This is the first known RCT to evaluate the efficacy/effectiveness of an evidence-based selective prevention transdiagnostic program for emotional problems in adolescents. The impact of three different interventions was evaluated: (1) PROCARE (Preventive transdiagnostic intervention for Adolescents at Risk for Emotional disorders), which is a group-based, online-delivered, abbreviated version of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A), along with adding a booster session, to reduce risk of onset of anxiety and depression, (2) PROCARE + , which includes the PROCARE protocol along with personalized add-on modules tailored to match adolescents' risk factors, and (3) an active control condition (ACC) based on emotional psychoeducation. In total, 286 adolescents (53.3% girls) evidencing high risk and low protective factors were randomized and allocated to PROCARE, PROCARE + or ACC. Self- and parent-reported measures were taken at baseline, as well as after the intervention, a 6-month follow-up was carried out, together with a 1-month follow-up after the booster session. Differences between conditions were significant on most of the outcome measures, with superior effect sizes for PROCARE +. Interventions were excellent in terms of acceptability, with good satisfaction rates. Tailored selective transdiagnostic interventions focused on mitigating risk factors and promoting protective factors in vulnerable adolescents are promising.
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Affiliation(s)
| | - Luis-Joaquin Garcia-Lopez
- University of Jaen, Jaen, Spain
- Department of Psychology, Division of Clinical Psychology, University of Jaen, Campus de Las Lagunillas S/N, C-5 Jaen, Spain
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Schienle A, Jurinec N. Placebo effects during the waiting period for psychotherapy in patients with depression. CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-022-04206-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AbstractPatients with mental health problems typically have to wait for psychological therapies. This study aimed to investigate the effects of a placebo administered to patients with depression while they were waiting for cognitive-behavioral therapy. Sixty-seven patients were randomly assigned to a three-week waiting period with or without treatment with a take-home placebo for daily usage (herbal medicine to mobilize the body’s natural healing powers to be taken orally). Symptoms of depression (self-rated and clinician-rated) were assessed at the beginning and end of the waiting period. Moreover, each week the patients evaluated levels of energy, concentration, relaxation, well-being, and sleep quality. The placebo group showed a greater reduction in symptoms of depression (self-rated and clinician-rated) compared to the standard group. Moreover, placebo treatment was associated with improved overall well-being during the waiting period. In conclusion, placebo treatment can make the wait time for psychotherapy more tolerable for patients with depression.Clinical trial registration: German Clinical Trials Register (DRKS00028118)
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Wijnhoven LAMW, Engels RCME, Onghena P, Otten R, Creemers DHM. The Additive Effect of CBT Elements on the Video Game 'Mindlight' in Decreasing Anxiety Symptoms of Children with Autism Spectrum Disorder. J Autism Dev Disord 2021; 52:150-168. [PMID: 33660138 PMCID: PMC8732870 DOI: 10.1007/s10803-021-04927-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 11/25/2022]
Abstract
The aim of the present study was to examine the additive effect of elements of cognitive behavioral therapy (CBT) on the video game Mindlight in decreasing anxiety of children with an autism spectrum disorder (ASD). A non-concurrent multiple baseline design with 8 children with ASD in the age of 8–12 was used. CBT did not have the hypothesized additive effect on Mindlight in decreasing anxiety of children with ASD. Instead, multiple participants already experienced a decrease in anxiety during the Mindlight sessions. Yet, several participants did experience a stabilization in anxiety at a low level during the CBT sessions. For now, it can be concluded that CBT does not have an additive effect on Mindlight.
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Affiliation(s)
- Lieke A. M. W. Wijnhoven
- Present Address: Mental Health Care Institute Karakter, Reinier Postlaan 12, 6525 GC Nijmegen, The Netherlands
- Present Address: Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
- Mental Health Care Institute GGZ Oost-Brabant, P.O. Box 3, 5427 ZG Boekel, The Netherlands
| | - Rutger C. M. E. Engels
- Erasmus School of Social and Behavioral Sciences, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
- Katholieke Universiteit Leuven, P.O. Box 5005, 3000 Leuven, Belgium
| | - Patrick Onghena
- Katholieke Universiteit Leuven, P.O. Box 5005, 3000 Leuven, Belgium
- Present Address: Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
| | - Roy Otten
- Erasmus School of Social and Behavioral Sciences, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
- Present Address: Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
- Present Address: REACH Institute, Arizona State University, P.O. Box 876005, Tempe, AZ USA
- Mental Health Care Institute GGZ Oost-Brabant, P.O. Box 3, 5427 ZG Boekel, The Netherlands
- Mental Health Care Institute Pluryn, P.O. Box 53, 6500 AB Nijmegen, The Netherlands
| | - Daan H. M. Creemers
- Present Address: Mental Health Care Institute Karakter, Reinier Postlaan 12, 6525 GC Nijmegen, The Netherlands
- Erasmus School of Social and Behavioral Sciences, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
- Present Address: Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
- Mental Health Care Institute GGZ Oost-Brabant, P.O. Box 3, 5427 ZG Boekel, The Netherlands
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Schlicker S, Baumeister H, Buntrock C, Sander L, Paganini S, Lin J, Berking M, Lehr D, Ebert DD. A Web- and Mobile-Based Intervention for Comorbid, Recurrent Depression in Patients With Chronic Back Pain on Sick Leave (Get.Back): Pilot Randomized Controlled Trial on Feasibility, User Satisfaction, and Effectiveness. JMIR Ment Health 2020; 7:e16398. [PMID: 32293577 PMCID: PMC7191351 DOI: 10.2196/16398] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/11/2020] [Accepted: 01/27/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chronic back pain (CBP) is linked to a higher prevalence and higher occurrence of major depressive disorder (MDD) and can lead to reduced quality of life. Unfortunately, individuals with both CBP and recurrent MDD are underidentified. Utilizing health care insurance data may provide a possibility to better identify this complex population. In addition, internet- and mobile-based interventions might enhance the availability of existing treatments and provide help to those highly burdened individuals. OBJECTIVE This pilot randomized controlled trial investigated the feasibility of recruitment via the health records of a German health insurance company. The study also examined user satisfaction and effectiveness of a 9-week cognitive behavioral therapy and Web- and mobile-based guided self-help intervention Get.Back in CBP patients with recurrent MDD on sick leave compared with a waitlist control condition. METHODS Health records from a German health insurance company were used to identify and recruit participants (N=76) via invitation letters. Study outcomes were measured using Web-based self-report assessments at baseline, posttreatment (9 weeks), and a 6-month follow-up. The primary outcome was depressive symptom severity (Center for Epidemiological Studies-Depression); secondary outcomes included anxiety (Hamilton Anxiety and Depression Scale), quality of life (Assessment of Quality of Life), pain-related variables (Oswestry Disability Index, Pain Self-Efficacy Questionnaire, and pain intensity), and negative effects (Inventory for the Assessment of Negative Effects of Psychotherapy). RESULTS The total enrollment rate with the recruitment strategy used was 1.26% (76/6000). Participants completed 4.8 modules (SD 2.6, range 0-7) of Get.Back. The overall user satisfaction was favorable (mean Client Satisfaction Questionnaire score=24.5, SD 5.2). Covariance analyses showed a small but statistically significant reduction in depressive symptom severity in the intervention group (n=40) at posttreatment compared with the waitlist control group (n=36; F1,76=3.62, P=.03; d=0.28, 95% CI -0.17 to 0.74). Similar findings were noted for the reduction of anxiety symptoms (F1,76=10.45; P=.001; d=0.14, 95% CI -0.31 to 0.60) at posttreatment. Other secondary outcomes were nonsignificant (.06≤P≤.44). At the 6-month follow-up, the difference between the groups with regard to reduction in depressive symptom severity was no longer statistically significant (F1,76=1.50, P=.11; d=0.10, 95% CI -0.34 to 0.46). The between-group difference in anxiety at posttreatment was maintained to follow-up (F1,76=2.94, P=.04; d=0.38, 95% CI -0.07 to 0.83). There were no statistically significant differences across groups regarding other secondary outcomes at the 6-month follow-up (.08≤P≤.42). CONCLUSIONS These results suggest that participants with comorbid depression and CBP on sick leave may benefit from internet- and mobile-based interventions, as exemplified with the positive user satisfaction ratings. The recruitment strategy via health insurance letter invitations appeared feasible, but more research is needed to understand how response rates in untreated individuals with CBP and comorbid depression can be increased. TRIAL REGISTRATION German Clinical Trials Register DRKS00010820; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00010820.
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Affiliation(s)
- Sandra Schlicker
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.,Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Lasse Sander
- Department of Rehabilitationpsychology and Psychotherapy, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Sarah Paganini
- Department of Sport and Sport Science, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Jiaxi Lin
- Department of Psychiatry and Psychotherapy Medical Center, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Dirk Lehr
- Health Psychology and Applied Biological Psychology, Leuphana University Lüneburg, Lüneburg, Germany
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.,Faculty of Behavioural and Movement Sciences, Section of Clinical Psychology, Vrije University Amsterdam, Amsterdam, Netherlands
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Abstract
UNLABELLED AimsThe aim of this study was to reanalyse the data from Cuijpers et al.'s (2018) meta-analysis, to examine Eysenck's claim that psychotherapy is not effective. Cuijpers et al., after correcting for bias, concluded that the effect of psychotherapy for depression was small (standardised mean difference, SMD, between 0.20 and 0.30), providing evidence that psychotherapy is not as effective as generally accepted. METHODS The data for this study were the effect sizes included in Cuijpers et al. (2018). We removed outliers from the data set of effects, corrected for publication bias and segregated psychotherapy from other interventions. In our study, we considered wait-list (WL) controls as the most appropriate estimate of the natural history of depression without intervention. RESULTS The SMD for all interventions and for psychotherapy compared to WL controls was approximately 0.70, a value consistent with past estimates of the effectiveness of psychotherapy. Psychotherapy was also more effective than care-as-usual (SMD = 0.31) and other control groups (SMD = 0.43). CONCLUSIONS The re-analysis reveals that psychotherapy for adult patients diagnosed with depression is effective.
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Wilks CR, Lungu A, Ang SY, Matsumiya B, Yin Q, Linehan MM. A randomized controlled trial of an Internet delivered dialectical behavior therapy skills training for suicidal and heavy episodic drinkers. J Affect Disord 2018; 232:219-228. [PMID: 29499504 PMCID: PMC5859943 DOI: 10.1016/j.jad.2018.02.053] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/25/2018] [Accepted: 02/16/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Given that alcohol misuse elevates risk of suicide death among ideators, the paucity of treatment outcome research for individuals presenting with both suicide ideation and problem drinking is particularly troubling. Dialectical behavior therapy (DBT) skills training, which effectively targets behaviors associated with emotion dysregulation including addictive and suicidal behaviors, provides a fitting model amenable to computerization. As stigma and scarcity stand as potential barriers to treatment, online dissemination platforms provide means for efficient treatment delivery that can augment the utility of suitable interventions. This pilot RCT sought to evaluate the feasibility, acceptability, and preliminary efficacy of an Internet-delivered DBT skills training intervention (iDBT-ST) for suicidal individuals who engage in heavy episodic drinking METHODS: Participants (N = 59) were randomized to receive iDBT-ST immediately or after an 8-week waiting period. Clinical outcomes were suicide ideation, alcohol use, and emotion dysregulation. RESULTS Participants on average saw a significant reduction in all outcomes over the four-month study period. Compared to waitlist controls, individuals who received iDBT-ST immediately showed faster reductions in alcohol consumption. CONCLUSIONS Preliminary results suggest that iDBT-ST may be a viable resource for the high-risk and underserved group represented in this study, and pathways for future development are suggested. LIMITATIONS There was difficulty retaining and engaging participants due to technological barriers.
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Affiliation(s)
- Chelsey R. Wilks
- University of Washington, 3539 University Way, Seattle, WA
98195
| | - Anita Lungu
- Lyra Health, 205 Park Rd, Burlingame, CA 98010, USA.
| | - Sin Yee Ang
- University of Washington, 3917 University Way, Seattle, WA 98195, USA.
| | - Brandon Matsumiya
- University of Central Florida, 4111 Pictor Ln, Orlando, FL 32816, USA.
| | - Qingqing Yin
- University of Washington, 3917 University Way, Seattle, WA 98195, USA.
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On Depression. J Nerv Ment Dis 2017; 205:587-588. [PMID: 28753174 DOI: 10.1097/nmd.0000000000000724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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