1
|
Atefi GL, Koh WQ, Kohl G, Seydavi M, Swift JK, Akbari M, de Vugt ME. Adherence to Online Interventions for Family Caregivers of People With Dementia: A Meta-Analysis and Systematic Review. Am J Geriatr Psychiatry 2024; 32:1271-1291. [PMID: 38735829 DOI: 10.1016/j.jagp.2024.04.008] [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: 02/26/2024] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE Online interventions hold promise in supporting the well-being of family caregivers and enhancing the quality of care they provide for individuals with long-term or chronic conditions. However, dropout rates from support programs among specific groups of caregivers, such as caregivers of people with dementia, pose a challenge. Focused reviews are needed to provide more accurate insights and estimates in this specific research area. METHODS A meta-analysis of dropout rates from available online interventions for family caregivers of people with dementia was conducted to assess treatment acceptability. A systematic search yielded 18 studies involving 1,215 caregivers. RESULTS The overall pooled dropout rate was 18.4%, with notable heterogeneity indicating varied intervention adherence. Interventions incorporating human contact, interactive features, and personalization strategies for specific types and stages of dementia predicted significantly lower dropout rates. Methodological assessment revealed variability in study quality. CONCLUSION Findings support the effectiveness of social support, personalization strategies, and co-design in enhancing intervention adherence among dementia family caregivers. Further research is needed to explore factors influencing dropout rates and conduct robust trials to refine the implementation of future interventions.
Collapse
Affiliation(s)
- Golnaz L Atefi
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg (GLA, MEV), Maastricht University, Maastricht, The Netherlands.
| | - Wei Qi Koh
- School of Health and Rehabilitation Sciences (WQK), The University of Queensland, Brisbane, Australia
| | - Gianna Kohl
- Research Department of Clinical (GK), Educational and Health Psychology, University College London, London, UK
| | - Mohammad Seydavi
- Department of Clinical Psychology (MS, MA), Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Joshua K Swift
- Department of Psychology (JKS), Idaho State University, 921 S. 8th St, Pocatello, ID
| | - Mehdi Akbari
- Department of Clinical Psychology (MS, MA), Faculty of Psychology and Education, Kharazmi University, Tehran, Iran.
| | - Marjolein E de Vugt
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg (GLA, MEV), Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
2
|
Babos CI, Zucchi G, Filimberti AE, Leucuta DC, Dumitrascu DL. Meditation and Compassion Therapy in Psychiatric Disorders: A Pilot Study. Cureus 2024; 16:e65678. [PMID: 39077673 PMCID: PMC11286201 DOI: 10.7759/cureus.65678] [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] [Accepted: 07/27/2024] [Indexed: 07/31/2024] Open
Abstract
Introduction Our study aimed to compare meditation and compassion-based group therapy with the standard of care in patients with eating disorders, drug addiction, alcohol addiction, and depression, concerning acceptance, mindfulness awareness, self-compassion, and psychological distress. Methods A controlled designed study was performed, comparing meditation and compassion-focused group therapy added to the standard of care with the standard of care alone, on patients with eating disorders, drug addiction, alcohol addiction, and mood disorders. Four validated questionnaires were administered: the Acceptance and Action Questionnaire-II (AAQ-II), which assesses the ability to be fully in touch with the present moment; the Mindful Attention Awareness Scale (MAAS), which assesses the ability to experience consciously what is happening in the present moment; the Self-Compassion Scale (SCS), which assesses self-compassion characteristics, including loving-kindness; and the Symptom Checklist-90 (SCL-90), which measures psychological distress (anxiety, depression, psychotic behavior, etc.). Results There was a total of 75 subjects, out of which 48 represented the experimental group, and 27 represented the control group. The overall mean age of the subjects was 44.8 ± 13.2 years. There were statistically significant increases in the experimental group (baseline vs. end of study) for the AAQ-II, MAAS, and SCS scores, and a statistically significant decrease in the SCL-90 score. In the control group, there was a statistically significant decrease in the SCL-90 score, but no significant differences for other measurements. The comparisons between the two groups at the end of the study were as follows: AAQ-II: 0.7 (-5.74 to 7.15), p = 0.827; MAAS: 4.78 (-3.19 to 12.75), p = 0.233; SCS: 5.89 (-3.18 to 14.96), p = 0.199; SCL-90: -0.26 (-0.62 to 0.1), p = 0.157. Conclusion Within the experimental group, all scales improved statistically significantly. There were no statistically significant differences at the end of the study concerning the four scales between the groups. The comparison between groups was limited by data availability.
Collapse
Affiliation(s)
- Cristian I Babos
- Second Medical Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, ROU
| | - Giovanni Zucchi
- Alcoholic Rehabilitation, Ospedale Maria Luigia, Monticelli Terme, ITA
| | | | - Daniel C Leucuta
- Medical Informatics and Biostatistics Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, ROU
| | - Dan L Dumitrascu
- Second Medical Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, ROU
| |
Collapse
|
3
|
Terhorst Y, Kaiser T, Brakemeier EL, Moshe I, Philippi P, Cuijpers P, Baumeister H, Sander LB. Heterogeneity of Treatment Effects in Internet- and Mobile-Based Interventions for Depression: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e2423241. [PMID: 39023887 PMCID: PMC11258589 DOI: 10.1001/jamanetworkopen.2024.23241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/21/2024] [Indexed: 07/20/2024] Open
Abstract
Importance While the effects of internet- and mobile-based interventions (IMIs) for depression have been extensively studied, no systematic evidence is available regarding the heterogeneity of treatment effects (HTEs), indicating to what extent patient-by-treatment interactions exist and personalized treatment models might be necessary. Objective To investigate the HTEs in IMIs for depression as well as their efficacy and effectiveness. Data Sources A systematic search in Embase, MEDLINE, Central, and PsycINFO for randomized clinical trials and supplementary reference searches was conducted on October 13, 2019, and updated March 25, 2022. The search string included various terms related to digital psychotherapy, depression, and randomized clinical trials. Study Selection Titles, abstracts, and full texts were reviewed by 2 independent researchers. Studies of all populations with at least 1 intervention group receiving an IMI for depression and at least 1 control group were eligible, if they assessed depression severity as a primary outcome and followed a randomized clinical trial (RCT) design. Data Extraction and Synthesis This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Risk of bias was evaluated using the Cochrane Risk of Bias Tool. HTE was investigated using logarithmic variance ratios (lnVR) and effect sizes using Hedges g. Three-level bayesian meta-regressions were conducted. Main Outcomes and Measures Heterogeneity of treatment effects was the primary outcome of this study; magnitudes of treatment effect sizes were the secondary outcome. Depression severity was measured by different self-report and clinician-rated scales in the included RCTs. Results The systematic review of 102 trials included 19 758 participants (mean [SD] age, 39.9 [10.58] years) with moderate depression severity (mean [SD] in Patient Health Questionnaire-9 score, 12.81 [2.93]). No evidence for HTE in IMIs was found (lnVR = -0.02; 95% credible interval [CrI], -0.07 to 0.03). However, HTE was higher in more severe depression levels (β̂ = 0.04; 95% CrI, 0.01 to 0.07). The effect size of IMI was medium (g = -0.56; 95% CrI, -0.46 to -0.66). An interaction effect between guidance and baseline severity was found (β̂ = -0.24, 95% CrI, -0.03 to -0.46). Conclusions and Relevance In this systematic review and meta-analysis of RCTs, no evidence for increased patient-by-treatment interaction in IMIs among patients with subthreshold to mild depression was found. Guidance did not increase effect sizes in this subgroup. However, the association of baseline severity with HTE and its interaction with guidance indicates a more sensitive, guided, digital precision approach would benefit individuals with more severe symptoms. Future research in this population is needed to explore personalization strategies and fully exploit the potential of IMI.
Collapse
Affiliation(s)
- Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
- Department of Psychology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Tim Kaiser
- Methods and Evaluation/Quality Assurance, Freie Universität Berlin, Berlin, Germany
| | - Eva-Lotta Brakemeier
- Department of Clinical Psychology and Psychotherapy, University Greifswald, Greifswald, Germany
| | - Isaac Moshe
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Paula Philippi
- Department of Clinical Child and Adolescent Psychology and Psychotherapy, Bergische Universität Wuppertal, Wuppertal, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
| | - Lasse Bosse Sander
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| |
Collapse
|
4
|
Durepos P, MacLean R, Ricketts N, Boamah SA, Witherspoon R, Gould O, Olthuis JV, Totton K, Tucker K, Boulay I, Robitaille A, Aquino-Russell C, Kaasalainen S. Engaging care partners of persons living with dementia in acceptance and commitment therapy (ACT) programs: a scoping review. Aging Ment Health 2024; 28:725-737. [PMID: 38100551 DOI: 10.1080/13607863.2023.2288864] [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: 01/09/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVES Acceptance and commitment therapy (ACT) is a relatively new type of psychotherapy effective for treating depression and anxiety amongst family care partners of persons living with dementia [PLWD]. However, care partner engagement in mental health services is low and specific guidelines for designing ACT programs for care partners of PLWD do not exist. The purpose of this scoping review was to examine patterns in care partner engagement in ACT programs to identify program factors potentially influencing engagement. METHODS A comprehensive scoping review according to Arksey and O'Malley's framework was followed. Databases and grey literature were searched for primary studies of ACT programs with care partners of PLWD. Data were charted and synthesized. RESULTS Ten studies met inclusion criteria and were analyzed. Amongst these, engagement was highest in three ACT programs that were delivered individually, remotely and were therapist-led or supported. Conversely, engagement was the lowest in two ACT programs that were self-directed, web-based and had minimal or no care partner-therapist interaction. Program factors perceived as influencing engagement included tailoring and personalization, mode of delivery and format, therapeutic support and connectedness, program duration and pace. CONCLUSION Findings from this review suggest that care partners engagement may be promoted by designing ACT programs that focus on the therapeutic client-therapist relationship, are delivered remotely and individually. Future research should focus on evaluation of best implementation practices for engagement and effectiveness.
Collapse
Affiliation(s)
- Pamela Durepos
- Faculty of Nursing, University of New Brunswick, Fredericton, Canada
| | - Rachel MacLean
- Faculty of Nursing, University of New Brunswick, Fredericton, Canada
| | | | | | | | - Odette Gould
- Department of Psychology, Mount Allison University, Sackville, Canada
| | - Janine V Olthuis
- Department of Psychology, University of New Brunswick, Fredericton, Canada
| | - Karen Totton
- Faculty of Nursing, University of New Brunswick, Fredericton, Canada
| | - Kate Tucker
- Master of Applied Health Services Research, University of New Brunswick, Fredericton, Canada
| | | | - Annie Robitaille
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
- Centre of Excellence in Frailty-Informed Care, The Perley and Rideau Veterans' Health Centre, Ottawa, Canada
| | | | | |
Collapse
|
5
|
De Jesús-Romero R, Holder-Dixon AR, Buss JF, Lorenzo-Luaces L. Race, Ethnicity, and Other Cultural Background Factors in Trials of Internet-Based Cognitive Behavioral Therapy for Depression: Systematic Review. J Med Internet Res 2024; 26:e50780. [PMID: 38300699 PMCID: PMC10870215 DOI: 10.2196/50780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/05/2023] [Accepted: 11/16/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND There is a growing interest in developing scalable interventions, including internet-based cognitive behavioral therapy (iCBT), to meet the increasing demand for mental health services. Given the growth in diversity worldwide, it is essential that the clinical trials of iCBT for depression include diverse samples or, at least, report information on the race, ethnicity, or other background indicators of their samples. Unfortunately, the field lacks data on how well diversity is currently reported and represented in the iCBT literature. OBJECTIVE Thus, the main objective of this systematic review was to examine the overall reporting of racial and ethnic identities in published clinical trials of iCBT for depression. We also aimed to review the representation of specific racial and ethnic minoritized groups and the inclusion of alternative background indicators such as migration status or country of residence. METHODS Studies were included if they were randomized controlled trials in which iCBT was compared to a waiting list, care-as-usual, active control, or another iCBT. The included papers also had to have a focus on acute treatment (eg, 4 weeks to 6 months) of depression, be delivered via the internet on a website or a smartphone app and use guided or unguided self-help. Studies were initially identified from the METAPSY database (n=59) and then extended to include papers up to 2022, with papers retrieved from Embase, PubMed, PsycINFO, and Cochrane (n=3). Risk of bias assessment suggested that reported studies had at least some risk of bias due to use of self-report outcome measures. RESULTS A total of 62 iCBT randomized controlled trials representing 17,210 participants are summarized in this study. Out of those 62 papers, only 17 (27%) of the trials reported race, and only 12 (19%) reported ethnicity. Reporting outside of the United States was very poor, with the United States accounting for 15 (88%) out of 17 of studies that reported race and 9 (75%) out of 12 for ethnicity. Out of 3,623 participants whose race was reported in the systematic review, the racial category reported the most was White (n=2716, 74.9%), followed by Asian (n=209, 5.8%) and Black (n=274, 7.6%). Furthermore, only 25 (54%) out of the 46 papers conducted outside of the United States reported other background demographics. CONCLUSIONS It is important to note that the underreporting observed in this study does not necessarily indicate an underrepresentation in the actual study population. However, these findings highlight the poor reporting of race and ethnicity in iCBT trials for depression found in the literature. This lack of diversity reporting may have significant implications for the scalability of these interventions.
Collapse
Affiliation(s)
- Robinson De Jesús-Romero
- Department of Psychological and Brain Sciences, Indiana University - Bloomington, Bloomington, IN, United States
| | - Amani R Holder-Dixon
- Department of Psychological and Brain Sciences, Indiana University - Bloomington, Bloomington, IN, United States
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - John F Buss
- Department of Psychological and Brain Sciences, Indiana University - Bloomington, Bloomington, IN, United States
| | - Lorenzo Lorenzo-Luaces
- Department of Psychological and Brain Sciences, Indiana University - Bloomington, Bloomington, IN, United States
| |
Collapse
|
6
|
Catella S, Gendreau RM, Kraus AC, Vega N, Rosenbluth MJ, Soefje S, Malhotra S, Luciano JV, McCracken LM, Williams DA, Arnold LM. Self-guided digital acceptance and commitment therapy for fibromyalgia management: results of a randomized, active-controlled, phase II pilot clinical trial. J Behav Med 2024; 47:27-42. [PMID: 37382794 PMCID: PMC10867073 DOI: 10.1007/s10865-023-00429-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 05/22/2023] [Indexed: 06/30/2023]
Abstract
Although empirically validated for fibromyalgia (FM), cognitive and behavioral therapies, including Acceptance and Commitment Therapy (ACT), are inaccessible to many patients. A self-guided, smartphone-based ACT program would significantly improve accessibility. The SMART-FM study assessed the feasibility of conducting a predominantly virtual clinical trial in an FM population in addition to evaluating preliminary evidence for the safety and efficacy of a digital ACT program for FM (FM-ACT). Sixty-seven patients with FM were randomized to 12 weeks of FM-ACT (n = 39) or digital symptom tracking (FM-ST; n = 28). The study population was 98.5% female, with an average age of 53 years and an average baseline FM symptom severity score of 8 out of 11. Endpoints included the Fibromyalgia Impact Questionnaire-Revised (FIQ-R) and the Patient Global Impression of Change (PGIC). The between-arm effect size for the change from baseline to Week 12 in FIQ-R total scores was d = 0.44 (least-squares mean difference, - 5.7; SE, 3.16; 95% CI, - 11.9 to 0.6; P = .074). At Week 12, 73.0% of FM-ACT participants reported improvement on the PGIC versus 22.2% of FM-ST participants (P < .001). FM-ACT demonstrated improved outcomes compared to FM-ST, with high engagement and low attrition in both arms. Retrospectively registered at ClinicalTrials.gov (NCT05005351) on August 13, 2021.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Juan V Luciano
- Department of Clinical and Health Psychology, Universitat Autónoma de Barcelona, Barcelona, Spain
- Teaching, Research & Innovation Unit, Parc Santari Sant Joan de Déu, St. Boi de Llobregat, Spain
| | | | - David A Williams
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Lesley M Arnold
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
| |
Collapse
|
7
|
Wu J, Wang M, Yan H. Web-based interventions on the resilience of informal caregivers: a systematic review and meta-analysis. PSYCHOL HEALTH MED 2024; 29:1-14. [PMID: 37676014 DOI: 10.1080/13548506.2023.2253510] [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: 01/20/2023] [Accepted: 08/25/2023] [Indexed: 09/08/2023]
Abstract
Informal caregivers play an increasingly important role in the provision of care services, especially for the ageing population. At present, the evidence on the resilience of the Internet to family caregivers is still limited. The purpose of this study was to evaluate the factors related to the resilience of the Internet to family caregivers. We searched retrieved randomized controlled trials (rct) of the effects of Internet interventions on resilience in informal caregivers from the beginning of the database to 1 November 2022. A preliminary search identified 3348 studies, 5 of which met the inclusion criteria. The studies involved 482 participants from four countries. Our results show that compared to the control group, internet intervention can effectively improve the resilience level of caregivers [SMD = 0.65, 95%CI(0.04,1.26), P ≤ 0.05]. In our study, Web-based interventions can significantly improve the adaptability of informal caregivers. In addition, our research also pointed out many resources that can be used, such as online learning, online answers and online psychological counseling provided for caregivers through the Internet, which can effectively reduce their burden of care and thus improve their resilience. In the future, these findings can be used to develop projects to improve the resilience of caregivers through personalized Internet intervention, so as to meet the care needs of patients.
Collapse
Affiliation(s)
- Jingwen Wu
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Min Wang
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hong Yan
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| |
Collapse
|
8
|
Powell LD, Vasiliou VS, Thompson AR. An ACT self-help intervention for adults with a visible difference in appearance: A pilot feasibility and acceptability randomized controlled study. Body Image 2023; 47:101637. [PMID: 37839287 DOI: 10.1016/j.bodyim.2023.101637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 09/14/2023] [Accepted: 10/06/2023] [Indexed: 10/17/2023]
Abstract
Individuals living with a visible difference in appearance experience high levels of social anxiety, yet self-help interventions for this heterogeneous population are not available. We conducted a pilot trial of a novel Acceptance and Commitment Therapy (ACT) based self-help intervention.Individuals with anxiety about having a visible difference in appearance (n = 284) were randomized to an ACT-based four-week intervention (n = 145) or a waitlist control condition (n = 139). We collected pre and follow-up (four-weeks after the completion of the intervention) data. Primary outcomes included social anxiety and impairments in functioning. Psychological flexibility (PF) was also examined. ANCOVAs, controlling for pre scores, indicated significant improvements in functioning by the intervention group. No significant differences were observed for anxiety and PF between conditions at follow-up. Drop out was 68% for the intervention and 41% for the control group, with no differences in the groups in age, origin, gender, or type of visible difference. Participants in the intervention group found the intervention almost equally, useful (77%) and helpful (73%). An ACT-based self-help intervention can alleviate distress related to visible difference in appearance. More sophisticated designs are needed now, to collect idiographic and longitudinal data and examine personalized changes across time in this population.
Collapse
Affiliation(s)
| | - Vasilis S Vasiliou
- South Wales Clinical Psychology Training, Cardiff University, 11th Floor, Tower Building, 70 Park Place, Cardiff CF10 3AT, Wales, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Andrew R Thompson
- University of Sheffield, School of Psychology, Sheffield, UK; South Wales Clinical Psychology Training, Cardiff University, 11th Floor, Tower Building, 70 Park Place, Cardiff CF10 3AT, Wales, UK.
| |
Collapse
|
9
|
Zhao B, Wang Q, Wang L, Chen J, Yin T, Zhang J, Cheng X, Hou R. Effect of acceptance and commitment therapy for depressive disorders: a meta-analysis. Ann Gen Psychiatry 2023; 22:34. [PMID: 37679716 PMCID: PMC10486021 DOI: 10.1186/s12991-023-00462-1] [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: 04/13/2023] [Accepted: 08/14/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE To systematically evaluate the effect of Acceptance and Commitment Therapy (ACT) on depressive disorders. METHODS The electronic databases of Web of Science Core Collection, Pubmed, EMBASE, Cochrane Library, PsycInfo, CNKI, Wanfang and Weipu were used to select relevant publications. Screening, data extraction, and quality assessment were undertaken following PRISMA guidelines for preferred reporting of systematic reviews and meta-analysis. RevMan5.4 was used for meta-analysis. RESULTS 11 studies with a total of 962 patients were included. Random-effects model analysis showed that ACT could effectively reduce the level of depressive symptoms in patients with depressive disorders (SMD = - 1.05, 95% CI: - 1.43-- 0.66, P < 0.00001), improve psychological flexibility (MD = 4.84, 95% CI: 2.70-6.97, P < 0.00001), and have good maintenance effect (SMD = - 0.70, 95% CI: - 1.15-- 0.25, P = 0.002). All differences were statistically significant. CONCLUSIONS ACT not only improves depressive symptoms and psychological flexibility, but also has a good maintenance effect, and it is particularly effective in Chinese patients. Large randomized controlled trials are needed to validate the findings from this meta-analysis.
Collapse
Affiliation(s)
- Bing Zhao
- School of Humanities and Social Sciences, Binzhou Medical University, Yantai, China
| | - Qian Wang
- Shandong Mental Health Centre, Shandong University, Jinan, China
| | - Liping Wang
- School of Humanities and Social Sciences, Binzhou Medical University, Yantai, China
| | - Jie Chen
- Shandong Mental Health Centre, Shandong University, Jinan, China
| | - Tongtong Yin
- Shandong Mental Health Centre, Shandong University, Jinan, China
| | - Jingxuan Zhang
- Shandong Mental Health Centre, Shandong University, Jinan, China
| | - Xiaojing Cheng
- Shandong Mental Health Centre, Shandong University, Jinan, China
| | - Ruihua Hou
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| |
Collapse
|
10
|
Thomas EBK, Sagorac Gruichich T, Maronge JM, Hoel S, Victory A, Stowe ZN, Cochran A. Mobile Acceptance and Commitment Therapy With Distressed First-Generation College Students: Microrandomized Trial. JMIR Ment Health 2023; 10:e43065. [PMID: 37184896 DOI: 10.2196/43065] [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: 10/01/2022] [Revised: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Extant gaps in mental health services are intensified among first-generation college students. Improving access to empirically based interventions is critical, and mobile health (mHealth) interventions are growing in support. Acceptance and commitment therapy (ACT) is an empirically supported intervention that has been applied to college students, via mobile app, and in brief intervals. OBJECTIVE This study evaluated the safety, feasibility, and effectiveness of an ACT-based mHealth intervention using a microrandomized trial (MRT) design. METHODS Participants (N=34) were 18- to 19-year-old first-generation college students reporting distress, who participated in a 6-week intervention period of twice-daily assessments and randomization to intervention. Participants logged symptoms, moods, and behaviors on the mobile app Lorevimo. After the assessment, participants were randomized to an ACT-based intervention or no intervention. Analyses examined proximal change after randomization using a weighted and centered least squares approach. Outcomes included values-based and avoidance behavior, as well as depressive symptoms and perceived stress. RESULTS The findings indicated the intervention was safe and feasible. The intervention increased values-based behavior but did not decrease avoidance behavior. The intervention reduced depressive symptoms but not perceived stress. CONCLUSIONS An MRT of an mHealth ACT-based intervention among distressed first-generation college students suggests that a larger MRT is warranted. Future investigations may tailor interventions to contexts where intervention is most impactful. TRIAL REGISTRATION ClinicalTrials.gov NCT04081662; https://clinicaltrials.gov/show/NCT04081662. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/17086.
Collapse
Affiliation(s)
| | | | - Jacob M Maronge
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sydney Hoel
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
| | - Amanda Victory
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Zachary N Stowe
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
| | - Amy Cochran
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, United States
- Department of Mathematics, University of Wisconsin-Madison, Madison, WI, United States
| |
Collapse
|
11
|
Han A, Kim TH. Efficacy of Internet-Based Acceptance and Commitment Therapy for Depressive Symptoms, Anxiety, Stress, Psychological Distress, and Quality of Life: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e39727. [PMID: 36485030 PMCID: PMC9789494 DOI: 10.2196/39727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/24/2022] [Accepted: 10/08/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Acceptance and commitment therapy (ACT) is an empirically supported transdiagnostic approach that involves mindfulness processes and behavior change processes for valued living. OBJECTIVE This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to assess the efficacy of internet-based ACT (iACT) for depressive symptoms, anxiety, stress, psychological distress, and quality of life (QoL). METHODS PubMed, CINAHL, PsycINFO, and SCOPUS databases were searched to identify relevant RCTs published up to June 5, 2021. The included RCTs were assessed using the Cochrane Collaboration risk-of-bias tool. The use of either a random effects model or fixed effects model was determined using I2 statistic values for heterogeneity. Subgroup analyses were conducted according to the type of control group, the use of therapist guidance, delivery modes, and the use of targeted participants, when applicable. RESULTS A total of 39 RCTs met the inclusion criteria. Meta-analyses found small effects of iACT on depressive symptoms, anxiety, stress, psychological distress, and QoL at the immediate posttest and follow-up. There was no significant effect of iACT on stress at follow-up. Subgroup analyses showed small to medium effects of iACT on all the outcomes at the immediate posttest and follow-up compared with the passive control groups. In contrast, subgroup analyses that compared iACT with active control groups found no differences between groups on stress, psychological distress, and QoL at the immediate posttest or on depressive symptoms, anxiety, and stress at follow-up. In addition, subgroup analyses conducted according to the use of therapist guidance, delivery modes, and the use of targeted participants found no statistically significant subgroup differences among studies in all the outcomes, except for the subgroup difference among studies according to the use of targeted participants for depressive symptoms at the immediate posttest (ie, a statistically significant, larger effect of iACT when studies targeted people with depressive symptoms). The overall risk of bias across the studies was unclear. CONCLUSIONS The findings of this study contribute to the body of evidence regarding the effects of iACT on depressive symptoms, anxiety, stress, psychological distress, and QoL and may be applicable in any population, as ACT is a transdiagnostic approach. Few studies have compared iACT with active control conditions, especially for stress and psychological distress at the immediate posttest and follow-up. In addition, the active control conditions varied among the included studies. Further high-quality studies are needed to better understand whether iACT is comparable or superior to other evidence-based interventions, such as cognitive behavioral therapy, in decreasing depressive symptoms, anxiety, stress, and psychological distress and improving QoL.
Collapse
Affiliation(s)
- Areum Han
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei Wonju Medical College, Wonju, Republic of Korea
- Department of Psychiatry, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| |
Collapse
|
12
|
Meyers M, Margraf J, Velten J. A Qualitative Study of Women's Experiences with Cognitive-Behavioral and Mindfulness-Based Online Interventions for Low Sexual Desire. JOURNAL OF SEX RESEARCH 2022; 59:1082-1091. [PMID: 35435791 DOI: 10.1080/00224499.2022.2056565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Cognitive-behavioral (CBT) and mindfulness-based therapy (MBT) are among the most researched types of psychological interventions for low sexual desire in women. While both have been found effective in improving women's sexual desire, little is known about how women personally experience these treatments. To closely examine both approaches from a participant's perspective, semi-structured telephone-based interviews were conducted with 51 cis-women (Mage = 39, SD = 11, range = 22 to 69) who participated in a randomized controlled study comparing internet-based CBT and MBT for low sexual desire with a waitlist. Interview data were analyzed using thematic and content analysis. Most women (n = 44, 86.3%) evaluated their respective treatment (i.e., CBT or MBT) as helpful in improving their sexual desire. CBT-techniques, such as cognitive restructuring, were mentioned as being helpful for challenging maladaptive thinking patterns, while formal mindfulness-exercises allowed women to disengage from negative sexuality-related thoughts. Elements of sex therapy, including self-stimulation exercises and sensate focus, were perceived as crucial for getting women in touch with their sexual desires and preferences. Strengths of the online format included anonymity, flexibility, and convenient access. Overall, women's personal accounts supported feasibility, acceptability, and clinical usefulness of CBT- and MBT-based internet interventions targeting low sexual desire.
Collapse
Affiliation(s)
- Milena Meyers
- Mental Health Research and Treatment Center, Clinical Psychology and Psychotherapy, Faculty of Psychology, Ruhr University Bochum
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Clinical Psychology and Psychotherapy, Faculty of Psychology, Ruhr University Bochum
| | - Julia Velten
- Mental Health Research and Treatment Center, Clinical Psychology and Psychotherapy, Faculty of Psychology, Ruhr University Bochum
| |
Collapse
|
13
|
Børtveit L, Dechsling A, Sütterlin S, Nordgreen T, Nordahl-Hansen A. Guided Internet-Delivered Treatment for Depression: Scoping Review. JMIR Ment Health 2022; 9:e37342. [PMID: 36194467 PMCID: PMC9579933 DOI: 10.2196/37342] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/01/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies on guided internet-delivered treatment have demonstrated promising results for patients with depressive disorder. OBJECTIVE The aim of this study was to provide an overview of this research area and identify potential gaps in the research. METHODS In this scoping review, web-based databases were used to identify research papers published between 2010 and 2022 where guided internet-delivered treatment was administered to participants with depressive disorders, a standardized rating scale of depressive symptoms was used as the primary outcome measure, and the treatment was compared with a control condition. RESULTS A total of 111 studies were included, and an overview of the studies was provided. Several gaps in the research were identified regarding the design of the studies, treatments delivered, participant representation, and treatment completion. CONCLUSIONS This review provides a comprehensive overview of the research area, and several research gaps were identified. The use of other designs and active control conditions is recommended. Future studies should provide access to treatment manuals, and more replications should be conducted. Researchers should aim to include underrepresented populations and provide reports of comorbidities. Definitions of adequate dosage, reports of completion rates, and reasons for treatment dropout are recommended for future studies.
Collapse
Affiliation(s)
- Line Børtveit
- Faculty of Health, Welfare and Organisation, Østfold University College, Halden, Norway.,Faculty of Health Sciences, Department of Behavioral Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Anders Dechsling
- Department of Education, ICT, and Learning, Østfold University College, Halden, Norway
| | - Stefan Sütterlin
- Faculty of Health, Welfare and Organisation, Østfold University College, Halden, Norway.,Faculty of Computer Science, Albstadt-Sigmaringen University, Sigmaringen, Germany
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Departement of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Anders Nordahl-Hansen
- Department of Education, ICT, and Learning, Østfold University College, Halden, Norway
| |
Collapse
|
14
|
Hoel S, Victory A, Sagorac Gruichich T, Stowe ZN, McInnis MG, Cochran A, Thomas EBK. A Mixed-Methods Analysis of Mobile ACT Responses From Two Cohorts. Front Digit Health 2022; 4:869143. [PMID: 35633737 PMCID: PMC9133380 DOI: 10.3389/fdgth.2022.869143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background Mobile transdiagnostic therapies offer a solution to the challenges of limited access to psychological care. However, it is unclear if individuals can actively synthesize and adopt concepts and skills via an app without clinician support. Aims The present study measured comprehension of and engagement with a mobile acceptance and commitment therapy (ACT) intervention in two independent cohorts. Authors hypothesized that participants would recognize that behaviors can be flexible in form and function and respond in an ACT process-aligned manner. Methods Mixed-methods analyses were performed on open-ended responses collected from initial participants (n = 49) in two parallel micro-randomized trials with: 1) first-generation college students (FGCSs) (n = 25) from a four-year public research university and 2) individuals diagnosed with bipolar disorder (BP) (n = 24). Twice each day over six weeks, participants responded to questions about mood and behavior, after which they had a 50-50 chance of receiving an ACT-based intervention. Participants identified current behavior and categorized behavior as values-based or avoidant. Interventions were selected randomly from 84 possible prompts, each targeting one ACT process: engagement with values, openness to internal experiences, or self-awareness. Participants were randomly assigned to either exploratory (10 FGCS, 9 BP) or confirmatory (15 FGCS, 15 BP) groups for analyses. Responses from the exploratory group were used to inductively derive a qualitative coding system. This system was used to code responses in the confirmatory group. Coded confirmatory data were used for final analyses. Results Over 50% of participants in both cohorts submitted a non-blank response 100% of the time. For over 50% of participants, intervention responses aligned with the target ACT process for at least 96% of the time (FGCS) and 91% of the time (BP), and current behavior was labeled as values-based 70% (FGCS) and 85% (BP) of the time. Participants labeled similar behaviors flexibly as either values-based or avoidant in different contexts. Dominant themes were needs-based behaviors, interpersonal and family relationships, education, and time as a cost. Conclusions Both cohorts were engaged with the app, as demonstrated by responses that aligned with ACT processes. This suggests that participants had some level of understanding that behavior can be flexible in form and function.
Collapse
Affiliation(s)
- Sydney Hoel
- Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
| | - Amanda Victory
- Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | | | - Zachary N. Stowe
- Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
| | | | - Amy Cochran
- Population Health Sciences and Mathematics, University of Wisconsin-Madison, Madison, WI, United States
- *Correspondence: Amy Cochran
| | - Emily B. K. Thomas
- Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
| |
Collapse
|
15
|
Han A, Kim TH. Effects of internet-based acceptance and commitment therapy on process measures: A systematic review and meta-analysis (Preprint). J Med Internet Res 2022; 24:e39182. [PMID: 36040783 PMCID: PMC9472046 DOI: 10.2196/39182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/22/2022] [Accepted: 07/29/2022] [Indexed: 12/03/2022] Open
Abstract
Background Acceptance and commitment therapy (ACT) is based on a psychological flexibility model that encompasses 6 processes: acceptance, cognitive defusion, self-as-context, being present, values, and committed action. Objective This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to examine the effects of internet-based ACT (iACT) on process measures. Methods A comprehensive search was conducted using 4 databases. The quality of the included RCTs was assessed using the Cochrane Collaboration Risk of Bias Tool. A random-effects or fixed-effects model was used. Subgroup analyses for each outcome were conducted according to the type of control group, use of therapist guidance, delivery modes, and use of targeted participants, when applicable. Results A total of 34 RCTs met the inclusion criteria. This meta-analysis found that iACT had a medium effect on psychological flexibility and small effects on mindfulness, valued living, and cognitive defusion at the immediate posttest. In addition, iACT had a small effect on psychological flexibility at follow-up. The overall risk of bias across studies was unclear. Conclusions Relatively few studies have compared the effects of iACT with active control groups and measured the effects on mindfulness, valued living, and cognitive defusion. These findings support the processes of change in iACT, which mental health practitioners can use to support the use of iACT.
Collapse
Affiliation(s)
- Areum Han
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Gangwon province, Republic of Korea
- Department of Psychiatry, Yonsei University Wonju Christian Hospital, Wonju, Gangwon province, Republic of Korea
| |
Collapse
|
16
|
Akbari M, Seydavi M, Hosseini ZS, Krafft J, Levin ME. Experiential avoidance in depression, anxiety, obsessive-compulsive related, and posttraumatic stress disorders: A comprehensive systematic review and meta-analysis. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
17
|
Zhao C, Ren Z, Jiang G, Zhang L. Mechanisms of change in an Internet-Based ACT study for depression in China. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
18
|
Effect of Acceptance and Commitment Therapy Combined with Music Relaxation Therapy on the Self-Identity of College Students. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:8422903. [PMID: 35186241 PMCID: PMC8853795 DOI: 10.1155/2022/8422903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/22/2021] [Accepted: 01/15/2022] [Indexed: 11/18/2022]
Abstract
This paper analyzes various effects of acceptance and commitment therapy combined with music relaxation therapy on the self-identity of the college students. Through open recruitment and following the principle of voluntary and confidential, 80 college students were selected from our school, and then they were divided into two groups: the control group (40 cases) and the observation group (40 cases). The observation group received acceptance and commitment therapy combined with music relaxation therapy. For the control group, conventional mental health interventions were administered. Two months after intervention, psychological status, mental resilience, and quality of life scores were compared between the two groups. Before intervention, there was no significant difference in SAS and SDS scores between the two groups
. After intervention, SAS and SDS scores were significantly higher than those in the control group, and the difference between the two groups was statistically significant
. Before intervention, there was no significant difference in the scores of toughness, strength, and optimism between the two groups
. After intervention, the scores of toughness, strength, and optimism in the two groups were all improved, and the scores of mental resilience in the observation group were higher than those in the control group, with statistical significance
. Before intervention, there was no significant difference in the quality of life scores between the observation group and the control group
. After intervention, the quality of life score of the observation group was higher than that of the control group, and the difference between the two groups was statistically significant
. The combined application of acceptance and commitment therapy and music relaxation therapy can help college students to improve their mental state, improve their mental resilience, enhance their evaluation of life quality, improve their sense of self-identity, and reduce the probability of the occurrence of unhealthy emotions such as depression.
Collapse
|
19
|
Leong QY, Sridhar S, Blasiak A, Tadeo X, Yeo G, Remus A, Ho D. Characteristics of Mobile Health Platforms for Depression and Anxiety: Content Analysis Through a Systematic Review of the Literature and Systematic Search of Two App Stores. J Med Internet Res 2022; 24:e27388. [PMID: 35119370 PMCID: PMC8857696 DOI: 10.2196/27388] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 06/05/2021] [Accepted: 11/08/2021] [Indexed: 12/20/2022] Open
Abstract
Background Mobile health (mHealth) platforms show promise in the management of mental health conditions such as anxiety and depression. This has resulted in an abundance of mHealth platforms available for research or commercial use. Objective The objective of this review is to characterize the current state of mHealth platforms designed for anxiety or depression that are available for research, commercial use, or both. Methods A systematic review was conducted using a two-pronged approach: searching relevant literature with prespecified search terms to identify platforms in published research and simultaneously searching 2 major app stores—Google Play Store and Apple App Store—to identify commercially available platforms. Key characteristics of the mHealth platforms were synthesized, such as platform name, targeted condition, targeted group, purpose, technology type, intervention type, commercial availability, and regulatory information. Results The literature and app store searches yielded 169 and 179 mHealth platforms, respectively. Most platforms developed for research purposes were designed for depression (116/169, 68.6%), whereas the app store search reported a higher number of platforms developed for anxiety (Android: 58/179, 32.4%; iOS: 27/179, 15.1%). The most common purpose of platforms in both searches was treatment (literature search: 122/169, 72.2%; app store search: 129/179, 72.1%). With regard to the types of intervention, cognitive behavioral therapy and referral to care or counseling emerged as the most popular options offered by the platforms identified in the literature and app store searches, respectively. Most platforms from both searches did not have a specific target age group. In addition, most platforms found in app stores lacked clinical and real-world evidence, and a small number of platforms found in the published research were available commercially. Conclusions A considerable number of mHealth platforms designed for anxiety or depression are available for research, commercial use, or both. The characteristics of these mHealth platforms greatly vary. Future efforts should focus on assessing the quality—utility, safety, and effectiveness—of the existing platforms and providing developers, from both commercial and research sectors, a reporting guideline for their platform description and a regulatory framework to facilitate the development, validation, and deployment of effective mHealth platforms.
Collapse
Affiliation(s)
- Qiao Ying Leong
- N.1 Institute for Health, National University of Singapore, Singapore, Singapore.,The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shreya Sridhar
- N.1 Institute for Health, National University of Singapore, Singapore, Singapore
| | - Agata Blasiak
- N.1 Institute for Health, National University of Singapore, Singapore, Singapore.,The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Biomedical Engineering, NUS Engineering, National University of Singapore, Singapore, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xavier Tadeo
- N.1 Institute for Health, National University of Singapore, Singapore, Singapore.,The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - GeckHong Yeo
- N.1 Institute for Health, National University of Singapore, Singapore, Singapore.,The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Alexandria Remus
- N.1 Institute for Health, National University of Singapore, Singapore, Singapore.,The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Biomedical Engineering, NUS Engineering, National University of Singapore, Singapore, Singapore
| | - Dean Ho
- N.1 Institute for Health, National University of Singapore, Singapore, Singapore.,The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Biomedical Engineering, NUS Engineering, National University of Singapore, Singapore, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Health District @ Queenstown, Singapore, Singapore
| |
Collapse
|
20
|
Vahabi M, Pui-Hing Wong J, Moosapoor M, Akbarian A, Fung K. Effects of Acceptance and Commitment Therapy (ACT) on Mental Health and Resiliency of Migrant Live-in Caregivers in Canada: Pilot Randomized Wait List Controlled Trial. JMIR Form Res 2022; 6:e32136. [PMID: 35084337 PMCID: PMC9090443 DOI: 10.2196/32136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background
Temporary migrant live-in caregivers constitute a vulnerable stream of temporary foreign workers in Canada. This is because the majority are racialized women from the Global South, the gendered nature of caregiving work has historically been undervalued, and their working and living spheres are intertwined which makes application of labor laws and surveillance almost impossible. Their invisible position in the fabric of Canadian society along with their precarious employment and immigration status place their mental health at jeopardy. There is a paucity of research about psychological support for this population.
Objective
Our pilot study Women Empowerment—Caregiver Acceptance and Resilience E-Learning (WE2CARE) aimed to assess the efficacy of a 6-week online delivery of a psychological intervention based on acceptance and commitment therapy (ACT) in reducing psychological distress and promoting resiliency among live-in care givers in the Greater Toronto Area.
Methods
A pilot randomized wait list controlled design was used. Participants were recruited by two community peer champions working with community health organizations serving migrant live-in caregivers. A total of 36 participants were recruited and randomly assigned to the intervention and wait list control groups; 7 dropped out of the study due to competing life priorities. Standardized self-reported surveys were administered online pre-, post-, and 6-week postintervention to assess mental distress (DASS-21), psychological flexibility (AAQ-2), mindfulness (CAMS-R), and Multi-System Model of Resilience (MSMR-I). Independent and dependent t tests were used to compare study outcomes at pre, post, and 6-week follow-up across and within both arms of the study. Linear mixed effects models were created for each outcome of interest from baseline to postintervention among intervention and control participants. Self-reported impact of the WE2CARE intervention was examined using independent t tests across the study arms.
Results
Average age of participants was 38 years. Many were born in the Philippines (23/29, 79%). The data on the impact of the psychological intervention showed a lower level of depression, anxiety, and stress among the intervention group compared with the control. However, the differences were not significant due to small sample size and COVID-19 crisis (6.94 vs 9.50, P=.54; 6.94 vs 10.83, P=.20; 7.76 vs 10.33, P=.44, respectively). There was a significant improvement in mindful qualities and external resilience, particularly in life satisfaction and accessible support among the intervention group (37.18 vs 32.92, t22=2.35, P=.03; 20.29 vs 16.5, t21=2.98, P=.007; 8.47 vs 6.75, t14=2.41, P=.03; 7.59 vs 5.33, t16=.008, respectively).
Conclusions
WE2CARE is among the first studies exploring the efficacy of online delivery of ACT in addressing mental health challenges among live-in caregivers. While there are increased web-based ACT interventions, few use group videoconferencing to promote peer connection and mutual support. WE2CARE showed promising results in reducing psychological distress and promoting mindfulness and resiliency. The intervention highly motivated participants to engage collectively in building social support networks.
International Registered Report Identifier (IRRID)
RR2-10.2196/preprints.31211
Collapse
Affiliation(s)
- Mandana Vahabi
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
| | | | - Masoomeh Moosapoor
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
| | - Abdolreza Akbarian
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
| | - Kenneth Fung
- Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| |
Collapse
|
21
|
Kirk MA, Pirbaglou M, Weerasekera R, Ritvo P. Effectiveness of online cognitive behavioral interventions that include mindfulness for clinically-diagnosed anxiety and depressive disorders: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2021. [DOI: 10.1080/00207411.2021.1959807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Megan A. Kirk
- School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Meysam Pirbaglou
- School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Rasanjala Weerasekera
- Donnelly Centre for Cellular and Biomolecular Research, University of Toronto, Toronto, Canada
| | - Paul Ritvo
- School of Kinesiology and Health Science, York University, Toronto, Canada
- Department of Psychology, York University, Toronto, Canada
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| |
Collapse
|
22
|
Fung KPL, Vahabi M, Moosapoor M, Akbarian A, Jing-Wen Liu J, Wong JPH. Implementation of an Internet-Based Acceptance and Commitment Therapy for Promoting Mental Health Among Migrant Live-in Caregivers in Canada: Protocol. JMIR Res Protoc 2021; 10:e31211. [PMID: 34515642 PMCID: PMC8694237 DOI: 10.2196/31211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 06/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background Psychological distress, isolation, feelings of powerlessness, and limited social support are realities faced by temporary migrant live-in caregivers in Canada. Furthermore, they experience multiple barriers in accessing mental health services due to their long work hours, limited knowledge of health resources, precarious employment, and immigration status. Objective The Women Empowerment - Caregiver Acceptance & Resilience E-Learning (WE2CARE) project is a pilot intervention research project that aims to promote the mental well-being and resiliency of migrant live-in caregivers. The objectives include exploring the effectiveness of this program in achieving the following: (1) reducing psychological distress (depression, anxiety, and stress); (2) promoting committed actions of self-care; and (3) building mutual support social networks. Further, participants’ satisfaction with the intervention and their perceived barriers to and facilitators of practicing the self-care strategies embedded in WE2CARE will be examined. Methods A total of 36 live-in caregivers residing in the Greater Toronto Area will be recruited and randomly assigned to either the intervention or waitlist control group. The intervention group will receive a 6-week web-based psychosocial intervention that will be based on Acceptance and Commitment Therapy (ACT). Standardized self-reported surveys will be administered online preintervention, postintervention, and at 6 weeks postintervention to assess mental distress (Depression, Anxiety and Stress Scale), psychological flexibility (Acceptance and Action Questionnaire), mindfulness (Cognitive and Affective Mindfulness Scale – Revised), and resilience (Multi-System Model of Resilience Inventory). In addition, two focus groups will be held with a subset of participants to explore their feedback on the utility of the WE2CARE program. Results WE2CARE was funded in January 2019 for a year. The protocol was approved by the research ethics boards of Ryerson University (REB 2019-036) and the University of Toronto (RIS37623) in February and May 2019, respectively. Data collection started upon ethics approval and was completed by May 2020. A total of 29 caregivers completed the study and 20 participated in the focus groups. Data analyses are in progress and results will be published in 2021. Conclusions WE2CARE could be a promising approach to reducing stress, promoting resilience, and providing a virtual space for peer emotional support and collaborative learning among socially isolated and marginalized women. The results of this pilot study will inform the adaptation of an ACT-based psychological intervention for online delivery and determine its utility in promoting mental health among disadvantaged and vulnerable populations. International Registered Report Identifier (IRRID) DERR1-10.2196/31211
Collapse
Affiliation(s)
- Kenneth Po-Lun Fung
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Mandana Vahabi
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Masoomeh Moosapoor
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
| | - Abdolreza Akbarian
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
| | - Jenny Jing-Wen Liu
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Josephine Pui-Hing Wong
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
23
|
Sommers-Spijkerman M, Austin J, Bohlmeijer E, Pots W. New Evidence in the Booming Field of Online Mindfulness: An Updated Meta-analysis of Randomized Controlled Trials. JMIR Ment Health 2021; 8:e28168. [PMID: 34279240 PMCID: PMC8329762 DOI: 10.2196/28168] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/05/2021] [Accepted: 05/16/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND There is a need to regularly update the evidence base on the effectiveness of online mindfulness-based interventions (MBIs), especially considering how fast this field is growing and developing. OBJECTIVE This study presents an updated meta-analysis of randomized controlled trials assessing the effects of online MBIs on mental health and the potential moderators of these effects. METHODS We conducted a systematic literature search in PsycINFO, PubMed, and Web of Science up to December 4, 2020, and included 97 trials, totaling 125 comparisons. Pre-to-post and pre-to-follow-up between-group effect sizes (Hedges g) were calculated for depression, anxiety, stress, well-being, and mindfulness using a random effects model. RESULTS The findings revealed statistically significant moderate pre-to-post effects on depression (g=0.34, 95% CI 0.18-0.50; P<.001), stress (g=0.44, 95% CI 0.32-0.55; P<.001), and mindfulness (g=0.40, 95% CI 0.30-0.50; P<.001) and small effects on anxiety (g=0.26, 95% CI 0.18-0.33; P<.001). For well-being, a significant small effect was found only when omitting outliers (g=0.22, 95% CI 0.15-0.29; P<.001) or low-quality studies (g=0.26, 95% CI 0.12-0.41; P<.001). Significant but small follow-up effects were found for depression (g=0.25, 95% CI 0.12-0.38) and anxiety (g=0.23, 95% CI 0.13-0.32). Subgroup analyses revealed that online MBIs resulted in higher effect sizes for stress when offered with guidance. In terms of stress and mindfulness, studies that used inactive control conditions yielded larger effects. For anxiety, populations with psychological symptoms had higher effect sizes. Adherence rates for the interventions ranged from 35% to 92%, but most studies lacked clear definitions or cut-offs. CONCLUSIONS Our findings not only demonstrate that online MBIs are booming but also corroborate previous findings that online MBIs are beneficial for improving mental health outcomes in a broad range of populations. To advance the field of online MBIs, future trials should pay specific attention to methodological quality, adherence, and long-term follow-up measurements.
Collapse
Affiliation(s)
- Marion Sommers-Spijkerman
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht, Netherlands
| | - Judith Austin
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Ernst Bohlmeijer
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Wendy Pots
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| |
Collapse
|
24
|
Punna M, Lappalainen R, Kettunen T, Lappalainen P, Muotka J, Kaipainen K, Villberg J, Kasila K. Can peer-tutored psychological flexibility training facilitate physical activity among adults with overweight? JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
25
|
Hämäläinen T, Kaipainen K, Lappalainen P, Puolakanaho A, Keinonen K, Lappalainen R, Kiuru N. Usage activity, perceived usefulness, and satisfaction in a web-based acceptance and commitment therapy program among Finnish ninth-grade adolescents. Internet Interv 2021; 25:100421. [PMID: 34401380 PMCID: PMC8350586 DOI: 10.1016/j.invent.2021.100421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 01/07/2023] Open
Abstract
Understanding adolescent usage activity and experiences in web-based psychological intervention programs helps in developing universal programs that can be adopted for promotion of adolescent well-being and prevention of mental health problems. This study examined the usage activity, perceived usefulness (i.e., learning of mindfulness, acceptance and value-related skills), and program satisfaction of 157 Finnish ninth-grade adolescents, who participated in a school-based five-week universal acceptance and commitment therapy web intervention called Youth Compass. Individual and growth environment-related antecedents were measured before the five-week intervention, adolescents' usage activity during the intervention, and perceived usefulness and satisfaction after the intervention. The results showed that female adolescents and adolescents with high self-regulation were more active program users and had more positive experiences of the program. Most of the adolescents used the program on at least a moderate level and perceived it to be moderately or highly useful and satisfactory. Four subgroups of adolescents were identified based on their usage activity, perceived usefulness, and satisfaction: adolescents in the satisfied group (41%) had average activity and high perceived usefulness and intervention satisfaction, the dissatisfied group (18%) had low activity and very low perceived usefulness and intervention satisfaction, the active group (8%) had very high activity and average perceived usefulness and intervention satisfaction, and the moderate group (33%) had average activity, perceived usefulness and intervention satisfaction. Gender, academic achievement, closeness to mother and teacher, and conflict with teacher were significantly related to subgroup membership. The results suggested that adolescent usage activity, perceived usefulness, and satisfaction with the Youth Compass program may to some extent be predicted based on different factors.
Collapse
Affiliation(s)
- Tetta Hämäläinen
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland,Corresponding author at: Department of Psychology, University of Jyväskylä, P.O. Box 35, 40014 Jyväskylä, Finland.
| | - Kirsikka Kaipainen
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland,Faculty of Information Technology and Communication Sciences, Tampere University, Finland
| | - Päivi Lappalainen
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland
| | - Anne Puolakanaho
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland
| | - Katariina Keinonen
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland
| | - Raimo Lappalainen
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland
| | - Noona Kiuru
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland
| |
Collapse
|
26
|
Tokgöz P, Hrynyschyn R, Hafner J, Schönfeld S, Dockweiler C. Digital Health Interventions in Prevention, Relapse, and Therapy of Mild and Moderate Depression: Scoping Review. JMIR Ment Health 2021; 8:e26268. [PMID: 33861201 PMCID: PMC8087966 DOI: 10.2196/26268] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/15/2021] [Accepted: 02/19/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Depression is a major cause for disability worldwide, and digital health interventions are expected to be an augmentative and effective treatment. According to the fast-growing field of information and communication technologies and its dissemination, there is a need for mapping the technological landscape and its benefits for users. OBJECTIVE The purpose of this scoping review was to give an overview of the digital health interventions used for depression. The main goal of this review was to provide a comprehensive review of the system landscape and its technological state and functions, as well as its evidence and benefits for users. METHODS A scoping review was conducted to provide a comprehensive overview of the field of digital health interventions for the treatment of depression. PubMed, PSYNDEX, and the Cochrane Library were searched by two independent researchers in October 2020 to identify relevant publications of the last 10 years, which were examined using the inclusion and exclusion criteria. To conduct the review, we used Rayyan, a freely available web tool. RESULTS In total, 65 studies were included in the qualitative synthesis. After categorizing the studies into the areas of prevention, early detection, therapy, and relapse prevention, we found dominant numbers of studies in the area of therapy (n=52). There was only one study for prevention, 5 studies for early detection, and 7 studies for relapse prevention. The most dominant therapy approaches were cognitive behavioral therapy, acceptance and commitment therapy, and problem-solving therapy. Most of the studies revealed significant effects of digital health interventions when cognitive behavioral therapy was applied. Cognitive behavioral therapy as the most dominant form was often provided through web-based systems. Combined interventions consisting of web-based and smartphone-based approaches are increasingly found. CONCLUSIONS Digital health interventions for treating depression are quite comprehensive. There are different interventions focusing on different fields of care. While most interventions can be beneficial to achieve a better depression treatment, it can be difficult to determine which approaches are suitable. Cognitive behavioral therapy through digital health interventions has shown good effects in the treatment of depression, but treatment for depression still stays very individualistic.
Collapse
Affiliation(s)
- Pinar Tokgöz
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Robert Hrynyschyn
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Health and Nursing Science, Berlin, Germany
| | - Jessica Hafner
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Simone Schönfeld
- School of Public Health, Bielefeld University, Bielefeld, Germany.,LWL-Klinik Lippstadt und Warstein, Lippstadt, Germany.,Universität Witten/Herdecke, Institut für Integrative Gesundheitsversorgung und Gesundheitsförderung, Witten, Germany
| | | |
Collapse
|
27
|
Ritvo P, Knyahnytska Y, Pirbaglou M, Wang W, Tomlinson G, Zhao H, Linklater R, Bai S, Kirk M, Katz J, Harber L, Daskalakis Z. Online Mindfulness-Based Cognitive Behavioral Therapy Intervention for Youth With Major Depressive Disorders: Randomized Controlled Trial. J Med Internet Res 2021; 23:e24380. [PMID: 33688840 PMCID: PMC7991990 DOI: 10.2196/24380] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/30/2020] [Accepted: 01/10/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Approximately 70% of mental health disorders appear prior to 25 years of age and can become chronic when ineffectively treated. Individuals between 18 and 25 years old are significantly more likely to experience mental health disorders, substance dependencies, and suicidality. Treatment progress, capitalizing on the tendencies of youth to communicate online, can strategically address depressive disorders. OBJECTIVE We performed a randomized controlled trial (RCT) that compared online mindfulness-based cognitive behavioral therapy (CBT-M) combined with standard psychiatric care to standard psychiatric care alone in youth (18-30 years old) diagnosed with major depressive disorder. METHODS Forty-five participants were randomly assigned to CBT-M and standard care (n=22) or to standard psychiatric care alone (n=23). All participants were provided standard psychiatric care (ie, 1 session per month), while participants in the experimental group received an additional intervention consisting of the CBT-M online software program. Interaction with online workbooks was combined with navigation coaching delivered by phone and secure text messaging. RESULTS In a two-level linear mixed-effects model intention-to-treat analysis, significant between-group differences were found for the Beck Depression Inventory-II score (difference -8.54, P=.01), Quick Inventory of Depressive Symptoms score (difference -4.94, P=.001), Beck Anxiety Inventory score (difference -11.29, P<.001), and Brief Pain Inventory score (difference -1.99, P=.03), while marginal differences were found for the Five Facet Mindfulness Questionnaire-Nonjudging subscale (difference -2.68, P=.05). CONCLUSIONS These results confirm that youth depression can be effectively treated with online CBT-M that can be delivered with less geographic restriction. TRIAL REGISTRATION Clinical Trials.gov NCT03406052; https://www.clinicaltrials.gov/ct2/show/NCT03406052.
Collapse
Affiliation(s)
- Paul Ritvo
- School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada.,Department of Psychology, York University, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yuliya Knyahnytska
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Meysam Pirbaglou
- School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada
| | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - George Tomlinson
- THETA Collaborative, University Health Network, University of Toronto, Toronto, ON, Canada.,Biostatistics Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Haoyu Zhao
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Renee Linklater
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Aboriginal Engagement and Outreach, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Shari Bai
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Megan Kirk
- School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada
| | - Joel Katz
- School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Lillian Harber
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Zafiris Daskalakis
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Mood and Anxiety Ambulatory Services, Centre for Addiction and Mental Health, Toronto, ON, Canada
| |
Collapse
|
28
|
Internet-Based Acceptance and Commitment Therapy: A Transdiagnostic Systematic Review and Meta-Analysis for Mental Health Outcomes. Behav Ther 2021; 52:492-507. [PMID: 33622516 DOI: 10.1016/j.beth.2020.07.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 07/04/2020] [Accepted: 07/08/2020] [Indexed: 02/02/2023]
Abstract
Internet-based acceptance and commitment therapy (iACT) primarily targets the process of psychological flexibility. Its accessibility and low-intensity delivery are applicable across different treatment and prevention scenarios. This transdiagnostic meta-analysis reviews the effectiveness of iACT on anxiety, depression, quality of life, and psychological flexibility across individuals with different psychological and somatic conditions/complaints, or undiagnosed complaints. Seven databases were searched for randomized controlled trials that reported on anxiety, depression, quality of life, and psychological flexibility outcomes from iACT in any adult population. Engagement with iACT was summarized and methodological and population-related variables were investigated as potential moderators of effectiveness. Across 25 studies, small pooled effects were found for all outcomes at post-assessment and maintained at follow-up time-points. Interventions with therapist guidance demonstrated greater effectiveness in improving depression and psychological flexibility outcomes compared to nonguided iACT, and populations defined by a psychological condition or symptoms (e.g., depressed samples) demonstrated greater improvements in anxiety compared to nonclinical or somatic populations (e.g., chronic pain samples or students). Participants completed on average 75.77% of iACT treatments. While we found iACT to be effective in improving and maintaining mental health outcomes across diverse populations, there was limited evidence of reliable, clinically significant effects. PROSPERO registration number: CRD42020140086.
Collapse
|
29
|
Ganapathy A, Clough BA, Casey LM. Organizational and Policy Barriers to the Use of Digital Mental Health by Mental Health Professionals. Telemed J E Health 2021; 27:1332-1343. [PMID: 33646057 DOI: 10.1089/tmj.2020.0455] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Digital mental health (DMH) provides effective methods of overcoming issues of time constraints, accessibility, and availability of mental health care. They can provide a valuable means to deliver mental health care in the present pandemic. However, adoption of these methods has been slow. Mental health professional (MHP) concerns at the organizational and policy level that influence this slow adoption need to be examined. Materials and Methods: A narrative review was conducted to identify the barriers. Searches using the databases Scopus, Embase, and PubMed were conducted to identify research focused on barriers reported by MHPs to use DMH. Results: The search resulted in 356 unique citations, and 21 papers met the inclusion and exclusion criteria. Forward and backward sampling resulted in identifying an additional 19 relevant papers. Discussion: Unmet needs for information, training, and infrastructure, challenges to the workflow and excessive workloads, and ambiguous policies serve as barriers to DMH use. This article recommends strategies for researchers, organizations, DMH designers, and governmental institutions to ensure efficient utilization of DMH. Conclusion: Concerted efforts at individual, organizational, and governmental levels are essential to ensure efficient utilization of DMH.
Collapse
Affiliation(s)
- Aarthi Ganapathy
- School of Applied Psychology, Griffith University, Brisbane, Australia.,Menzies Health Institute, Mount Gravatt, Australia
| | - Bonnie A Clough
- School of Applied Psychology, Griffith University, Brisbane, Australia.,Menzies Health Institute, Mount Gravatt, Australia
| | - Leanne M Casey
- School of Applied Psychology, Griffith University, Brisbane, Australia.,Menzies Health Institute, Mount Gravatt, Australia
| |
Collapse
|
30
|
Köhnen M, Dreier M, Seeralan T, Kriston L, Härter M, Baumeister H, Liebherz S. Evidence on Technology-Based Psychological Interventions in Diagnosed Depression: Systematic Review. JMIR Ment Health 2021; 8:e21700. [PMID: 33565981 PMCID: PMC7904404 DOI: 10.2196/21700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/30/2020] [Accepted: 11/18/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Evidence on technology-based psychological interventions (TBIs) for the treatment of depression is rapidly growing and covers a broad scope of research. Despite extensive research in this field, guideline recommendations are still limited to the general effectiveness of TBIs. OBJECTIVE This study aims to structure evidence on TBIs by considering different application areas (eg, TBIs for acute treatment and their implementation in health care, such as stand-alone interventions) and treatment characteristics (eg, therapeutic rationale of TBIs) to provide a comprehensive evidence base and to identify research gaps in TBIs for diagnosed depression. Moreover, the reporting of negative events in the included studies is investigated in this review to enable subsequent safety assessment of the TBIs. METHODS Randomized controlled trials on adults diagnosed with unipolar depression receiving any kind of psychotherapeutic treatment, which was at least partly delivered by a technical medium, were eligible for inclusion in our preregistered systematic review. We searched for trials in CENTRAL (Cochrane Central Register of Controlled Trials; until August 2020), MEDLINE, PsycINFO, PSYNDEX, CINAHL; until the end of January 2018), clinical trial registers, and sources of gray literature (until the end of January 2019). Study selection and data extraction were conducted by 2 review authors independently. RESULTS Database searches resulted in 15,546 records, of which 241 publications were included, representing 83 completed studies and 60 studies awaiting classification (ie, preregistered studies, study protocols). Almost all completed studies (78/83, 94%) addressed the acute treatment phase, being largely either implemented as stand-alone interventions (66/83, 80%) or blended treatment approaches (12/83, 14%). Studies on TBIs for aftercare (4/83, 5%) and for bridging waiting periods (1/83, 1%) were scarce. Most TBI study arms (n=107) were guided (59/107, 55.1%), delivered via the internet (80/107, 74.8%), and based on cognitive behavioral treatment approaches (88/107, 79.4%). Almost all studies (77/83, 93%) reported information on negative events, considering dropouts from treatment as a negative event. However, reports on negative events were heterogeneous and largely unsystematic. CONCLUSIONS Research has given little attention to studies evaluating TBIs for aftercare and for bridging waiting periods in people with depression, even though TBIs are seen as highly promising in these application areas; thus, high quality studies are urgently needed. In addition, the variety of therapeutic rationales on TBIs has barely been represented by identified studies hindering the consideration of patient preferences when planning treatment. Finally, future studies should use specific guidelines to systematically assess and report negative events. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) CRD42016050413; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42016050413. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2018-028042.
Collapse
Affiliation(s)
- Moritz Köhnen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mareike Dreier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tharanya Seeralan
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Harald Baumeister
- Department for Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Sarah Liebherz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
31
|
Světlák M, Linhartová P, Knejzlíková T, Knejzlík J, Kóša B, Horníčková V, Jarolínová K, Lučanská K, Slezáčková A, Šumec R. Being Mindful at University: A Pilot Evaluation of the Feasibility of an Online Mindfulness-Based Mental Health Support Program for Students. Front Psychol 2021; 11:581086. [PMID: 33505332 PMCID: PMC7829670 DOI: 10.3389/fpsyg.2020.581086] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/30/2020] [Indexed: 12/15/2022] Open
Abstract
University study can be a life period of heightened psychological distress for many students. The development of new preventive and intervention programs to support well-being in university students is a fundamental challenge for mental health professionals. We designed an 8-week online mindfulness-based program (eMBP) combining a face-to-face approach, text, audio, video components, and support psychotherapy principles with a unique intensive reminder system using the Facebook Messenger and Slack applications in two separate runs (N = 692). We assessed the program's effect on mindful experiencing, perceived stress, emotion regulation strategies, self-compassion, negative affect, and quality of life. The results of the presented pilot study confirmed that eMBP is a feasible and effective tool in university students' mental health support. The students who completed the eMBP reported a reduction of perceived stress with a large effect size ( p η2 = 0.42) as well as a decrease of negative affect experience frequency and intensity ( p η2 = 0.31), an increase of being mindful in their life (Five Facet Mindfulness Questionnaire subscales: p η2 = 0.21, 0.27, 0.25, 0.28, 0.28), and a higher rate of self-compassion ( p η2 = 0.28) with a medium effect size. A small effect size was found in the frequency of using a cognitive reappraisal strategy ( p η2 = 0.073). One new result is the observation of an eMBP effect ( p η2 = 0.27) on the decrease in attributed importance to the quality-of-life components replicated in two consecutive runs of the program. The study affirms that mindfulness-based interventions can be effectively delivered in an eHealth form to university students.
Collapse
Affiliation(s)
- Miroslav Světlák
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Pavla Linhartová
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Terezia Knejzlíková
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jakub Knejzlík
- Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Barbora Kóša
- Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Veronika Horníčková
- Department of Psychology, Faculty of Arts, Masaryk University, Brno, Czechia
| | - Kristýna Jarolínová
- Department of Psychology, Faculty of Arts, Masaryk University, Brno, Czechia
| | - Klaudia Lučanská
- Department of Psychology, Faculty of Arts, Masaryk University, Brno, Czechia
| | - Alena Slezáčková
- Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Psychology, Faculty of Arts, Masaryk University, Brno, Czechia
| | - Rastislav Šumec
- Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia.,First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czechia
| |
Collapse
|
32
|
Apolinário-Hagen J, Drüge M, Hennemann S, Breil B. Acceptance and Commitment Therapy for Major Depressive Disorder: Insights into a New Generation of Face-to-Face Treatment and Digital Self-Help Approaches. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1305:311-332. [PMID: 33834407 DOI: 10.1007/978-981-33-6044-0_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Major depressive disorder (MDD) represents a key contributor to the global burden of mental illness given its relatively high lifetime prevalence, frequent comorbidity, and disability rates. Evidence-based treatment options for depression include pharmacotherapy and psychotherapy, such as cognitive behavioral therapy (CBT). Beyond traditional CBT, over 15 years ago, Hayes proclaimed a new generation of contextualistic and process-orientated so-called third wave of CBT interventions, including acceptance and commitment therapy (ACT). Using mindfulness and acceptance as well as commitment and behavior change processes, the transdiagnostic ACT approach aims to increase psychological flexibility as universal mechanism of behavior change and to build a value-driven orientation in life. ACT for MDD can be provided as either stand-alone individual, group, or self-help formats (e.g., apps) or combined with other approaches like behavioral activation. To date, a steadily growing empirical support from outcome and process research suggests the efficacy of ACT, which appears to work specifically through the six proposed core processes involved in psychological flexibility, such as defusion. In view of an ongoing interest of clinicians in "third-wave" CBTs and the important role of clients' preferences in providing therapy choices that work, the purpose of this chapter is to give a brief overview on the application of ACT in the treatment of MDD in adults.
Collapse
Affiliation(s)
- Jennifer Apolinário-Hagen
- Faculty of Medicine, Institute of Occupational, Social and Environmental Medicine, Centre of Health and Society (chs), Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
- Centre of Health and Society (chs), University Hospital Düsseldorf, Düsseldorf, Germany.
| | - Marie Drüge
- Institute of Psychology, Department of Clinical Psychology/Psychotherapy Research, University of Zurich, Zurich, Switzerland
| | - Severin Hennemann
- Institute of Psychology, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, University of Mainz, Mainz, Germany
| | - Bernhard Breil
- Faculty of Healthcare, Niederrhein University of Applied Sciences, Krefeld, Germany
| |
Collapse
|
33
|
Matis J, Svetlak M, Slezackova A, Svoboda M, Šumec R. Mindfulness-Based Programs for Patients With Cancer via eHealth and Mobile Health: Systematic Review and Synthesis of Quantitative Research. J Med Internet Res 2020; 22:e20709. [PMID: 33196452 PMCID: PMC7704284 DOI: 10.2196/20709] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 01/07/2023] Open
Abstract
Background eHealth mindfulness-based programs (eMBPs) are on the rise in complex oncology and palliative care. However, we are still at the beginning of answering the questions of how effective eMBPs are and for whom, and what kinds of delivery modes are the most efficient. Objective This systematic review aims to examine the feasibility and efficacy of eMBPs in improving the mental health and well-being of patients with cancer, to describe intervention characteristics and delivery modes of these programs, and to summarize the results of the included studies in terms of moderators, mediators, and predictors of efficacy, adherence, and attrition. Methods In total, 4 databases (PubMed, PsycINFO, Scopus, and Web of Knowledge) were searched using relevant search terms (eg, mindfulness, program, eHealth, neoplasm) and their variations. No restrictions were imposed on language or publication type. The results of the efficacy of eMBPs were synthesized through the summarizing effect estimates method. Results
A total of 29 published papers describing 24 original studies were included in this review. In general, the results indicate that eMBPs have the potential to reduce the levels of stress, anxiety, depression, fatigue, sleep problems, and pain, and improve the levels of mindfulness, posttraumatic growth, and some parameters of general health. The largest median of Cohen d effect sizes were observed in reducing anxiety and depression (within-subject: median −0.38, IQR −0.62 to −0.27; between-group:
median −0.42, IQR −0.58 to −0.22) and facilitating posttraumatic growth (within-subject: median 0.42, IQR 0.35 to 0.48;
between-group: median 0.32, IQR 0.22 to 0.39). The efficacy of eMBP may be comparable with that of parallel, face-to-face
MBPs in some cases. All studies that evaluated the feasibility of eMBPs reported that they are feasible for patients with cancer.
Potential moderators, mediators, and predictors of the efficacy, attrition, and adherence of eMBPs are discussed.
Conclusions Although the effects of the reviewed studies were highly heterogeneous, the review provides evidence that eMBPs are an appropriate way for mindfulness practice to be delivered to patients with cancer. Thus far, existing eMBPs have mostly attempted to convert proven face-to-face mindfulness programs to the eHealth mode. They have not yet fully exploited the potential of eHealth technology.
Collapse
Affiliation(s)
- Juraj Matis
- Department of Psychology, Faculty of Arts, Masaryk University, Brno, Czech Republic
| | - Miroslav Svetlak
- Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Alena Slezackova
- Department of Psychology, Faculty of Arts, Masaryk University, Brno, Czech Republic.,Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marek Svoboda
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Rastislav Šumec
- Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czech Republic
| |
Collapse
|
34
|
Köhnen M, Kriston L, Härter M, Baumeister H, Liebherz S. Effectiveness and acceptance of technology-based psychological interventions for the acute treatment of unipolar depression: a systematic review and meta-analysis (Preprint). J Med Internet Res 2020; 23:e24584. [PMID: 36260395 PMCID: PMC8386371 DOI: 10.2196/24584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/08/2021] [Accepted: 04/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background Evidence on technology-based psychological interventions (TBIs) for the acute treatment of depression is rapidly growing. Despite extensive research in this field, there is a lack of research determining effectiveness and acceptance of TBIs considering different application formats in people with a formally diagnosed depressive disorder. Objective The goal of the review was to investigate the effectiveness and acceptance of TBIs in people with diagnosed depression with particular focus on application formats (stand-alone interventions, blended treatments, collaborative and/or stepped care interventions). Methods Studies investigating adults with diagnosed unipolar depressive disorders receiving any kind of psychotherapeutic treatment delivered (at least partly) by a technical medium and conducted as randomized controlled trials (RCTs) were eligible for inclusion. We searched CENTRAL (Cochrane Central Register of Controlled Trials; August 2020), MEDLINE, PsycINFO, PSYNDEX, CINAHL (January 2018), clinical trial registers, and sources of grey literature (January 2019). Two independent authors decided about study inclusion and extracted data. We performed random effects meta-analyses to synthesize the data. Results Database searches resulted in 15,546 records of which 78 completed studies were included. TBIs delivered as stand-alone interventions showed positive effects on posttreatment depression severity when compared to treatment as usual (SMD –0.44, 95% CI –0.73 to –0.15, k=10; I²=86%), attention placebo (SMD –0.51, 95% CI –0.73 to –0.30; k=12; I²=66%), and waitlist controls (SMD –1.01, 95% CI –1.23 to –0.79; k=19; I²=73%). Superior long-term effects on depression severity were shown when TBIs were compared to treatment as usual (SMD –0.24, 95% CI –0.41 to –0.07; k=6; I²=48%) attention placebo (SMD –0.23, 95% CI –0.40 to –0.07; k=7; I²=21%) and waitlist controls (SMD –0.74, 95% CI –1.31 to –0.18; k=3; I²=79%). TBIs delivered as blended treatments (providing a TBI as an add-on to face-to-face treatment) yielded beneficial effects on posttreatment depression severity (SMD –0.27, 95% CI –0.48 to –0.05; k=8; I²=53%) compared to face-to-face treatments only. Additionally, TBIs delivered within collaborative care trials were more effective in reducing posttreatment (SMD –0.20, 95% CI –0.36 to –0.04; k=2; I²=0%) and long-term (SMD –0.23, 95% CI –0.39 to –0.07; k=2; I²=0%) depression severity than usual care. Dropout rates did not differ between the intervention and control groups in any comparison (all P≥.09). Conclusions We found that TBIs are effective not only when delivered as stand-alone interventions but also when they are delivered as blended treatments or in collaborative care trials for people with diagnosed depression. Our results may be useful to inform routine care, since we focused specifically on different application formats, formally diagnosed patients, and the long-term effectiveness of TBIs. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42016050413; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42016050413 International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2018-028042
Collapse
Affiliation(s)
- Moritz Köhnen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Harald Baumeister
- Department for Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
| | - Sarah Liebherz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
35
|
Feasibility of a Brief Online Psychoeducational Intervention for Women With Sexual Interest/Arousal Disorder. J Sex Med 2020; 17:2208-2219. [PMID: 32919927 PMCID: PMC7480645 DOI: 10.1016/j.jsxm.2020.07.086] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/14/2020] [Accepted: 07/31/2020] [Indexed: 01/07/2023]
Abstract
Background Low sexual desire and arousal are the most common sexual concerns in women, but most women lack access to effective treatment such as cognitive behavioral therapy. Web-based psychological interventions, which are economical, private, easily accessible, and potentially effective, may increase the reach of evidence-based treatment. Aim To determine the feasibility of translating cognitive behavioral therapy for the most common female sexual dysfunction, Female Sexual Interest/Arousal Disorder, into an online format. The present study examined the feasibility of an introductory psychoeducational module of eSense, an online program currently being developed that is based on existing empirically supported in-person treatments, which delivers content to the user in a visually appealing and interactive manner. Methods Sixteen cisgender women (M age = 31.9) with female sexual arousal/interest disorder worked through a pilot module of eSense inperson at a sexual health laboratory. Outcomes Qualitative semistructured interviews and online questionnaires were used to assess participants’ experiences of usability of the platform, clarity/relevance of the content, satisfaction with the experience, and any changes in clinical outcomes of sexual function and distress. Results Participants reported a high level of satisfaction with the website’s functionality and presentation. They reported greater knowledge, felt validated and more hopeful, and were eager to continue the remaining modules. Participants also reported notable prepost improvements in sexual desire, arousal, and satisfaction. Clinical Implications Initial user-experience assessment may represent a method of simultaneously improving online interventions and providing therapeutic education to participants. Strengths & Limitations This is one of the first studies, to our knowledge, to test a graphics-rich, interactive online intervention for sexual difficulties that does not require direct contact with expert providers or support groups. Limitations include the high level of education, motivation, and technical fluency of the sample and the potentially confounding effect of the researcher’s presence during interviews. Because this was a feasibility study, the sample size was small, and no control group was included, limiting conclusions about efficacy and generalizability. Conclusion The format of eSense appears to be feasible and usable, lending support to the growing evidence that it is possible to take in-person therapeutic interventions online. Zippan N, Stephenson KR, Brotto LA, Feasibility of a Brief Online Psychoeducational Intervention for Women With Sexual Interest/Arousal Disorder. J Sex Med 2020;17:2208–2219.
Collapse
|
36
|
El Morr C, Layal M. Effectiveness of ICT-based intimate partner violence interventions: a systematic review. BMC Public Health 2020; 20:1372. [PMID: 32894115 PMCID: PMC7476255 DOI: 10.1186/s12889-020-09408-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/18/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Intimate Partner Violence is a "global pandemic". Meanwhile, information and communication technologies (ICT), such as the internet, mobile phones, and smartphones, are spreading worldwide, including in low- and middle-income countries. We reviewed the available evidence on the use of ICT-based interventions to address intimate partner violence (IPV), evaluating the effectiveness, acceptability, and suitability of ICT for addressing different aspects of the problem (e.g., awareness, screening, prevention, treatment, mental health). METHODS We conducted a systematic review, following PRISMA guidelines, using the following databases: PubMed, PsycINFO, and Web of Science. Key search terms included women, violence, domestic violence, intimate partner violence, information, communication technology, ICT, technology, email, mobile, phone, digital, ehealth, web, computer, online, and computerized. Only articles written in English were included. RESULTS Twenty-five studies addressing screening and disclosure, IPV prevention, ICT suitability, support and women's mental health were identified. The evidence reviewed suggests that ICT-based interventions were effective mainly in screening, disclosure, and prevention. However, there is a lack of homogeneity among the studies' outcome measurements and the sample sizes, the control groups used (if any), the type of interventions, and the study recruitment space. Questions addressing safety, equity, and the unintended consequences of the use of ICT in IPV programming are virtually non-existent. CONCLUSIONS There is a clear need to develop women-centered ICT design when programming for IPV. Our study showed only one study that formally addressed software usability. The need for more research to address safety, equity, and the unintended consequences of the use of ICT in IPV programming is paramount. Studies addressing long term effects are also needed.
Collapse
Affiliation(s)
- Christo El Morr
- School of Health Policy and Management, York University, 4700 Keele St, Toronto, Ontario, Canada.
| | - Manpreet Layal
- Global Health Program, York University, 4700 Keele St, Toronto, Ontario, Canada
| |
Collapse
|
37
|
Brown M, Hooper N, James P, Scott D, Bodger O, John A. A Web-Delivered Acceptance and Commitment Therapy Intervention With Email Reminders to Enhance Subjective Well-Being and Encourage Engagement With Lifestyle Behavior Change in Health Care Staff: Randomized Cluster Feasibility Stud. JMIR Form Res 2020; 4:e18586. [PMID: 32763887 PMCID: PMC7442951 DOI: 10.2196/18586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/29/2020] [Accepted: 05/26/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Poor mental health and emotional well-being can negatively impact ability to engage in healthy lifestyle behavior change. Health care staff have higher rates of sickness and absence than other public sector staff, which has implications at both individual and societal levels. Individual efforts to self-manage health and well-being which add to the UK mental health prevention agenda need to be supported. OBJECTIVE The objective of this study was to establish the feasibility and acceptability of the inclusion of a self-guided, automated, web-based acceptance and commitment therapy intervention in an existing health promotion program, to improve subjective well-being and encourage engagement with lifestyle behavior change. METHODS For this 12-week, 4-armed, randomized controlled cluster feasibility study, we recruited participants offline and randomly allocated them to 1 of 3 intervention arms or control (no well-being intervention) using an automated web-based allocation procedure. Eligibility criteria were current health care staff in 1 Welsh health board, age≥18 years, ability to read English, and ability to provide consent. The primary researcher was blinded to cluster allocation. Feasibility outcomes were randomization procedure, acceptance of intervention, and adherence to and engagement with the wider program. We evaluated health and well-being data via self-assessment at 2 time points, registration and postintervention, using the 14-item Warwick-Edinburgh Mental Well-Being Scale, the 4-item Patient Health Questionnaire, and the 7-item Acceptance and Action Questionnaire-Revised. RESULTS Of 124 participants who provided consent and were randomly allocated, 103 completed full registration and engaged with the program. Most participants (76/103) enrolled in at least one health behavior change module, and 43% (41/96) of those randomly allocated to an intervention arm enrolled in the well-being module. Adherence and engagement was low (7/103, 6.8%), but qualitative feedback was positive. CONCLUSIONS The procedure and randomization process proved feasible, and the addition of the well-being module proved acceptable to health care staff. However, participant engagement was limited, and no one completed the full 12-week program. User feedback should be used to develop the intervention to address poor engagement. Effectiveness should then be evaluated in a full-scale randomized controlled trial, which would be feasible with additional recruitment. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number (ISRCTN) 50074817; http://www.isrctn.com/ISRCTN50074817.
Collapse
Affiliation(s)
- Menna Brown
- Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Nic Hooper
- Department of Health and Social Sciences, University of the West of England, Bristol, United Kingdom
| | - Phillip James
- Department of Computer Science, Swansea University, Swansea, United Kingdom
| | - Darren Scott
- Department of Computer Science, Swansea University, Swansea, United Kingdom
| | - Owen Bodger
- Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Ann John
- Swansea University Medical School, Swansea University, Swansea, United Kingdom
| |
Collapse
|
38
|
Laitinen J, Korkiakangas E, Mäkiniemi JP, Tiitinen S, Tikka P, Oinas-Kukkonen H, Simunaniemi AM, Ahola S, Jaako J, Kekkonen M, Muhos M, Heikkilä-Tammi K, Hannonen H, Lusa S, Punakallio A, Oksa J, Mänttäri S, Ilomäki S, Logren A, Verbeek J, Ruotsalainen J, Remes J, Ruusuvuori J, Oksanen T. The effects of counseling via a smartphone application on microentrepreneurs' work ability and work recovery: a study protocol. BMC Public Health 2020; 20:438. [PMID: 32245379 PMCID: PMC7118938 DOI: 10.1186/s12889-020-8449-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/03/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- J Laitinen
- Finnish Institute of Occupational Health, Helsinki, Finland.
| | - E Korkiakangas
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - J P Mäkiniemi
- Faculty of Management and Business, Tampere University, Tampere, Finland
| | - S Tiitinen
- Faculty of Sciences, Tampere University, Tampere, Finland
| | - P Tikka
- Faculty of Information Technology and Electrical Engineering, Oulu Advanced Research on Service and Information Systems (OASIS), University of Oulu, Oulu, Finland
| | - H Oinas-Kukkonen
- Faculty of Information Technology and Electrical Engineering, Oulu Advanced Research on Service and Information Systems (OASIS), University of Oulu, Oulu, Finland
| | - A M Simunaniemi
- Kerttu Saalasti Institute, University of Oulu, Oulu, Finland
| | - S Ahola
- Faculty of Management and Business, Tampere University, Tampere, Finland
| | - J Jaako
- Faculty of Information Technology and Electrical Engineering, Oulu Advanced Research on Service and Information Systems (OASIS), University of Oulu, Oulu, Finland
| | - M Kekkonen
- Faculty of Information Technology and Electrical Engineering, Oulu Advanced Research on Service and Information Systems (OASIS), University of Oulu, Oulu, Finland
| | - M Muhos
- Kerttu Saalasti Institute, University of Oulu, Oulu, Finland
| | - K Heikkilä-Tammi
- Faculty of Management and Business, Tampere University, Tampere, Finland
| | - H Hannonen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - S Lusa
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - A Punakallio
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - J Oksa
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - S Mänttäri
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - S Ilomäki
- Faculty of Sciences, Tampere University, Tampere, Finland
| | - A Logren
- Faculty of Sciences, Tampere University, Tampere, Finland
| | - J Verbeek
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - J Ruotsalainen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - J Remes
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - J Ruusuvuori
- Faculty of Sciences, Tampere University, Tampere, Finland
| | - T Oksanen
- Finnish Institute of Occupational Health, Helsinki, Finland
| |
Collapse
|
39
|
van Aubel E, Bakker JM, Batink T, Michielse S, Goossens L, Lange I, Schruers K, Lieverse R, Marcelis M, van Amelsvoort T, van Os J, Wichers M, Vaessen T, Reininghaus U, Myin-Germeys I. Blended care in the treatment of subthreshold symptoms of depression and psychosis in emerging adults: A randomised controlled trial of Acceptance and Commitment Therapy in Daily-Life (ACT-DL). Behav Res Ther 2020; 128:103592. [PMID: 32146218 DOI: 10.1016/j.brat.2020.103592] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 02/05/2020] [Accepted: 02/19/2020] [Indexed: 02/07/2023]
Abstract
In this study, the feasibility and efficacy of Acceptance and Commitment Therapy in Daily Life (ACT-DL), ACT augmented with a daily life application, was investigated in 55 emerging adults (age 16 to 25) with subthreshold depressive and/or psychotic complaints. Participants were randomized to ACT-DL (n = 27) or to active control (n = 28), with assessments completed at pre- and post-measurement and 6- and 12-months follow-up. It took up to five (ACT-DL) and 11 (control) months to start group-based interventions. Participants attended on average 4.32 out of 5 ACT-DL sessions. On the app, they filled in on average 69 (48%) of signal-contingent beep-questionnaires, agreed to 15 (41%) of offered beep-exercises, initiated 19 on-demand exercises, and rated ACT-DL metaphors moderately useful. Relative to active control, interviewer-rated depression scores decreased significantly in ACT-DL participants (p = .027). Decreases in self-reported depression, psychotic-related distress, anxiety, and general psychopathology did not differ between conditions. ACT-DL participants reported increased mean NA (p = .011), relative to active controls. Mean PA did not change in either group, nor did psychological flexibility. ACT-DL is a feasible intervention, although adaptations in future research may improve delivery of and compliance with the intervention. There were mixed findings for its efficacy in reducing subthreshold psychopathology in emerging adults. Dutch Trial Register no.: NTR3808.
Collapse
Affiliation(s)
- Evelyne van Aubel
- Department of Neurosciences, Center for Contextual Psychiatry (CCP), University of Leuven, Leuven, Belgium.
| | - Jindra Myrthe Bakker
- Department of Neurosciences, Center for Contextual Psychiatry (CCP), University of Leuven, Leuven, Belgium; Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Tim Batink
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands; U-Center, Epen, Netherlands.
| | - Stijn Michielse
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Liesbet Goossens
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Iris Lange
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Koen Schruers
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Health Psychology, Faculty of Psychology, University of Leuven, Leuven, Belgium.
| | - Ritsaert Lieverse
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Machteld Marcelis
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands; Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, the Netherlands.
| | - Thérèse van Amelsvoort
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Jim van Os
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Psychosis Studies, Institute of Psychiatry, King's College London, King's Health Partners, London, England, United Kingdom; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Marieke Wichers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry (UCP), Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), the Netherlands.
| | - Thomas Vaessen
- Department of Neurosciences, Center for Contextual Psychiatry (CCP), University of Leuven, Leuven, Belgium.
| | - Ulrich Reininghaus
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNs), EURON, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Public Mental Health, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany; Center for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Inez Myin-Germeys
- Department of Neurosciences, Center for Contextual Psychiatry (CCP), University of Leuven, Leuven, Belgium.
| |
Collapse
|
40
|
Ahmad F, El Morr C, Ritvo P, Othman N, Moineddin R. An Eight-Week, Web-Based Mindfulness Virtual Community Intervention for Students' Mental Health: Randomized Controlled Trial. JMIR Ment Health 2020; 7:e15520. [PMID: 32074061 PMCID: PMC7055779 DOI: 10.2196/15520] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/08/2019] [Accepted: 12/16/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Innovative interventions are needed to address the increasing mental health needs of university students. Given the demonstrated anxiolytic and antidepressant benefits of mindfulness training, we developed an 8-week, Web-based Mindfulness Virtual Community (MVC) intervention informed by cognitive behavioral therapy (CBT) constructs. OBJECTIVE This study investigated the efficacy of the MVC intervention in reducing symptoms of depression, anxiety, and stress among undergraduate students in Toronto, Canada. The secondary outcomes included quality of life, life satisfaction, and mindfulness. METHODS The first 4 weeks of the full MVC intervention (F-MVC) comprised: (1) 12 video-based modules with psycho-education on students' preidentified stressful topics and topically applied mindfulness practice; (2) anonymous peer-to-peer discussion forums; and (3) anonymous, group-based, professionally guided, 20-min live videoconferences. The second 4 weeks of F-MVC involved access only to video-based modules. The 8-week partial MVC (P-MVC) comprised 12 video-based modules. A randomized controlled trial was conducted with 4 parallel arms: F-MVC, P-MVC, waitlist control (WLC), and group-based face-to-face CBT; results for the latter group are presented elsewhere. Students recruited through multiple strategies consented and were randomized: WLC=40; F-MVC=40, P-MVC=39; all learned about allocation after consenting. The online surveys at baseline (T1), 4 weeks (T2), and 8 weeks (T3) included the Patient Health Questionnaire-9 item, Beck Anxiety Inventory, Perceived Stress Scale, Quality of Life Scale, Brief Multi-Dimensional Students Life Satisfaction Scale, and Five-Facet Mindfulness Questionnaire. Analyses employed generalized estimation equation methods with AR(1) covariance structures and were adjusted for possible confounders (gender, age, birth country, paid work, unpaid work, physical activities, self-rated health, and mental health counseling access). RESULTS Of the 113 students who provided T1 data, 28 were males and 85 were females with a mean age of 24.8 years. Participants in F-MVC (n=39), P-MVC (n=35), and WLC (n=39) groups were similar in sociodemographic characteristics at T1. At T3 follow-up, per adjusted comparisons, there were statistically significant reductions in depression scores for F-MVC (score change -4.03; P<.001) and P-MVC (score change -4.82; P<.001) when compared with WLC. At T3, there was a statistically significant reduction in anxiety scores only for P-MVC (score change -7.35; P=.01) when compared with WLC. There was a statistically significant reduction in scores for perceived stress for both F-MVC (score change -5.32; P<.001) and P-MVC (score change -5.61; P=.005) compared with WLC. There were statistically significant changes at T3 for quality of life and mindfulness for F-MVC and P-MVC vs WLC but not for life satisfaction. CONCLUSIONS Internet-based mindfulness CBT-based interventions, such as F-MVC and P-MVC, can result in significant reductions in symptoms of depression, anxiety, and stress in a student population. Future research with a larger sample from multiple universities would more precisely test generalizability. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number ISRCTN92827275; https://www.isrctn.com/ISRCTN92827275.
Collapse
Affiliation(s)
- Farah Ahmad
- School of Health Policy and Management, York University, Toronto, ON, Canada
| | - Christo El Morr
- School of Health Policy and Management, York University, Toronto, ON, Canada
| | - Paul Ritvo
- Kinesiology & Health Science, York University, Toronto, ON, Canada
| | - Nasih Othman
- School of Health Policy and Management, York University, Toronto, ON, Canada
| | - Rahim Moineddin
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | -
- See Authors' Contributions,
| |
Collapse
|
41
|
Puolakanaho A, Tolvanen A, Kinnunen SM, Lappalainen R. A psychological flexibility -based intervention for Burnout:A randomized controlled trial. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2019.11.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
42
|
Sairanen E, Lappalainen R, Lappalainen P, Hiltunen A. Mediators of change in online acceptance and commitment therapy for psychological symptoms of parents of children with chronic conditions: An investigation of change processes. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2019.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
43
|
El Morr C, Maule C, Ashfaq I, Ritvo P, Ahmad F. Design of a Mindfulness Virtual Community: A focus-group analysis. Health Informatics J 2019; 26:1560-1576. [PMID: 31709878 DOI: 10.1177/1460458219884840] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mental illnesses are on the rise on campuses worldwide. There is a need for a scalable and economically sound innovation to address these mental health challenges. The aim of this study was to explore university students' needs and concerns in relation to an online mental health virtual community. Eight focus groups (N = 72, 55.6% female) were conducted with university students aged 18-47 (mean = 23.38, SD = 5.82) years. Participants were asked about their views in relation to online mental health platform. Three major themes and subthemes emerged: (1) perceived concerns: potential loss of personal encounter and relationships, fear of cyber bullying, engagement challenge, and privacy and distraction; (2) perceived advantages: anonymity and privacy, convenience and flexibility, filling a gap, and togetherness; and (3) desired features: user-centered design, practical trustworthy support, and online moderation. The analysis informed design features for a mindfulness virtual community.
Collapse
|
44
|
Evaluating the Open and Engaged Components of Acceptance and Commitment Therapy in an Online Self-Guided Website: Results from a Pilot Trial. Behav Modif 2019; 45:480-501. [DOI: 10.1177/0145445519878668] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Online acceptance and commitment therapy (ACT) is promising for treating a range of psychological problems. Component research can further clarify which components are needed for optimal outcomes in what contexts. Online platforms provide a highly controlled format for such research. In this pilot trial, 55 adults were randomized to: ACT-Open (i.e., acceptance, defusion components), ACT-Engaged (i.e., values, committed action), or ACT-Combined (i.e., acceptance, defusion, values, committed action). Each condition was 12 sessions over 6 weeks, with assessments at baseline, post-treatment, and 4-week follow-up. ACT-Open, ACT-Engaged, and ACT-Combined all significantly improved from pre- to post-treatment on mental health, psychosocial functioning, and components of psychological flexibility. Compared to ACT-Combined, ACT-Open improved less on psychosocial functioning at post-treatment, and ACT-Engaged worsened on functioning at follow-up. The platform was acceptable with high satisfaction ratings. Results support the feasibility of conducting online ACT component research, which will be tested in a fully powered non-inferiority trial.
Collapse
|
45
|
Ritvo P, Daskalakis ZJ, Tomlinson G, Ravindran A, Linklater R, Kirk Chang M, Knyahnytska Y, Lee J, Alavi N, Bai S, Harber L, Jain T, Katz J. An Online Mindfulness-Based Cognitive Behavioral Therapy Intervention for Youth Diagnosed With Major Depressive Disorders: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e11591. [PMID: 31359869 PMCID: PMC6690226 DOI: 10.2196/11591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/12/2018] [Accepted: 12/21/2018] [Indexed: 12/30/2022] Open
Abstract
Background About 70% of all mental health disorders appear before the age of 25 years. When untreated, these disorders can become long-standing and impair multiple life domains. When compared with all Canadian youth (of different ages), individuals aged between 15 and 25 years are significantly more likely to experience mental health disorders, substance dependencies, and risks for suicidal ideation and death by suicide. Progress in the treatment of youth, capitalizing on their online responsivity, can strategically address depressive disorders. Objective We will conduct a randomized controlled trial to compare online mindfulness-oriented cognitive behavioral therapy (CBT-M) combined with standard psychiatric care versus psychiatric care alone in youth diagnosed with major depressive disorder. We will enroll 168 subjects in the age range of 18 to 30 years; 50% of subjects will be from First Nations (FN) backgrounds, whereas the other 50% will be from all other ethnic backgrounds. There will be equal stratification into 2 intervention groups (INT1 and INT2) and 2 wait-list control groups (CTL1 and CTL2) with 42 subjects per group, resulting in an equal number of INT1 and CTL1 of FN background and INT2 and CTL2 of non-FN background. Methods The inclusion criteria are: (1) age 18 to 30 years, FN background or other ethnicity; (2) Beck Depression Inventory (BDI)-II of at least mild severity (BDI-II score ≥14) and no upper limit; (3) Mini-International Neuropsychiatric Interview (MINI)–confirmed psychiatric diagnosis of major depressive disorder; and (4) fluent in English. All patients are diagnosed by a Centre for Addiction and Mental Health psychiatrist, with diagnoses confirmed using the MINI interview. The exclusion criteria are: (1) individuals receiving weekly structured psychotherapy; (2) individuals who meet the Diagnostic and Statistical Manual of Mental Disorders criteria for severe alcohol/substance use disorder in the past 3 months, or who demonstrate clinically significant suicidal ideation defined as imminent intent, or who have attempted suicide in the past 6 months; and (3) individuals with comorbid diagnoses of borderline personality, schizophrenia, bipolar disorder, and/or obsessive compulsive disorder. All subjects are provided standard psychiatric care defined as 1 monthly session that focuses on appropriate medication, with session durations of 15 to 30 min. Experimental subjects receive an additional intervention consisting of the CBT-M online software program (in collaboration with Nex J Health, Inc). Exposure to and interaction with the online workbooks are combined with navigation-coaching delivered by phone and secure text message interactions. Results The outcomes selected, combined with measurement blinding, are key features in assessing whether significant benefits regarding depression and anxiety symptoms occur. Conclusions If results confirm the hypothesis that youth can be effectively treated with online CBT-M, effective services may be widely delivered with less geographic restriction. International Registered Report Identifier (IRRID) PRR1-10.2196/11591
Collapse
Affiliation(s)
- Paul Ritvo
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - George Tomlinson
- THETA and Biostatistics Unit, University Health Network, Toronto, ON, Canada
| | - Arun Ravindran
- Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Renee Linklater
- Aboriginal Engagement and Outreach, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Megan Kirk Chang
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Yuliya Knyahnytska
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jonathan Lee
- Child and Youth Services, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Nazanin Alavi
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Shari Bai
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Lillian Harber
- Mood and Anxiety Services, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tania Jain
- Mood and Anxiety Services, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Joel Katz
- Department of Psychology, York University, Toronto, ON, Canada
| |
Collapse
|
46
|
Sairanen E, Lappalainen R, Lappalainen P, Kaipainen K, Carlstedt F, Anclair M, Hiltunen A. Effectiveness of a web-based Acceptance and Commitment Therapy intervention for wellbeing of parents whose children have chronic conditions: A randomized controlled trial. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019. [DOI: 10.1016/j.jcbs.2019.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
47
|
Sard-Peck TE, Martín-Asuero A, Oller MT, Calvo A, Santesteban-Echarri O. Estudio comparativo entre un programa de reducción del estrés basado en mindfulness presencial y online en población general española. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.psiq.2019.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
48
|
Lappalainen P, Langrial S, Oinas-Kukkonen H, Muotka J, Lappalainen R. ACT for sleep - Internet-delivered self-help ACT for sub-clinical and clinical insomnia: A randomized controlled trial. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019. [DOI: 10.1016/j.jcbs.2019.04.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
49
|
Puolakanaho A, Lappalainen R, Lappalainen P, Muotka JS, Hirvonen R, Eklund KM, Ahonen TPS, Kiuru N. Reducing Stress and Enhancing Academic Buoyancy among Adolescents Using a Brief Web-based Program Based on Acceptance and Commitment Therapy: A Randomized Controlled Trial. J Youth Adolesc 2019; 48:287-305. [PMID: 30560515 PMCID: PMC6394525 DOI: 10.1007/s10964-018-0973-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/29/2018] [Indexed: 10/31/2022]
Abstract
Acceptance and commitment therapy programs have rarely been used as preventive tools for alleviating stress and enhancing coping skills among adolescents. This randomized controlled trial examined the efficacy of a novel Finnish web- and mobile-delivered five-week intervention program called Youth COMPASS among a general sample of ninth-grade adolescents (n= 249, 49% females). The intervention group showed a small but significant decrease in overall stress (between-group Cohen's d = 0.22) and an increase in academic buoyancy (d= 0.27). Academic skills did not influence the intervention gains, but the intervention gains were largest among high-stressed participants. The results suggest that the acceptance and commitment based Youth COMPASS program may be well suited for promoting adolescents' well-being in the school context.
Collapse
Affiliation(s)
- Anne Puolakanaho
- Department of Psychology, University of Jyväskylä, P.O. Box 35, Jyväskylä, 40014, Finland.
| | - Raimo Lappalainen
- Department of Psychology, University of Jyväskylä, P.O. Box 35, Jyväskylä, 40014, Finland
| | - Päivi Lappalainen
- Department of Psychology and Gerocenter, University of Jyväskylä, P.O. Box 35, Jyväskylä, 40014, Finland
| | - Joona S Muotka
- Department of Psychology, University of Jyväskylä, P.O. Box 35, Jyväskylä, 40014, Finland
| | - Riikka Hirvonen
- Department of Psychology, University of Jyväskylä, P.O. Box 35, Jyväskylä, 40014, Finland
| | - Kenneth M Eklund
- Faculty of Education and Psychology, University of Jyväskylä, P.O. Box 35, Jyväskylä, 40014, Finland
| | - Timo P S Ahonen
- Department of Psychology, University of Jyväskylä, P.O. Box 35, Jyväskylä, 40014, Finland
| | - Noona Kiuru
- Department of Psychology, University of Jyväskylä, P.O. Box 35, Jyväskylä, 40014, Finland
| |
Collapse
|
50
|
Mechanisms of the Acceptance and Commitment Therapy: A meta-analytic structural equation model. ACTA PSYCHOLOGICA SINICA 2019. [DOI: 10.3724/sp.j.1041.2019.00662] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|