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Nazem S, Barnes SM, Forster JE, Hostetter TA, Monteith LL, Kramer EB, Gaeddert LA, Brenner LA. Efficacy of an Internet-Delivered Intervention for Improving Insomnia Severity and Functioning in Veterans: Randomized Controlled Trial. JMIR Ment Health 2023; 10:e50516. [PMID: 37999953 DOI: 10.2196/50516] [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: 07/03/2023] [Revised: 09/26/2023] [Accepted: 10/06/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Despite a growing evidence base that internet-delivered cognitive behavioral therapy for insomnia (iCBT-I) is associated with decreased insomnia severity, its efficacy has been minimally examined in veterans. OBJECTIVE The objective of this study was to evaluate the efficacy of an unguided iCBT-I (Sleep Healthy Using the Internet [SHUTi]) among veterans. METHODS We conducted a single-blind, randomized controlled trial in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans eligible for Veterans Health Administration care. Participants were randomly assigned (1:1) to receive SHUTi (a self-guided and interactive program) or an Insomnia Education Website (IEW) that provided nontailored and fixed insomnia information. Web-based assessments were administered at baseline, postintervention, 6 months postintervention, and 1 year postintervention. The primary outcome was self-reported insomnia severity (Insomnia Severity Index [ISI]). Secondary outcomes were self-reported mental and physical health functioning (Veterans RAND 36-item Health Survey). Exploratory outcomes comprised sleep diary parameters. RESULTS Of the 231 randomized participants (mean age 39.3, SD 7.8 years; 170/231, 73.5% male sex; 26/231, 11.3% Black; 172/231, 74.5% White; 10/231, 4.3% multiracial; and 17/231, 7.4% other; 36/231, 15.6% Hispanic) randomized between April 2018 and January 2019, a total of 116 (50.2%) were randomly assigned to SHUTi and 115 (49.8%) to the IEW. In intent-to-treat analyses, SHUTi participants experienced significantly larger ISI decreases compared with IEW participants at all time points (generalized η2 values of 0.13, 0.12, and 0.10, respectively; all P<.0001). These corresponded to estimated larger differences in changes of -3.47 (95% CI -4.78 to -2.16), -3.80 (95% CI -5.34 to -2.27), and -3.42 (95% CI -4.97 to 1.88) points on the ISI for the SHUTi group. SHUTi participants experienced significant improvements in physical (6-month generalized η2=0.04; P=.004) and mental health functioning (6-month and 1-year generalized η2=0.04; P=.009 and P=.005, respectively). Significant sleep parameter improvements were noted for SHUTi (all P<.05), though the pattern and magnitude of these reductions varied by parameter. No adverse events were reported. CONCLUSIONS Self-administered iCBT-I was associated with immediate and long-term improvements in insomnia severity. Findings suggest that leveraging technology to meet insomnia treatment demands among veterans may be a promising approach. TRIAL REGISTRATION ClinicalTrials.gov NCT03366870; https://clinicaltrials.gov/ct2/show/NCT03366870.
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Affiliation(s)
- Sarra Nazem
- Dissemination & Training Division, National Center for Posttraumatic Stress Disorder, Menlo Park, CA, United States
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
| | - Sean M Barnes
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jeri E Forster
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Trisha A Hostetter
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
| | - Lindsey L Monteith
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Emily B Kramer
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
| | - Laurel A Gaeddert
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
| | - Lisa A Brenner
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Weitzel EC, Pabst A, Luppa M, Kersting A, König HH, Löbner M, Riedel-Heller SG. Are self-managed online interventions for depression effective in improving behavioral activation? A secondary analysis of a cluster-randomized controlled trial. J Affect Disord 2022; 308:413-420. [PMID: 35460734 DOI: 10.1016/j.jad.2022.04.090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Online interventions can effectively improve depressive symptoms. They often include behavioral activation (BA) techniques, but research on the effects on behavioral activation is scarce. This study aims to examine short- and long-term effects of online interventions on behavioral activation in routine care. METHODS This study is a secondary analysis of a pragmatic cluster-randomized controlled trial (@ktiv) with a sample of N = 647 GP patients with mild to moderate depression. The intervention group (IG) received treatment-as-usual (TAU) and adjunct access to an online intervention; the control group (CG) received TAU. BA was assessed in terms of the frequency and enjoyment of pleasant activities at baseline, after six weeks and after six months. Intention-to-treat analyses were performed via multilevel mixed linear regression. RESULTS The frequency of pleasant activities was significantly higher in the IG than in the CG six months after baseline (t(1406) = 2.25, p = .024). The enjoyment of pleasant activities was significantly higher in the IG than in the CG both six weeks (t(1405) = 2.11, p = .035) and six months after baseline (t(1405) = 3.44, p = .001). Initial depressive symptoms significantly moderated the treatment effect on the enjoyment but not the frequency of pleasant activities. LIMITATIONS BA measures have not been validated in a clinical context. CONCLUSIONS GP patients with mild to moderate depressive symptoms profited from access to an online adjunct intervention in terms of improved behavioral activation. The findings emphasize the usefulness of online interventions as supportive options in mental health care.
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Affiliation(s)
- E C Weitzel
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany.
| | - A Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - M Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - A Kersting
- Clinic of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - H H König
- Department of Health Economics and Health Services Research, Hamburg Centre for Health Economics, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - M Löbner
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - S G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
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Clinical wisdom in the age of computer apps: a systematic review of four functions that may complement clinical treatment. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Mental health clinicians perform complex tasks with patients that potentially could be improved by the massive computing power available through mobile apps. This study aimed to analyse commercially available mobile and computer applications (apps) focused on treating psychiatric disorders. Apps were analysed by two independent raters for whether they took advantage of computer power to process data in a fashion that augments four main elements of clinical treatment including (1) assessment/diagnosis, (2) treatment planning, (3) treatment fidelity monitoring, and (4) outcome tracking. The evidence base for each of these apps was also explored via PsychINFO, Research Gate and Google Scholar. Searches of the Google Play Store, the Apple App Store, and the One Mind PsyberGuide found 722 apps labelled for mental health use, of which 163 apps were judged relevant to clinical work with patients with psychiatric disorders. Fifty-nine of these were determined to contain a computer-driven function for at least one of the four main elements of clinical treatment. The most common element was assessment/diagnosis (55/59 apps), followed by outcome tracking (34/59 apps). Six apps updated treatment plans using user input. Only one app tracked treatment fidelity. None of the apps contained computer-driven functions for all four elements. Twelve apps were supported in randomized clinical trials to show greater efficacy compared with either wait-list or other active treatments. Results showed that these four clinical elements can be meaningfully augmented, but the full potential of computer processing appears unreached in mental health-related apps.
Key learning aims
(1)
To understand what apps are currently available to treat clinical-level psychiatric problems.
(2)
To understand how many of the commercially available mental health-focused apps can be used for the treatment of clinical populations.
(3)
To understand how mental health services can be complemented by utilizing computer processing power within apps.
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Yang Y, Li Y, Zhang H, Xu Y, Wang B. The efficacy of computer-assisted cognitive behavioral therapy (cCBT) on psychobiological responses and perioperative outcomes in patients undergoing functional endoscopic sinus surgery: a randomized controlled trial. Perioper Med (Lond) 2021; 10:28. [PMID: 34407884 PMCID: PMC8375045 DOI: 10.1186/s13741-021-00195-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 05/31/2021] [Indexed: 01/06/2023] Open
Abstract
Background Functional endoscopic sinus surgery (FESS) is required to minimize bleeding to maintain a clear operative field during surgery, so it is important to preoperative anti-anxiety and stable hemodynamics. Initial evidence suggests cognitive behavioral therapy (CBT) is effective to minimize surgery-related stress and to speed up recovery. The study aimed to evaluate the efficacy of a newly developed computer-assisted CBT (cCBT) program on surgery-related psychobiological responses in patients undergoing FESS. Methods Participants were allocated to a CCBT group (cCBT; n = 50) or a UC group (usual care; n = 50) by random number table. The State Anxiety Inventory (SAI), Patients Health Questionnaire-9 (PHQ-9), Athens Insomnia Scale (AIS), systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were assessed before intervention (T1), at 1 h before operation (T2), at postoperative 48 h (T3), and 96 h (T4: after intervention completed) respectively. The stress hormone was assayed at T1 and T2. The duration of surgery, anesthesia, and post-anesthesia care unit (PACU) were recorded. A satisfaction survey about nursing services was completed by participants before discharge. Results Compared to the UC group, the SAI scores at T2 and the AIS scores at T3 were lower in the CCBT group (p < 0.01 and p = 0.002). The positive rate of participants who were moderate and severe anxiety (SAI score > 37) at T2 were lower (72% vs. 88%, p = 0.04); the cortisol levels, SBP, DBP, and HR at T2 in the CCBT group were lower (p = 0.019 and all p < 0.01); the duration of anesthesia and PACU was shorter (p = 0.001 and p < 0.01); the CCBT group showed higher satisfaction scores. Conclusion The newly developed cCBT program was an effective non-pharmacological adjunctive treatment for improving the surgery-related psychosomatic responses and perioperative outcomes. Trial registration The study was registered with the Chinese Clinical Trial Registry (ChiCTR1900025994) on 17 September 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13741-021-00195-3.
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Affiliation(s)
- Yang Yang
- Nursing College, Shanxi Medical University, Taiyuan, People's Republic of China.,Nursing Department, The First Hospital of Shanxi Medical University, Taiyuan, People's Republic of China
| | - Yuling Li
- Nursing Department, The First Hospital of Shanxi Medical University, Taiyuan, People's Republic of China
| | - Haibin Zhang
- Department of Anesthesia, The First Hospital of Shanxi Medical University, Taiyuan, People's Republic of China
| | - Yong Xu
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, People's Republic of China. .,Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, The First Hospital of Shanxi Medical University, Taiyuan, People's Republic of China.
| | - Binquan Wang
- Department of Otorhinolaryngology Head and Neck Surgery, The First Hospital of Shanxi Medical University, Taiyuan, People's Republic of China. .,Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China.
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"When the first session may be the last!": A case report of the implementation of "rapid tele-psychotherapy" with single-session music therapy in the COVID-19 outbreak. Palliat Support Care 2021; 20:290-295. [PMID: 34399867 PMCID: PMC8458841 DOI: 10.1017/s1478951521001425] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective Conventional psychotherapy with a lengthy and regular number of meetings is no longer relevant in the case of COVID-19, when persons with psychiatric problems, especially COVID-19 patients/clients, really require immediate psychological assistance. It is recognized as a “rapid test” in the field of body health to rapidly decide whether or not a person is affected by COVID-19. So, we should now be able to use the term “rapid tele-psychotherapy” with Single-Session Music Therapy (SSMT) in the field of mental health to characterize the mechanism of assistance provided to persons who seek therapeutic assistance virtually during this COVID-19 outbreak, so that they will easily and reliably be freed from troubling psychiatric issues. Method The author reports the case of a 33-year-old widow with asymptomatic COVID-19 who was admitted to her own home. Results The author describes the effectiveness of the implementation of rapid tele-psychotherapy with SSMT in reducing the scale of anxiety, panic, fear, depression, acute stress, insomnia, and delusions of death. Significance of results This case can provide new inputs or ideas for counselors/psychologists/psychiatrists/therapists who work in hospitals/institutions to provide rapid tele-psychotherapy with SSMT as therapeutic assistance for individuals who need psychotherapy in this COVID-19 outbreak, especially for COVID-19 patients/clients. Besides that, this concept is not only suitable for rapidly screening individuals that may face psychological problems and helping them better seek therapeutic assistance, but can also be used as an adjuvant therapy for psychiatric patients.
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Ziadni MS, Anderson SR, Gonzalez-Castro L, Darnall BD. Comparative efficacy of a single-session "Empowered Relief" videoconference-delivered group intervention for chronic pain: study protocol for a randomized controlled trial. Trials 2021; 22:358. [PMID: 34022930 PMCID: PMC8140415 DOI: 10.1186/s13063-021-05303-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/30/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Chronic pain is naturally aversive and often distressing for patients. Pain coping and self-regulatory skills have been shown to effectively reduce pain-related distress and other symptoms. In this trial, the primary goal is to pilot test the comparative efficacy of a single-session videoconference-delivered group pain education class to a waitlist control among patients with chronic pain. METHODS Our study is a randomized clinical trial pilot testing the superiority of our 2-h single-session videoconference-delivered group pain education class against a waitlist control. We will enroll 120 adult patients with mixed etiology chronic pain and randomize 1:1 to one of the two study arms. We hypothesize superiority for the pain education class for bolstering pain and symptom management. Team researchers masked to treatment assignment will assess the outcomes up to 3 months post-treatment. DISCUSSION This study aims to test the utility of a single-session videoconference-delivered group pain education class to improve self-regulation of pain and pain-related outcomes. Findings from our project have the potential to significantly reduce barriers to effective psychological treatment for pain, optimizing the delivery of increasingly vital online and remote-delivered intervention options. TRIAL REGISTRATION ClinicalTrials.gov NCT04546685 . Registered on 04 September 2020.
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Affiliation(s)
- Maisa S Ziadni
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 200, Palo Alto, CA, 94304, USA.
| | - Steven R Anderson
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 200, Palo Alto, CA, 94304, USA
| | - Lluvia Gonzalez-Castro
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 200, Palo Alto, CA, 94304, USA
| | - Beth D Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 200, Palo Alto, CA, 94304, USA
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Farrell LJ, Miyamoto T, Donovan CL, Waters AM, Krisch KA, Ollendick TH. Virtual Reality One-Session Treatment of Child-Specific Phobia of Dogs: A Controlled, Multiple Baseline Case Series. Behav Ther 2021; 52:478-491. [PMID: 33622515 DOI: 10.1016/j.beth.2020.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 11/25/2022]
Abstract
Specific phobia (SP) typically onsets in childhood and frequently predicts other mental health disorders later in life. Fortunately, childhood SP can be effectively treated with cognitive behavior therapy (CBT), including the exposure-based one-session treatment (OST) approach. Despite empirical support for CBT and OST, clinicians, for various reasons, frequently fail to implement exposure-based therapy in routine clinical practice, including perceived difficulties in implementing exposure. Virtual reality (VR) exposure therapy may overcome some of these challenges and provides an alternative modality of therapy. This preliminary study examined the efficacy of VR OST for 8 children with a SP of dogs (aged 8-12 years) (M = age 10.25; SD = 2.11) using a multiple-baseline controlled case series. Following a stable baseline period of either 2, 3, or 4 weeks, it was expected that specific phobia severity would significantly decline after VR OST and remain improved over the 3-week maintenance phase. Assessments were conducted posttreatment and at 1-month follow up (study end-point). It was found that phobia symptoms remained relatively stable across the baselines, with significant reductions from pretreatment to posttreatment and to follow-up on clinician severity ratings (pre- to post- g = 1.12; pre- to follow-up g = 2.40), target symptom ratings (g = 1.14; 1.29), and behavioral avoidance (g = -1.27; -1.96). The treatment was also associated with clinically significant outcomes, whereby at one-month follow up, 75% of children were considered "recovered" and 88% completed the BAT (interacted with their feared stimuli). This study provides support for the effectiveness of VR OST.
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Situmorang DDB. Online/Cyber Counseling Services in the COVID-19 Outbreak: Are They Really New? THE JOURNAL OF PASTORAL CARE & COUNSELING : JPCC 2020; 74:166-174. [PMID: 32967547 PMCID: PMC7528539 DOI: 10.1177/1542305020948170] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Online/cyber counseling has been named as the best way to offer counseling services during the COVID-19 outbreak. The purpose of this article is to explore the use of online/cyber counseling during the COVID-19 outbreak to solve psychological problems. The author examines the history and concepts, the therapeutic relationship, transference and countertransference, the advantages along with the disadvantages, considerations, implications, and curriculum for online/cyber counseling during COVID-19 outbreak.
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Everitt H, Landau S, Little P, Bishop FL, O'Reilly G, Sibelli A, Holland R, Hughes S, Windgassen S, McCrone P, Goldsmith K, Coleman N, Logan R, Chalder T, Moss-Morris R. Therapist telephone-delivered CBT and web-based CBT compared with treatment as usual in refractory irritable bowel syndrome: the ACTIB three-arm RCT. Health Technol Assess 2020; 23:1-154. [PMID: 31042143 DOI: 10.3310/hta23170] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) affects 10-22% of people in the UK. Abdominal pain, bloating and altered bowel habits affect quality of life and can lead to time off work. Current treatment relies on a positive diagnosis, reassurance, lifestyle advice and drug therapies, but many people suffer ongoing symptoms. Cognitive-behavioural therapy (CBT) is recommended in guidelines for patients with ongoing symptoms but its availability is limited. OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of therapist telephone-delivered CBT (TCBT) and web-based CBT (WCBT) with minimal therapist support compared with treatment as usual (TAU) in refractory IBS. DESIGN This was a three-arm randomised controlled trial. SETTING This trial took place in UK primary and secondary care. PARTICIPANTS Adults with refractory IBS (clinically significant symptoms for 12 months despite first-line therapies) were recruited from 74 general practices and three gastroenterology centres from May 2014 to March 2016. INTERVENTIONS TCBT - patient CBT self-management manual, six 60-minute telephone sessions over 9 weeks and two 60-minute booster sessions at 4 and 8 months (8 hours' therapist time). WCBT - interactive, tailored web-based CBT, three 30-minute telephone sessions over 9 weeks and two 30-minute boosters at 4 and 8 months (2.5 hours' therapist time). MAIN OUTCOME MEASURES Primary outcomes - IBS symptom severity score (IBS SSS) and Work and Social Adjustment Scale (WSAS) at 12 months. Cost-effectiveness [quality-adjusted life-years (QALYs) and health-care costs]. RESULTS In total, 558 out of 1452 patients (38.4%) screened for eligibility were recruited - 186 were randomised to TCBT, 185 were randomised to WCBT and 187 were randomised to TAU. The mean baseline Irritable Bowel Syndrome Symptom Severity Score (IBS SSS) was 265.0. An intention-to-treat analysis with multiple imputation was carried out at 12 months; IBS SSS were 61.6 points lower in the TCBT arm [95% confidence interval (CI) 89.5 to 33.8; p < 0.001] and 35.2 points lower in the WCBT arm (95% CI 57.8 to 12.6; p = 0.002) than in the TAU arm (IBS SSS of 205.6). The mean WSAS score at 12 months was 10.8 in the TAU arm, 3.5 points lower in the TCBT arm (95% CI 5.1 to 1.9; p < 0.001) and 3.0 points lower in the WCBT arm (95% CI 4.6 to 1.3; p = 0.001). For the secondary outcomes, the Subject's Global Assessment showed an improvement in symptoms at 12 months (responders) in 84.8% of the TCBT arm compared with 41.7% of the TAU arm [odds ratio (OR) 6.1, 95% CI 2.5 to 15.0; p < 0.001] and 75.0% of the WCBT arm (OR 3.6, 95% CI 2.0 to 6.3; p < 0.001). Patient enablement was 78.3% (responders) for TCBT, 23.5% for TAU (OR 9.3, 95% CI 4.5 to 19.3; p < 0.001) and 54.8% for WCBT (OR 3.5, 95% CI 2.0 to 5.9; p < 0.001). Adverse events were similar between the trial arms. The incremental cost-effectiveness ratio (ICER) (QALY) for TCBT versus TAU was £22,284 and for WCBT versus TAU was £7724. Cost-effectiveness reduced after imputation for missing values. Qualitative findings highlighted that, in the CBT arms, there was increased capacity to cope with symptoms, negative emotions and challenges of daily life. Therapist input was important in supporting WCBT. CONCLUSIONS In this large, rigorously conducted RCT, both CBT arms showed significant improvements in IBS outcomes compared with TAU. WCBT had lower costs per QALY than TCBT. Sustained improvements in IBS symptoms are possible at an acceptable cost. Suggested future research work is longer-term follow-up and research to translate these findings into usual clinical practice. FUTURE WORK Longer-term follow-up and research to translate these findings into usual clinical practice is needed. TRIAL REGISTRATION Current Controlled Trials ISRCTN44427879. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme and will be published in full in Health Technology Assessment; Vol. 23, No. 17. See the NIHR Journals Library website for further project information. The University of Southampton sponsored this study. Funding was received from the NIHR HTA Board and the NIHR Clinical Research Network and support was received from the NIHR Clinical Research Network.
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Affiliation(s)
- Hazel Everitt
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Sabine Landau
- Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paul Little
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Felicity L Bishop
- Centre for Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Gillian O'Reilly
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Alice Sibelli
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rachel Holland
- Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Stephanie Hughes
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Sula Windgassen
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paul McCrone
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kim Goldsmith
- Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Nicholas Coleman
- Department of Gastroenterology, Southampton University Hospital, Southampton, UK
| | - Robert Logan
- Department of Gastroenterology, King's College Hospital, London, UK
| | - Trudie Chalder
- Academic Department of Psychological Medicine, King's College London, London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Morabito DM, Mathes BM, Schmidt NB. The Impact of Two Brief Web-Based Psychological Interventions on Functional Outcomes. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10144-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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How Effective are Serious Games for Promoting Mental Health and Health Behavioral Change in Children and Adolescents? A Systematic Review and Meta-analysis. CHILD & YOUTH CARE FORUM 2020. [DOI: 10.1007/s10566-020-09566-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ortiz C, Vidair H, Acri M, Chacko A, Kobak K. Pilot Study of an Online Parent-Training Course for Disruptive Behavior with Live Remote Coaching for Practitioners. ACTA ACUST UNITED AC 2020; 51:125-133. [PMID: 34017154 DOI: 10.1037/pro0000286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective Many clinicians find it challenging to obtain training in evidence-based interventions, including behavioral parent training, which is considered the front-line treatment for children with disruptive behaviors (Chacko et al., 2017). Workshops, ongoing consultation, and feedback provided in person are effective, yet are rarely feasible for clinicians in the field (Fixsen, Blase, Duda, Naoom, & Van Dyke, 2010). The purpose of the present study was to conduct a preliminary assessment of an online tutorial combined with live remote coaching for training mental health professionals in behavioral parent training. Method Participants in this pretest-posttest open trial were 22 clinicians and graduate students (73% female) from around the United States. Results The web platform operated successfully, and clinicians found the training to be highly satisfactory. Compared to pre-training, participants demonstrated large improvements in knowledge about disruptive behavior and behavioral parent training and performed significantly better on demonstrations of skill in administering behavioral parent-training components. Conclusions An online course combined with live remote coaching is a promising methodology for significantly increasing the number of clinicians trained in evidence-based interventions for disruptive behavior in children. Next steps for evaluation and expansion of this training model are discussed.
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Schmidt B, Silva IMD, Pieta MAM, Crepaldi MA, Wagner A. Terapia On-line com Casais e Famílias: Prática e Formação na Pandemia de Covid-19. PSICOLOGIA: CIÊNCIA E PROFISSÃO 2020. [DOI: 10.1590/1982-3703003243001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo A pandemia de Covid-19 potencializou o já emergente processo de intensificação das conexões virtuais. Para terapeutas de casal e família, essa grave crise de saúde pública acarretou mudanças na forma de atender clientes e interagir com colegas, exigindo a rápida transição da modalidade presencial para a modalidade remota, em muitos casos. O presente estudo sistematizou conhecimentos sobre terapia on-line com casais e famílias, trazendo considerações para a prática e a formação profissional diante da pandemia. Por meio de revisão narrativa da literatura, foram sumarizados resultados de estudos empíricos, bem como recomendações sobre aspectos técnicos, éticos e formativos. Destacaram-se, em particular, potencialidades e desafios para a utilização de tecnologias da informação e da comunicação na prática clínica com casais e famílias, incluindo indicações e contraindicações, recursos mais apropriados e seguros, relação terapêutica on-line, capacitação e supervisão. Entende-se que a Covid-19 representa uma oportunidade para revisão e reflexão da prática clínica e da formação profissional de terapeutas de casal e família no Brasil, país em que as intervenções on-line permaneciam relativamente pouco exploradas até a pandemia.
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Tielman ML, Neerincx MA, Brinkman WP. Design and Evaluation of Personalized Motivational Messages by a Virtual Agent that Assists in Post-Traumatic Stress Disorder Therapy. J Med Internet Res 2019; 21:e9240. [PMID: 30916660 PMCID: PMC6456821 DOI: 10.2196/jmir.9240] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 04/24/2018] [Accepted: 12/05/2018] [Indexed: 11/20/2022] Open
Abstract
Background Systems incorporating virtual agents can play a major role in electronic-mental (e-mental) health care, as barriers to care still prevent some patients from receiving the help they need. To properly assist the users of these systems, a virtual agent needs to promote motivation. This can be done by offering motivational messages. Objective The objective of this study was two-fold. The first was to build a motivational message system for a virtual agent assisting in post-traumatic stress disorder (PTSD) therapy based on domain knowledge from experts. The second was to test the hypotheses that (1) computer-generated motivating messages influence users’ motivation to continue with therapy, trust in a good therapy outcome, and the feeling of being heard by the agent and (2) personalized messages outperform generic messages on these factors. Methods A system capable of generating motivational messages was built by analyzing expert (N=13) knowledge on what types of motivational statements to use in what situation. To test the 2 hypotheses, a Web-based study was performed (N=207). Participants were asked to imagine they were in a certain situation, specified by the progression of their symptoms and initial trust in a good therapy outcome. After this, they received a message from a virtual agent containing either personalized motivation as generated by the system, general motivation, or no motivational content. They were asked how this message changed their motivation to continue and trust in a good outcome as well as how much they felt they were being heard by the agent. Results Overall, findings confirmed the first hypothesis, as well as the second hypothesis for the measure feeling of being heard by the agent. Personalization of the messages was also shown to be important in those situations where the symptoms were getting worse. In these situations, personalized messages outperformed general messages both in terms of motivation to continue and trust in a good therapy outcome. Conclusions Expert input can successfully be used to develop a personalized motivational message system. Messages generated by such a system seem to improve people’s motivation and trust in PTSD therapy as well as the user’s feeling of being heard by a virtual agent. Given the importance of motivation, trust, and therapeutic alliance for successful therapy, we anticipate that the proposed system can improve adherence in e-mental therapy for PTSD and that it can provide a blueprint for the development of an adaptive system for persuasive messages based on expert input.
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Affiliation(s)
| | - Mark A Neerincx
- Delft University of Technology, Delft, Netherlands.,Netherlands Organisation for Applied Scientific Research (TNO), Soesterberg, Netherlands
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Tielman ML, Neerincx MA, Pagliari C, Rizzo A, Brinkman WP. Considering patient safety in autonomous e-mental health systems - detecting risk situations and referring patients back to human care. BMC Med Inform Decis Mak 2019; 19:47. [PMID: 30885190 PMCID: PMC6421702 DOI: 10.1186/s12911-019-0796-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 03/07/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Digital health interventions can fill gaps in mental healthcare provision. However, autonomous e-mental health (AEMH) systems also present challenges for effective risk management. To balance autonomy and safety, AEMH systems need to detect risk situations and act on these appropriately. One option is sending automatic alerts to carers, but such 'auto-referral' could lead to missed cases or false alerts. Requiring users to actively self-refer offers an alternative, but this can also be risky as it relies on their motivation to do so. This study set out with two objectives. Firstly, to develop guidelines for risk detection and auto-referral systems. Secondly, to understand how persuasive techniques, mediated by a virtual agent, can facilitate self-referral. METHODS In a formative phase, interviews with experts, alongside a literature review, were used to develop a risk detection protocol. Two referral protocols were developed - one involving auto-referral, the other motivating users to self-refer. This latter was tested via crowd-sourcing (n = 160). Participants were asked to imagine they had sleeping problems with differing severity and user stance on seeking help. They then chatted with a virtual agent, who either directly facilitated referral, tried to persuade the user, or accepted that they did not want help. After the conversation, participants rated their intention to self-refer, to chat with the agent again, and their feeling of being heard by the agent. RESULTS Whether the virtual agent facilitated, persuaded or accepted, influenced all of these measures. Users who were initially negative or doubtful about self-referral could be persuaded. For users who were initially positive about seeking human care, this persuasion did not affect their intentions, indicating that a simply facilitating referral without persuasion was sufficient. CONCLUSION This paper presents a protocol that elucidates the steps and decisions involved in risk detection, something that is relevant for all types of AEMH systems. In the case of self-referral, our study shows that a virtual agent can increase users' intention to self-refer. Moreover, the strategy of the agent influenced the intentions of the user afterwards. This highlights the importance of a personalised approach to promote the user's access to appropriate care.
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Affiliation(s)
- Myrthe L. Tielman
- Department of Interactive Intelligence, Delft University of Technology, van Mourik Broekmanweg 6, 2628 XE Delft, The Netherlands
| | - Mark A. Neerincx
- Department of Interactive Intelligence, Delft University of Technology, van Mourik Broekmanweg 6, 2628 XE Delft, The Netherlands
- TNO Perceptual and Cognitive Systems, Soesterberg, The Netherlands
| | | | - Albert Rizzo
- USC Institute of Creative Technologies, Playa Vista, California USA
| | - Willem-Paul Brinkman
- Department of Interactive Intelligence, Delft University of Technology, van Mourik Broekmanweg 6, 2628 XE Delft, The Netherlands
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Bedford LA, Dietch JR, Taylor DJ, Boals A, Zayfert C. Computer-Guided Problem-Solving Treatment for Depression, PTSD, and Insomnia Symptoms in Student Veterans: A Pilot Randomized Controlled Trial. Behav Ther 2018; 49:756-767. [PMID: 30146142 DOI: 10.1016/j.beth.2017.11.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/18/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
Abstract
Depression is a highly prevalent psychological disorder experienced disproportionately by college student military veterans with many deleterious effects including risk for suicide. Treatment can help, but the debilitating nature of depression often makes seeking in-person treatment difficult and many are deterred by stigma, inconvenience, concerns about privacy, or a preference to manage problems themselves. The current study examines the efficacy of a computer-guided Problem-Solving Treatment (ePST®) for reducing symptoms of depression, posttraumatic stress disorder (PTSD), and insomnia in student military veterans. Twenty-four student veterans (Meanage = 32.7) with symptoms of depression were randomly assigned either to a treatment group receiving six weekly sessions of ePST or to a minimal contact control group (MCC). Participants completed the Patient Health Questionnaire-9 (PHQ-9) depression scale at baseline and then weekly through post-ePST or post-MCC. PTSD and insomnia questionnaires were also completed at baseline and posttreatment. A linear mixed model regression showed a statistically significant Group (ePST vs. MCC) × Time (pretreatment through posttreatment) interaction for depression, with the ePST showing substantial improvements in depressive symptoms over the 6-week period. Significant improvements were also seen in PTSD and insomnia symptoms. Results suggest that ePST can effectively treat depression, PTSD, and insomnia symptoms in student military veterans and may be a viable alternative for those who are not able to access live therapy. Future work should examine the durability of treatment effects and utility for more severe depression and suicide prevention.
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Tielman ML, Neerincx MA, van Meggelen M, Franken I, Brinkman WP. How should a virtual agent present psychoeducation? Influence of verbal and textual presentation on adherence. Technol Health Care 2018; 25:1081-1096. [PMID: 28800346 PMCID: PMC5814660 DOI: 10.3233/thc-170899] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE With the rise of autonomous e-mental health applications, virtual agents can play a major role in improving trustworthiness, therapy outcome and adherence. In these applications, it is important that patients adhere in the sense that they perform the tasks, but also that they adhere to the specific recommendations on how to do them well. One important construct in improving adherence is psychoeducation, information on the why and how of therapeutic interventions. In an e-mental health context, this can be delivered in two different ways: verbally by a (virtual) embodied conversational agent or just via text on the screen. The aim of this research is to study which presentation mode is preferable for improving adherence. METHODS This study takes the approach of evaluating a specific part of a therapy, namely psychoeducation. This was done in a non-clinical sample, to first test the general constructs of the human-computer interaction. We performed an experimental study on the effect of presentation mode of psychoeducation on adherence. In this study, we took into account the moderating effects of attitude towards the virtual agent and recollection of the information. Within the paradigm of expressive writing, we asked participants (n= 46) to pick one of their worst memories to describe in a digital diary after receiving verbal or textual psychoeducation. RESULTS AND CONCLUSION We found that both the attitude towards the virtual agent and how well the psychoeducation was recollected were positively related to adherence in the form of task execution. Moreover, after controlling for the attitude to the agent and recollection, presentation of psychoeducation via text resulted in higher adherence than verbal presentation by the virtual agent did.
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Affiliation(s)
| | - Mark A Neerincx
- Delft University of Technology, Delft, The Netherlands.,TNO Perceptual and Cognitive Systems, Soesterberg, The Netherlands
| | | | - Ingmar Franken
- Erasmus University Rotterdam, Rotterdam, The Netherlands
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Chan M, Li TMH, Law YW, Wong PWC, Chau M, Cheng C, Fu KW, Bacon-Shone J, Cheng QE, Yip PSF. Engagement of vulnerable youths using internet platforms. PLoS One 2017; 12:e0189023. [PMID: 29261687 PMCID: PMC5737897 DOI: 10.1371/journal.pone.0189023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 11/19/2017] [Indexed: 11/26/2022] Open
Abstract
Aim The aim of this study was to explore the online distress and help-seeking behavior of youths in Hong Kong. Methods A cross-sectional telephone-based survey was conducted among 1,010 young people in Hong Kong. Logistic regression analysis was then performed to identify the factors associated with those who reported expressing emotional distress online and the differences in help-seeking behavior among four groups of youths: (1) the non-distressed (reference) group; (2) “Did not seek help” group; (3) “Seek informal help” group; and (4) “Seek formal help” group. Results The seeking of help and expression of distress online were found to be associated with a higher lifetime prevalence of suicidal ideation. The “Seek formal help” and “Did not seek help” groups had a similar risk profile, including a higher prevalence of suicidal ideation, non-suicidal self-injury, unsafe sex, and being bullied. The “Seek informal help” group was more likely to express distress online, which indicates that this population of youths may be accessible to professional identification. Approximately 20% of the distressed youths surveyed had not sought help despite expressing their distress online. Implication The study’s results indicate that helping professionals have opportunities to develop strategic engagement methods that make use of social media to help distressed youths.
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Affiliation(s)
- Melissa Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Tim M. H. Li
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Yik Wa Law
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong
- * E-mail:
| | - Paul W. C. Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong
| | - Michael Chau
- School of Business, Faculty of Business and Economics, The University of Hong Kong, Pokfulam, Hong Kong
| | - Cecilia Cheng
- Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong
| | - King Wa Fu
- Journalism and Media Studies Centre, The University of Hong Kong, Pokfulam, Hong Kong
| | - John Bacon-Shone
- Social Sciences Research Centre, The University of Hong Kong, Pokfulam, Hong Kong
| | - Qijin Emily Cheng
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong
| | - Paul S. F. Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong
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Tielman ML, Neerincx MA, Bidarra R, Kybartas B, Brinkman WP. A Therapy System for Post-Traumatic Stress Disorder Using a Virtual Agent and Virtual Storytelling to Reconstruct Traumatic Memories. J Med Syst 2017; 41:125. [PMID: 28699083 PMCID: PMC5506234 DOI: 10.1007/s10916-017-0771-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/29/2017] [Indexed: 11/29/2022]
Abstract
Although post-traumatic stress disorder (PTSD) is well treatable, many people do not get the desired treatment due to barriers to care (such as stigma and cost). This paper presents a system that bridges this gap by enabling patients to follow therapy at home. A therapist is only involved remotely, to monitor progress and serve as a safety net. With this system, patients can recollect their memories in a digital diary and recreate them in a 3D WorldBuilder. Throughout the therapy, a virtual agent is present to inform and guide patients through the sessions, employing an ontology-based question module for recollecting traumatic memories to further elicit a detailed memory recollection. In a usability study with former PTSD patients (n = 4), these questions were found useful for memory recollection. Moreover, the usability of the whole system was rated positively. This system has the potential to be a valuable addition to the spectrum of PTSD treatments, offering a novel type of home therapy assisted by a virtual agent.
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Affiliation(s)
| | - Mark A Neerincx
- Delft University of Technology, Delft, Netherlands
- TNO Human Factors, Soesterberg, Netherlands
| | | | - Ben Kybartas
- Delft University of Technology, Delft, Netherlands
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Torous J, Levin ME, Ahern DK, Oser ML. Cognitive Behavioral Mobile Applications: Clinical Studies, Marketplace Overview, and Research Agenda. COGNITIVE AND BEHAVIORAL PRACTICE 2017. [DOI: 10.1016/j.cbpra.2016.05.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Kobak KA, Wolitzky-Taylor K, Craske MG, Rose RD. Therapist Training on Cognitive Behavior Therapy for Anxiety Disorders Using Internet-Based Technologies. COGNITIVE THERAPY AND RESEARCH 2017; 41:252-265. [PMID: 28435174 PMCID: PMC5396958 DOI: 10.1007/s10608-016-9819-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study investigated a technology-enhanced training protocol to facilitate dissemination of therapist training on cognitive behavior therapy (CBT) for anxiety disorders. Seventy community clinicians received an online tutorial followed by live remote observation of clinical skills via videoconference. Impact of training on patient outcomes was also assessed. Training resulted in a significant increase in both trainee knowledge of CBT concepts and techniques and therapist competence in applying these skills. Patients treated by trainees following training had significant reductions in anxiety and depression. Ratings of user satisfaction were high. Results provide support for the use of these technologies for therapist training in CBT.
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Affiliation(s)
| | - Kate Wolitzky-Taylor
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | | | - Raphael D. Rose
- Department of Psychology, University of California, Los Angeles
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Witt KJ, Oliver M, McNichols C. Counseling via Avatar: Professional Practice in Virtual Worlds. INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING 2016. [DOI: 10.1007/s10447-016-9269-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Castelnuovo G, Pietrabissa G, Cattivelli R, Manzoni GM, Molinari E. Not Only Clinical Efficacy in Psychological Treatments: Clinical Psychology Must Promote Cost-Benefit, Cost-Effectiveness, and Cost-Utility Analysis. Front Psychol 2016; 7:563. [PMID: 27242562 PMCID: PMC4860399 DOI: 10.3389/fpsyg.2016.00563] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/05/2016] [Indexed: 01/17/2023] Open
Affiliation(s)
- Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilano, Italy
| | - Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilano, Italy
| | - Roberto Cattivelli
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilano, Italy
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCSVerbania, Italy; Faculty of Psychology, eCampus UniversityNovedrate, Italy
| | - Enrico Molinari
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCSVerbania, Italy; Department of Psychology, Catholic University of MilanMilano, Italy
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Rossi PJ, Gunduz A, Judy J, Wilson L, Machado A, Giordano JJ, Elias WJ, Rossi MA, Butson CL, Fox MD, McIntyre CC, Pouratian N, Swann NC, de Hemptinne C, Gross RE, Chizeck HJ, Tagliati M, Lozano AM, Goodman W, Langevin JP, Alterman RL, Akbar U, Gerhardt GA, Grill WM, Hallett M, Herrington T, Herron J, van Horne C, Kopell BH, Lang AE, Lungu C, Martinez-Ramirez D, Mogilner AY, Molina R, Opri E, Otto KJ, Oweiss KG, Pathak Y, Shukla A, Shute J, Sheth SA, Shih LC, Steinke GK, Tröster AI, Vanegas N, Zaghloul KA, Cendejas-Zaragoza L, Verhagen L, Foote KD, Okun MS. Proceedings of the Third Annual Deep Brain Stimulation Think Tank: A Review of Emerging Issues and Technologies. Front Neurosci 2016; 10:119. [PMID: 27092042 PMCID: PMC4821860 DOI: 10.3389/fnins.2016.00119] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/11/2016] [Indexed: 11/25/2022] Open
Abstract
The proceedings of the 3rd Annual Deep Brain Stimulation Think Tank summarize the most contemporary clinical, electrophysiological, imaging, and computational work on DBS for the treatment of neurological and neuropsychiatric disease. Significant innovations of the past year are emphasized. The Think Tank's contributors represent a unique multidisciplinary ensemble of expert neurologists, neurosurgeons, neuropsychologists, psychiatrists, scientists, engineers, and members of industry. Presentations and discussions covered a broad range of topics, including policy and advocacy considerations for the future of DBS, connectomic approaches to DBS targeting, developments in electrophysiology and related strides toward responsive DBS systems, and recent developments in sensor and device technologies.
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Affiliation(s)
- P Justin Rossi
- Department of Neuroscience, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Aysegul Gunduz
- Department of Neuroscience, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Jack Judy
- Department of Neuroscience, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Linda Wilson
- Formerly affiliated with the International Technology Roadmap for Semiconductors (ITRS) Washington, USA
| | - Andre Machado
- Neurological Institute Cleveland Clinic Cleveland, OH, USA
| | - James J Giordano
- Neuroethics Studies Program, Department of Neurology, Georgetown University Medical Center Washington, DC, USA
| | - W Jeff Elias
- Neurological Surgery and Neurology, Stereotactic and Functional Neurosurgery, Department of Neurosurgery, University of Virginia Health Science Center Charlottesville, VA, USA
| | - Marvin A Rossi
- Department of Neurology, Rush University Medical Center Chicago, IL, USA
| | - Christopher L Butson
- Scientific Computing and Imaging Institute, University of Utah Salt Lake City, UT, USA
| | - Michael D Fox
- Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA, USA
| | - Cameron C McIntyre
- Department of Biomedical Engineering, School of Medicine, Case Western Reserve University Cleveland, OH, USA
| | - Nader Pouratian
- Department of Neurosurgery, University of California, Los Angeles Los Angeles, CA, USA
| | - Nicole C Swann
- University of California, San Francisco San Francisco, CA, USA
| | | | | | - Howard J Chizeck
- Department of Electrical Engineering, University of Washington Seattle, WA, USA
| | - Michele Tagliati
- Movement Disorders Program, Department of Neurology, Cedars-Sinai Medical Center Los Angeles, CA, USA
| | - Andres M Lozano
- Department of Neurosurgery, University of Toronto Toronto, ON, Canada
| | - Wayne Goodman
- The Icahn School of Medicine at Mount Sinai New York, NY, USA
| | | | - Ron L Alterman
- Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA, USA
| | - Umer Akbar
- Department of Neurology, Alpert Medical School, Brown University Providence, RI, USA
| | | | - Warren M Grill
- Department of Biomedical Engineering, Duke University Durham, NC, USA
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke, National Institutes of Health Bethesda, MD, USA
| | - Todd Herrington
- Massachusetts General Hospital, Harvard Medical School Boston, MA, USA
| | - Jeffrey Herron
- Department of Electrical Engineering, University of Washington Seattle, WA, USA
| | | | - Brian H Kopell
- The Icahn School of Medicine at Mount Sinai New York, NY, USA
| | - Anthony E Lang
- Department of Neurosurgery, University of Toronto Toronto, ON, Canada
| | - Codrin Lungu
- National Institute of Neurological Disorders and Stroke, National Institutes of Health Bethesda, MD, USA
| | - Daniel Martinez-Ramirez
- Department of Neuroscience, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Alon Y Mogilner
- Department of Neurosurgery-Center for Neuromodulation, NYU Langone Medical Center New York, NY, USA
| | - Rene Molina
- Department of Neuroscience, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Enrico Opri
- Department of Neuroscience, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Kevin J Otto
- Department of Neuroscience, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Karim G Oweiss
- Department of Neuroscience, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Yagna Pathak
- Neurological Institute, Columbia University Medical Center New York, NY, USA
| | - Aparna Shukla
- Department of Neuroscience, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Jonathan Shute
- Department of Neuroscience, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Sameer A Sheth
- Neurological Institute, Columbia University Medical Center New York, NY, USA
| | - Ludy C Shih
- Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA, USA
| | | | - Alexander I Tröster
- Department of Clinical Neuropsychology, Barrow Neurological Institute Phoenix, AZ, USA
| | - Nora Vanegas
- Neurological Institute, Columbia University Medical Center New York, NY, USA
| | - Kareem A Zaghloul
- National Institute of Neurological Disorders and Stroke, National Institutes of Health Bethesda, MD, USA
| | | | - Leonard Verhagen
- Department of Neurology, Rush University Medical Center Chicago, IL, USA
| | - Kelly D Foote
- Department of Neuroscience, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Michael S Okun
- Department of Neuroscience, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
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Does Computerized Cognitive Behavioral Therapy Help People with Inflammatory Bowel Disease? A Randomized Controlled Trial. Inflamm Bowel Dis 2016; 22:171-81. [PMID: 26360545 DOI: 10.1097/mib.0000000000000567] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cognitive behavioral therapy may be useful for improving health-related quality of life (HRQOL) of at least some patients with inflammatory bowel disease (IBD), especially those with psychiatric comorbidities. However, cognitive behavioral therapy can be difficult to access. These difficulties can be overcome by computerized cognitive behavioral therapy (CCBT). This is a randomized controlled trial of a self-administered CCBT intervention for patients with IBD focused on improving HRQOL. It is hypothesized that CCBT completers will have an improved HRQOL relative to people not allocated to CCBT. METHODS Patients with IBD were randomly allocated to CCBT (n = 113) versus treatment as usual (n = 86). The IBD Questionnaire at 12 weeks after baseline was the primary outcome, while generic HRQOL, anxiety, depression, coping strategies, perceived stress, and IBD symptoms were secondary outcomes. Outcomes were also measured at 6 months after baseline. Predictors of dropout were also determined. RESULTS Twenty-nine CCBT participants (25.7%) completed the CCBT. The IBD Questionnaire was significantly increased at 12 weeks in CCBT completers compared with treatment-as-usual patients (F = 6.38, P = 0.01). Short Form-12 mental score (F = 5.00, P = 0.03) was also significantly better in CCBT compared with treatment-as-usual patients at 12 weeks. These outcomes were not maintained at 6 months. The predictors of dropout were baseline depression, biological use, lower IBD Questionnaire scores, and not having steroids. CONCLUSIONS Improvements at 12 weeks after baseline were not maintained at 6 months. Future research should aim to improve adherence rates. Moreover, CCBT may not work for patients with IBD with comorbid depression.
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Wilks CR, Zieve GG, Lessing HK. Are Trials of Computerized Therapy Generalizable? A Multidimensional Meta-analysis. Telemed J E Health 2015; 22:450-7. [PMID: 26461235 DOI: 10.1089/tmj.2015.0129] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Previous meta-analyses have established that computerized cognitive behavioral therapy (cCBT) is an effective, acceptable, and efficient method of delivering treatment for anxiety and depression. However, the potential generalizability of these conclusions to nonresearch settings has not yet been investigated. MATERIALS AND METHODS We conducted a multidimensional meta-analysis of randomized controlled trials of cCBT for anxiety and/or depressive disorders quantifying generalizability by examining the relationship between participant exclusion and treatment outcome. Thirty-six trials of cCBT were identified through systematic searches in six databases. The number of exclusion criteria and exclusion rate served as indices of participant exclusion. Outcome variables included between- and within-group effect sizes in addition to rates of clinically significant improvement. RESULTS Analyses were performed for all studies, depression studies (n = 11), and anxiety studies (n = 23). Pooling across all studies, we found a between-group effect size of 0.85 (95% confidence interval, 0.77-0.94). The mean number of exclusionary criteria was 12 (range, 2-24), and the mean exclusion rate was 0.49 (range, 0.08-0.92). Risk for suicide was the most common criterion for exclusion. Correlation analyses revealed a large relationship between number of exclusion criteria and proportion clinically changed in the treatment group for anxiety studies (r = 0.70). Results provide evidence for the limited effectiveness of cCBT for anxiety disorders in nonresearch samples. CONCLUSIONS As computerized therapy is developed to address barriers to dissemination, future trials should examine the effectiveness of cCBT for anxiety for patients with more complex clinical presentations.
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Affiliation(s)
- Chelsey R Wilks
- Behavioral Research and Therapy Clinics, Department of Clinical Psychology, University of Washington , Seattle, Washington
| | - Garret G Zieve
- Behavioral Research and Therapy Clinics, Department of Clinical Psychology, University of Washington , Seattle, Washington
| | - Hannah K Lessing
- Behavioral Research and Therapy Clinics, Department of Clinical Psychology, University of Washington , Seattle, Washington
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Khanna MS, Kendall PC. Bringing Technology to Training: Web-Based Therapist Training to Promote the Development of Competent Cognitive-Behavioral Therapists. COGNITIVE AND BEHAVIORAL PRACTICE 2015. [DOI: 10.1016/j.cbpra.2015.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Morris RR, Schueller SM, Picard RW. Efficacy of a Web-based, crowdsourced peer-to-peer cognitive reappraisal platform for depression: randomized controlled trial. J Med Internet Res 2015; 17:e72. [PMID: 25835472 PMCID: PMC4395771 DOI: 10.2196/jmir.4167] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/04/2015] [Accepted: 02/12/2015] [Indexed: 12/03/2022] Open
Abstract
Background Self-guided, Web-based interventions for depression show promising results but suffer from high attrition and low user engagement. Online peer support networks can be highly engaging, but they show mixed results and lack evidence-based content. Objective Our aim was to introduce and evaluate a novel Web-based, peer-to-peer cognitive reappraisal platform designed to promote evidence-based techniques, with the hypotheses that (1) repeated use of the platform increases reappraisal and reduces depression and (2) that the social, crowdsourced interactions enhance engagement. Methods Participants aged 18-35 were recruited online and were randomly assigned to the treatment group, “Panoply” (n=84), or an active control group, online expressive writing (n=82). Both are fully automated Web-based platforms. Participants were asked to use their assigned platform for a minimum of 25 minutes per week for 3 weeks. Both platforms involved posting descriptions of stressful thoughts and situations. Participants on the Panoply platform additionally received crowdsourced reappraisal support immediately after submitting a post (median response time=9 minutes). Panoply participants could also practice reappraising stressful situations submitted by other users. Online questionnaires administered at baseline and 3 weeks assessed depression symptoms, reappraisal, and perseverative thinking. Engagement was assessed through self-report measures, session data, and activity levels. Results The Panoply platform produced significant improvements from pre to post for depression (P=.001), reappraisal (P<.001), and perseverative thinking (P<.001). The expressive writing platform yielded significant pre to post improvements for depression (P=.02) and perseverative thinking (P<.001), but not reappraisal (P=.45). The two groups did not diverge significantly at post-test on measures of depression or perseverative thinking, though Panoply users had significantly higher reappraisal scores (P=.02) than expressive writing. We also found significant group by treatment interactions. Individuals with elevated depression symptoms showed greater comparative benefit from Panoply for depression (P=.02) and perseverative thinking (P=.008). Individuals with baseline reappraisal deficits showed greater comparative benefit from Panoply for depression (P=.002) and perseverative thinking (P=.002). Changes in reappraisal mediated the effects of Panoply, but not the expressive writing platform, for both outcomes of depression (ab=-1.04, SE 0.58, 95% CI -2.67 to -.12) and perseverative thinking (ab=-1.02, SE 0.61, 95% CI -2.88 to -.20). Dropout rates were similar for the two platforms; however, Panoply yielded significantly more usage activity (P<.001) and significantly greater user experience scores (P<.001). Conclusions Panoply engaged its users and was especially helpful for depressed individuals and for those who might ordinarily underutilize reappraisal techniques. Further investigation is needed to examine the long-term effects of such a platform and whether the benefits generalize to a more diverse population of users. Trial Registration ClinicalTrials.gov NCT02302248; https://clinicaltrials.gov/ct2/show/NCT02302248 (Archived by WebCite at http://www.webcitation.org/6Wtkj6CXU).
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Affiliation(s)
- Robert R Morris
- MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, United States.
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Fasciano KM, Souza PM, Braun I, Trevino K. An Innovative Website in the United States for Meeting the Emotional and Supportive Care Needs of Young Adults with Cancer. J Adolesc Young Adult Oncol 2015; 4:44-9. [DOI: 10.1089/jayao.2014.0035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Karen M. Fasciano
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Phoebe M. Souza
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ilana Braun
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Kelly Trevino
- Department of Medicine, Weill Cornell Medical College, New York, New York
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Computerised Cognitive Behavioural Therapy for Psychological Distress in Patients with Physical Illnesses: A Systematic Review. J Clin Psychol Med Settings 2015; 22:20-44. [DOI: 10.1007/s10880-015-9420-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Kazdin AE. Evidence-based psychotherapies II: changes in models of treatment and treatment delivery. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2014. [DOI: 10.1177/0081246314538733] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Decades of psychotherapy research have yielded a few hundred interventions with strong evidence on their behalf. In the prior companion article, methodological and substantive concerns were raised in relation to what we can say about evidence-based psychotherapies and their impact. Among the methodological concerns are the control conditions to which evidence-based psychotherapies are compared, selective reporting of measures, and the paucity of evidence that evidence-based psychotherapies have clinically significant impact. Among the substantive concerns are limited findings to help direct patients to treatments from which they are likely to profit and to understand the mechanisms responsible for therapeutic change. In this article, two shifts in evidence-based psychotherapy research are highlighted to convey novel and needed directions to augment the impact of treatment and the scale on which it can be delivered. First, transdiagnosis and transtreatment are discussed as a departure from traditional evidence-based psychotherapy research by emphasizing interventions that can be applied across multiple domains. Common biological, psychological, and environmental underpinnings of many disorders and select treatments showing reliable changes across multiple problems are altering evidence-based psychotherapy research. Second, novel models of treatment delivery have emerged from global health care, business, economics, and the media, and are well outside of mainstream mental health professions. Two models (task shifting and best-buy interventions) illustrate how different ways of delivering treatment are essential to reach large and diverse swaths of unserved individuals and have impact on the burden of mental illness.
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McCombie A, Gearry R, Mulder R. Preferences of inflammatory bowel disease patients for computerised versus face-to-face psychological interventions. J Crohns Colitis 2014; 8:536-42. [PMID: 24331922 DOI: 10.1016/j.crohns.2013.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 11/11/2013] [Accepted: 11/12/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Psychological interventions can be effective treatments for patients with medical illnesses such as inflammatory bowel disease (IBD). However, there are barriers to their widespread implementation such as lack of therapists, high costs, stigma, and poor accessibility in remote areas. Computerised psychological interventions can overcome these barriers. The aim of this study was to measure and compare the preferences of IBD patients for computerised versus face-to-face psychological interventions. METHODS One hundred and two IBD patients were given a support willingness questionnaire which measured their willingness and confidence to participate in computerised and face-to-face psychological interventions as well as the number of sessions they would be willing to participate in. RESULTS IBD patients were more likely to want to take part in a computer based than face-to-face intervention (45.5% versus 16.8%, p=0.045). Furthermore, IBD patients were willing to participate in more sessions of computerised than face-to-face intervention median (5 vs. 3.5, Z=3.93, p<0.001). Younger females had a significantly higher acceptability of a computerised intervention than older females (χ(2)(1)=6.77, p=0.009) but the same was not found for males. Duration of disease was not associated with willingness to participate in an intervention. CONCLUSIONS IBD patients appear more willing to participate in a computerised than face-to face psychological intervention. Future studies should attempt to study the effectiveness of computerised psychological interventions in IBD.
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Abstract
A psicoterapia pela internet é uma prática que, no Brasil, só é permitida aos psicólogos na forma de pesquisa. O objetivo do presente artigo foi realizar uma revisão dos estudos em psicoterapia pela internet, discorrendo sobre os recursos e os limites desse atendimento psicológico e suas implicações para a relação terapêutica e para a efetividade do tratamento. São apresentadas questões legais e éticas concernentes à prática. Os resultados apontaram similaridades entre a relação terapêutica online e a presencial, mostrando-se a psicoterapia pela internet efetiva nas mais distintas modalidades, embora a maioria dos estudos seja sobre intervenções cognitivo-comportamentais. As questões legais e éticas podem ser parcialmente solucionadas com diretrizes claras das organizações profissionais e com o treino de terapeutas na modalidade online. Concluímos que a psicoterapia pela internet, embora requeira maiores estudos, anuncia-se como uma prática viável e promissora.
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Whiteside U, Lungu A, Richards J, Simon GE, Clingan S, Siler J, Snyder L, Ludman E. Designing messaging to engage patients in an online suicide prevention intervention: survey results from patients with current suicidal ideation. J Med Internet Res 2014; 16:e42. [PMID: 24509475 PMCID: PMC3936268 DOI: 10.2196/jmir.3173] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 01/14/2014] [Accepted: 01/18/2014] [Indexed: 01/19/2023] Open
Abstract
Background Computerized, Internet-delivered interventions can be efficacious; however, uptake and maintaining sustained client engagement are still big challenges. We see the development of effective engagement strategies as the next frontier in online health interventions, an area where much creative research has begun. We also argue that for engagement strategies to accomplish their purpose with novel targeted populations, they need to be tailored to such populations (ie, content is designed with the target population in mind). User-centered design frameworks provide a theoretical foundation for increasing user engagement and uptake by including users in development. However, deciding how to implement this approach to enage users in mental health intervention development is challenging. Objective The aim of this study was to get user input and feedback on acceptability of messaging content intended to engage suicidal individuals. Methods In March 2013, clinic intake staff distributed flyers announcing the study, “Your Feedback Counts” to potential participants (individuals waiting to be seen for a mental health appointment) together with the Patient Health Questionnaire. The flyer explained that a score of two or three (“more than half the days” or “nearly every day” respectively) on the suicide ideation question made them eligible to provide feedback on components of a suicide prevention intervention under development. The patient could access an anonymous online survey by following a link. After providing consent online, participants completed the anonymous survey. Results Thirty-four individuals provided data on past demographic information. Participants reported that they would be most drawn to an intervention where they knew that they were cared about, that was personalized, that others like them had found it helpful, and that included examples with real people. Participants preferred email invitations with subject lines expressing concern and availability of extra resources. Participants also provided feedback about a media prototype including a brand design and advertisement video for introducing the intervention. Conclusions This paper provides one model (including development of an engagement survey, audience for an engagement survey, methods for presenting results of an engagement survey) for including target users in the development of uptake strategies for online mental health interventions.
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Look on the Bright Side: A Model of Cognitive Change in Virtual Agents. INTELLIGENT VIRTUAL AGENTS 2014. [DOI: 10.1007/978-3-319-09767-1_37] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Cavanagh K, Millings A. (Inter)personal Computing: The Role of the Therapeutic Relationship in E-mental Health. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2013. [DOI: 10.1007/s10879-013-9242-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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38
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Overholser JC. Technology-Assisted Psychotherapy (TAP): Adapting Computerized Treatments into Traditional Psychotherapy for Depression. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2013. [DOI: 10.1007/s10879-013-9241-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Smith DJ, Young AH. Practical considerations for the development of a psychoeducation programme: lessons from the Cardiff experience. Acta Psychiatr Scand 2013:25-8. [PMID: 23581790 DOI: 10.1111/acps.12121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- D. J. Smith
- Institute of Health and Wellbeing; University of Glasgow; Glasgow; UK
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Hedman E, Andersson E, Lindefors N, Andersson G, Rück C, Ljótsson B. Cost-effectiveness and long-term effectiveness of internet-based cognitive behaviour therapy for severe health anxiety. Psychol Med 2013; 43:363-374. [PMID: 22608115 DOI: 10.1017/s0033291712001079] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Severe health anxiety is a common condition associated with functional disability, making it a costly disorder from a societal perspective. Internet-based cognitive behaviour therapy (ICBT) is a promising treatment but no previous study has assessed the cost-effectiveness or long-term outcome of ICBT for severe health anxiety. The aim of this study was to investigate the cost-effectiveness and 1-year treatment effects of ICBT for severe health anxiety. METHOD Cost-effectiveness and 1-year follow-up data were obtained from a randomized controlled trial (RCT) comparing ICBT (n = 40) to an attention control condition (CC, n = 41). The primary outcome measure was the Health Anxiety Inventory (HAI). A societal perspective was taken and incremental cost-effectiveness ratios (ICERs) were calculated using bootstrap sampling. RESULTS The main ICER was -£1244, indicating the societal economic gain for each additional case of remission when administering ICBT. Baseline to 1-year follow-up effect sizes on the primary outcome measure were large (d = 1.71-1.95). CONCLUSIONS ICBT is a cost-effective treatment for severe health anxiety that can produce substantial and enduring effects.
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Affiliation(s)
- E Hedman
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
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Cartreine JA, Locke SE, Buckey JC, Sandoval L, Hegel MT. Electronic problem-solving treatment: description and pilot study of an interactive media treatment for depression. JMIR Res Protoc 2012; 1:e11. [PMID: 23611902 PMCID: PMC3626146 DOI: 10.2196/resprot.1925] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 04/10/2012] [Accepted: 05/02/2012] [Indexed: 11/13/2022] Open
Abstract
Background Computer-automated depression interventions rely heavily on users reading text to receive the intervention. However, text-delivered interventions place a burden on persons with depression and convey only verbal content. Objective The primary aim of this project was to develop a computer-automated treatment for depression that is delivered via interactive media technology. By using branching video and audio, the program simulates the experience of being in therapy with a master clinician who provides six sessions of problem-solving therapy. A secondary objective was to conduct a pilot study of the program’s usability, acceptability, and credibility, and to obtain an initial estimate of its efficacy. Methods The program was produced in a professional multimedia production facility and incorporates video, audio, graphics, animation, and text. Failure analyses of patient data are conducted across sessions and across problems to identify ways to help the user improve his or her problem solving. A pilot study was conducted with persons who had minor depression. An experimental group (n = 7) used the program while a waitlist control group (n = 7) was provided with no treatment for 6 weeks. Results All of the experimental group participants completed the trial, whereas 1 from the control was lost to follow-up. Experimental group participants rated the program high on usability, acceptability, and credibility. The study was not powered to detect clinical improvement, although these pilot data are encouraging. Conclusions Although the study was not powered to detect treatment effects, participants did find the program highly usable, acceptable, and credible. This suggests that the highly interactive and immersive nature of the program is beneficial. Further clinical trials are warranted. Trial Registration ClinicalTrials.gov NCT00906581; http://clinicaltrials.gov/ct2/show/NCT00906581 (Archived by WebCite at http://www.webcitation.org/6A5Ni5HUp)
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Affiliation(s)
- James Albert Cartreine
- Program on Behavioral Informatics and eHealth, Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States.
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Baker TB, Hawkins R, Pingree S, Roberts LJ, McDowell HE, Shaw BR, Serlin R, Dillenburg L, Swoboda CM, Han JY, Stewart JA, Carmack-Taylor CL, Salner A, Schlam TR, McTavish F, Gustafson DH. Optimizing eHealth breast cancer interventions: which types of eHealth services are effective? Transl Behav Med 2011; 1:134-145. [PMID: 21709810 PMCID: PMC3119549 DOI: 10.1007/s13142-010-0004-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Little is known about the effective elements of Interactive Cancer Communication Systems (ICCSs). A randomized trial explored which types of services of a multifaceted ICCS benefited patients and the nature of the benefit. Women with breast cancer (N=450) were randomized to different types of ICCS services or to a control condition that provided internet access. The Comprehensive Health Enhancement Support System (CHESS), served as the ICCS. ICCS services providing information and support, but not coaching such as cognitive behavior therapy, produced significant benefits in health information competence and emotional processing. Provision of Information and Support ICCS services significantly benefited women with breast cancer. More complex and interactive services designed to train the user had negligible effects.
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Affiliation(s)
- Timothy B Baker
- />Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, 1930 Monroe St., Suite 200, Madison, 53711 WI USA
- />UW-Center for Tobacco Research and Intervention, 1930 Monroe Street, Suite 200, Madison, WI 53711 USA
| | - Robert Hawkins
- />School of Journalism and Mass Communication, University of Wisconsin, Madison, WI USA
| | - Suzanne Pingree
- />Department of Life Sciences Communication, University of Wisconsin, Madison, WI USA
| | - Linda J Roberts
- />School of Human Ecology, University of Wisconsin, Madison, WI USA
| | - Helene E McDowell
- />Department of Industrial Engineering, University of Wisconsin, Madison, WI USA
| | - Bret R Shaw
- />Department of Life Sciences Communication, University of Wisconsin, Madison, WI USA
| | - Ron Serlin
- />Department of Educational Psychology, University of Wisconsin, Madison, WI USA
| | - Lisa Dillenburg
- />Department of Industrial Engineering, University of Wisconsin, Madison, WI USA
| | | | | | | | | | - Andrew Salner
- />Department of Radiation Oncology, Hartford Hospital, Hartford, CT USA
| | - Tanya R Schlam
- />Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, 1930 Monroe St., Suite 200, Madison, 53711 WI USA
| | - Fiona McTavish
- />Department of Industrial Engineering, University of Wisconsin, Madison, WI USA
| | - David H Gustafson
- />Department of Industrial Engineering, University of Wisconsin, Madison, WI USA
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Barnes E, Simpson S, Griffiths E, Hood K, Craddock N, Smith DJ. Developing an online psychoeducation package for bipolar disorder. J Ment Health 2011; 20:21-31. [DOI: 10.3109/09638237.2010.525565] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kendall PC, Khanna MS, Edson A, Cummings C, Harris MS. Computers and psychosocial treatment for child anxiety: recent advances and ongoing efforts. Depress Anxiety 2011; 28:58-66. [PMID: 21049529 DOI: 10.1002/da.20757] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Building on the empirical data supporting the efficacy of cognitive-behavioral therapy (CBT) for child anxiety, researchers are working on the development and evaluation of cost-effective and transportable CBT approaches. Related to this, a widely endorsed goal is to disseminate evidence-based treatments from research settings to community settings. Computer-assisted treatments have emerged as a means to provide cost-effective and efficient service to an increased number of anxious youth for whom a CBT treatment would be otherwise unavailable. We offer a rationale for the development and evaluation of computer-assisted psychosocial treatments for anxiety in youth, offer illustrative advances made in this area, and describe our efforts in using computers to enhance dissemination of CBT for child anxiety. Specifically, our illustrations include a description of (a) Camp-Cope-A-Lot (CCAL), a computer-assisted CBT for the treatment of anxiety disorders in youth ages 7-12, and (b) CBT4CBT: Computer-based training in CBT for anxious youth. Findings from evaluations of these programs are summarized, and further advances are proposed and discussed.
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Affiliation(s)
- Philip C Kendall
- Child and Adolescent Anxiety Disorders Clinic, Department of Psychology at Temple University, 1701 N. 12th Street, Philadelphia, PA 19122, USA.
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Farzanfar R, Locke SE, Heeren TC, Stevens A, Vachon L, Nguyen MKT, Friedman RH. Workplace Telecommunications Technology to Identify Mental Health Disorders and Facilitate Self-Help or Professional Referrals. Am J Health Promot 2011; 25:207-16. [DOI: 10.4278/ajhp.100118-quan-14] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. Test the feasibility and impact of an automated workplace mental health assessment and intervention. Design. Efficacy was evaluated in a randomized control trial comparing employees who received screening and intervention with those who received only screening. Setting. Workplace. Subjects. 463 volunteers from Boston Medical Center, Boston University, and EMC and other employed adults, among whom 164 were randomized to the intervention (N = 87) and control (N = 77) groups. Intervention. The system administers a panel of telephonic assessment instruments followed by tailored information, education, and referrals. Measures. The Work Limitation Questionnaire, the Medical Outcomes Questionnaire Short Form-12, the Patient Health Questionnaire-9, question 10 from the Patient Health Questionnaire to measure functional impairment, and the Perceived Stress Scale-4 and questions written by study psychiatrists to measure emotional distress and social support respectively. The WHO-Five Well-being Index was administered to measure overall well-being. Analysis. Independent sample t-tests and χ2 tests as well as mean change were used to compare the data. Results. No significant differences on 16 of the 20 comparisons at 3- and 6-month time points. The intervention group showed a significant improvement in depression (p ≤ .05) at 3 months and on two Work Limitation Questionnaire subscales, the Mental-Interpersonal Scale (p ≤ .05) and the Time and Scheduling Scale (p ≤ .05), at 3 and 6 months respectively with a suggestive improvement in mental health at 6 months (p ≤ .10). Conclusions. This is a potentially fruitful area for research with important implications for workplace behavioral interventions. (Am J Health Promot 2011;25[3]:207–216.)
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Affiliation(s)
- Ramesh Farzanfar
- Ramesh Farzanfar, PhD, is an Assistant Professor of Medicine, Medical Information Systems Unit, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts. Steven E. Locke, MD, is a Consulting Psychiatrist, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts. Timothy C. Heeren, PhD, is a Professor of Public Health, Boston University School of Public Health, Boston, Massachusetts. Allison Stevens, MA, is a Research Technician, and Mai Khoa Thi Nguyen, BA
| | - Steven E. Locke
- Ramesh Farzanfar, PhD, is an Assistant Professor of Medicine, Medical Information Systems Unit, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts. Steven E. Locke, MD, is a Consulting Psychiatrist, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts. Timothy C. Heeren, PhD, is a Professor of Public Health, Boston University School of Public Health, Boston, Massachusetts. Allison Stevens, MA, is a Research Technician, and Mai Khoa Thi Nguyen, BA
| | - Timothy C. Heeren
- Ramesh Farzanfar, PhD, is an Assistant Professor of Medicine, Medical Information Systems Unit, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts. Steven E. Locke, MD, is a Consulting Psychiatrist, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts. Timothy C. Heeren, PhD, is a Professor of Public Health, Boston University School of Public Health, Boston, Massachusetts. Allison Stevens, MA, is a Research Technician, and Mai Khoa Thi Nguyen, BA
| | - Allison Stevens
- Ramesh Farzanfar, PhD, is an Assistant Professor of Medicine, Medical Information Systems Unit, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts. Steven E. Locke, MD, is a Consulting Psychiatrist, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts. Timothy C. Heeren, PhD, is a Professor of Public Health, Boston University School of Public Health, Boston, Massachusetts. Allison Stevens, MA, is a Research Technician, and Mai Khoa Thi Nguyen, BA
| | - Louis Vachon
- Ramesh Farzanfar, PhD, is an Assistant Professor of Medicine, Medical Information Systems Unit, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts. Steven E. Locke, MD, is a Consulting Psychiatrist, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts. Timothy C. Heeren, PhD, is a Professor of Public Health, Boston University School of Public Health, Boston, Massachusetts. Allison Stevens, MA, is a Research Technician, and Mai Khoa Thi Nguyen, BA
| | - Mai Khoa Thi Nguyen
- Ramesh Farzanfar, PhD, is an Assistant Professor of Medicine, Medical Information Systems Unit, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts. Steven E. Locke, MD, is a Consulting Psychiatrist, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts. Timothy C. Heeren, PhD, is a Professor of Public Health, Boston University School of Public Health, Boston, Massachusetts. Allison Stevens, MA, is a Research Technician, and Mai Khoa Thi Nguyen, BA
| | - Robert H. Friedman
- Ramesh Farzanfar, PhD, is an Assistant Professor of Medicine, Medical Information Systems Unit, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts. Steven E. Locke, MD, is a Consulting Psychiatrist, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts. Timothy C. Heeren, PhD, is a Professor of Public Health, Boston University School of Public Health, Boston, Massachusetts. Allison Stevens, MA, is a Research Technician, and Mai Khoa Thi Nguyen, BA
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