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van Genugten CR, Schuurmans J, Hoogendoorn AW, Araya R, Andersson G, Baños R, Botella C, Cerga Pashoja A, Cieslak R, Ebert DD, García-Palacios A, Hazo JB, Herrero R, Holtzmann J, Kemmeren L, Kleiboer A, Krieger T, Smoktunowicz E, Titzler I, Topooco N, Urech A, Smit JH, Riper H. Examining the Theoretical Framework of Behavioral Activation for Major Depressive Disorder: Smartphone-Based Ecological Momentary Assessment Study. JMIR Ment Health 2021; 8:e32007. [PMID: 34874888 PMCID: PMC8727050 DOI: 10.2196/32007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/06/2021] [Accepted: 10/28/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Behavioral activation (BA), either as a stand-alone treatment or as part of cognitive behavioral therapy, has been shown to be effective for treating depression. The theoretical underpinnings of BA derive from Lewinsohn et al's theory of depression. The central premise of BA is that having patients engage in more pleasant activities leads to them experiencing more pleasure and elevates their mood, which, in turn, leads to further (behavioral) activation. However, there is a dearth of empirical evidence about the theoretical framework of BA. OBJECTIVE This study aims to examine the assumed (temporal) associations of the 3 constructs in the theoretical framework of BA. METHODS Data were collected as part of the "European Comparative Effectiveness Research on Internet-based Depression Treatment versus treatment-as-usual" trial among patients who were randomly assigned to receive blended cognitive behavioral therapy (bCBT). As part of bCBT, patients completed weekly assessments of their level of engagement in pleasant activities, the pleasure they experienced as a result of these activities, and their mood over the course of the treatment using a smartphone-based ecological momentary assessment (EMA) application. Longitudinal cross-lagged and cross-sectional associations of 240 patients were examined using random intercept cross-lagged panel models. RESULTS The analyses did not reveal any statistically significant cross-lagged coefficients (all P>.05). Statistically significant cross-sectional positive associations between activities, pleasure, and mood levels were identified. Moreover, the levels of engagement in activities, pleasure, and mood slightly increased over the duration of the treatment. In addition, mood seemed to carry over, over time, while both levels of engagement in activities and pleasurable experiences did not. CONCLUSIONS The results were partially in accordance with the theoretical framework of BA, insofar as the analyses revealed cross-sectional relationships between levels of engagement in activities, pleasurable experiences deriving from these activities, and enhanced mood. However, given that no statistically significant temporal relationships were revealed, no conclusions could be drawn about potential causality. A shorter measurement interval (eg, daily rather than weekly EMA reports) might be more attuned to detecting potential underlying temporal pathways. Future research should use an EMA methodology to further investigate temporal associations, based on theory and how treatments are presented to patients. TRIAL REGISTRATION ClinicalTrials.gov, NCT02542891, https://clinicaltrials.gov/ct2/show/NCT02542891; German Clinical Trials Register, DRKS00006866, https://tinyurl.com/ybja3xz7; Netherlands Trials Register, NTR4962, https://www.trialregister.nl/trial/4838; ClinicalTrials.Gov, NCT02389660, https://clinicaltrials.gov/ct2/show/NCT02389660; ClinicalTrials.gov, NCT02361684, https://clinicaltrials.gov/ct2/show/NCT02361684; ClinicalTrials.gov, NCT02449447, https://clinicaltrials.gov/ct2/show/NCT02449447; ClinicalTrials.gov, NCT02410616, https://clinicaltrials.gov/ct2/show/NCT02410616; ISRCTN registry, ISRCTN12388725, https://www.isrctn.com/ISRCTN12388725.
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Affiliation(s)
- Claire Rosalie van Genugten
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam Public Health Institute, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, Netherlands.,Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Josien Schuurmans
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam Public Health Institute, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, Netherlands
| | - Adriaan W Hoogendoorn
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam Public Health Institute, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, Netherlands
| | - Ricardo Araya
- Institute of Psychiatry Psychology and Neurosciences, King's College London, London, United Kingdom
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Rosa Baños
- Polibienestar Research Institute, University of Valencia, Valencia, Spain.,Institute of Health Carlos III, CIBERObn CB06 03/0052, Madrid, Spain.,Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Cristina Botella
- Institute of Health Carlos III, CIBERObn CB06 03/0052, Madrid, Spain.,Department of Basic and Clinical Psychology and Psychobiology, Faculty of Health Sciences, Jaume I University, Castellon de la Plana, Spain
| | - Arlinda Cerga Pashoja
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Roman Cieslak
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland.,Lyda Hill Institute for Human Resilience, Colorado Springs, Colorado Springs, CO, United States
| | - David Daniel Ebert
- Department for Sport and Health Sciences, Technical University Munich, Munich, Germany
| | - Azucena García-Palacios
- Institute of Health Carlos III, CIBERObn CB06 03/0052, Madrid, Spain.,Department of Basic and Clinical Psychology and Psychobiology, Faculty of Health Sciences, Jaume I University, Castellon de la Plana, Spain
| | - Jean-Baptiste Hazo
- Eceve, Unit 1123, Inserm, University of Paris, Paris, France.,Health Economics Research Unit, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Rocío Herrero
- Polibienestar Research Institute, University of Valencia, Valencia, Spain.,Institute of Health Carlos III, CIBERObn CB06 03/0052, Madrid, Spain
| | - Jérôme Holtzmann
- Mood Disorders and Emotional Pathologies Unit, Pôle de Psychiatrie, Neurologie et Rééducation Neurologique, University Hospital Grenoble Alpes, Grenoble, France
| | - Lise Kemmeren
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam Public Health Institute, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, Netherlands
| | - Annet Kleiboer
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Tobias Krieger
- Department of Clinical Psychology, University of Bern, Bern, Switzerland
| | - Ewelina Smoktunowicz
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Ingrid Titzler
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Naira Topooco
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Centre for m2health, Palo Alto University, Palo Alto, CA, United States
| | - Antoine Urech
- Department of Clinical Psychology, University of Bern, Bern, Switzerland
| | - Johannes H Smit
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam Public Health Institute, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, Netherlands
| | - Heleen Riper
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam Public Health Institute, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, Netherlands.,Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands.,Institute of Telepsychiatry, University of Southern Denmark, Odense, Denmark.,Faculty of Medicine, University of Turku, Turku, Finland
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2
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Kerber A, Schaeuffele C, Krieger T, Urech A, Riper H, Berger T, Boettcher J, Knaevelsrud C. Differential Effects of Psychological Interventions in Online and Face-to-Face Settings on DSM-5 and ICD-11 Maladaptive Trait Domains: An Exploratory Pilot Study. Front Psychiatry 2021; 12:648367. [PMID: 34194347 PMCID: PMC8236509 DOI: 10.3389/fpsyt.2021.648367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/04/2021] [Indexed: 01/25/2023] Open
Abstract
While mental health treatments have proven to be effective for a range of mental health problems, there is comparably little research on its effects on personality disorders or difficulty (PD). New dimensional conceptualizations of PD such as the ICD-11 PD model enable the cost- and time-effective dimensional assessment of severity and style of PD. Furthermore, they constitute a promising tool to investigate PD, not only as a treatment endpoint but also as a predictive or influencing factor for mental health treatments. In this study, we investigated the effects in two different mental health treatment settings [online (N = 38); face-to-face and blended [FTF/blended] (N = 35)] on the reduction of maladaptive personality traits as well as the interaction between maladaptive personality patterns and the response on primary endpoints (i.e., mental distress). Results indicate that both treatment settings have comparable within-group effects on the reduction of distress symptoms, while the treatment in the FTF/blended setting seems to have a stronger impact on the reduction of maladaptive traits. Further, reduction of maladaptive trait expressions was a reliable predictor of treatment response in the FTF/blended setting while explaining less variance in the online setting. Beyond the promising findings on the utility of maladaptive trait change as an outcome measure, we discuss possible applications as an information source for treatment decisions.
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Affiliation(s)
- André Kerber
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Carmen Schaeuffele
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Tobias Krieger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Antoine Urech
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Neurology, Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
- Department of Research and Innovation, GGZ in Geest/Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Johanna Boettcher
- Department of Research and Innovation, GGZ in Geest/Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
- Psychologische Hochschule Berlin, Berlin, Germany
| | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
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3
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Knottnerus IHA, Pyatchenkov S, Onishchenko O, Urech A, Schreck F, Siviloglou GA. Microscope objective for imaging atomic strontium with 0.63 micrometer resolution. Opt Express 2020; 28:11106-11116. [PMID: 32403628 DOI: 10.1364/oe.388809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/17/2020] [Indexed: 06/11/2023]
Abstract
Imaging and manipulating individual atoms with submicrometer separation can be instrumental for quantum simulation of condensed matter Hamiltonians and quantum computation with neutral atoms. Here we present an open-source design of a microscope objective for atomic strontium, consisting solely of off-the-shelf lenses, that is diffraction-limited for 461 nm light. A prototype built with a simple stacking design is measured to have a resolution of 0.63(4) µm, which is in agreement with the predicted value. This performance, together with the near diffraction-limited performance for 532 nm light, makes this design useful for both quantum gas microscopes and optical tweezer experiments with strontium. Our microscope can easily be adapted to experiments with other atomic species such as erbium, ytterbium, and dysprosium, as with rubidium Rydberg atoms.
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Friedl N, Krieger T, Chevreul K, Hazo JB, Holtzmann J, Hoogendoorn M, Kleiboer A, Mathiasen K, Urech A, Riper H, Berger T. Using the Personalized Advantage Index for Individual Treatment Allocation to Blended Treatment or Treatment as Usual for Depression in Secondary Care. J Clin Med 2020; 9:jcm9020490. [PMID: 32054084 PMCID: PMC7073663 DOI: 10.3390/jcm9020490] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 01/02/2023] Open
Abstract
A variety of effective psychotherapies for depression are available, but patients who suffer from depression vary in their treatment response. Combining face-to-face therapies with internet-based elements in the sense of blended treatment is a new approach to treatment for depression. The goal of this study was to answer the following research questions: (1) What are the most important predictors determining optimal treatment allocation to treatment as usual or blended treatment? and (2) Would model-determined treatment allocation using this predictive information and the personalized advantage index (PAI)-approach result in better treatment outcomes? Bayesian model averaging (BMA) was applied to the data of a randomized controlled trial (RCT) comparing the efficacy of treatment as usual and blended treatment in depressive outpatients. Pre-treatment symptomatology and treatment expectancy predicted outcomes irrespective of treatment condition, whereas different prescriptive predictors were found. A PAI of 2.33 PHQ-9 points was found, meaning that patients who would have received the treatment that is optimal for them would have had a post-treatment PHQ-9 score that is two points lower than if they had received the treatment that is suboptimal for them. For 29% of the sample, the PAI was five or greater, which means that a substantial difference between the two treatments was predicted. The use of the PAI approach for clinical practice must be further confirmed in prospective research; the current study supports the identification of specific interventions favorable for specific patients.
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Affiliation(s)
- Nadine Friedl
- Department of Clinical Psychology, University of Bern, 3012 Bern, Switzerland
- Correspondence:
| | - Tobias Krieger
- Department of Clinical Psychology, University of Bern, 3012 Bern, Switzerland
| | - Karine Chevreul
- URC Eco Ile-de-France (AP-HP), Hotel Dieu, 1, Place du Parvis Notre Dame, 75004 Paris, France
| | - Jean Baptiste Hazo
- Eceve, Unit 1123, Inserm, University of Paris, Health Economics Research Unit, Assistance Publique-Hôpitaux de Paris, 75004 Paris, France
| | - Jérôme Holtzmann
- University Hospital Grenoble Alpes, Mood Disorders and Emotional Pathologies Unit, Pôle de Psychiatrie, Neurologie et Rééducation Neurologique, 38043 Grenoble, France
| | - Mark Hoogendoorn
- Department of Computer Science, VU University Amsterdam Faculty of Sciences, De Boelelaan 1081m, 1081 HV Amsterdam, The Netherlands
| | - Annet Kleiboer
- Section Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam and EMGO+ Institute for Health Care and Research, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Kim Mathiasen
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, 5230 Odense M, Denmark
- Center of Telepsychiatry, University of Southern Denmark, 5000 Odense, Denmark
| | - Antoine Urech
- INSELSPITAL, University Hospital Bern, University Clinic for Neurology, University Acute-Neurorehabilitation Center, 3010 Bern, Switzerland
| | - Heleen Riper
- Department of Psychiatry and the Amsterdam Public Health Research Institute, GGZ inGeest/Amsterdam UMC, Vrije Universiteit, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
- Department of Clinical, Neuro-and Developmental Psychology and the Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Thomas Berger
- Department of Clinical Psychology, University of Bern, 3012 Bern, Switzerland
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Krieger T, Reber F, von Glutz B, Urech A, Moser CT, Schulz A, Berger T. An Internet-Based Compassion-Focused Intervention for Increased Self-Criticism: A Randomized Controlled Trial. Behav Ther 2019; 50:430-445. [PMID: 30824257 DOI: 10.1016/j.beth.2018.08.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 08/02/2018] [Accepted: 08/08/2018] [Indexed: 01/07/2023]
Abstract
Increased levels of self-criticism and a lack of self-compassion have been associated with the development and maintenance of a range of psychological disorders. In the current study, we tested the efficacy of an online version of a compassion-focused intervention, mindfulness-based compassionate living (MBCL), with guidance on request. A total of 122 self-referred participants with increased levels of self-criticism were randomly assigned to care as usual (CAU) or the intervention group (CAU + online intervention). Primary endpoints were self-reported depressive, anxiety and distress symptoms (DASS-21) and self-compassion (SCS) at 8 weeks. Secondary endpoints were self-criticism, mindfulness, satisfaction with life, fear of self-compassion, self-esteem, and existential shame. At posttreatment, the intervention group showed significant changes with medium to large effect sizes compared to the control group regarding primary outcomes (Cohen's d: 0.79 [DASS] and -1.21 [SCS]) and secondary outcomes (Cohen's ds: between 0.40 and 0.94 in favor of the intervention group). The effects in the intervention group were maintained at 6-months postrandomization. Adherence measures (number of completed modules, self-reported number of completed exercises per week) predicted postintervention scores for self-compassion but not for depressive, anxiety, and distress symptoms in the intervention group. The current study shows the efficacy of an online intervention with a transdiagnostic intervention target on a broad range of measures, including depressive and anxiety symptoms and self-compassion.
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Stolz T, Schulz A, Krieger T, Vincent A, Urech A, Moser C, Westermann S, Berger T. A mobile app for social anxiety disorder: A three-arm randomized controlled trial comparing mobile and PC-based guided self-help interventions. J Consult Clin Psychol 2018; 86:493-504. [DOI: 10.1037/ccp0000301] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Urech A, Krieger T, Möseneder L, Biaggi A, Vincent A, Poppe C, Meyer B, Riper H, Berger T. A patient post hoc perspective on advantages and disadvantages of blended cognitive behaviour therapy for depression: A qualitative content analysis. Psychother Res 2018; 29:986-998. [DOI: 10.1080/10503307.2018.1430910] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Antoine Urech
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Tobias Krieger
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Laura Möseneder
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Adriana Biaggi
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Alessia Vincent
- Department of Psychology, University of Bern, Bern, Switzerland
| | | | - Björn Meyer
- Department of Psychology, City University, London, UK
- Research Department, Hamburg, Germany
| | - Heleen Riper
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit (VU), Amsterdam, Netherlands
| | - Thomas Berger
- Department of Psychology, University of Bern, Bern, Switzerland
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Topooco N, Riper H, Araya R, Berking M, Brunn M, Chevreul K, Cieslak R, Ebert DD, Etchmendy E, Herrero R, Kleiboer A, Krieger T, García-Palacios A, Cerga-Pashoja A, Smoktunowicz E, Urech A, Vis C, Andersson G. Attitudes towards digital treatment for depression: A European stakeholder survey. Internet Interv 2017; 8:1-9. [PMID: 30135823 PMCID: PMC6096292 DOI: 10.1016/j.invent.2017.01.001] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The integration of digital treatments into national mental health services is on the agenda in the European Union. The E-COMPARED consortium conducted a survey aimed at exploring stakeholders' knowledge, acceptance and expectations of digital treatments for depression, and at identifying factors that might influence their opinions when considering the implementation of these approaches. METHOD An online survey was conducted in eight European countries: France, Germany, Netherlands, Poland, Spain, Sweden, Switzerland and The United Kingdom. Organisations representing government bodies, care providers, service-users, funding/insurance bodies, technical developers and researchers were invited to participate in the survey. The participating countries and organisations reflect the diversity in health care infrastructures and e-health implementation across Europe. RESULTS A total of 764 organisations were invited to the survey during the period March-June 2014, with 175 of these organisations participating in our survey. The participating stakeholders reported moderate knowledge of digital treatments and considered cost-effectiveness to be the primary incentive for integration into care services. Low feasibility of delivery within existing care services was considered to be a primary barrier. Digital treatments were regarded more suitable for milder forms of depression. Stakeholders showed greater acceptability towards blended treatment (the integration of face-to-face and internet sessions within the same treatment protocol) compared to standalone internet treatments. Organisations in countries with developed e-health solutions reported greater knowledge and acceptability of digital treatments. CONCLUSION Mental health stakeholders in Europe are aware of the potential benefits of digital interventions. However, there are variations between countries and stakeholders in terms of level of knowledge about such interventions and their feasibility within routine care services. The high acceptance of blended treatments is an interesting finding that indicates a gradual integration of technology into clinical practice may fit the attitudes and needs of stakeholders. The potential of the blended treatment approach, in terms of enhancing acceptance of digital treatment while retaining the benefit of cost-effectiveness in delivery, should be further explored. FUNDING The E-COMPARED project has received funding from the European Union Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 603098.
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Affiliation(s)
- Naira Topooco
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Corresponding author at: Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden.
| | - Heleen Riper
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, The Netherlands
| | - Ricardo Araya
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | | | | | - Roman Cieslak
- Department of Psychology, SWPS University of Social Sciences and Humanities, Warszawa, Poland
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Ernestina Etchmendy
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
| | - Rocío Herrero
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Universitat Jaume I, Castellón, Spain
| | - Annet Kleiboer
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, The Netherlands
| | - Tobias Krieger
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Azucena García-Palacios
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Universitat Jaume I, Castellón, Spain
| | - Arlinda Cerga-Pashoja
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ewelina Smoktunowicz
- Department of Psychology, SWPS University of Social Sciences and Humanities, Warszawa, Poland
| | - Antoine Urech
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Christiaan Vis
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, The Netherlands
- EMGO + Institute, VU Medical Centre Amsterdam, VU Amsterdam, The Netherlands
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden
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Berger T, Urech A, Krieger T, Stolz T, Schulz A, Vincent A, Moser CT, Moritz S, Meyer B. Effects of a transdiagnostic unguided Internet intervention ('velibra') for anxiety disorders in primary care: results of a randomized controlled trial. Psychol Med 2017; 47:67-80. [PMID: 27655039 DOI: 10.1017/s0033291716002270] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Internet-based cognitive-behavioural treatment (ICBT) for anxiety disorders has shown some promise, but no study has yet examined unguided ICBT in primary care. This randomized controlled trial (RCT) investigated whether a transdiagnostic, unguided ICBT programme for anxiety disorders is effective in primary care settings, after a face-to-face consultation with a physician (MD). We hypothesized that care as usual (CAU) plus unguided ICBT would be superior to CAU in reducing anxiety and related symptoms among patients with social anxiety disorder (SAD), panic disorder with or without agoraphobia (PDA) and/or generalized anxiety disorder (GAD). METHOD Adults (n = 139) with at least one of these anxiety disorders, as reported by their MD and confirmed by a structured diagnostic interview, were randomized. Unguided ICBT was provided by a novel transdiagnostic ICBT programme ('velibra'). Primary outcomes were generic measures, such as anxiety and depression symptom severity, and diagnostic status at post-treatment (9 weeks). Secondary outcomes included anxiety disorder-specific measures, quality of life, treatment adherence, satisfaction, and general psychiatric symptomatology at follow-up (6 months after randomization). RESULTS CAU plus unguided ICBT was more effective than CAU at post-treatment, with small to medium between-group effect sizes on primary (Cohen's d = 0.41-0.47) and secondary (Cohen's d = 0.16-0.61) outcomes. Treatment gains were maintained at follow-up. In the treatment group, 28.2% of those with a SAD diagnosis, 38.3% with a PDA diagnosis, and 44.8% with a GAD diagnosis at pretreatment no longer fulfilled diagnostic criteria at post-treatment. CONCLUSIONS The unguided ICBT intervention examined is effective for anxiety disorders when delivered in primary care.
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Affiliation(s)
- T Berger
- Department of Clinical Psychology and Psychotherapy,University of Bern,Bern,Switzerland
| | - A Urech
- Department of Clinical Psychology and Psychotherapy,University of Bern,Bern,Switzerland
| | - T Krieger
- Department of Clinical Psychology and Psychotherapy,University of Bern,Bern,Switzerland
| | - T Stolz
- Department of Clinical Psychology and Psychotherapy,University of Bern,Bern,Switzerland
| | - A Schulz
- Department of Clinical Psychology and Psychotherapy,University of Bern,Bern,Switzerland
| | - A Vincent
- Department of Clinical Psychology and Psychotherapy,University of Bern,Bern,Switzerland
| | - C T Moser
- Department of Clinical Psychology and Psychotherapy,University of Bern,Bern,Switzerland
| | - S Moritz
- Department of Psychiatry and Psychotherapy,University Medical Centre Hamburg-Eppendorf,Hamburg,Germany
| | - B Meyer
- Department of Psychology,City University,London,UK
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Urech A, Krieger T, Chesham A, Mast FW, Berger T. Virtual Reality-Based Attention Bias Modification Training for Social Anxiety: A Feasibility and Proof of Concept Study. Front Psychiatry 2015; 6:154. [PMID: 26578986 PMCID: PMC4623392 DOI: 10.3389/fpsyt.2015.00154] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/15/2015] [Indexed: 12/03/2022] Open
Abstract
Attention bias modification (ABM) programs have been considered as a promising new approach for the treatment of various disorders, including social anxiety disorder (SAD). However, previous studies yielded ambiguous results regarding the efficacy of ABM in SAD. The present proof-of-concept study investigates the feasibility of a newly developed virtual reality (VR)-based dot-probe training paradigm. It was designed to facilitate attentional disengagement from threatening stimuli in socially anxious individuals (N = 15). The following outcomes were examined: (a) self-reports of enjoyment, motivation, flow, and presence; (b) attentional bias for social stimuli; and (c) social anxiety symptoms. Results showed that ABM training is associated with high scores in enjoyment, motivation, flow, and presence. Furthermore, significant improvements in terms of attention bias and social anxiety symptoms were observed from pre- to follow-up assessment. The study suggests that VR is a feasible and presumably a promising new medium for ABM trainings. Controlled studies will need to be carried out.
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Affiliation(s)
- Antoine Urech
- Department of Psychology, University of Bern , Bern , Switzerland
| | - Tobias Krieger
- Department of Psychology, University of Bern , Bern , Switzerland
| | - Alvin Chesham
- Department of Psychology, University of Bern , Bern , Switzerland
| | - Fred W Mast
- Department of Psychology, University of Bern , Bern , Switzerland
| | - Thomas Berger
- Department of Psychology, University of Bern , Bern , Switzerland
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Urech A. Radiology information system requirements. Radiol Manage 1986; 8:39-43. [PMID: 10287350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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