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Ruwaard J, L' Ami MJ, Kneepkens EL, Krieckaert C, Nurmohamed MT, Hooijberg F, van Kuijk A, van Denderen JC, Burgemeister L, Rispens T, Boers M, Wolbink GJ. Interval prolongation of etanercept in rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis: a randomized controlled trial. Scand J Rheumatol 2023; 52:129-136. [PMID: 35234569 DOI: 10.1080/03009742.2022.2028364] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The majority of patients with a rheumatic disease treated with etanercept may be overexposed. Data regarding etanercept tapering are scarce, particularly in psoriatic arthritis (PsA) and ankylosing spondylitis (AS). We compared extending the dose interval to continuation of the standard dose and studied the success rate of etanercept discontinuation. Etanercept concentrations were measured throughout the study. METHOD 160 patients with rheumatoid arthritis (RA), PsA, or AS with sustained minimal disease activity (MDA) were enrolled in this 18-month, open-label, randomized controlled trial. The intervention group doubled the dosing interval at baseline and discontinued etanercept 6 months later. The control group continued the standard dose for 6 months and doubled the dosing-interval thereafter. The primary outcome was the proportion of patients maintaining MDA at 6 month follow-up. RESULTS At 6 months, MDA status was maintained in 47 patients (63%) in the intervention group and 56 (74%) in the control group (p = 0.15), with comparable results in all rheumatic diseases. And median etanercept concentrations decreased from 1.50 µg/mL (interquartile range 1.06- 2.65) to 0.46 µg/mL (0.28-0.92). In total, 40% discontinued etanercept successfully with maintained MDA for at least 6 months. CONCLUSION Etanercept tapering can be done without losing efficacy in RA, PsA, and AS patients in sustained MDA. A substantial proportion of patients could stop etanercept for at least 6 months. In many patients, low drug concentrations proved sufficient to control disease activity. However, the risk of minor and major flares is substantial, even in patients continuing standard dosing.
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Affiliation(s)
- J Ruwaard
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - M J L' Ami
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - E L Kneepkens
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Clm Krieckaert
- Department of Rheumatology, Amsterdam UMC
- Vrije Universiteit, Amsterdam, The Netherlands
| | - M T Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands.,Department of Rheumatology, Amsterdam UMC
- Vrije Universiteit, Amsterdam, The Netherlands
| | - F Hooijberg
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Awr van Kuijk
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - J C van Denderen
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - L Burgemeister
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - T Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, Amsterdam, The Netherlands
| | - M Boers
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands.,Department of Rheumatology, Amsterdam UMC
- Vrije Universiteit, Amsterdam, The Netherlands.,Department of Epidemiology and Data Science, Amsterdam UMC
- Vrije Universiteit, Amsterdam, The Netherlands
| | - G J Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands.,Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, Amsterdam, The Netherlands
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Parikh R, Hoogendoorn A, Michelson D, Ruwaard J, Sharma R, Bhat B, Malik K, Sahu R, Cuijpers P, Patel V. Increasing demand for school counselling through a lay counsellor-delivered classroom sensitisation intervention: a stepped-wedge cluster randomised controlled trial in New Delhi, India. BMJ Glob Health 2021; 6:bmjgh-2020-003902. [PMID: 34172486 PMCID: PMC8237731 DOI: 10.1136/bmjgh-2020-003902] [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] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 05/27/2021] [Indexed: 01/20/2023] Open
Abstract
Introduction We evaluated a classroom-based sensitisation intervention that was designed to reduce demand-side barriers affecting referrals to a school counselling programme. The sensitisation intervention was offered in the context of a host trial evaluating a low-intensity problem-solving treatment for common adolescent mental health problems. Methods We conducted a stepped-wedge, cluster randomised controlled trial with 70 classes in 6 secondary schools serving low-income communities in New Delhi, India. The classes were randomised to receive a classroom sensitisation session involving a brief video presentation and moderated group discussion, delivered by a lay counsellor over one class period (intervention condition, IC), in two steps of 4 weeks each. The control condition (CC) was whole-school sensitisation (teacher-meetings and whole-school activities such as poster displays). The primary outcome was the proportion of students referred into the host trial. Secondary outcomes were the proportion of students who met mental health caseness criteria and the proportion of self-referred adolescents. Results Between 20 August 2018 and 9 December 2018, 835 students (23.3% of all students) were referred into the host trial. The referred sample included 591 boys (70.8%), and had a mean age of 15.8 years, SD=0.06; 194 students (31.8% of 610 with complete data) met mental health caseness criteria. The proportion of students referred in each trial conditionwas significantly higher in the IC (IC=21.7%, CC=1.5%, OR=111.36, 95% CI 35.56 to 348.77, p<0.001). The proportion of self-referred participants was also higher in the IC (IC=98.1%, CC=89.1%, Pearson χ2 (1)=16.92, p<0.001). Although the proportion of referred students meeting caseness criteria was similar in both conditions (IC=32.0% vs CC=28.1%), the proportion weighted for the total student population was substantially higher in the IC (IC=5.2%, CC=0.3%, OR=52.39, 95% CI 12.49 to 219.66, p<0.001). Conclusion A single, lay counsellor-delivered, classroom sensitisation session increased psychological help-seeking for common mental health problems among secondary school pupils from urban, low-income communities in India. Trial registration number NCT03633916.
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Affiliation(s)
- Rachana Parikh
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Sangath, Delhi, India.,PATH, Delhi, India
| | - Adriaan Hoogendoorn
- GGZ inGeest, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Jeroen Ruwaard
- GGZ inGeest, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | | | | | | | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Vikram Patel
- Sangath, Porvorim, Goa, India .,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Bührmann L, Schuurmans J, Ruwaard J, Fleuren M, Etzelmüller A, Piera-Jiménez J, Finch T, Rapley T, Potthoff S, Aouizerate B, Batterham PJ, Calear A, Christensen H, Pedersen CD, Ebert DD, Van der Eycken E, Fanaj N, van Genugten C, Hanssen D, Hegerl U, Hug J, Kleiboer A, Mathiasen K, May C, Mustafa S, Oehler C, Cerga-Pashoja A, Pope C, Qirjako G, Rosmalen J, Sacco Y, Samalin L, Skjøth MM, Tarp K, Titzler I, Zanalda E, Zbukvic I, Smit JH, Riper H, Vis C. Tailored implementation of internet-based cognitive behavioural therapy in the multinational context of the ImpleMentAll project: a study protocol for a stepped wedge cluster randomized trial. Trials 2020; 21:893. [PMID: 33115545 PMCID: PMC7592568 DOI: 10.1186/s13063-020-04686-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 08/14/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Internet-based Cognitive Behavioural Therapy (iCBT) is found effective in treating common mental disorders. However, the use of these interventions in routine care is limited. The international ImpleMentAll study is funded by the European Union's Horizon 2020 programme. It is concerned with studying and improving methods for implementing evidence-based iCBT services for common mental disorders in routine mental health care. A digitally accessible implementation toolkit (ItFits-toolkit) will be introduced to mental health care organizations with the aim to facilitate the ongoing implementation of iCBT services within local contexts. This study investigates the effectiveness of the ItFits-toolkit by comparing it to implementation-as-usual activities. METHODS A stepped wedge cluster randomized controlled trial (SWT) design will be applied. Over a trial period of 30 months, the ItFits-toolkit will be introduced sequentially in twelve routine mental health care organizations in primary and specialist care across nine countries in Europe and Australia. Repeated measures are applied to assess change over time in the outcome variables. The effectiveness of the ItFits-toolkit will be assessed in terms of the degree of normalization of the use of the iCBT services. Several exploratory outcomes including uptake of the iCBT services will be measured to feed the interpretation of the primary outcome. Data will be collected via a centralized data collection system and analysed using generalized linear mixed modelling. A qualitative process evaluation of routine implementation activities and the use of the ItFits-toolkit will be conducted within this study. DISCUSSION The ImpleMentAll study is a large-scale international research project designed to study the effectiveness of tailored implementation. Using a SWT design that allows to examine change over time, this study will investigate the effect of tailored implementation on the normalization of the use of iCBT services and their uptake. It will provide a better understanding of the process and methods of tailoring implementation strategies. If found effective, the ItFits-toolkit will be made accessible for mental health care service providers, to help them overcome their context-specific implementation challenges. TRIAL REGISTRATION ClinicalTrials.gov NCT03652883 . Retrospectively registered on 29 August 2018.
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Affiliation(s)
- Leah Bührmann
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, The Netherlands.
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Josien Schuurmans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Jeroen Ruwaard
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Margot Fleuren
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Dutch Nurses Association, Utrecht, The Netherlands
| | - Anne Etzelmüller
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- GET.ON Institute, Hamburg, Germany
| | - Jordi Piera-Jiménez
- Department of Research and Innovation, Badalona Serveis Assistencials, Badalona, Spain
| | - Tracy Finch
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Sebastian Potthoff
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Bruno Aouizerate
- Fondation FondaMental, Creteil, France
- Regional Reference Center for the Management and Treatment of Anxiety and Depressive Disorders, Expert Center for Treatment-Resistant Depression, CH Charles Perrens, University of Bordeaux, Bordeaux, France
| | - Philip J Batterham
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Alison Calear
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Randwick, Australia
| | - Claus Duedal Pedersen
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - David Daniel Ebert
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, The Netherlands
- GET.ON Institute, Hamburg, Germany
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Naim Fanaj
- Mental Health Center Prizren, Prizren, Kosovo
- College of Medical Sciences Rezonanca, Prishtina, Kosovo
| | - Claire van Genugten
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Denise Hanssen
- University Medical Center Groningen, Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Ulrich Hegerl
- Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe-Universität Frankfurt, Frankfurt, Germany
| | - Juliane Hug
- European Alliance Against Depression e.V., Leipzig, Germany
| | - Annet Kleiboer
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Kim Mathiasen
- Research Unit for Depression and Anxiety, Aarhus University Hospital, Aarhus N, Denmark
| | - Carl May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Sevim Mustafa
- Mental Health Center Prizren, Prizren, Kosovo
- Faculty of Education, University St. Kliment Ohridski, Bitola, North Macedonia
| | | | - Arlinda Cerga-Pashoja
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gentiana Qirjako
- Department of Public Health, Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Judith Rosmalen
- University Medical Center Groningen, Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Ylenia Sacco
- Dipartimento di Salute Mentale, Azienda Sanitaria Locale Torino 3, Turin, Italy
| | - Ludovic Samalin
- Fondation FondaMental, Creteil, France
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Mette Maria Skjøth
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kristine Tarp
- Centre for Telepsychiatry, Region of Southern Denmark, Denmark
| | - Ingrid Titzler
- GET.ON Institute, Hamburg, Germany
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Enrico Zanalda
- Dipartimento di Salute Mentale, Azienda Sanitaria Locale Torino 3, Turin, Italy
| | - Isabel Zbukvic
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Johannes H Smit
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Christiaan Vis
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Provoost S, Kleiboer A, Ornelas J, Bosse T, Ruwaard J, Rocha A, Cuijpers P, Riper H. Improving adherence to an online intervention for low mood with a virtual coach: study protocol of a pilot randomized controlled trial. Trials 2020; 21:860. [PMID: 33066805 PMCID: PMC7565359 DOI: 10.1186/s13063-020-04777-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 09/29/2020] [Indexed: 01/17/2023] Open
Abstract
Background Internet-based cognitive-behavioral therapy (iCBT) is more effective when it is guided by human support than when it is unguided. This may be attributable to higher adherence rates that result from a positive effect of the accompanying support on motivation and on engagement with the intervention. This protocol presents the design of a pilot randomized controlled trial that aims to start bridging the gap between guided and unguided interventions. It will test an intervention that includes automated support delivered by an embodied conversational agent (ECA) in the form of a virtual coach. Methods/design The study will employ a pilot two-armed randomized controlled trial design. The primary outcomes of the trial will be (1) the effectiveness of iCBT, as supported by a virtual coach, in terms of improved intervention adherence in comparison with unguided iCBT, and (2) the feasibility of a future, larger-scale trial in terms of recruitment, acceptability, and sample size calculation. Secondary aims will be to assess the virtual coach’s effect on motivation, users’ perceptions of the virtual coach, and general feasibility of the intervention as supported by a virtual coach. We will recruit N = 70 participants from the general population who wish to learn how they can improve their mood by using Moodbuster Lite, a 4-week cognitive-behavioral therapy course. Candidates with symptoms of moderate to severe depression will be excluded from study participation. Included participants will be randomized in a 1:1 ratio to either (1) Moodbuster Lite with automated support delivered by a virtual coach or (2) Moodbuster Lite without automated support. Assessments will be taken at baseline and post-study 4 weeks later. Discussion The study will assess the preliminary effectiveness of a virtual coach in improving adherence and will determine the feasibility of a larger-scale RCT. It could represent a significant step in bridging the gap between guided and unguided iCBT interventions. Trial registration Netherlands Trial Register (NTR) NL8110. Registered on 23 October 2019.
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Affiliation(s)
- Simon Provoost
- Department of Clinical, Neuro- and Developmental Psychology, Clinical Psychology Section, VU University and Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
| | - Annet Kleiboer
- Department of Clinical, Neuro- and Developmental Psychology, Clinical Psychology Section, VU University and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - José Ornelas
- Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal
| | - Tibor Bosse
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Jeroen Ruwaard
- Department of Psychiatry, Amsterdam UMC, Location VU University Medical Centre, and Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | - Artur Rocha
- Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Clinical Psychology Section, VU University and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro- and Developmental Psychology, Clinical Psychology Section, VU University and Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam UMC, Location VU University Medical Centre, and Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands
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L’ami MJ, Ruwaard J, Kneepkens EL, Krieckaert CLM, Nurmohamed M, Hooijberg F, Van Denderen JC, Van Kuijk A, Burgemeister L, Boers M, Wolbink GJ. OP0209 INTERVAL PROLONGATION IN ETANERCEPT-TREATED PATIENTS WITH RHEUMATOID ARTHRITIS, ANKYLOSING SPONDYLITIS OR PSORIATIC ARTHRITIS: AN OPEN-LABEL, RANDOMISED CONTROLLED TRIAL. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The majority of patients with a rheumatic disease treated with etanercept may be overexposed. Data regarding etanercept tapering is scarce, particularly in psoriatic arthritis (PsA) and ankylosing spondylitis (AS). Dose reductions can potentially reduce blood drug levels too much, resulting in loss of effect.Objectives:We compared extending the dose interval to continuation of the standard dose and studied the success rate of etanercept discontinuation. Etanercept concentrations were measured throughout the study.Methods:160 consecutive patients with rheumatoid arthritis (RA), PsA or AS with sustained minimal disease activity (MDA) were enrolled in this 18-month, open-label, randomised controlled trial. The intervention group doubled the dosing-interval at baseline and discontinued etanercept 6 months later. The control group continued the standard dose up to 6 months, after which the dosing-interval was doubled. Primary outcome was the proportion of patients maintaining MDA after 6 months follow-up.Results:At 6 months, MDA status was maintained in 47 (63%) patients in the intervention group and 56 (74%) in the control group (p=0.15), with comparable results in all rheumatic diseases. Median etanercept concentrations decreased from 1.50 µg/mL (25-75thpercentile 1.06-2.65) to 0.46 µg/mL (0.28-0.92) after 6 months of interval prolongation (figure 1). In total, 40% discontinued etanercept successfully with maintained MDA for at least 6 months.Figure 1.Median (with Q1 to Q3 boxplots) etanercept concentrations (per protocol) during the first 6 months of follow-up in the intervention group (prolongation; gray boxplots) and the control group (continuation; white boxplots), separated by disease (RA, PsA, AS). Bars represent 10-90 percentile and outliers are shown separately (dots).Conclusion:As observed in RA, etanercept tapering can be safely attempted in PsA and AS patients in sustained MDA. A substantial proportion of patients could stop etanercept for at least 6 months. In many patients low drug concentrations proved sufficient to control disease activity. However, the risk of minor and major flares is substantial, even in patients continuing standard dosing.References:noneDisclosure of Interests:Merel J. l’Ami Speakers bureau: Novartis, Jill Ruwaard: None declared, Eva L. Kneepkens: None declared, Charlotte L.M. Krieckaert: None declared, Michael Nurmohamed Grant/research support from: Not related to this research, Consultant of: Not related to this research, Speakers bureau: Not related to this research, Femke Hooijberg: None declared, J.C. van Denderen: None declared, Arno Van Kuijk: None declared, Lot Burgemeister: None declared, Maarten Boers: None declared, Gert-Jan Wolbink: None declared
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Kooistra L, Ruwaard J, Wiersma J, van Oppen P, Riper H. Working Alliance in Blended Versus Face-to-Face Cognitive Behavioral Treatment for Patients with Depression in Specialized Mental Health Care. J Clin Med 2020; 9:jcm9020347. [PMID: 32012722 PMCID: PMC7073833 DOI: 10.3390/jcm9020347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 01/14/2020] [Accepted: 01/18/2020] [Indexed: 12/24/2022] Open
Abstract
This study investigates working alliance in blended cognitive behavioral therapy (bCBT) for depressed adults in specialized mental health care. Patients were randomly allocated to bCBT (n = 47) or face-to-face CBT (n = 45). After 10 weeks of treatment, both patients and therapists in the two groups rated the therapeutic alliance on the Working Alliance Inventory Short-Form Revised (WAI-SR; Task, Bond, Goal, and composite scores). No between-group differences were found in relation to either patient or therapist alliance ratings, which were high in both groups. In the full sample, a moderate positive association was found between patient and therapist ratings on Task (ρ = 0.41, 95% CI 0.20; 0.59), but no significant associations emerged on other components or composite scores. At 30 weeks, within-and between-group associations between alliance and changes in depression severity (QIDS, Quick Inventory of Depressive Symptomatology) were analyzed with linear mixed models. The analyses revealed an association between depression over time, patient-rated alliance, and group (p < 0.001). In face-to-face CBT, but not in bCBT, lower depression scores were associated with higher alliance ratings. The online component in bCBT may have led patients to evaluate the working alliance differently from patients receiving face-to-face CBT only.
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Affiliation(s)
- Lisa Kooistra
- 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
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands; (J.W.); (P.v.O.)
- Correspondence:
| | - Jeroen Ruwaard
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands; (J.W.); (P.v.O.)
- Department of Psychiatry and the Amsterdam Public Health Research Institute, GGZ inGeest/Amsterdam UMC, Vrije Universiteit, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Jenneke Wiersma
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands; (J.W.); (P.v.O.)
| | - Patricia van Oppen
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands; (J.W.); (P.v.O.)
- Department of Psychiatry and the Amsterdam Public Health Research Institute, GGZ inGeest/Amsterdam UMC, Vrije Universiteit, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Heleen Riper
- 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
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands; (J.W.); (P.v.O.)
- Department of Psychiatry and the Amsterdam Public Health Research Institute, GGZ inGeest/Amsterdam UMC, Vrije Universiteit, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Kooistra LC, Wiersma JE, Ruwaard J, Neijenhuijs K, Lokkerbol J, van Oppen P, Smit F, Riper H. Cost and Effectiveness of Blended Versus Standard Cognitive Behavioral Therapy for Outpatients With Depression in Routine Specialized Mental Health Care: Pilot Randomized Controlled Trial. J Med Internet Res 2019; 21:e14261. [PMID: 31663855 PMCID: PMC6914243 DOI: 10.2196/14261] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/25/2019] [Accepted: 08/18/2019] [Indexed: 12/13/2022] Open
Abstract
Background Cognitive behavioral therapy (CBT) is an effective treatment, but access is often restricted due to costs and limited availability of trained therapists. Blending online and face-to-face CBT for depression might improve cost-effectiveness and treatment availability. Objective This pilot study aimed to examine the costs and effectiveness of blended CBT compared with standard CBT for depressed patients in specialized mental health care to guide further research and development of blended CBT. Methods Patients were randomly allocated to blended CBT (n=53) or standard CBT (n=49). Blended CBT consisted of 10 weekly face-to-face sessions and 9 Web-based sessions. Standard CBT consisted of 15 to 20 weekly face-to-face sessions. At baseline and 10, 20, and 30 weeks after start of treatment, self-assessed depression severity, quality-adjusted life-years (QALYs), and costs were measured. Clinicians, blinded to treatment allocation, assessed psychopathology at all time points. Data were analyzed using linear mixed models. Uncertainty intervals around cost and effect estimates were estimated with 5000 Monte Carlo simulations. Results Blended CBT treatment duration was mean 19.0 (SD 12.6) weeks versus mean 33.2 (SD 23.0) weeks in standard CBT (P<.001). No significant differences were found between groups for depressive episodes (risk difference [RD] 0.06, 95% CI −0.05 to 0.19), response to treatment (RD 0.03, 95% CI −0.10 to 0.15), and QALYs (mean difference 0.01, 95% CI −0.03 to 0.04). Mean societal costs for blended CBT were €1183 higher than standard CBT. This difference was not significant (95% CI −399 to 2765). Blended CBT had a probability of being cost-effective compared with standard CBT of 0.02 per extra QALY and 0.37 for an additional treatment response, at a ceiling ratio of €25,000. For health care providers, mean costs for blended CBT were €176 lower than standard CBT. This difference was not significant (95% CI −659 to 343). At €0 per additional unit of effect, the probability of blended CBT being cost-effective compared with standard CBT was 0.75. The probability increased to 0.88 at a ceiling ratio of €5000 for an added treatment response, and to 0.85 at €10,000 per QALY gained. For avoiding new depressive episodes, blended CBT was deemed not cost-effective compared with standard CBT because the increase in costs was associated with negative effects. Conclusions This pilot study shows that blended CBT might be a promising way to engage depressed patients in specialized mental health care. Compared with standard CBT, blended CBT was not considered cost-effective from a societal perspective but had an acceptable probability of being cost-effective from the health care provider perspective. Results should be carefully interpreted due to the small sample size. Further research in larger replication studies focused on optimizing the clinical effects of blended CBT and its budget impact is warranted. Trial Registration Netherlands Trial Register NTR4650; https://www.trialregister.nl/trial/4408 International Registered Report Identifier (IRRID) RR2-10.1186/s12888-014-0290-z
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Affiliation(s)
- Lisa Catharine Kooistra
- Department of Clinical, Neuro and Developmental Psychology, Clinical Psychology Section, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Research and Innovation, GGZ in Geest/Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
| | - Jenneke Elize Wiersma
- Department of Research and Innovation, GGZ in Geest/Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
| | - Jeroen Ruwaard
- Department of Research and Innovation, GGZ in Geest/Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
| | - Koen Neijenhuijs
- Department of Clinical, Neuro and Developmental Psychology, Clinical Psychology Section, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands.,Cancer Center Amsterdam, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
| | - Joran Lokkerbol
- Center of Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, Netherlands
| | - Patricia van Oppen
- Department of Research and Innovation, GGZ in Geest/Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands.,Department of Psychiatry, GGZ in Geest/Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
| | - Filip Smit
- Department of Clinical, Neuro and Developmental Psychology, Clinical Psychology Section, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands.,Center of Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Clinical Psychology Section, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Research and Innovation, GGZ in Geest/Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands.,Department of Psychiatry, GGZ in Geest/Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
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Parikh R, Michelson D, Malik K, Shinde S, Weiss HA, Hoogendoorn A, Ruwaard J, Krishna M, Sharma R, Bhat B, Sahu R, Mathur S, Sudhir P, King M, Cuijpers P, Chorpita BF, Fairburn CG, Patel V. The effectiveness of a low-intensity problem-solving intervention for common adolescent mental health problems in New Delhi, India: protocol for a school-based, individually randomized controlled trial with an embedded stepped-wedge, cluster randomized controlled recruitment trial. Trials 2019; 20:568. [PMID: 31533783 PMCID: PMC6751586 DOI: 10.1186/s13063-019-3573-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 07/11/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Conduct, anxiety, and depressive disorders account for over 75% of the adolescent mental health burden globally. The current protocol will test a low-intensity problem-solving intervention for school-going adolescents with common mental health problems in India. The protocol also tests the effects of a classroom-based sensitization intervention on the demand for counselling services in an embedded recruitment trial. METHODS/DESIGN We will conduct a two-arm, individually randomized controlled trial in six Government-run secondary schools in New Delhi. The targeted sample is 240 adolescents in grades 9-12 with persistent, elevated mental health symptoms and associated distress/impairment. Participants will receive either a brief problem-solving intervention delivered over 3 weeks by lay counsellors (intervention) or enhanced usual care comprised of problem-solving booklets (control). Self-reported adolescent mental health symptoms and idiographic problems will be assessed at 6 weeks (co-primary outcomes) and again at 12 weeks post-randomization. In addition, adolescent-reported distress/impairment, perceived stress, mental wellbeing, and clinical remission, as well as parent-reported adolescent mental health symptoms and impact scores, will be assessed at 6 and 12 weeks post-randomization. We will also complete a parallel process evaluation, including estimations of the costs of delivering the interventions. An embedded recruitment trial will apply a stepped-wedge, cluster (class)-randomized controlled design in 70 classes across the six schools. This will evaluate the added effect of a classroom-based sensitization intervention over and above school-level sensitization activities on the primary outcome of referral rate into the host trial. Other outcomes will be the proportion of referrals eligible to participate in the host trial, proportion of self-generated referrals, and severity and pattern of symptoms among referred adolescents in each condition. Power calculations were undertaken separately for each trial. A detailed statistical analysis plan will be developed separately for each trial prior to unblinding. DISCUSSION Both trials were initiated on 20 August 2018. A single research protocol for both trials offers a resource-efficient methodology for testing the effectiveness of linked procedures to enhance uptake and outcomes of a school-based psychological intervention for common adolescent mental health problems. TRIAL REGISTRATION Both trials are registered prospectively with the National Institute of Health registry ( www.clinicaltrials.gov ), registration numbers NCT03633916 and NCT03630471 , registered on 16th August, 2018 and 14th August, 2018 respectively).
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Affiliation(s)
- Rachana Parikh
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi 110016 India
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorstraat 1, 1081 BT Amsterdam, The Netherlands
| | - Daniel Michelson
- School of Psychology, University of Sussex, Falmer, Brighton, BN1 9RH UK
| | - Kanika Malik
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi 110016 India
| | - Sachin Shinde
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi 110016 India
| | - Helen A. Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Adriaan Hoogendoorn
- Amsterdam UMC, Amsterdam Public Health research institute, Vrije Universitiet, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HL Amsterdam, The Netherlands
| | - Jeroen Ruwaard
- Amsterdam UMC, Amsterdam Public Health research institute, Vrije Universitiet, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HL Amsterdam, The Netherlands
| | - Madhuri Krishna
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi 110016 India
| | - Rhea Sharma
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi 110016 India
| | - Bhargav Bhat
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi 110016 India
| | - Rooplata Sahu
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi 110016 India
| | - Sonal Mathur
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi 110016 India
| | - Paulomi Sudhir
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, Karnataka 560029 India
| | - Michael King
- Division of Psychiatry, Faculty of Brain Sciences, University College London, Maple House, 149 Tottenham Court Rd, London, W1T 7NF UK
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, van der Boechorstraat 1, 1081, BT Amsterdam, The Netherlands
| | - Bruce F. Chorpita
- Department of Psychology, University of California, Los Angeles, 3227 Franz Hall, Los Angeles, CA 90095-1563 USA
| | | | - Vikram Patel
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi 110016 India
- Department of Global Health and Social Medicine, Harvard Medical School, 641, Huntington Avenue, Boston, MA 02115 USA
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9
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Kemmeren LL, van Schaik A, Smit JH, Ruwaard J, Rocha A, Henriques M, Ebert DD, Titzler I, Hazo JB, Dorsey M, Zukowska K, Riper H. Unraveling the Black Box: Exploring Usage Patterns of a Blended Treatment for Depression in a Multicenter Study. JMIR Ment Health 2019; 6:e12707. [PMID: 31344670 PMCID: PMC6686640 DOI: 10.2196/12707] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 11/07/2018] [Revised: 05/23/2019] [Accepted: 06/10/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Blended treatments, combining digital components with face-to-face (FTF) therapy, are starting to find their way into mental health care. Knowledge on how blended treatments should be set up is, however, still limited. To further explore and optimize blended treatment protocols, it is important to obtain a full picture of what actually happens during treatments when applied in routine mental health care. OBJECTIVE The aims of this study were to gain insight into the usage of the different components of a blended cognitive behavioral therapy (bCBT) for depression and reflect on actual engagement as compared with intended application, compare bCBT usage between primary and specialized care, and explore different usage patterns. METHODS Data used were collected from participants of the European Comparative Effectiveness Research on Internet-Based Depression Treatment project, a European multisite randomized controlled trial comparing bCBT with regular care for depression. Patients were recruited in primary and specialized routine mental health care settings between February 2015 and December 2017. Analyses were performed on the group of participants allocated to the bCBT condition who made use of the Moodbuster platform and for whom data from all blended components were available (n=200). Included patients were from Germany, Poland, the Netherlands, and France; 64.5% (129/200) were female and the average age was 42 years (range 18-74 years). RESULTS Overall, there was a large variability in the usage of the blended treatment. A clear distinction between care settings was observed, with longer treatment duration and more FTF sessions in specialized care and a more active and intensive usage of the Web-based component by the patients in primary care. Of the patients who started the bCBT, 89.5% (179/200) also continued with this treatment format. Treatment preference, educational level, and the number of comorbid disorders were associated with bCBT engagement. CONCLUSIONS Blended treatments can be applied to a group of patients being treated for depression in routine mental health care. Rather than striving for an optimal blend, a more personalized blended care approach seems to be the most suitable. The next step is to gain more insight into the clinical and cost-effectiveness of blended treatments and to further facilitate uptake in routine mental health care.
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Affiliation(s)
- Lise L Kemmeren
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands.,Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Anneke van Schaik
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands.,Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Johannes H Smit
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands.,Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jeroen Ruwaard
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands.,Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Artur Rocha
- Centre for Information Systems and Computer Graphics, Institute for Systems Engineering and Computers, Technology and Science, Porto, Portugal
| | - Mário Henriques
- Centre for Information Systems and Computer Graphics, Institute for Systems Engineering and Computers, Technology and Science, Porto, Portugal
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Ingrid Titzler
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Jean-Baptiste Hazo
- Eceve, Unit 1123, Inserm, Université de Paris, Paris, France.,Unité de Recherche en Economie de la Santé, Assistance Publique, Hôpitaux de Paris, Paris, France.,World Health Organization Collaborating Centre for Research and Training in Mental Health, Lille, France
| | - Maya Dorsey
- Eceve, Unit 1123, Inserm, Université de Paris, Paris, France.,Unité de Recherche en Economie de la Santé, Assistance Publique, Hôpitaux de Paris, Paris, France.,World Health Organization Collaborating Centre for Research and Training in Mental Health, Lille, France
| | - Katarzyna Zukowska
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Heleen Riper
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands.,Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Institute of Telepsychiatry, University of Southern Denmark, Odense, Denmark
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10
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Provoost S, Ruwaard J, van Breda W, Riper H, Bosse T. Validating Automated Sentiment Analysis of Online Cognitive Behavioral Therapy Patient Texts: An Exploratory Study. Front Psychol 2019; 10:1065. [PMID: 31156504 PMCID: PMC6530336 DOI: 10.3389/fpsyg.2019.01065] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 10/23/2018] [Accepted: 04/24/2019] [Indexed: 11/21/2022] Open
Abstract
Introduction Sentiment analysis may be a useful technique to derive a user’s emotional state from free text input, allowing for more empathic automated feedback in online cognitive behavioral therapy (iCBT) interventions for psychological disorders such as depression. As guided iCBT is considered more effective than unguided iCBT, such automated feedback may help close the gap between the two. The accuracy of automated sentiment analysis is domain dependent, and it is unclear how well the technology is applicable to iCBT. This paper presents an empirical study in which automated sentiment analysis by an algorithm for the Dutch language is validated against human judgment. Methods A total of 493 iCBT user texts were evaluated on overall sentiment and the presence of five specific emotions by an algorithm, and by 52 psychology students who evaluated 75 randomly selected texts each, providing about eight human evaluations per text. Inter-rater agreement (IRR) between algorithm and humans, and humans among each other, was analyzed by calculating the intra-class correlation under a numerical interpretation of the data, and Cohen’s kappa, and Krippendorff’s alpha under a categorical interpretation. Results All analyses indicated moderate agreement between the algorithm and average human judgment with respect to evaluating overall sentiment, and low agreement for the specific emotions. Somewhat surprisingly, the same was the case for the IRR among human judges, which means that the algorithm performed about as well as a randomly selected human judge. Thus, considering average human judgment as a benchmark for the applicability of automated sentiment analysis, the technique can be considered for practical application. Discussion/Conclusion The low human-human agreement on the presence of emotions may be due to the nature of the texts, it may simply be difficult for humans to agree on the presence of the selected emotions, or perhaps trained therapists would have reached more consensus. Future research may focus on validating the algorithm against a more solid benchmark, on applying the algorithm in an application in which empathic feedback is provided, for example, by an embodied conversational agent, or on improving the algorithm for the iCBT domain with a bottom-up machine learning approach.
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Affiliation(s)
- Simon Provoost
- Department of Clinical, Neuro- and Developmental Psychology, Section Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jeroen Ruwaard
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | | | - Heleen Riper
- Department of Clinical, Neuro- and Developmental Psychology, Section Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands.,Centre for Telepsychiatry, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tibor Bosse
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands
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11
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L' Ami MJ, Ruwaard J, Krieckaert C, Nurmohamed MT, van Vollenhoven RF, Rispens T, Wolbink GJ. Serum drug concentrations to optimize switching from adalimumab to etanercept in rheumatoid arthritis. Scand J Rheumatol 2019; 48:266-270. [PMID: 31012365 DOI: 10.1080/03009742.2019.1577915] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Inadequate response to adalimumab can be caused by insufficient blockade of the target tumour necrosis factor (TNF) at low serum concentrations. In such cases, patients may respond to another TNF inhibitor. We investigated whether the serum adalimumab concentration is related to the efficacy of a second TNF inhibitor, etanercept, in rheumatoid arthritis (RA). Methods: Patients with RA starting etanercept treatment were prospectively observed in the Reade Rheumatology Registry. In patients previously on adalimumab, serum concentrations were determined before treatment discontinuation. According to this concentration, three subgroups were formed: < 0.5 μg/mL, 0.5-5.0 μg/mL, and ≥ 5.0 μg/mL. The European League Against Rheumatism (EULAR) good/moderate response rate after 52 weeks of etanercept was compared between the switcher subgroups and biologic-naive patients. Results: In total, 449 consecutive patients were included, of whom 69 switched from adalimumab (15%) and 380 were biologic naive (85%). EULAR good or moderate response was achieved by 74% of the biologic-naive patients and by 72%, 50%, and 52% of switchers with adalimumab concentration < 0.5 μg/mL, 0.5-5.0 μg/mL, and ≥ 5.0 μg/mL, respectively (p = 0.15). Patients with an adalimumab concentration ≥ 0.5 μg/mL were significantly less likely to achieve EULAR good/moderate response on etanercept compared to biologic-naive patients, whereas patients with a concentration < 0.5 μg/mL did not significantly differ from patients starting etanercept without prior biologic treatment. Conclusion: RA patients with an inadequate response to adalimumab, in the presence of sufficient drug concentrations, benefit less from switching to another TNF inhibitor, etanercept.
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Affiliation(s)
- M J L' Ami
- a Department of Rheumatology , Amsterdam Rheumatology and Immunology Center , Reade , Amsterdam , The Netherlands
| | - J Ruwaard
- a Department of Rheumatology , Amsterdam Rheumatology and Immunology Center , Reade , Amsterdam , The Netherlands
| | - Clm Krieckaert
- a Department of Rheumatology , Amsterdam Rheumatology and Immunology Center , Reade , Amsterdam , The Netherlands
| | - M T Nurmohamed
- a Department of Rheumatology , Amsterdam Rheumatology and Immunology Center , Reade , Amsterdam , The Netherlands.,b Department of Rheumatology , Amsterdam Rheumatology and Immunology Center, UMC/VU University Medical Center , Amsterdam , The Netherlands
| | - R F van Vollenhoven
- a Department of Rheumatology , Amsterdam Rheumatology and Immunology Center , Reade , Amsterdam , The Netherlands.,b Department of Rheumatology , Amsterdam Rheumatology and Immunology Center, UMC/VU University Medical Center , Amsterdam , The Netherlands.,c Department of Rheumatology , Amsterdam Rheumatology and Immunology Center, UMC/Academic Medical Center , Amsterdam , The Netherlands
| | - T Rispens
- d Department of Immunopathology , Sanquin Research and Landsteiner Laboratory Academic Medical Center , Amsterdam , The Netherlands
| | - G J Wolbink
- a Department of Rheumatology , Amsterdam Rheumatology and Immunology Center , Reade , Amsterdam , The Netherlands.,d Department of Immunopathology , Sanquin Research and Landsteiner Laboratory Academic Medical Center , Amsterdam , The Netherlands
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Vis C, Ruwaard J, Finch T, Rapley T, de Beurs D, van Stel H, van Lettow B, Mol M, Kleiboer A, Riper H, Smit J. Toward an Objective Assessment of Implementation Processes for Innovations in Health Care: Psychometric Evaluation of the Normalization Measure Development (NoMAD) Questionnaire Among Mental Health Care Professionals. J Med Internet Res 2019; 21:e12376. [PMID: 30785402 PMCID: PMC6401675 DOI: 10.2196/12376] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/21/2018] [Accepted: 01/20/2019] [Indexed: 11/13/2022] Open
Abstract
Background Successfully implementing eMental health (eMH) interventions in routine mental health care constitutes a major challenge. Reliable instruments to assess implementation progress are essential. The Normalization MeAsure Development (NoMAD) study developed a brief self-report questionnaire that could be helpful in measuring implementation progress. Based on the Normalization Process Theory, this instrument focuses on 4 generative mechanisms involved in implementation processes: coherence, cognitive participation, collective action, and reflexive monitoring. Objective The aim of this study was to translate the NoMAD questionnaire to Dutch and to confirm the factor structure in Dutch mental health care settings. Methods Dutch mental health care professionals involved in eMH implementation were invited to complete the translated NoMAD questionnaire. Confirmatory factor analysis (CFA) was conducted to verify interpretability of scale scores for 3 models: (1) the theoretical 4-factor structure, (2) a unidimensional model, and (3) a hierarchical model. Potential improvements were explored, and correlated scale scores with 3 control questions were used to assess convergent validity. Results A total of 262 professionals from mental health care settings in the Netherlands completed the questionnaire (female: 81.7%; mean age: 45 [SD=11]). The internal consistency of the 20-item questionnaire was acceptable (.62≤alpha≤.85). The theorized 4-factor model fitted the data slightly better in the CFA than the hierarchical model (Comparative Fit Index=0.90, Tucker Lewis Index=0.88, Root Mean Square Error of Approximation=0.10, Standardized Root Mean Square Residual=0.12, χ22=22.5, P≤.05). However, the difference is small and possibly not outweighing the practical relevance of a total score and subscale scores combined in one hierarchical model. One item was identified as weak (λCA.2=0.10). A moderate-to-strong convergent validity with 3 control questions was found for the Collective Participation scale (.47≤r≤.54, P≤.05). Conclusions NoMAD’s theoretical factor structure was confirmed in Dutch mental health settings to acceptable standards but with room for improvement. The hierarchical model might prove useful in increasing the practical utility of the NoMAD questionnaire by combining a total score with information on the 4 generative mechanisms. Future research should assess the predictive value and responsiveness over time and elucidate the conceptual interpretability of NoMAD in eMH implementation practices.
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Affiliation(s)
- Christiaan Vis
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Mental Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Jeroen Ruwaard
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Research and Innovation, GGZ inGeest Specialized Mental Healthcare, Amsterdam, Netherlands
| | - Tracy Finch
- Department of Nursing, Midwifery & Health, Northumbria University, Northumbria, United Kingdom
| | - Tim Rapley
- Department of Social Work, Education & Community Wellbeing, Northumbria University, Northumbria, United Kingdom
| | - Derek de Beurs
- Mental Health, Netherlands Institute For Health Services Research (NIVEL), Utrecht, Netherlands
| | - Henk van Stel
- Julius Center Research Program Methodology, Department of Public Health, Healthcare Innovation & Evaluation and Medical Humanities, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Mayke Mol
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Research and Innovation, GGZ inGeest Specialized Mental Healthcare, Amsterdam, Netherlands
| | - Annet Kleiboer
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Mental Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Mental Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Research and Innovation, GGZ inGeest Specialized Mental Healthcare, Amsterdam, Netherlands
| | - Jan Smit
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Research and Innovation, GGZ inGeest Specialized Mental Healthcare, Amsterdam, Netherlands
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13
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Nuij C, van Ballegooijen W, Ruwaard J, de Beurs D, Mokkenstorm J, van Duijn E, de Winter RF, O'Connor RC, Smit JH, Riper H, Kerkhof A. Smartphone-based safety planning and self-monitoring for suicidal patients: Rationale and study protocol of the CASPAR (Continuous Assessment for Suicide Prevention And Research) study. Internet Interv 2018; 13:16-23. [PMID: 30206514 PMCID: PMC6112103 DOI: 10.1016/j.invent.2018.04.005] [Citation(s) in RCA: 41] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 04/25/2018] [Accepted: 04/30/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND It remains difficult to predict and prevent suicidal behaviour, despite growing understanding of the aetiology of suicidality. Clinical guidelines recommend that health care professionals develop a safety plan in collaboration with their high-risk patients, to lower the imminent risk of suicidal behaviour. Mobile health applications provide new opportunities for safety planning, and enable daily self-monitoring of suicide-related symptoms that may enhance safety planning. This paper presents the rationale and protocol of the Continuous Assessment for Suicide Prevention And Research (CASPAR) study. The aim of the study is two-fold: to evaluate the feasibility of mobile safety planning and daily mobile self-monitoring in routine care treatment for suicidal patients, and to conduct fundamental research on suicidal processes. METHODS The study is an adaptive single cohort design among 80 adult outpatients or day-care patients, with the main diagnosis of major depressive disorder or dysthymia, who have an increased risk for suicidal behaviours. There are three measurement points, at baseline, at 1 and 3 months after baseline. Patients are instructed to use their mobile safety plan when necessary and monitor their suicidal symptoms daily. Both these apps will be used in treatment with their clinician. CONCLUSION The results from this study will provide insight into the feasibility of mobile safety planning and self-monitoring in treatment of suicidal patients. Furthermore, knowledge of the suicidal process will be enhanced, especially regarding the transition from suicidal ideation to behaviour.The study protocol is currently under revision for medical ethics approval by the medical ethics board of the Vrije Universiteit Medical centre Amsterdam (METc number 2017.512/NL62795.029.17).
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Affiliation(s)
- Chani Nuij
- Department of Clinical Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Wouter van Ballegooijen
- Department of Clinical Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam Public Health research institute, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ Ingeest, Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Jeroen Ruwaard
- Department of Psychiatry, Amsterdam Public Health research institute, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ Ingeest, Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Derek de Beurs
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Jan Mokkenstorm
- Department of Psychiatry, Amsterdam Public Health research institute, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ Ingeest, Specialized Mental Health Care, Amsterdam, The Netherlands
- 113 Suicide Prevention, Amsterdam, The Netherlands
| | | | - Remco F.P. de Winter
- Department of Clinical Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands
- Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Rory C. O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jan H. Smit
- Department of Psychiatry, Amsterdam Public Health research institute, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ Ingeest, Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Clinical Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam Public Health research institute, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ Ingeest, Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Ad Kerkhof
- Department of Clinical Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands
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14
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Karyotaki E, Ebert DD, Donkin L, Riper H, Twisk J, Burger S, Rozental A, Lange A, Williams AD, Zarski AC, Geraedts A, van Straten A, Kleiboer A, Meyer B, Ünlü Ince BB, Buntrock C, Lehr D, Snoek FJ, Andrews G, Andersson G, Choi I, Ruwaard J, Klein JP, Newby JM, Schröder J, Laferton JAC, Van Bastelaar K, Imamura K, Vernmark K, Boß L, Sheeber LB, Kivi M, Berking M, Titov N, Carlbring P, Johansson R, Kenter R, Perini S, Moritz S, Nobis S, Berger T, Kaldo V, Forsell Y, Lindefors N, Kraepelien M, Björkelund C, Kawakami N, Cuijpers P. Do guided internet-based interventions result in clinically relevant changes for patients with depression? An individual participant data meta-analysis. Clin Psychol Rev 2018; 63:80-92. [PMID: 29940401 DOI: 10.1016/j.cpr.2018.06.007] [Citation(s) in RCA: 181] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 06/06/2018] [Accepted: 06/14/2018] [Indexed: 12/22/2022]
Abstract
Little is known about clinically relevant changes in guided Internet-based interventions for depression. Moreover, methodological and power limitations preclude the identification of patients' groups that may benefit more from these interventions. This study aimed to investigate response rates, remission rates, and their moderators in randomized controlled trials (RCTs) comparing the effect of guided Internet-based interventions for adult depression to control groups using an individual patient data meta-analysis approach. Literature searches in PubMed, Embase, PsycINFO and Cochrane Library resulted in 13,384 abstracts from database inception to January 1, 2016. Twenty-four RCTs (4889 participants) comparing a guided Internet-based intervention with a control group contributed data to the analysis. Missing data were multiply imputed. To examine treatment outcome on response and remission, mixed-effects models with participants nested within studies were used. Response and remission rates were calculated using the Reliable Change Index. The intervention group obtained significantly higher response rates (OR = 2.49, 95% CI 2.17-2.85) and remission rates compared to controls (OR = 2.41, 95% CI 2.07-2.79). The moderator analysis indicated that older participants (OR = 1.01) and native-born participants (1.66) were more likely to respond to treatment compared to younger participants and ethnic minorities respectively. Age (OR = 1.01) and ethnicity (1.73) also moderated the effects of treatment on remission.Moreover, adults with more severe depressive symptoms at baseline were more likely to remit after receiving internet-based treatment (OR = 1.19). Guided Internet-based interventions lead to substantial positive treatment effects on treatment response and remission at post-treatment. Thus, such interventions may complement existing services for depression and potentially reduce the gap between the need and provision of evidence-based treatments.
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Affiliation(s)
- Eirini Karyotaki
- Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands.
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Liesje Donkin
- The Brain and Mind Research Institute, University of Sydney, NSW 2050, Australia
| | - Heleen Riper
- Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands
| | - Jos Twisk
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands
| | - Simone Burger
- Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands
| | - Alexander Rozental
- Institute of Child Health, University College London, United Kingdom; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Alfred Lange
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Alishia D Williams
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Anna Carlotta Zarski
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Annemieke van Straten
- Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands
| | - Annet Kleiboer
- Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands
| | - Björn Meyer
- Research Department, Gaia AG, Hamburg, Germany; Department of Psychology, City, University of London, London, United Kingdom
| | | | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Dirk Lehr
- Institute of Psychology, Leuphana University Lüneburg, Germany
| | - Frank J Snoek
- Department of Medical Psychology, VU Medical Center, Academic Medical Center, Public Health Research institute, Amsterdam, the Netherlands
| | - Gavin Andrews
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Gerhard Andersson
- Department of Behavioral Sciences and Learning, Linköping University, Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institute for Disability Research, Stockholm, Sweden
| | - Isabella Choi
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Jeroen Ruwaard
- Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, Luebeck University, Luebeck, Germany
| | - Jill M Newby
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia; The MRC Cognition and Brain Sciences Unit, Cambridge, United Kingdom; School of Psychology, the University of New South Wales, Sydney, Australia
| | - Johanna Schröder
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute for Sex Research and Forensic Psychiatry, Hamburg, Germany
| | - Johannes A C Laferton
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Kim Van Bastelaar
- Department of Medical Psychology, VU Medical Center, Amsterdam, the Netherlands
| | - Kotaro Imamura
- Department of Mental Health, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyō-ku, Tokyo, Japan
| | - Kristofer Vernmark
- Department of Behavioural Sciences and Learning, Linkoping University, Linkoping, Sweden
| | - Leif Boß
- Institute of Psychology, Leuphana University Lüneburg, Germany
| | | | - Marie Kivi
- Department of Psychology, University of Gothenburg, Göteborg, Sweden
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Nickolai Titov
- MindSpot Clinic and eCentreClinic, Department of Psychology, Macquarie University, Australia
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden; Department of Psychology, University of Southern Denmark, Denmark
| | - Robert Johansson
- Department of Behavioral Sciences and Learning, Linköping University, and Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Robin Kenter
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Sarah Perini
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Steffen Moritz
- Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands
| | - Stephanie Nobis
- Division of Online Health Training, Innovation Incubator, Leuphana University Lüneburg, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Viktor Kaldo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Yvonne Forsell
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Nils Lindefors
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Martin Kraepelien
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Cecilia Björkelund
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Norito Kawakami
- Department of Mental Health, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyō-ku, Tokyo, Japan
| | - Pim Cuijpers
- Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands
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15
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Mikus A, Hoogendoorn M, Rocha A, Gama J, Ruwaard J, Riper H. Predicting short term mood developments among depressed patients using adherence and ecological momentary assessment data. Internet Interv 2018; 12:105-110. [PMID: 30135774 PMCID: PMC6096213 DOI: 10.1016/j.invent.2017.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 07/06/2017] [Revised: 09/29/2017] [Accepted: 10/01/2017] [Indexed: 11/15/2022] Open
Abstract
Technology driven interventions provide us with an increasing amount of fine-grained data about the patient. This data includes regular ecological momentary assessments (EMA) but also response times to EMA questions by a user. When observing this data, we see a huge variation between the patterns exhibited by different patients. Some are more stable while others vary a lot over time. This poses a challenging problem for the domain of artificial intelligence and makes on wondering whether it is possible to predict the future mental state of a patient using the data that is available. In the end, these predictions could potentially contribute to interventions that tailor the feedback to the user on a daily basis, for example by warning a user that a fall-back might be expected during the next days, or by applying a strategy to prevent the fall-back from occurring in the first place. In this work, we focus on short term mood prediction by considering the adherence and usage data as an additional predictor. We apply recurrent neural networks to handle the temporal aspects best and try to explore whether individual, group level, or one single predictive model provides the highest predictive performance (measured using the root mean squared error (RMSE)). We use data collected from patients from five countries who used the ICT4Depression/MoodBuster platform in the context of the EU E-COMPARED project. In total, we used the data from 143 patients (with between 9 and 425 days of EMA data) who were diagnosed with a major depressive disorder according to DSM-IV. Results show that we can make predictions of short term mood change quite accurate (ranging between 0.065 and 0.11). The past EMA mood ratings proved to be the most influential while adherence and usage data did not improve prediction accuracy. In general, group level predictions proved to be the most promising, however differences were not significant. Short term mood prediction remains a difficult task, but from this research we can conclude that sophisticated machine learning algorithms/setups can result in accurate performance. For future work, we want to use more data from the mobile phone to improve predictive performance of short term mood.
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Affiliation(s)
- Adam Mikus
- Vrije Universiteit Amsterdam, Department of Computer Science, De Boelelaan 1081, Amsterdam 1081 HV, The Netherlands
| | - Mark Hoogendoorn
- Vrije Universiteit Amsterdam, Department of Computer Science, De Boelelaan 1081, Amsterdam 1081 HV, The Netherlands
| | - Artur Rocha
- Centre for Information Systems and Computer Graphics, INESC TEC, Porto, Portugal
| | - Joao Gama
- University of Porto, Laboratory of Artificial Intelligence and Decision Support, Porto, Portugal
| | - Jeroen Ruwaard
- Vrije Universiteit Amsterdam, Department of Clinical Psychology, De Boelelaan 1081, Amsterdam 1081 HV, The Netherlands
| | - Heleen Riper
- Vrije Universiteit Amsterdam, Department of Clinical Psychology, De Boelelaan 1081, Amsterdam 1081 HV, The Netherlands
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16
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Hill C, Creswell C, Vigerland S, Nauta MH, March S, Donovan C, Wolters L, Spence SH, Martin JL, Wozney L, McLellan L, Kreuze L, Gould K, Jolstedt M, Nord M, Hudson JL, Utens E, Ruwaard J, Albers C, Khanna M, Albano AM, Serlachius E, Hrastinski S, Kendall PC. Navigating the development and dissemination of internet cognitive behavioral therapy (iCBT) for anxiety disorders in children and young people: A consensus statement with recommendations from the #iCBTLorentz Workshop Group. Internet Interv 2018; 12:1-10. [PMID: 30135763 PMCID: PMC6096322 DOI: 10.1016/j.invent.2018.02.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 12/21/2022] Open
Abstract
Initial internet-based cognitive behavioral therapy (iCBT) programs for anxiety disorders in children and young people (CYP) have been developed and evaluated, however these have not yet been widely adopted in routine practice. The lack of guidance and formalized approaches to the development and dissemination of iCBT has arguably contributed to the difficulty in developing iCBT that is scalable and sustainable beyond academic evaluation and that can ultimately be adopted by healthcare providers. This paper presents a consensus statement and recommendations from a workshop of international experts in CYP anxiety and iCBT (#iCBTLorentz Workshop Group) on the development, evaluation, engagement and dissemination of iCBT for anxiety in CYP.
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Affiliation(s)
- Claire Hill
- School of Psychology & Clinical Language Sciences, University of Reading, UK
| | - Cathy Creswell
- School of Psychology & Clinical Language Sciences, University of Reading, UK
| | - Sarah Vigerland
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
- Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Maaike H. Nauta
- Clinical Psychology and Experimental Psychopathology, University of Groningen, The Netherlands
| | - Sonja March
- School of Psychology and Counselling & Institute for Resilient Regions, University of Southern Queensland, Australia
| | | | - Lidewij Wolters
- Norwegian University of Science and Technology (NTNU), Faculty of Medicine, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Trondheim, Norway
- Academic Center for Child and Adolescent Psychiatry, de Bascule, Amsterdam, The Netherlands
| | - Susan H. Spence
- Australian Institute of Suicide Research and Prevention and School of Applied Psychology, Griffith University, Australia
| | - Jennifer L. Martin
- NIHR MindTech Cooperative, Faculty of Medicine & Health Sciences, University of Nottingham, UK
| | - Lori Wozney
- Centre for Research in Family Health, IWK Health Centre, Halifax, Canada
| | - Lauren McLellan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Australia
| | - Leonie Kreuze
- Clinical Psychology and Experimental Psychopathology, University of Groningen, The Netherlands
| | - Karen Gould
- Centre for Emotional Health, Department of Psychology, Macquarie University, Australia
| | - Maral Jolstedt
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
- Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Martina Nord
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
- Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Jennifer L. Hudson
- Centre for Emotional Health, Department of Psychology, Macquarie University, Australia
| | - Elisabeth Utens
- Academic Center for Child and Adolescent Psychiatry, de Bascule, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, The Netherlands
| | - Jeroen Ruwaard
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - Casper Albers
- Department of Psychometrics & Statistics, University of Groningen, The Netherlands
| | - Muniya Khanna
- OCD & Anxiety Institute, Plymouth Meeting, PA, USA
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Eva Serlachius
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
- Stockholm Health Care Services, Stockholm County Council, Sweden
| | | | - Philip C. Kendall
- Child & Adolescent Anxiety Disorders Clinic, Temple University, Philadelphia, PA, USA
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17
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van Breda W, Bremer V, Becker D, Hoogendoorn M, Funk B, Ruwaard J, Riper H. Predicting therapy success for treatment as usual and blended treatment in the domain of depression. Internet Interv 2018; 12:100-104. [PMID: 29862165 PMCID: PMC5945603 DOI: 10.1016/j.invent.2017.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 07/04/2017] [Revised: 08/16/2017] [Accepted: 08/16/2017] [Indexed: 11/17/2022] Open
Abstract
In this paper, we explore the potential of predicting therapy success for patients in mental health care. Such predictions can eventually improve the process of matching effective therapy types to individuals. In the EU project E-COMPARED, a variety of information is gathered about patients suffering from depression. We use this data, where 276 patients received treatment as usual and 227 received blended treatment, to investigate to what extent we are able to predict therapy success. We utilize different encoding strategies for preprocessing, varying feature selection techniques, and different statistical procedures for this purpose. Significant predictive power is found with average AUC values up to 0.7628 for treatment as usual and 0.7765 for blended treatment. Adding daily assessment data for blended treatment does currently not add predictive accuracy. Cost effectiveness analysis is needed to determine the added potential for real-world applications.
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Affiliation(s)
- Ward van Breda
- Department of Computer Science, VU University, Amsterdam, The Netherlands
| | - Vincent Bremer
- Institute of Information Systems, Leuphana University, Luneburg, Germany
| | - Dennis Becker
- Institute of Information Systems, Leuphana University, Luneburg, Germany
| | - Mark Hoogendoorn
- Department of Computer Science, VU University, Amsterdam, The Netherlands
| | - Burkhardt Funk
- Institute of Information Systems, Leuphana University, Luneburg, Germany
| | - Jeroen Ruwaard
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
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18
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Becker D, van Breda W, Funk B, Hoogendoorn M, Ruwaard J, Riper H. Predictive modeling in e-mental health: A common language framework. Internet Interv 2018; 12:57-67. [PMID: 30135769 PMCID: PMC6096321 DOI: 10.1016/j.invent.2018.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/01/2018] [Accepted: 03/02/2018] [Indexed: 11/28/2022] Open
Abstract
Recent developments in mobile technology, sensor devices, and artificial intelligence have created new opportunities for mental health care research. Enabled by large datasets collected in e-mental health research and practice, clinical researchers and members of the data mining community increasingly join forces to build predictive models for health monitoring, treatment selection, and treatment personalization. This paper aims to bridge the historical and conceptual gaps between the distant research domains involved in this new collaborative research by providing a conceptual model of common research goals. We first provide a brief overview of the data mining field and methods used for predictive modeling. Next, we propose to characterize predictive modeling research in mental health care on three dimensions: 1) time, relative to treatment (i.e., from screening to post-treatment relapse monitoring), 2) types of available data (e.g., questionnaire data, ecological momentary assessments, smartphone sensor data), and 3) type of clinical decision (i.e., whether data are used for screening purposes, treatment selection or treatment personalization). Building on these three dimensions, we introduce a framework that identifies four model types that can be used to classify existing and future research and applications. To illustrate this, we use the framework to classify and discuss published predictive modeling mental health research. Finally, in the discussion, we reflect on the next steps that are required to drive forward this promising new interdisciplinary field.
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Affiliation(s)
- Dennis Becker
- Institute of Information Systems, Leuphana University Luneburg, Germany,Corresponding author.
| | - Ward van Breda
- Faculty of Science, Department of Computer Science, Vrije Universiteit Amsterdam, De Boelelaan 1081, 1081 HV Amsterdam, The Netherlands
| | - Burkhardt Funk
- Institute of Information Systems, Leuphana University Luneburg, Germany
| | - Mark Hoogendoorn
- Institute of Information Systems, Leuphana University Luneburg, Germany
| | - Jeroen Ruwaard
- Department of Research & Innovation, GGZ inGeest, Amsterdam, P.O. Box 7057, Amsterdam MB 1007, The Netherlands,Faculty of Behavioural and Movement Sciences, Department of Clinical, Neuro- and Developmental Psychology, Clinical Psychology Section, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Research & Innovation, GGZ inGeest, Amsterdam, P.O. Box 7057, Amsterdam MB 1007, The Netherlands,Faculty of Behavioural and Movement Sciences, Department of Clinical, Neuro- and Developmental Psychology, Clinical Psychology Section, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
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19
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Ruwaard J, l'Ami MJ, Marsman AF, Kneepkens EL, van Denderen JC, van der Horst-Bruinsma IE, Nurmohamed MT, Wolbink G. Comparison of drug survival and clinical outcome in patients with ankylosing spondylitis treated with etanercept or adalimumab. Scand J Rheumatol 2017; 47:122-126. [PMID: 28745108 DOI: 10.1080/03009742.2017.1330419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To compare rates of drug survival and clinical response during 2 years of follow-up in ankylosing spondylitis (AS) patients treated with etanercept or adalimumab in routine care. METHOD Biological-naïve consecutive AS patients treated with etanercept (n = 163) or adalimumab (n = 82) were followed. Treatment discontinuation was due to inefficacy, adverse events, loss to follow-up, planning a pregnancy, or uveitis. Disease activity was assessed by the Ankylosing Spondylitis Disease Activity Score using C-reactive protein (ASDAS-CRP). Moderate disease activity was defined as an ASDAS-CRP < 2.1. RESULTS Twenty-seven patients (32.9%) treated with adalimumab and 30 (18.4%) with etanercept discontinued treatment. Cox regression analysis demonstrated a significant difference in survival rate between discontinuation of the drug in adalimumab patients compared with etanercept patients [hazard ratio (HR) 2.1, 95% confidence interval (CI) 1.3-4.5, p = 0.005; corrected for confounding factors: HR 2.5, 95% CI 1.3-4.5, p = 0.006]. There was no significant difference at 2 years of follow-up between the adalimumab- and the etanercept-treated patients in mean ± sd ASDAS-CRP (1.9 ± 1.1 and 2.0 ± 0.9, respectively, p = 0.624), and 23 out of 34 (67.6%) compared to 71 out of 117 (60.7%) reached ASDAS-CRP moderate disease activity (odds ratio 0.738, 95% CI 0.329-1.657, p = 0.530). CONCLUSION No significant difference was found between AS patients treated with etanercept and those treated with adalimumab in mean ASDAS-CRP and reaching ASDAS-CRP minimal disease activity at 2 year follow-up. Drug survival rate was higher in etanercept- compared to adalimumab-treated patients. However, this should be interpreted cautiously as the risk of allocation bias cannot be excluded.
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Affiliation(s)
- J Ruwaard
- a Rheumatology , Amsterdam Rheumatology and Immunology Center, Location Reade , Amsterdam , The Netherlands
| | - M J l'Ami
- a Rheumatology , Amsterdam Rheumatology and Immunology Center, Location Reade , Amsterdam , The Netherlands
| | - A F Marsman
- a Rheumatology , Amsterdam Rheumatology and Immunology Center, Location Reade , Amsterdam , The Netherlands
| | - E L Kneepkens
- a Rheumatology , Amsterdam Rheumatology and Immunology Center, Location Reade , Amsterdam , The Netherlands
| | - J C van Denderen
- a Rheumatology , Amsterdam Rheumatology and Immunology Center, Location Reade , Amsterdam , The Netherlands
| | - I E van der Horst-Bruinsma
- b Rheumatology , Amsterdam Rheumatology and Immunology Center, Location VU Medical Center , Amsterdam , The Netherlands
| | - M T Nurmohamed
- a Rheumatology , Amsterdam Rheumatology and Immunology Center, Location Reade , Amsterdam , The Netherlands.,b Rheumatology , Amsterdam Rheumatology and Immunology Center, Location VU Medical Center , Amsterdam , The Netherlands
| | - G Wolbink
- a Rheumatology , Amsterdam Rheumatology and Immunology Center, Location Reade , Amsterdam , The Netherlands.,c Department of Immunopathology , Sanquin Research and Landsteiner Laboratory Academic Medical Centre , Amsterdam , The Netherlands
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van de Ven P, O’Brien H, Henriques R, Klein M, Msetfi R, Nelson J, Rocha A, Ruwaard J, O’Sullivan D, Riper H. ULTEMAT: A mobile framework for smart ecological momentary assessments and interventions. Internet Interv 2017; 9:74-81. [PMID: 30135840 PMCID: PMC6096290 DOI: 10.1016/j.invent.2017.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 05/09/2017] [Revised: 06/22/2017] [Accepted: 07/01/2017] [Indexed: 11/25/2022] Open
Abstract
In this paper we introduce a new Android library, called ULTEMAT, for the delivery of ecological momentary assessments (EMAs) on mobile devices and we present its use in the MoodBuster app developed in the H2020 E-COMPARED project. We discuss context-aware, or event-based, triggers for the presentation of EMAs and discuss the potential they have to improve the effectiveness of mobile provision of mental health interventions as they allow for the delivery of assessments to the patients when and where these are most appropriate. Following this, we present the abilities of ULTEMAT to use such context-aware triggers to schedule EMAs and we discuss how a similar approach can be used for Ecological Momentary Interventions (EMIs).
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Affiliation(s)
- Pepijn van de Ven
- University of Limerick, Limerick, Ireland,Corresponding author at: Main Building C2057, University of Limerick, Limerick, Ireland.
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Provoost S, Lau HM, Ruwaard J, Riper H. Embodied Conversational Agents in Clinical Psychology: A Scoping Review. J Med Internet Res 2017; 19:e151. [PMID: 28487267 PMCID: PMC5442350 DOI: 10.2196/jmir.6553] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 01/07/2017] [Accepted: 03/07/2017] [Indexed: 11/13/2022] Open
Abstract
Background Embodied conversational agents (ECAs) are computer-generated characters that simulate key properties of human face-to-face conversation, such as verbal and nonverbal behavior. In Internet-based eHealth interventions, ECAs may be used for the delivery of automated human support factors. Objective We aim to provide an overview of the technological and clinical possibilities, as well as the evidence base for ECA applications in clinical psychology, to inform health professionals about the activity in this field of research. Methods Given the large variety of applied methodologies, types of applications, and scientific disciplines involved in ECA research, we conducted a systematic scoping review. Scoping reviews aim to map key concepts and types of evidence underlying an area of research, and answer less-specific questions than traditional systematic reviews. Systematic searches for ECA applications in the treatment of mood, anxiety, psychotic, autism spectrum, and substance use disorders were conducted in databases in the fields of psychology and computer science, as well as in interdisciplinary databases. Studies were included if they conveyed primary research findings on an ECA application that targeted one of the disorders. We mapped each study’s background information, how the different disorders were addressed, how ECAs and users could interact with one another, methodological aspects, and the study’s aims and outcomes. Results This study included N=54 publications (N=49 studies). More than half of the studies (n=26) focused on autism treatment, and ECAs were used most often for social skills training (n=23). Applications ranged from simple reinforcement of social behaviors through emotional expressions to sophisticated multimodal conversational systems. Most applications (n=43) were still in the development and piloting phase, that is, not yet ready for routine practice evaluation or application. Few studies conducted controlled research into clinical effects of ECAs, such as a reduction in symptom severity. Conclusions ECAs for mental disorders are emerging. State-of-the-art techniques, involving, for example, communication through natural language or nonverbal behavior, are increasingly being considered and adopted for psychotherapeutic interventions in ECA research with promising results. However, evidence on their clinical application remains scarce. At present, their value to clinical practice lies mostly in the experimental determination of critical human support factors. In the context of using ECAs as an adjunct to existing interventions with the aim of supporting users, important questions remain with regard to the personalization of ECAs’ interaction with users, and the optimal timing and manner of providing support. To increase the evidence base with regard to Internet interventions, we propose an additional focus on low-tech ECA solutions that can be rapidly developed, tested, and applied in routine practice.
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Affiliation(s)
- Simon Provoost
- Department of Clinical, Neuro & Developmental Psychology, Section Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, Netherlands
| | - Ho Ming Lau
- EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, Netherlands.,GGZ inGeest, Amsterdam, Netherlands
| | - Jeroen Ruwaard
- Department of Clinical, Neuro & Developmental Psychology, Section Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro & Developmental Psychology, Section Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, Netherlands.,GGZ inGeest, Amsterdam, Netherlands.,Telepsychiatry Unit, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
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Schuurmans J, van der Linden JL, van Ballegooijen W, Ruwaard J, Stek ML, Smit JH, Riper H. Tablet-based support for older adults with severe mood disorders treated in an ambulatory geriatric psychiatry setting: Protocol of a feasibility study of the eCare@Home platform. Internet Interv 2016; 6:22-28. [PMID: 30135811 PMCID: PMC6096249 DOI: 10.1016/j.invent.2016.09.001] [Citation(s) in RCA: 2] [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: 04/18/2016] [Revised: 09/01/2016] [Accepted: 09/01/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Although older adults are just as likely to benefit from e-mental health as their younger counterparts, there are virtually no applications specifically designed to accommodate the needs of older adults with recurrent depression or bipolar disorder. Recurrent mood disorders constitute a large and rising proportion of the global disease in older populations, indicating a need for more e-mental health applications targeting this group. This paper describes the theoretical background and methodology of a study examining the feasibility of a tablet-based self-management platform for older adults with recurrent mood disorders. The eCare@Home platform was designed to 1) improve patients' awareness and knowledge of recurrent mood disorders and their treatment, 2) promote self-management through the use of a simple daily monitoring tool, and 3) facilitate online contact with their clinician through videoconferencing. METHODS The design involves a single-group four-month pilot study, with measurements at baseline (T0), and at weeks 8 and 16 (T1 and T2). The target group consists of older outpatients (aged 60 or above) who are undergoing treatment for recurrent depressive or bipolar disorder (N = 50), and their clinicians (N = 10). Primary feasibility endpoints will be system acceptability, system usability, and client satisfaction with the platform. In addition, qualitative data from semi-structured interviews in N = 10 patients and N = 5 clinicians will be gathered to provide more insight into user experiences and evaluations of the platform's added value. DISCUSSION To the best of our knowledge, this is the first study to evaluate the feasibility and acceptability of a tablet-based e-mental health platform for older adults with severe mood disorders. If tablet-based support for this group is shown to be feasible, the intention is to proceed with the design of a large-scale process and outcome evaluation. The strengths and limitations of the methodology used are addressed in this article.Trial Registration: registration is pending.
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Affiliation(s)
- Josien Schuurmans
- Department of Research & Innovation, GGZ inGeest, Amsterdam, P.O. Box 7057, Amsterdam MB 1007, The Netherlands
| | - Juliette L. van der Linden
- Department of Research & Innovation, GGZ inGeest, Amsterdam, P.O. Box 7057, Amsterdam MB 1007, The Netherlands
- Department of Psychiatry and EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, The Netherlands
| | - Wouter van Ballegooijen
- Department of Research & Innovation, GGZ inGeest, Amsterdam, P.O. Box 7057, Amsterdam MB 1007, The Netherlands
- Department of Psychiatry and EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, The Netherlands
- Faculty of Behavioural and Movement Sciences/Department of Clinical, Neuro- and Developmental Psychology, Clinical Psychology section, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Jeroen Ruwaard
- Faculty of Behavioural and Movement Sciences/Department of Clinical, Neuro- and Developmental Psychology, Clinical Psychology section, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Max L. Stek
- Department of Research & Innovation, GGZ inGeest, Amsterdam, P.O. Box 7057, Amsterdam MB 1007, The Netherlands
- Department of Psychiatry and EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, The Netherlands
| | - Jan H. Smit
- Department of Research & Innovation, GGZ inGeest, Amsterdam, P.O. Box 7057, Amsterdam MB 1007, The Netherlands
- Department of Psychiatry and EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Research & Innovation, GGZ inGeest, Amsterdam, P.O. Box 7057, Amsterdam MB 1007, The Netherlands
- Department of Psychiatry and EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, The Netherlands
- Faculty of Behavioural and Movement Sciences/Department of Clinical, Neuro- and Developmental Psychology, Clinical Psychology section, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
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van Ballegooijen W, Ruwaard J, Karyotaki E, Ebert DD, Smit JH, Riper H. Reactivity to smartphone-based ecological momentary assessment of depressive symptoms (MoodMonitor): protocol of a randomised controlled trial. BMC Psychiatry 2016; 16:359. [PMID: 27769201 PMCID: PMC5075187 DOI: 10.1186/s12888-016-1065-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 10/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ecological momentary assessment (EMA) of mental health symptoms may influence the symptoms that it measures, i.e. assessment reactivity. In the field of depression, EMA reactivity has received little attention. We aim to investigate whether EMA of depressive symptoms induces assessment reactivity. Reactivity will be operationalised as an effect of EMA on depressive symptoms measured by a retrospective questionnaire, and, secondly, as a change in response rate and variance of the EMA ratings. METHODS This study is a 12-week randomised controlled trial comprising three groups: group 1 carries out EMA of mood and completes a retrospective questionnaire, group 2 carries out EMA of how energetic they feel and completes a retrospective questionnaire, group 3 is the control group, which completes only the retrospective questionnaire. The retrospective questionnaire (Centre for Epidemiologic Studies Depression scale; CES-D) assesses depressive symptoms and is administered at baseline, 6 weeks after baseline and 12 weeks after baseline. We aim to recruit 160 participants who experience mild to moderate depressive symptoms, defined as a Patient Health Questionnaire (PHQ-9) score of 5 to 15. This study is powered to detect a small between-groups effect, where no clinically relevant effect is defined as the effect size margin -0.25< d <0.25. DISCUSSION To our knowledge, this is the first study to investigate whether self-rated EMA of depressive symptoms could induce assessment reactivity among mildly depressed individuals. TRIAL REGISTRATION Netherlands Trial Register NTR5803. Registered 12 April 2016. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5803 .
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Affiliation(s)
- Wouter van Ballegooijen
- Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, Netherlands. .,Department of Psychiatry, VU Medical Centre/GGZ inGeest, Amsterdam, Netherlands.
| | - Jeroen Ruwaard
- Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, Netherlands
| | - Eirini Karyotaki
- Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, Netherlands
| | - David D. Ebert
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Johannes H. Smit
- Department of Psychiatry, VU Medical Centre/GGZ inGeest, Amsterdam, Netherlands
| | - Heleen Riper
- Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, Netherlands
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Ebert DD, Donkin L, Andersson G, Andrews G, Berger T, Carlbring P, Rozenthal A, Choi I, Laferton JAC, Johansson R, Kleiboer A, Lange A, Lehr D, Reins JA, Funk B, Newby J, Perini S, Riper H, Ruwaard J, Sheeber L, Snoek FJ, Titov N, Ince BÜ, van Bastelaar K, Vernmark K, van Straten A, Warmerdam L, Salsman N, Cuijpers P. Does Internet-based guided-self-help for depression cause harm? An individual participant data meta-analysis on deterioration rates and its moderators in randomized controlled trials. Psychol Med 2016; 46:2679-2693. [PMID: 27649340 PMCID: PMC5560500 DOI: 10.1017/s0033291716001562] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Almost nothing is known about the potential negative effects of Internet-based psychological treatments for depression. This study aims at investigating deterioration and its moderators within randomized trials on Internet-based guided self-help for adult depression, using an individual patient data meta-analyses (IPDMA) approach. METHOD Studies were identified through systematic searches (PubMed, PsycINFO, EMBASE, Cochrane Library). Deterioration in participants was defined as a significant symptom increase according to the reliable change index (i.e. 7.68 points in the CES-D; 7.63 points in the BDI). Two-step IPDMA procedures, with a random-effects model were used to pool data. RESULTS A total of 18 studies (21 comparisons, 2079 participants) contributed data to the analysis. The risk for a reliable deterioration from baseline to post-treatment was significantly lower in the intervention v. control conditions (3.36 v. 7.60; relative risk 0.47, 95% confidence interval 0.29-0.75). Education moderated effects on deterioration, with patients with low education displaying a higher risk for deterioration than patients with higher education. Deterioration rates for patients with low education did not differ statistically significantly between intervention and control groups. The benefit-risk ratio for patients with low education indicated that 9.38 patients achieve a treatment response for each patient experiencing a symptom deterioration. CONCLUSIONS Internet-based guided self-help is associated with a mean reduced risk for a symptom deterioration compared to controls. Treatment and symptom progress of patients with low education should be closely monitored, as some patients might face an increased risk for symptom deterioration. Future studies should examine predictors of deterioration in patients with low education.
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Affiliation(s)
- D. D. Ebert
- Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - L. Donkin
- The Brain and Mind Research Institute, University of Sydney, NSW, Australia
- Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, the Netherlands
| | - G. Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - G. Andrews
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent’s Hospital, Darlinghurst, NSW, Australia
| | - T. Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - P. Carlbring
- Department of Psychology, Stockholm University, Sweden
| | - A. Rozenthal
- Department of Psychology, Stockholm University, Sweden
| | - I. Choi
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | | | - R. Johansson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - A. Kleiboer
- Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, the Netherlands
| | - A. Lange
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - D. Lehr
- Leuphana University Lüneburg, Germany
| | | | - B. Funk
- Leuphana University Lüneburg, Germany
| | - J. Newby
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent’s Hospital, Darlinghurst, NSW, Australia
| | - S. Perini
- Centre for Emotional Health, Macquarie University, Australia
| | - H. Riper
- Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, the Netherlands
| | - J. Ruwaard
- Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, the Netherlands
| | - L. Sheeber
- Oregon Research Institute, Eugene, Oregon, USA
| | - F. J. Snoek
- Department of Medical Psychology, VU University Medical Center Amsterdam, The Netherlands
- Academic Medical Center/University of Amsterdam, The Netherlands
| | - N. Titov
- eCentreClinic and MindSpot Clinic, Department of Psychology, Macquarie University, Australia
| | - B. Ünlü Ince
- Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, the Netherlands
| | - K. van Bastelaar
- Department of Medical Psychology, VU University Medical Center Amsterdam, The Netherlands
| | - K. Vernmark
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Psykologpartners, Private Practice, Linköping, Sweden
| | - A. van Straten
- Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, the Netherlands
| | - L. Warmerdam
- Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, the Netherlands
| | - N. Salsman
- School of Psychology, Xavier University, Cincinnati, USA
| | - P. Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, the Netherlands
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Kleiboer A, Smit J, Bosmans J, Ruwaard J, Andersson G, Topooco N, Berger T, Krieger T, Botella C, Baños R, Chevreul K, Araya R, Cerga-Pashoja A, Cieślak R, Rogala A, Vis C, Draisma S, van Schaik A, Kemmeren L, Ebert D, Berking M, Funk B, Cuijpers P, Riper H. European COMPARative Effectiveness research on blended Depression treatment versus treatment-as-usual (E-COMPARED): study protocol for a randomized controlled, non-inferiority trial in eight European countries. Trials 2016; 17:387. [PMID: 27488181 PMCID: PMC4972947 DOI: 10.1186/s13063-016-1511-1] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 06/17/2016] [Indexed: 12/28/2022] Open
Abstract
Background Effective, accessible, and affordable depression treatment is of high importance considering the large personal and economic burden of depression. Internet-based treatment is considered a promising clinical and cost-effective alternative to current routine depression treatment strategies such as face-to-face psychotherapy. However, it is not clear whether research findings translate to routine clinical practice such as primary or specialized mental health care. The E-COMPARED project aims to gain knowledge on the clinical and cost-effectiveness of blended depression treatment compared to treatment-as-usual in routine care. Methods/design E-COMPARED will employ a pragmatic, multinational, randomized controlled, non-inferiority trial in eight European countries. Adults diagnosed with major depressive disorder (MDD) will be recruited in primary care (Germany, Poland, Spain, Sweden, and the United Kingdom) or specialized mental health care (France, The Netherlands, and Switzerland). Regular care for depression is compared to “blended” service delivery combining mobile and Internet technologies with face-to-face treatment in one treatment protocol. Participants will be followed up at 3, 6, and 12 months after baseline to determine clinical improvements in symptoms of depression (primary outcome: Patient Health Questionnaire-9), remission of depression, and cost-effectiveness. Main analyses will be conducted on the pooled data from the eight countries (n = 1200 in total, 150 participants in each country). Discussion The E-COMPARED project will provide mental health care stakeholders with evidence-based information and recommendations on the clinical and cost-effectiveness of blended depression treatment. Trial registration France: ClinicalTrials.gov NCT02542891. Registered on 4 September 2015; Germany: German Clinical Trials Register DRKS00006866. Registered on 2 December 2014; The Netherlands: Netherlands Trials Register NTR4962. Registered on 5 January 2015; Poland: ClinicalTrials.Gov NCT02389660. Registered on 18 February 2015; Spain: ClinicalTrials.gov NCT02361684. Registered on 8 January 2015; Sweden: ClinicalTrials.gov NCT02449447. Registered on 30 March 2015; Switzerland: ClinicalTrials.gov NCT02410616. Registered on 2 April 2015; United Kingdom: ISRCTN registry, ISRCTN12388725. Registered on 20 March 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1511-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annet Kleiboer
- Section Clinical Psychology, Vrije Universiteit Amsterdam and EMGO+ Institute for Health Care and Research, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
| | - Jan Smit
- Department of Psychiatry, VU University Medical Centre and EMGO+ Institute for Health Care and Research, Amsterdam, The Netherlands
| | - Judith Bosmans
- Department of Health Sciences, Vrije Universiteit Amsterdam and EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Jeroen Ruwaard
- Section Clinical Psychology, Vrije Universiteit Amsterdam and EMGO+ Institute for Health Care and Research, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden
| | - Naira Topooco
- Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Tobias Krieger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Cristina Botella
- Department of Psychology and Technology, Jaume University, Castellon, Spain.,Department of Personalidad, Evaluación y Tratamiento Psicológicos, Valencia, Spain
| | - Rosa Baños
- Department of Personalidad, Evaluación y Tratamiento Psicológicos, Valencia, Spain
| | | | - Ricardo Araya
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Arlinda Cerga-Pashoja
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Roman Cieślak
- Department of Psychology, Szkoła Wyzsza Psychologii Społeczne, University of Social Sciences and Humanities, Warsaw, Poland
| | - Anna Rogala
- Department of Psychology, Szkoła Wyzsza Psychologii Społeczne, University of Social Sciences and Humanities, Warsaw, Poland
| | - Christiaan Vis
- Section Clinical Psychology, Vrije Universiteit Amsterdam and EMGO+ Institute for Health Care and Research, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
| | - Stasja Draisma
- Department of Psychiatry, VU University Medical Centre and EMGO+ Institute for Health Care and Research, Amsterdam, The Netherlands
| | - Anneke van Schaik
- Department of Psychiatry, VU University Medical Centre and EMGO+ Institute for Health Care and Research, Amsterdam, The Netherlands
| | - Lise Kemmeren
- Department of Psychiatry, VU University Medical Centre and EMGO+ Institute for Health Care and Research, Amsterdam, The Netherlands
| | - David Ebert
- Department of Clinical Psychology, Philipps University, Marburg, Germany
| | - Matthias Berking
- Department of Clinical Psychology, Philipps University, Marburg, Germany
| | - Burkhardt Funk
- Institut für elektronische Geschäftsprozesse, Leuphana University Lüneburg, Lüneburg, Germany
| | - Pim Cuijpers
- Section Clinical Psychology, Vrije Universiteit Amsterdam and EMGO+ Institute for Health Care and Research, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
| | - Heleen Riper
- Section Clinical Psychology, Vrije Universiteit Amsterdam and EMGO+ Institute for Health Care and Research, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.,Department of Psychiatry, VU University Medical Centre and EMGO+ Institute for Health Care and Research, Amsterdam, The Netherlands
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l'Ami M, Marsman A, Krieckaert C, Ruwaard J, Kneepkens E, Nurmohamed M, Wolbink G. AB0324 Tapering of Adalimumab Based on Therapeutic Drug Monitoring in Rheumatoid Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ruwaard J, l'Ami M, Marsman A, Kneepkens E, van der Horst-Bruinsma I, van Denderen C, Nurmohamed M, Wolbink G. SAT0397 Comparison of Long-Term Drug Survival Outcome with Etanercept Treatment and Adalimumab Treatment of Ankylosing Spondylitis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Asselbergs J, Ruwaard J, Ejdys M, Schrader N, Sijbrandij M, Riper H. Mobile Phone-Based Unobtrusive Ecological Momentary Assessment of Day-to-Day Mood: An Explorative Study. J Med Internet Res 2016; 18:e72. [PMID: 27025287 PMCID: PMC4829730 DOI: 10.2196/jmir.5505] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 02/14/2016] [Indexed: 11/13/2022] Open
Abstract
Background Ecological momentary assessment (EMA) is a useful method to tap the dynamics of psychological and behavioral phenomena in real-world contexts. However, the response burden of (self-report) EMA limits its clinical utility. Objective The aim was to explore mobile phone-based unobtrusive EMA, in which mobile phone usage logs are considered as proxy measures of clinically relevant user states and contexts. Methods This was an uncontrolled explorative pilot study. Our study consisted of 6 weeks of EMA/unobtrusive EMA data collection in a Dutch student population (N=33), followed by a regression modeling analysis. Participants self-monitored their mood on their mobile phone (EMA) with a one-dimensional mood measure (1 to 10) and a two-dimensional circumplex measure (arousal/valence, –2 to 2). Meanwhile, with participants’ consent, a mobile phone app unobtrusively collected (meta) data from six smartphone sensor logs (unobtrusive EMA: calls/short message service (SMS) text messages, screen time, application usage, accelerometer, and phone camera events). Through forward stepwise regression (FSR), we built personalized regression models from the unobtrusive EMA variables to predict day-to-day variation in EMA mood ratings. The predictive performance of these models (ie, cross-validated mean squared error and percentage of correct predictions) was compared to naive benchmark regression models (the mean model and a lag-2 history model). Results A total of 27 participants (81%) provided a mean 35.5 days (SD 3.8) of valid EMA/unobtrusive EMA data. The FSR models accurately predicted 55% to 76% of EMA mood scores. However, the predictive performance of these models was significantly inferior to that of naive benchmark models. Conclusions Mobile phone-based unobtrusive EMA is a technically feasible and potentially powerful EMA variant. The method is young and positive findings may not replicate. At present, we do not recommend the application of FSR-based mood prediction in real-world clinical settings. Further psychometric studies and more advanced data mining techniques are needed to unlock unobtrusive EMA’s true potential.
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Affiliation(s)
- Joost Asselbergs
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
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Marsman AF, Kneepkens EL, Ruwaard J, Wei JC, Nurmohamed MT, van Denderen C, van der Horst-Bruinsma IE, Rispens T, Wolbink G. Search for a concentration–effect curve of adalimumab in ankylosing spondylitis patients. Scand J Rheumatol 2016; 45:331-4. [DOI: 10.3109/03009742.2015.1114666] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- AF Marsman
- Amsterdam Rheumatology and Immunology Centre, location Reade, Amsterdam, The Netherlands
| | - EL Kneepkens
- Amsterdam Rheumatology and Immunology Centre, location Reade, Amsterdam, The Netherlands
| | - J Ruwaard
- Amsterdam Rheumatology and Immunology Centre, location Reade, Amsterdam, The Netherlands
| | - JC Wei
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - MT Nurmohamed
- Amsterdam Rheumatology and Immunology Centre, location Reade, Amsterdam, The Netherlands
- Amsterdam Rheumatology and Immunology Centre, location VU University Medical Centre, Amsterdam, The Netherlands
| | - C van Denderen
- Amsterdam Rheumatology and Immunology Centre, location Reade, Amsterdam, The Netherlands
| | - IE van der Horst-Bruinsma
- Amsterdam Rheumatology and Immunology Centre, location Reade, Amsterdam, The Netherlands
- Amsterdam Rheumatology and Immunology Centre, location VU University Medical Centre, Amsterdam, The Netherlands
| | - T Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Centre, Amsterdam, The Netherlands
| | - G Wolbink
- Amsterdam Rheumatology and Immunology Centre, location Reade, Amsterdam, The Netherlands
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Centre, Amsterdam, The Netherlands
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Ruwaard J, Kneepkens E, Marsman A, Vogelzang E, van der Horst-Bruinsma I, Rispens T, Nurmohamed M, Wolbink G. THU0208 Efficacy of Switching Tumor Necrosis Factor α Inhibitor to a Second Tumor Necrosis Factor α Inhibitor and the Influence of Drug Levels and Anti-Drug Antibodies in Patients with Ankylosing Spondylitis and Psoriatic Arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Marsman A, Kneepkens E, Ruwaard J, Cheng-Chung Wei J, Rispens T, Nurmohamed M, van Denderen C, van der Horst-Bruinsma I, Wolbink G. THU0243 A Concentration-Effect Curve of Adalimumab in Ankylosing Spondylitis Patients; Does it Exist or Not? Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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l'Ami M, Kneepkens E, Krieckaert C, Marsman A, Ruwaard J, Wolbink G, Nurmohamed M. SAT0156 The Effect of Methotrexate in Treatment with Adalimumab And Etanercept in Patients with Rheumatoid Arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Knaevelsrud C, Brand J, Lange A, Ruwaard J, Wagner B. Web-based psychotherapy for posttraumatic stress disorder in war-traumatized Arab patients: randomized controlled trial. J Med Internet Res 2015; 17:e71. [PMID: 25799024 PMCID: PMC4385175 DOI: 10.2196/jmir.3582] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 09/01/2014] [Accepted: 11/26/2014] [Indexed: 01/27/2023] Open
Abstract
Background In recent years, armed conflicts in the Middle East have resulted in high rates of exposure to traumatic events. Despite the increasing demand of mental health care provision, ongoing violence limits conventional approaches of mental health care provision. Internet-based interventions for posttraumatic stress disorder (PTSD) have proved feasible and effective in Western countries, but their applicability and efficacy in war and conflict regions remains unknown. Objective This study investigated the efficacy of a cognitive behavioral Internet-based intervention for war-traumatized Arab patients, with focus on Iraq. Methods A total of 159 individuals with PTSD participated in a parallel group randomized trial. Participants were randomly allocated by a computer-generated sequence to a treatment group (n=79) or a waiting list control group (n=80). The treatment group received 2 weekly 45-minute cognitive behavioral interventions via Internet over a 5-week period (10 sessions in total). The primary outcome was recovery from posttraumatic stress symptoms. Results Posttraumatic stress symptoms were significantly reduced from baseline to posttreatment (intention-to-treat analysis) in the treatment group relative to the control group (F1,157=44.29, P<.001, d=0.92). Treatment effects were sustained at 3-month follow-up. Completer analysis indicated that 29 of 47 patients (62%) in the treatment group had recovered from posttraumatic stress symptoms at posttreatment (reliable change and Posttraumatic Stress Diagnostic Scale score <20) versus 1 patient (2%) in the control group (OR 74.19, 95% CI 9.93-585.8, P<.001) indicating that the chance of recovering was 74.19 times higher in the treatment than in the control group. Conclusions The results indicate, even in unstable and insecure settings with ongoing exposure to human rights violations through war and dictatorships, people with posttraumatic stress symptoms benefit from a cognitive behavioral treatment provided entirely through the Internet. This method of delivery could improve patients’ access to humanitarian aid in the form of e-mental health services. Trial Registration Australian New Zealand Clinical Trial Registry, ACTRN12611001019998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=347505 (Archived by WebCite at http://www.webcitation.org/6Wto4HCdH).
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Kooistra LC, Wiersma JE, Ruwaard J, van Oppen P, Smit F, Lokkerbol J, Cuijpers P, Riper H. Blended vs. face-to-face cognitive behavioural treatment for major depression in specialized mental health care: study protocol of a randomized controlled cost-effectiveness trial. BMC Psychiatry 2014; 14:290. [PMID: 25326035 PMCID: PMC4209039 DOI: 10.1186/s12888-014-0290-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [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: 09/29/2014] [Accepted: 10/08/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Depression is a prevalent disorder, associated with a high disease burden and substantial societal, economic and personal costs. Cognitive behavioural treatment has been shown to provide adequate treatment for depression. By offering this treatment in a blended format, in which online and face-to-face treatment are combined, it might be possible to reduce the number of costly face-to-face sessions required to deliver the treatment protocol. This could improve the cost-effectiveness of treatment, while maintaining clinical effects. This protocol describes the design of a pilot study for the evaluation of the feasibility, acceptability and cost-effectiveness of blended cognitive behavioural therapy for patients with major depressive disorder in specialized outpatient mental health care. METHODS/DESIGN In a randomized controlled trial design, adult patients with major depressive disorder are allocated to either blended cognitive behavioural treatment or traditional face-to-face cognitive behavioural treatment (treatment as usual). We aim to recruit one hundred and fifty patients. Blended treatment will consist of ten face-to-face and nine online sessions provided alternately on a weekly basis. Traditional cognitive behavioural treatment will consist of twenty weekly sessions. Costs and effects are measured at baseline and after 10, 20 and 30 weeks. Evaluations are directed at cost-effectiveness (with depression severity and diagnostic status as outcomes), and cost-utility (with costs per quality adjusted life year, QALY, as outcome). Costs will encompass health care uptake costs and productivity losses due to absence from work and lower levels of efficiency while at work. Other measures of interest are mastery, working alliance, treatment preference at baseline, depressive cognitions, treatment satisfaction and system usability. DISCUSSION The results of this pilot study will provide an initial insight into the feasibility and acceptability of blended cognitive behavioural treatment in terms of clinical and economic outcomes (proof of concept) in routine specialized mental health care settings, and an indication as to whether a well-powered clinical trial of blended cognitive behavioural treatment for depression in routine practice would be advisable. This will be determined based on the perspective of various stakeholders including patients, mental health service providers and health insurers. Strengths and limitations of the study are discussed. TRIAL REGISTRATION Netherlands Trial Register NTR4650 . Registered 18 June 2014.
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Affiliation(s)
- Lisa C Kooistra
- Faculty of Psychology and Education, Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, BT, 1081, Amsterdam, the Netherlands. .,EMGO institute for Health Care and Research, VU University Medical Centre, Van der Boechorststraat 7, BT, 1081, Amsterdam, the Netherlands.
| | - Jenneke E Wiersma
- EMGO institute for Health Care and Research, VU University Medical Centre, Van der Boechorststraat 7, BT, 1081, Amsterdam, the Netherlands. .,Department of Psychiatry, GGZ inGeest and VU University Medical Centre, P.O. Box 7057, Amsterdam, MB, 1007, the Netherlands.
| | - Jeroen Ruwaard
- Faculty of Psychology and Education, Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, BT, 1081, Amsterdam, the Netherlands. .,EMGO institute for Health Care and Research, VU University Medical Centre, Van der Boechorststraat 7, BT, 1081, Amsterdam, the Netherlands.
| | - Patricia van Oppen
- EMGO institute for Health Care and Research, VU University Medical Centre, Van der Boechorststraat 7, BT, 1081, Amsterdam, the Netherlands. .,Department of Psychiatry, GGZ inGeest and VU University Medical Centre, P.O. Box 7057, Amsterdam, MB, 1007, the Netherlands.
| | - Filip Smit
- Faculty of Psychology and Education, Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, BT, 1081, Amsterdam, the Netherlands. .,EMGO institute for Health Care and Research, VU University Medical Centre, Van der Boechorststraat 7, BT, 1081, Amsterdam, the Netherlands. .,Trimbos Institute, P.O. Box 725, Utrecht, AS, 3500, the Netherlands. .,Department of Epidemiology and Biostatistics, VU University Medical Centre, P.O. Box 725, Utrecht, AS, 3500, the Netherlands.
| | - Joran Lokkerbol
- Faculty of Psychology and Education, Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, BT, 1081, Amsterdam, the Netherlands. .,EMGO institute for Health Care and Research, VU University Medical Centre, Van der Boechorststraat 7, BT, 1081, Amsterdam, the Netherlands. .,Trimbos Institute, P.O. Box 725, Utrecht, AS, 3500, the Netherlands.
| | - Pim Cuijpers
- Faculty of Psychology and Education, Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, BT, 1081, Amsterdam, the Netherlands. .,EMGO institute for Health Care and Research, VU University Medical Centre, Van der Boechorststraat 7, BT, 1081, Amsterdam, the Netherlands. .,Leuphana University, Innovation Incubator, Division Health Trainings online, Rotenbleicher Weg 67, Lüneburg, 21335, Germany.
| | - Heleen Riper
- Faculty of Psychology and Education, Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, BT, 1081, Amsterdam, the Netherlands. .,EMGO institute for Health Care and Research, VU University Medical Centre, Van der Boechorststraat 7, BT, 1081, Amsterdam, the Netherlands. .,Leuphana University, Innovation Incubator, Division Health Trainings online, Rotenbleicher Weg 67, Lüneburg, 21335, Germany.
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Ünlü Ince B, Fassaert T, de Wit MAS, Cuijpers P, Smit J, Ruwaard J, Riper H. The relationship between acculturation strategies and depressive and anxiety disorders in Turkish migrants in the Netherlands. BMC Psychiatry 2014; 14:252. [PMID: 25189615 PMCID: PMC4172911 DOI: 10.1186/s12888-014-0252-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 08/27/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Turkish migrants in the Netherlands have a high prevalence of depressive and/or anxiety disorders. Acculturation has been shown to be related to higher levels of psychological distress, although it is not clear whether this also holds for depressive and anxiety disorders in Turkish migrants. This study aims to clarify the relationship between acculturation strategies (integration, assimilation, separation and marginalization) and the prevalence of depressive and anxiety disorders as well as utilisation of GP care among Turkish migrants. METHODS Existing data from an epidemiological study conducted among Dutch, Turkish and Moroccan inhabitants of Amsterdam were re-examined. Four scales of acculturation strategies were created in combination with the bi-dimensional approach of acculturation by factor analysis. The Lowlands Acculturation Scale and the Composite International Diagnostic Interview were used to assess acculturation and mood and anxiety disorders. Socio-demographic variables, depressive, anxiety and co-morbidity of both disorders and the use of health care services were associated with the four acculturation strategies by means of Chi-Squared and Likelihood tests. Three two-step logistic regression analyses were performed to control for possible, confounding variables. RESULTS The sample consisted of 210 Turkish migrants. Significant associations were found between the acculturation strategies and age (p < .01), education (p < .01), daily occupation (p < .01) and having a long-term relationship (p = .03). A significant association was found between acculturation strategies and depressive disorders (p = .049): integration was associated with a lower risk of depression, separation with a higher risk. Using the axis separately, participation in Dutch society showed a significant relationship with a decreased risk of depressive, anxiety and co-morbidity of both disorders (OR = .15; 95% CI: .024 - .98). Non-participation showed no significant association. No association was found between the acculturation strategies and uptake of GP care. CONCLUSIONS Turkish migrants who integrate may have a lower risk of developing a depressive disorder. Participation in Dutch culture is associated with a decreased risk of depressive, anxiety and co-morbidity of both disorders. Further research should focus on the assessment of acculturation in the detection of depression.
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Affiliation(s)
- Burçin Ünlü Ince
- Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands ,EMGO Institute for Health and Care Research (EMGO+), VU University Medical Center, Amsterdam, The Netherlands
| | - Thijs Fassaert
- Public Health Service Amsterdam, Epidemiology and Health Promotion, Amsterdam, The Netherlands
| | - Matty AS de Wit
- Public Health Service Amsterdam, Epidemiology and Health Promotion, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands ,EMGO Institute for Health and Care Research (EMGO+), VU University Medical Center, Amsterdam, The Netherlands ,Division of Online Health Training, Innovation Incubator, Leuphana University, Lueneburg, Germany
| | - Jan Smit
- EMGO Institute for Health and Care Research (EMGO+), VU University Medical Center, Amsterdam, The Netherlands ,GGZ inGeest, Regional Mental Health Service Centre, VU University Medical Centre, Amsterdam, The Netherlands
| | - Jeroen Ruwaard
- Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands ,EMGO Institute for Health and Care Research (EMGO+), VU University Medical Center, Amsterdam, The Netherlands ,Division of Online Health Training, Innovation Incubator, Leuphana University, Lueneburg, Germany
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Ruwaard J, Lange A, Schrieken B, Dolan CV, Emmelkamp P. The effectiveness of online cognitive behavioral treatment in routine clinical practice. PLoS One 2012; 7:e40089. [PMID: 22792217 PMCID: PMC3390320 DOI: 10.1371/journal.pone.0040089] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 05/31/2012] [Indexed: 11/23/2022] Open
Abstract
CONTEXT Randomized controlled trails have identified online cognitive behavioral therapy as an efficacious intervention in the management of common mental health disorders. OBJECTIVE To assess the effectiveness of online CBT for different mental disorders in routine clinical practice. DESIGN An uncontrolled before-after study, with measurements at baseline, posttest, 6-week follow-up, and 1-year follow-up. PARTICIPANTS & SETTING 1500 adult patients (female: 67%; mean age: 40 years) with a GP referral for psychotherapy were treated at a Dutch online mental health clinic for symptoms of depression (n = 413), panic disorder (n = 139), posttraumatic stress (n = 478), or burnout (n = 470). INTERVENTIONS Manualized, web-based, therapist-assisted CBT, of which the efficacy was previously demonstrated in a series of controlled trials. Standardized duration of treatment varied from 5 weeks (online CBT for Posttraumatic stress) to 16 weeks (online CBT for Depression). MAIN OUTCOME MEASURES Validated self-report questionnaires of specific and general psychopathology, including the Beck Depression Inventory, the Impact of Event Scale, the Panic Disorder Severity Scale-Self Report, the Oldenburg Burnout Inventory, and the Depression Anxiety Stress Scales. RESULTS Treatment adherence was 71% (n = 1071). Study attrition was 21% at posttest, 33% at 6-week FU and 65% at 1-year FU. Mixed-model repeated measures regression identified large short-term reductions in all measures of primary symptoms (d = 1.9±0.2 to d = 1.2±0.2; P<.001), which sustained up to one year after treatment. At posttest, rates of reliable improvement and recovery were 71% and 52% in the completer sample (full sample: 55%/40%). Patient satisfaction was high. CONCLUSIONS Results suggest that online therapist-assisted CBT may be as effective in routine practice as it is in clinical trials. Although pre-treatment withdrawal and long-term outcomes require further study, results warrant continued implementation of online CBT.
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Affiliation(s)
- Jeroen Ruwaard
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
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Ruwaard J, Lange A, Broeksteeg J, Renteria-Agirre A, Schrieken B, Dolan CV, Emmelkamp P. Online cognitive-behavioural treatment of bulimic symptoms: a randomized controlled trial. Clin Psychol Psychother 2012; 20:308-18. [PMID: 22298417 DOI: 10.1002/cpp.1767] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 12/16/2011] [Accepted: 12/16/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND Manualized cognitive-behavioural treatment (CBT) is underutilized in the treatment of bulimic symptoms. Internet-delivered treatment may reduce current barriers. OBJECTIVE This study aimed to assess the efficacy of a new online CBT of bulimic symptoms. METHOD Participants with bulimic symptoms (n = 105) were randomly allocated to online CBT, bibliotherapy or waiting list/delayed treatment condition. Data were gathered at pre-treatment, post-treatment and 1-year follow-up. OUTCOME MEASURES The primary outcome measures were the Eating Disorder Examination Questionnaire (EDE-Q) and the frequency of binge eating and purging episodes. The secondary outcome measure was the Body Attitude Test. RESULTS Dropout from Internet treatment was 26%. Intention-to-treat ANCOVAs of post-test data revealed that the EDE-Q scores and the frequency of binging and purging reduced more in the online CBT group compared with the bibliotherapy and waiting list groups (pooled between-group effect size: d = 0.9). At 1-year follow-up, improvements in the online CBT group had sustained. CONCLUSION This study identifies online CBT as a viable alternative in the treatment of bulimic symptoms.
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Affiliation(s)
- Jeroen Ruwaard
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
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Ruwaard J, Lange A, Schrieken B, Emmelkamp P. Efficacy and effectiveness of online cognitive behavioral treatment: a decade of interapy research. Stud Health Technol Inform 2011; 167:9-14. [PMID: 21685634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Since 1996, researchers of the Interapy research group of the University of Amsterdam have been examining the effects of online cognitive behavioral treatment (online CBT). Over the years, the group conducted nine controlled trials of online CBT for a variety of mental health disorders, among a total of 840 participants. These studies suggest that online CBT is a viable and effective alternative to face-to-face treatment. Treatment adherence was 82%, and reductions in psychopathology represented a large between-group effect size of SMD = 0.9 (95% CI: .7 to 1.1), which was maintained over long periods. The research culminated in the foundation of the Interapy clinic, which received Dutch health regulatory body approval in 2005. Since then, costs of online CBT are reimbursed through public health insurance. A large study of the treatment outcome of 1,500 patients of the Interapy clinic showed that effects in clinical practice are similar to those observed in the controlled trials, and comparable to selected benchmarks of naturalistic studies of face-to-face CBT. The accumulated evidence provides compelling support for the efficacy and effectiveness of online CBT.
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Affiliation(s)
- Jeroen Ruwaard
- University of Amsterdam, Department of Psychology, Amsterdam, the Netherlands.
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Lange A, Ruwaard J. Ethical dilemmas in online research and treatment of sexually abused adolescents. J Med Internet Res 2010; 12:e58. [PMID: 21169170 PMCID: PMC3057314 DOI: 10.2196/jmir.1455] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 04/27/2010] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND In a recent uncontrolled trial of a new therapist-assisted Web-based treatment of adolescent victims of sexual abuse, the treatment effects were found to be promising. However, the study suffered a large pretreatment withdrawal rate that appeared to emanate from reluctance among the participants to disclose their identity and obtain their parents' consent. OBJECTIVE Our objectives were to confirm the effects of the online treatment in a controlled trial and to evaluate measures to reduce pretreatment withdrawal in vulnerable populations including young victims of sexual abuse. METHODS The study was designed as a within-subject baseline-controlled trial. Effects of an 8-week attention-placebo intervention were contrasted with the effects of an 8-week treatment episode. Several measures were taken to reduce pretreatment dropout. RESULTS Pretreatment withdrawal was reduced but remained high (82/106, 77%). On the other hand, treatment dropout was low (4 out of 24 participants), and improvement during treatment showed significantly higher effects than during the attention placebo control period (net effect sizes between 0.5 and 1.6). CONCLUSIONS In treatment of vulnerable young populations, caregivers and researchers will have to come to terms with high pretreatment withdrawal rates. Possible measures may reduce pretreatment withdrawal to some degree. Providing full anonymity is not a viable option since it is incompatible with the professional responsibility of the caregiver and restricts research possibilities.
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Affiliation(s)
- Alfred Lange
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands.
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Ruwaard J, Schrieken B, Schrijver M, Broeksteeg J, Dekker J, Vermeulen H, Lange A. Standardized web-based cognitive behavioural therapy of mild to moderate depression: a randomized controlled trial with a long-term follow-up. Cogn Behav Ther 2010; 38:206-21. [PMID: 19221919 DOI: 10.1080/16506070802408086] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Depression is common but undertreated. Web-based self-help provides a widely accessible treatment alternative for mild to moderate depression. However, the lack of therapist guidance may limit its efficacy. The authors assess the efficacy of therapist-guided web-based cognitive behavioural treatment (web-CBT) of mild to moderate depression. Fifty-four individuals with chronic, moderate depression participated in a randomized wait-list controlled trial, with an 18-month follow-up (immediate treatment: n = 36, wait-list control: n = 18). Primary outcome measures were the Beck Depression Inventory (BDI-IA) and the Depression scale of the Symptom Checklist-90-Revised (SCL-90-R. DEP). Secondary outcome measures were the Depression Anxiety Stress Scales and the Well-Being Questionnaire. Five participants (9%) dropped out. Intention-to-treat analyses of covariance revealed that participants in the treatment condition improved significantly more than those in the wait-list control condition (.011 < p < .015). With regard to the primary measures, between-group effects (d) were 0.7 for the BDI-IA and 1.1 for the SCL-90-R DEP. Posttest SCL-90- R DEP scores indicated recovery of 49% of the participants in the treatment group compared with 6% in the control group (odds ratio = 14.5; p < .004). On average, the effects were stable up to 18 months (n = 39), although medication was a strong predictor of relapse. The results demonstrate the efficacy of web-CBT for mild to moderate depression and the importance of therapist guidance in psychological interventions.
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Ruwaard J, Broeksteeg J, Schrieken B, Emmelkamp P, Lange A. Web-based therapist-assisted cognitive behavioral treatment of panic symptoms: a randomized controlled trial with a three-year follow-up. J Anxiety Disord 2010; 24:387-96. [PMID: 20227241 DOI: 10.1016/j.janxdis.2010.01.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2009] [Revised: 11/20/2009] [Accepted: 01/30/2010] [Indexed: 01/04/2023]
Abstract
BACKGROUND Internet-delivered treatment may reduce barriers to care in those unwilling or unable to access traditional forms of treatment. OBJECTIVE To assesses the efficacy of web-based therapist-assisted cognitive behavioral treatment (web-CBT) of panic symptoms. DESIGN A randomized waiting-list controlled trial with an uncontrolled three-year follow-up. PARTICIPANTS A community sample of 58 participants with chronic panic symptoms of varying severity (immediate treatment: n=27, waiting-list control: n=31). OUTCOME MEASURES The primary outcome measures were a one-week Panic Diary and the Panic Disorder Severity Scale - Self-Report (PDSS-SR); secondary measures were the Agoraphobic Cognitions Questionnaire (ACQ), the Body Sensations Questionnaire (BSQ), the Mobility Inventory - Alone subscale (MI-AAL), and the Depression Anxiety Stress Scales (DASS-42). RESULTS In the RCT, 54 participants (93%) completed posttest measurements. With regard to the primary outcome measures, intention-to-treat ANCOVAs revealed that participants in the treatment condition improved more than the participants in the waiting-list control condition (p<.03), with a pooled between-group effect size of d=.7. After three years (n=47; 81% study compliance), effects were more pronounced. CONCLUSION The results demonstrate the efficacy of therapist-assisted web-CBT in the treatment of panic symptoms.
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Affiliation(s)
- Jeroen Ruwaard
- University of Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands.
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Ruwaard J, Lange A. Book review. Cogn Behav Ther 2009. [DOI: 10.1080/16506070802651792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ruwaard J, Lange A, Bouwman M, Broeksteeg J, Schrieken B. E-mailed standardized cognitive behavioural treatment of work-related stress: a randomized controlled trial. Cogn Behav Ther 2008; 36:179-92. [PMID: 17852171 DOI: 10.1080/16506070701381863] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The aim of this study was to assess the effects of a 7-week standardized cognitive behavioural treatment of work-related stress conducted via e-mail. A total of 342 people applied for treatment in reaction to a newspaper article. Initial screening reduced the sample to a heterogeneous (sub)clinical group of 239 participants. Participants were assigned randomly to a waiting list condition (n = 62), or to immediate treatment (n = 177). A follow-up was conducted 3 years after inception of the treatment. The outcome measures used were the Depression Anxiety Stress Scales (DASS-42) and the Emotional Exhaustion scale of the Maslach Burnout Inventory - General Survey (MBI-GS). Fifty participants (21%) dropped out. Both groups showed statistically significant improvements. Intention-to-treat analysis of covariance (ANCOVAs) revealed that participants in the treatment condition improved significantly more than those in the waiting control condition (0.001<p < or = 0.025). In the treatment group, the effects were large to moderate (0.9 (stress) > or = d > or = 0.5 (anxiety)). The between-group effects ranged from d = 0.6 (stress) to d = 0.1 (anxiety). At follow-up, the effects were more pronounced, but this result requires replication in view of high attrition at follow-up. The results warrant further research on Internet-driven standardized cognitive behavioural therapy for work-related stress. Such research should include the direct comparison of this treatment with face-to-face treatment, and should address the optimal level of therapist contact in Internet-driven treatment.
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