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Palau-Batet M, Bretón-López J, Grimaldos J, Díaz-Sanahuja L, Quero S. Improving the efficacy of exposure therapy using projection-based augmented reality for the treatment of cockroach phobia: a randomised clinical trial protocol. BMJ Open 2023; 13:e069026. [PMID: 37208142 DOI: 10.1136/bmjopen-2022-069026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
INTRODUCTION In vivo exposure is the treatment of choice for specific phobia (SP), but this technique presents limitations related to access and acceptability. Augmented reality (AR) offers advantages like maximising strategies such as 'variability' (varying stimuli, durations, levels of intensity or the order of the items), control by the therapist, or 'exposure to multiple contexts', which can produce positive effects in terms of fear renewal and generalisation of the results. The aim of this study is to test the efficacy of varying the phobic stimuli during treatment with AR: using multiple stimuli (MS) versus a single stimulus (SS) in participants with SP. METHODS AND ANALYSIS Participants (N=80) with a diagnosis of an SP of cockroaches will be randomised into two conditions: (1) projection-based AR exposure therapy with MS (P-ARET MS); (2) P-ARET with an SS (P-ARET SS). The measures are related to the efficacy results (fear, avoidance and negative thoughts, performance on the behavioural avoidance test (BAT) and preferences). The primary outcome measure is the BAT, and the secondary outcome measures are the BAT through AR, Fear of Cockroaches Questionnaire, Cockroach Phobia Beliefs Questionnaire, Fear and Avoidance Scales Patient's Improvement Scale, and Beck Depression Inventory Second Edition. Five evaluation moments will be included: preintervention, postintervention, and 1-month, 6-month, and 12-month follow-ups. The treatment will follow the guidelines of the 'one-session treatment'. Student's t-tests to compare the two groups on the post-test will be applied. In addition, two-way analysis of variances with repeated measures in one of the two factors (pretest, post-test and follow-ups) will be carried out to compare intragroup differences. ETHICS AND DISSEMINATION The Universitat Jaume I Ethics Committee (Castellón, Spain) granted approval for the study (CD/64/2019). Dissemination will include publications and presentations at national and international conferences. TRIAL REGISTRATION NUMBER NCT04563403.
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Affiliation(s)
- María Palau-Batet
- Department of Basic, Clinical Psychology, and Psychobiology, Universitat Jaume I, Castello de la Plana, Spain
| | - Juana Bretón-López
- Department of Basic, Clinical Psychology, and Psychobiology, Universitat Jaume I, Castello de la Plana, Spain
- CIBER of Physiopathology of Obesity and Nutrition (CIBERobn), Madrid, Spain
| | - Jorge Grimaldos
- Department of Basic, Clinical Psychology, and Psychobiology, Universitat Jaume I, Castello de la Plana, Spain
| | - Laura Díaz-Sanahuja
- Department of Basic, Clinical Psychology, and Psychobiology, Universitat Jaume I, Castello de la Plana, Spain
| | - Soledad Quero
- Department of Basic, Clinical Psychology, and Psychobiology, Universitat Jaume I, Castello de la Plana, Spain
- CIBER of Physiopathology of Obesity and Nutrition (CIBERobn), Madrid, Spain
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Grimaldos J, Bretón-López J, Palau-Batet M, Díaz-Sanahuja L, Quero S. Effectiveness of a projection-based augmented reality exposure system in treating cockroach phobia: study protocol of a randomised controlled trial. BMJ Open 2023; 13:e069025. [PMID: 37208132 DOI: 10.1136/bmjopen-2022-069025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Despite being the treatment of choice for phobic disorders, in vivo exposure treatment (IVET) presents some important limitations related mainly to low acceptance and high drop-out rates. Augmented reality (AR) technologies can help to overcome these limitations. Evidence supports the use of AR in exposure treatment for small animal phobia. A new projection-based AR exposure treatment system (P-ARET) that offers the possibility of projecting the animals in a natural and non-intrusive environment has been developed. There are no randomised controlled trials (RCTs) available that have tested the efficacy of this system in cockroach phobia. This paper aims to present the protocol of an RCT that evaluates the efficacy of the P-ARET, versus an IVET group and a waiting list control group (WL), in carrying out exposure treatment for cockroach phobia. METHODS/DESIGN Participants will be randomly allocated to one of three conditions: (1) P-ARET, (2) IVET and (3) WL. Both treatment conditions will follow the 'one-session treatment' guidelines. As a diagnostic measure, the Anxiety Disorders Interview Schedule for Diagnostic and Statistical Manual for Mental Health Disorders-Version 5 will be used. The Behavioral Avoidance Test will be used as the primary outcome measure. Secondary outcome measures will include an attentional biases task (measured using eye-tracking technology), the Fear of Cockroaches Questionnaire, Cockroach Phobia Beliefs Questionnaire, Fear and Avoidance Scales, Beck Depression Inventory second edition, Disgust Propensity and Sensitivity Scale-Revised-12, State-Trait Anxiety Inventory, Clinician Severity Scale, and Expectation and Satisfaction with the Treatment Scale. The evaluation protocol will include pretreatment and post-treatment evaluations and 1, 6 and 12 months of follow-ups. Intention-to-treat and per-protocol analyses will be performed. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of Universitat Jaume I (Castellón, Spain; 13 December 2019). The results of the presented RCT will be disseminated in presentations at international scientific meetings and peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT04563390.
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Affiliation(s)
- Jorge Grimaldos
- Department of Basic, Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Juana Bretón-López
- Department of Basic, Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto Carlos III, Santiago de Compostela, Spain
| | - María Palau-Batet
- Department of Basic, Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Laura Díaz-Sanahuja
- Department of Basic, Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Soledad Quero
- Department of Basic, Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto Carlos III, Santiago de Compostela, Spain
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González-Pérez A, Matey-Sanz M, Granell C, Diaz-Sanahuja L, Bretón-López J, Casteleyn S. AwarNS: A framework for developing context-aware reactive mobile applications for health and mental health. J Biomed Inform 2023; 141:104359. [PMID: 37044134 DOI: 10.1016/j.jbi.2023.104359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/21/2022] [Revised: 03/10/2023] [Accepted: 04/05/2023] [Indexed: 04/14/2023]
Abstract
In recent years, interest and investment in health and mental health smartphone apps have grown significantly. However, this growth has not been followed by an increase in quality and the incorporation of more advanced features in such applications. This can be explained by an expanding fragmentation of existing mobile platforms along with more restrictive privacy and battery consumption policies, with a consequent higher complexity of developing such smartphone applications. To help overcome these barriers, there is a need for robust, well-designed software development frameworks which are designed to be reliable, power-efficient and ethical with respect to data collection practices, and which support the sense-analyse-act paradigm typically employed in reactive mHealth applications. In this article, we present the AwarNS Framework, a context-aware modular software development framework for Android smartphones, which facilitates transparent, reliable, passive and active data sampling running in the background (sense), on-device and server-side data analysis (analyse), and context-aware just-in-time offline and online intervention capabilities (act). It is based on the principles of versatility, reliability, privacy, reusability, and testability. It offers built-in modules for capturing smartphone and associated wearable sensor data (e.g. IMU sensors, geolocation, Wi-Fi and Bluetooth scans, physical activity, battery level, heart rate), analysis modules for data transformation, selection and filtering, performing geofencing analysis and machine learning regression and classification, and act modules for persistence and various notification deliveries. We describe the framework's design principles and architecture design, explain its capabilities and implementation, and demonstrate its use at the hand of real-life case studies implementing various mobile interventions for different mental disorders used in clinical practice.
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Affiliation(s)
- Alberto González-Pérez
- GEOTEC Research Group, Institute of New Imaging Technologies, Universitat Jaume I, Castellon, 12071, Spain.
| | - Miguel Matey-Sanz
- GEOTEC Research Group, Institute of New Imaging Technologies, Universitat Jaume I, Castellon, 12071, Spain.
| | - Carlos Granell
- GEOTEC Research Group, Institute of New Imaging Technologies, Universitat Jaume I, Castellon, 12071, Spain.
| | - Laura Diaz-Sanahuja
- Department of Basic Psychology, Clinical and Psychobiology, Universitat Jaume I, Castellon, 12071, Spain.
| | - Juana Bretón-López
- Department of Basic Psychology, Clinical and Psychobiology, Universitat Jaume I, Castellon, 12071, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain.
| | - Sven Casteleyn
- GEOTEC Research Group, Institute of New Imaging Technologies, Universitat Jaume I, Castellon, 12071, Spain.
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Gómez-Cambronero Á, Casteleyn S, Bretón-López J, García-Palacios A, Mira A. A smartphone-based serious game for depressive symptoms: Protocol for a pilot randomized controlled trial. Internet Interv 2023; 32:100624. [PMID: 37273930 PMCID: PMC10235433 DOI: 10.1016/j.invent.2023.100624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 04/04/2023] [Accepted: 04/20/2023] [Indexed: 06/06/2023] Open
Abstract
Background Depression is the most prevalent mental disorder, with detrimental effects on the patient's well-being, high disability, and a huge associated societal and economic cost. There are evidence-based treatments, but it is difficult to reach all people in need. Internet-based interventions, and more recently smartphone-based interventions, were explored to overcome barriers to access. Evidence shows them to be effective alternatives to traditional treatments. This paper presents the protocol of a pilot study whose primary aim is to investigate the efficacy of a smartphone-based serious game intervention for patients with mild to moderate depressive symptoms. Methods This randomized controlled pilot trial protocol foresees two arms design: 1/ smartphone- based serious game intervention (based on Cognitive Behavior Therapy with particular emphasis on Behavioral Activation and Physical Activity), 2/ waiting list control group. The study is expected to recruit 40 participants (18+), which will be randomly assigned to one of the experimental conditions. The duration of the intervention is two months. The primary outcome measure will be depressive symptomatology. Secondary outcomes will include other variables such as physical activity, resilience, anxiety, depression impairment, and positive and negative affect. Treatment expectation, satisfaction, usability, and game playability will also be measured. The data will be analyzed based on the intention-to-treat and per protocol analyses. Discussion The study aims to establish initial evidence for the efficacy of a smartphone-based serious game intervention, to serve as input for a larger-scale randomized control trial. The intervention exploits advanced smartphone capabilities, such as the use of a serious game as delivery mode, with the potential benefit of engagement and treatment adherence, and motion sensors to monitor and stimulate physical activity. As a secondary objective, the study aims to gather initial evidence on the user's expectations, satisfaction, usability and playability of the serious game as a treatment.
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Affiliation(s)
| | - Sven Casteleyn
- University Jaume I, Av. de Vicent Sos Baynat, s/n, Castellón 12006, Spain
| | - Juana Bretón-López
- University Jaume I, Av. de Vicent Sos Baynat, s/n, Castellón 12006, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CB06/03 Instituto Salud Carlos III), C/ Sinesio Delgado, 4, Madrid 28029, Spain
| | - Azucena García-Palacios
- University Jaume I, Av. de Vicent Sos Baynat, s/n, Castellón 12006, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CB06/03 Instituto Salud Carlos III), C/ Sinesio Delgado, 4, Madrid 28029, Spain
| | - Adriana Mira
- University of Valencia, Av. de Blasco Ibáñez, 13, Valencia 46010, Spain
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Gual-Montolio P, Suso-Ribera C, García-Palacios A, Castilla D, Zaragoza I, Bretón-López J. Enhancing Internet-based psychotherapy for adults with emotional disorders using ecological momentary assessments and interventions: Study protocol of a feasibility trial with "My EMI, Emotional Well-being" app. Internet Interv 2023; 31:100601. [PMID: 36686334 PMCID: PMC9852876 DOI: 10.1016/j.invent.2023.100601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Emotional disorders are the most frequent mental health problems globally. To ensure the dissemination of psychological treatments for these conditions, novel forms of delivery (e.g., Internet or mobile apps) and more scalable forms of psychotherapy (e.g., transdiagnostic interventions) have become increasingly popular. Research, however, shows that a significant number of patients, around 40 % according to some studies, do not respond to the interventions as expected (i.e., not-on-track patients). Ecological momentary assessments (EMAs) and ecological momentary interventions (EMIs) could simplify tailoring treatments to the patients' progress and rapidly respond to undesired outcomes during psychotherapy. Therefore, these would facilitate measurement-based care with little therapist involvement. This study aims to explore the feasibility of an app-based system called My EMI, Emotional Well-being for people with emotional disorders. According to daily EMAs, the app will provide personalized EMIs while participants receive a self-applied online transdiagnostic treatment. The app will be used as an add-tool to the online intervention to address emotion dysregulation, foster adherence, and reinforce contents. The current study describes the study protocol for this trial. METHOD AND ANALYSIS A single-group, open trial design will be used. Participants will be 30 adults suffering from emotional disorders. Primary outcomes will be app usability, acceptability, and response rates. Secondary outcomes will be either evaluated in Qualtrics at pre-treatment, post-treatment, and 3-month follow-up (depression and anxiety severity, and transdiagnostic dimensions of emotional disorders) or daily throughout the study with the app (EMAs of mood and five transdiagnostic mechanisms of therapeutic change). EMIs will consist of brief, evidence-based transdiagnostic CBT digital content (images, infographics, or videos) delivered just-in-time. Only if problems persist, short phone calls or episodic videocalls will be conducted. The Ethics Committee of the Jaume I University approved the study and all its procedures (CD/111/2021) in December 2021. DISCUSSION Identifying personalized and scalable interventions is paramount to improve mental health care, especially its accessibility, and to reduce the psychological distress of people with mental health problems. Feasibility data of the app (EMA and EMI system) supported by a self-applied online transdiagnostic intervention will be important to explore whether this modern approach is a real option to move forward personalized psychological interventions for persons with emotional disorders. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05109780. Registered 05 November 2021, https://clinicaltrials.gov/ct2/show/NCT05109780.
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Affiliation(s)
- Patricia Gual-Montolio
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, 12071 Castellon de la Plana, Spain
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, 12071 Castellon de la Plana, Spain,CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain,Corresponding author at: Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, 12071 Castellon de la Plana, Spain.
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, 12071 Castellon de la Plana, Spain,CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Diana Castilla
- Department of Personality, Assessment, and Psychological Treatments, Universidad de Valencia, 46010 Valencia, Spain,CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Irene Zaragoza
- Department of Personality, Assessment, and Psychological Treatments, Universidad de Valencia, 46010 Valencia, Spain,CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Juana Bretón-López
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, 12071 Castellon de la Plana, Spain,CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
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Miralles I, Granell C, Díaz-Sanahuja L, Van Woensel W, Bretón-López J, Mira A, Castilla D, Casteleyn S. Smartphone Apps for the Treatment of Mental Disorders: Systematic Review. JMIR Mhealth Uhealth 2020; 8:e14897. [PMID: 32238332 PMCID: PMC7163422 DOI: 10.2196/14897] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [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: 06/03/2019] [Revised: 12/05/2019] [Accepted: 01/20/2020] [Indexed: 12/15/2022] Open
Abstract
Background Smartphone apps are an increasingly popular means for delivering psychological interventions to patients suffering from a mental disorder. In line with this popularity, there is a need to analyze and summarize the state of the art, both from a psychological and technical perspective. Objective This study aimed to systematically review the literature on the use of smartphones for psychological interventions. Our systematic review has the following objectives: (1) analyze the coverage of mental disorders in research articles per year; (2) study the types of assessment in research articles per mental disorder per year; (3) map the use of advanced technical features, such as sensors, and novel software features, such as personalization and social media, per mental disorder; (4) provide an overview of smartphone apps per mental disorder; and (5) provide an overview of the key characteristics of empirical assessments with rigorous designs (ie, randomized controlled trials [RCTs]). Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews were followed. We performed searches in Scopus, Web of Science, American Psychological Association PsycNET, and Medical Literature Analysis and Retrieval System Online, covering a period of 6 years (2013-2018). We included papers that described the use of smartphone apps to deliver psychological interventions for known mental disorders. We formed multidisciplinary teams, comprising experts in psychology and computer science, to select and classify articles based on psychological and technical features. Results We found 158 articles that met the inclusion criteria. We observed an increasing interest in smartphone-based interventions over time. Most research targeted disorders with high prevalence, that is, depressive (31/158,19.6%) and anxiety disorders (18/158, 11.4%). Of the total, 72.7% (115/158) of the papers focused on six mental disorders: depression, anxiety, trauma and stressor-related, substance-related and addiction, schizophrenia spectrum, and other psychotic disorders, or a combination of disorders. More than half of known mental disorders were not or very scarcely (<3%) represented. An increasing number of studies were dedicated to assessing clinical effects, but RCTs were still a minority (25/158, 15.8%). From a technical viewpoint, interventions were leveraging the improved modalities (screen and sound) and interactivity of smartphones but only sparingly leveraged their truly novel capabilities, such as sensors, alternative delivery paradigms, and analytical methods. Conclusions There is a need for designing interventions for the full breadth of mental disorders, rather than primarily focusing on most prevalent disorders. We further contend that an increasingly systematic focus, that is, involving RCTs, is needed to improve the robustness and trustworthiness of assessments. Regarding technical aspects, we argue that further exploration and innovative use of the novel capabilities of smartphones are needed to fully realize their potential for the treatment of mental health disorders.
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Affiliation(s)
| | | | | | | | - Juana Bretón-López
- Universitat Jaume I, Castellón de la Plana, Spain.,CIBER of Physiopathology of Obesity and Nutrition CIBERobn, Castellón, Spain
| | - Adriana Mira
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
| | - Diana Castilla
- CIBER of Physiopathology of Obesity and Nutrition CIBERobn, Castellón, Spain.,Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
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Miralles I, Granell C, García-Palacios A, Castilla D, González-Pérez A, Casteleyn S, Bretón-López J. Enhancing In Vivo Exposure in the Treatment of Panic Disorder and Agoraphobia Using Location-Based Technologies: A Case Study. Clin Case Stud 2019. [DOI: 10.1177/1534650119892900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Indexed: 02/01/2023]
Abstract
Panic disorder (PD) is quite prevalent and often appears along with agoraphobia (PD/A). The treatment of choice is cognitive behavioral therapy (CBT). Transdiagnostic intervention, an emotion-focused, cognitive behavioral intervention that has led to the Unified Protocol (UP), emphasizes the common underlying mechanisms that contribute to the development and maintenance of emotional disorders such as PD/A. A core feature of this treatment approach is in vivo exposure (IVE) to feared situations, which aims to prevent avoidance behaviors and encourages the patient to confront feared situations gradually. It is a difficult component for patients, especially when implementing the exposure on their own. Different feedback formats can be used to increase adequate IVE and reduce overt or subtle avoidance. The use of smartphones is a very useful option to initiate and sustain exposure behavior. The purpose of this study is to describe the use of location-based technologies (LBTs) during the IVE component of the UP treatment of a 47-year-old patient with PD/A. The acceptability and usability of the system were assessed. The Symptoms platform was employed during the exposure module, using LBT with a smartphone app. The patient reported positive expectations, high satisfaction scores, and an overall satisfactory experience. Enhancing key therapeutic components during treatment through the development of media-based tools is a very promising future research aim, and the possibility of using advanced smartphone features should be explored.
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Affiliation(s)
| | | | | | - Diana Castilla
- Universitat de València, Spain
- Instituto Salud Carlos III, Santiago de Compostela, Spain
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Mira A, Díaz-García A, Castilla D, Campos D, Romero S, Bretón-López J, García-Palacios A, Baños R, Botella C. Protocol for a randomized controlled dismantling study of an internet-based intervention for depressive symptoms: exploring the contribution of behavioral activation and positive psychotherapy strategies. BMC Psychiatry 2019; 19:133. [PMID: 31053067 PMCID: PMC6500058 DOI: 10.1186/s12888-019-2099-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 04/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are evidence-based interventions for depression that include different components. However, the efficacy of their therapeutic components is unknown. Another important issue related to depression interventions is that, up to now, their therapeutic components have only focused on reducing negative symptoms rather than on improving positive affect and well-being. Because the low levels of positive affect are more strongly linked to depression than to other emotional disorders, it is important to include this variable as an important treatment target. Positive psychotherapeutic strategies (PPs) could help in this issue. The results obtained so far are consistent and promising, showing that Internet-based interventions are effective in treating depression. However, most of them are also multi-component, and it is important to make progress in investigating what each component contributes to the intervention. METHODS The current study will be a three-armed, simple-blinded, randomized controlled clinical trial with a dismantling design. 192 participants will be randomly assigned to: a) an Internet-based Global Protocol condition, which includes traditional therapeutic components of evidence-based treatments for depression (Motivation for change, Psychoeducation, Cognitive Therapy, Behavioral Activation (BA), Relapse Prevention) and PPs component, offering strategies to enhance positive mood and promote psychological strengths; b) an Internet-based BA Protocol condition (without the PPs component), and c) an Internet-based PPs Protocol condition (without the BA component). Primary outcome measures will be the BDI-II and PANAS. Secondary outcomes will include other variables such as depression, anxiety and stress, quality of life, resilience, and wellbeing related measures. Treatment acceptance and usability will also be measured. Participants will be assessed at pre-, post-treatment, 3-, 6- and 12- month follow- ups. The data will be analyzed based on the Intention-to-treat principle. Per protocol analyses will also be performed. DISCUSSION To the best of our knowledge, this is the first randomized dismantling intervention study for depression with the aim of exploring the contribution of a PPs component and the BA component in an Internet-based intervention. The three protocols are online interventions, helping to reach many people who need psychological treatments and otherwise would not have access to them. TRIAL REGISTRATION Clinicalstrials.gov as NCT03159715 . Registered 19 May 2017.
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Affiliation(s)
- Adriana Mira
- Universidad de Zaragoza, Teruel, Spain
- Universitat Jaume I, Castellón, Spain
| | | | - Diana Castilla
- Universidad de Zaragoza, Teruel, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | | | | | - Juana Bretón-López
- Universitat Jaume I, Castellón, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Azucena García-Palacios
- Universitat Jaume I, Castellón, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Rosa Baños
- Universidad de Valencia, Valencia, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Cristina Botella
- Universitat Jaume I, Castellón, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
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Campos D, Bretón-López J, Botella C, Mira A, Castilla D, Mor S, Baños R, Quero S. Efficacy of an internet-based exposure treatment for flying phobia (NO-FEAR Airlines) with and without therapist guidance: a randomized controlled trial. BMC Psychiatry 2019; 19:86. [PMID: 30841930 PMCID: PMC6404352 DOI: 10.1186/s12888-019-2060-4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Internet-based treatments appear to be a promising way to enhance the in vivo exposure approach, specifically in terms of acceptability and access to treatment. However, the literature on specific phobias is scarce, and, as far as we know, there are no studies on Flying Phobia (FP). This study aims to investigate the effectiveness of an Internet-based exposure treatment for FP (NO-FEAR Airlines) that includes exposure scenarios composed of images and sounds, versus a waiting-list control group. A secondary aim is to explore two ways of delivering NO-FEAR Airlines, with and without therapist guidance. METHODS A randomized controlled trial (RCT) was conducted in which 69 participants were allocated to: 1) NO-FEAR Airlines totally self-applied, 2) NO-FEAR Airlines with therapist guidance, 3) a waiting-list control group. Primary outcome measures were the Fear of Flying Questionnaire-II and the Fear of Flying Scale. Secondary outcomes included the Fear and Avoidance Scales, Clinician Severity Scale, and Patient's Improvement scale. Behavioral outcomes (post-treatment flights and safety behaviors) were also included. Mixed-model analyses with no ad hoc imputations were conducted for primary and secondary outcome measures. RESULTS NO-FEAR Airlines (with and without therapist guidance) was significantly effective, compared to the waiting list control group, on all primary and secondary outcomes (all ps < .05), and no significant differences were found between the two ways of delivering the intervention. Significant improvements on diagnostic status and reliable change indexes were also found in both treatment groups at post-treatment. Regarding behavioral outcomes, significant differences in safety behaviors were found at post-treatment, compared to the waiting list. Treatment gains were maintained at 3- and 12-month follow-ups. CONCLUSION FP can be treated effectively via the Internet. NO-FEAR Airlines helps to enhance the exposure technique and provide access to evidence-based psychological treatment to more people in need. These data are congruent with previous studies highlighting the usefulness of computer-assisted exposure programs for FP, and they contribute to the literature on Internet-based interventions. To the best of our knowledge, this is the first RCT to investigate the effectiveness of an Internet-based treatment for FP and explore two ways of delivering the intervention (with and without therapist guidance). TRIAL REGISTRATION Clinicaltrials.gov: NCT02298478 ( https://clinicaltrials.gov/ct2/show/NCT02298478 ). Trial registration date 3 November 2014.
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Affiliation(s)
- Daniel Campos
- 0000 0001 1957 9153grid.9612.cUniversitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain
| | - Juana Bretón-López
- 0000 0001 1957 9153grid.9612.cUniversitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain ,0000 0000 9314 1427grid.413448.eCIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Cristina Botella
- 0000 0001 1957 9153grid.9612.cUniversitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain ,0000 0000 9314 1427grid.413448.eCIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Adriana Mira
- 0000 0001 1957 9153grid.9612.cUniversitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain ,0000 0001 2152 8769grid.11205.37Department of Psychology and Sociology, Area of Psychobiology, University of Zaragoza, IIS Aragón, Teruel, Spain
| | - Diana Castilla
- 0000 0001 1957 9153grid.9612.cUniversitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain ,0000 0000 9314 1427grid.413448.eCIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain ,0000 0001 2152 8769grid.11205.37Department of Psychology and Sociology, Area of Psychobiology, University of Zaragoza, IIS Aragón, Teruel, Spain
| | - Sonia Mor
- 0000 0001 1957 9153grid.9612.cUniversitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain
| | - Rosa Baños
- 0000 0000 9314 1427grid.413448.eCIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain ,0000 0001 2173 938Xgrid.5338.dUniversitat de València, Valencia, Spain
| | - Soledad Quero
- Universitat Jaume I, Av. Vicente Sos Baynat s/n, 12006, Castellón, Spain. .,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain.
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10
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Mira A, González-Robles A, Molinari G, Miguel C, Díaz-García A, Bretón-López J, García-Palacios A, Quero S, Baños R, Botella C. Capturing the Severity and Impairment Associated With Depression: The Overall Depression Severity and Impairment Scale (ODSIS) Validation in a Spanish Clinical Sample. Front Psychiatry 2019; 10:180. [PMID: 31024352 PMCID: PMC6465570 DOI: 10.3389/fpsyt.2019.00180] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/11/2019] [Indexed: 01/04/2023] Open
Abstract
Background: The Overall Depression Severity and Impairment Scale (ODSIS) is a self-report scale designed to evaluate the severity and functional impairment associated with depression. Objective: This study evaluated the psychometric properties of the online version of the ODSIS in Spanish outpatients with depression and anxiety disorders. Method: Patients with a main diagnosis of a depressive (n = 283) or anxiety disorder (n = 191) and a mean age of 38.15 (SD = 12.06) were evaluated with a clinical diagnostic interview and measures assessing depression, anxiety, positive and negative affect, and quality of life. Factorial structure, internal consistency, convergent, and discriminant validity and cutoff scores were analyzed. Results: Consistent with previous validations of the instrument, Confirmatory Factor Analysis showed a unidimensional factor structure. Furthermore, the results obtained supported the internal consistency and construct validity of the ODSIS scores. A score of 5 was found to meet the criteria used in this study for the optimal cutoff score. Conclusion: The results obtained in this study show that the Spanish version of the ODSIS delivered online is an adequate tool to assess the depression-related severity and impairment in a brief and easy fashion.
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Affiliation(s)
- Adriana Mira
- Department of Psychology and Sociology, Universidad de Zaragoza, Teruel, Spain.,Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castelló de La Plana, Spain
| | - Alberto González-Robles
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castelló de La Plana, Spain
| | - Guadalupe Molinari
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castelló de La Plana, Spain.,CIBER Fisiopatología Obesidad y Nutrición, Instituto Salud Carlos III, Madrid, Spain
| | - Clara Miguel
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castelló de La Plana, Spain
| | - Amanda Díaz-García
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castelló de La Plana, Spain
| | - Juana Bretón-López
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castelló de La Plana, Spain.,CIBER Fisiopatología Obesidad y Nutrición, Instituto Salud Carlos III, Madrid, Spain
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castelló de La Plana, Spain.,CIBER Fisiopatología Obesidad y Nutrición, Instituto Salud Carlos III, Madrid, Spain
| | - Soledad Quero
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castelló de La Plana, Spain.,CIBER Fisiopatología Obesidad y Nutrición, Instituto Salud Carlos III, Madrid, Spain
| | - Rosa Baños
- CIBER Fisiopatología Obesidad y Nutrición, Instituto Salud Carlos III, Madrid, Spain.,Department of Personality, Evaluation and Psychological Treatment, Universitat de València, Valencia, Spain
| | - Cristina Botella
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castelló de La Plana, Spain.,CIBER Fisiopatología Obesidad y Nutrición, Instituto Salud Carlos III, Madrid, Spain
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11
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Mira A, Bretón-López J, Enrique Á, Castilla D, García-Palacios A, Baños R, Botella C. Exploring the Incorporation of a Positive Psychology Component in a Cognitive Behavioral Internet-Based Program for Depressive Symptoms. Results Throughout the Intervention Process. Front Psychol 2018; 9:2360. [PMID: 30555384 PMCID: PMC6281749 DOI: 10.3389/fpsyg.2018.02360] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 07/30/2018] [Accepted: 11/10/2018] [Indexed: 12/12/2022] Open
Abstract
Traditionally, evidence-based treatments for depression have focused on negative symptoms. Different authors describe the need to include positive affect as a major target of treatment. Positive psychology aims to fill this gap. Reaching everyone in need is also important, and Internet-based interventions can help in this task. The present study is a secondary analysis derived from a randomized controlled trial aimed to test the efficacy of an Internet-based intervention for patients with depressive symptoms. This intervention consisted of an 8-module Internet-based program that combined four modules based on cognitive-behavioral therapy strategies and four modules based on positive psychology strategies. The main goal of this secondary analysis is to report the data collected after each module from the participants who completed the intervention, explore the changes throughout the intervention process, and examine the changes observed in the different variables before versus after the introduction of the positive psychology component. A total of 103 patients completed the intervention. At pre-, post-intervention, and post-module evaluations, they completed positive and negative affect, depression, and anxiety measures. Negative affect and anxiety decreased significantly during the implementation of the cognitive-behavioral therapy and positive psychology modules. However, depression and positive affect improved only after the introduction of the positive psychology modules. This is the first study to explore, throughout the intervention process (module by module), the incorporation of a positive psychology component in an Internet-based program. Results suggest that positive psychology techniques might have an impact on clinical symptomatology, and they emphasize the need to include these techniques to achieve a more profound change in positive functioning measures. Clinical Trial Registration: NCT02148354 (http://ClinicalTrials.gov/ct2/show/NCT02148354).
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Affiliation(s)
- Adriana Mira
- Department of Psychology and Sociology, Universidad de Zaragoza, Teruel, Spain.,Department of Basic Psychology, Clinic and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Juana Bretón-López
- Department of Basic Psychology, Clinic and Psychobiology, Universitat Jaume I, Castellón, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Santiago de Compostela, Spain
| | - Ángel Enrique
- E-mental Health Research Group, School of Psychology, University of Dublin, Trinity College, Dublin, Ireland
| | - Diana Castilla
- Department of Psychology and Sociology, Universidad de Zaragoza, Teruel, Spain.,Department of Basic Psychology, Clinic and Psychobiology, Universitat Jaume I, Castellón, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Santiago de Compostela, Spain
| | - Azucena García-Palacios
- Department of Basic Psychology, Clinic and Psychobiology, Universitat Jaume I, Castellón, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Santiago de Compostela, Spain
| | - Rosa Baños
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Santiago de Compostela, Spain.,Department of Personality, Evaluation and Psychological Treatment, Universidad de Valencia, Valencia, Spain
| | - Cristina Botella
- Department of Basic Psychology, Clinic and Psychobiology, Universitat Jaume I, Castellón, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Santiago de Compostela, Spain
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12
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Karyotaki E, Kemmeren L, Riper H, Twisk J, Hoogendoorn A, Kleiboer A, Mira A, Mackinnon A, Meyer B, Botella C, Littlewood E, Andersson G, Christensen H, Klein JP, Schröder J, Bretón-López J, Scheider J, Griffiths K, Farrer L, Huibers MJH, Phillips R, Gilbody S, Moritz S, Berger T, Pop V, Spek V, Cuijpers P. Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis. Psychol Med 2018; 48:2456-2466. [PMID: 29540243 PMCID: PMC6190066 DOI: 10.1017/s0033291718000648] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/02/2018] [Accepted: 02/16/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Little is known about potential harmful effects as a consequence of self-guided internet-based cognitive behaviour therapy (iCBT), such as symptom deterioration rates. Thus, safety concerns remain and hamper the implementation of self-guided iCBT into clinical practice. We aimed to conduct an individual participant data (IPD) meta-analysis to determine the prevalence of clinically significant deterioration (symptom worsening) in adults with depressive symptoms who received self-guided iCBT compared with control conditions. Several socio-demographic, clinical and study-level variables were tested as potential moderators of deterioration. METHODS Randomised controlled trials that reported results of self-guided iCBT compared with control conditions in adults with symptoms of depression were selected. Mixed effects models with participants nested within studies were used to examine possible clinically significant deterioration rates. RESULTS Thirteen out of 16 eligible trials were included in the present IPD meta-analysis. Of the 3805 participants analysed, 7.2% showed clinically significant deterioration (5.8% and 9.1% of participants in the intervention and control groups, respectively). Participants in self-guided iCBT were less likely to deteriorate (OR 0.62, p < 0.001) compared with control conditions. None of the examined participant- and study-level moderators were significantly associated with deterioration rates. CONCLUSIONS Self-guided iCBT has a lower rate of negative outcomes on symptoms than control conditions and could be a first step treatment approach for adult depression as well as an alternative to watchful waiting in general practice.
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Affiliation(s)
- Eirini Karyotaki
- Department of Clinical Psychology, VU Amsterdam and Institute for Public Health Research, Amsterdam, the Netherlands
| | - Lise Kemmeren
- Department of Psychiatry, GGZ inGeest and VU University Medical Centre, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Heleen Riper
- Department of Clinical Psychology, VU Amsterdam and Institute for Public Health Research, Amsterdam, the Netherlands
| | - Jos Twisk
- Department of Epidemiology and Biostatistics and Amsterdam Institute for Public Health Research, VU University Amsterdam, Amsterdam, the Netherlands
| | - Adriaan Hoogendoorn
- Department of Psychiatry, GGZ inGeest and VU University Medical Centre, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Annet Kleiboer
- Department of Clinical Psychology, VU Amsterdam and Institute for Public Health Research, Amsterdam, the Netherlands
| | - Adriana Mira
- Department of Psychology and Technology, Jaume University, Castellon, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Spain
| | - Andrew Mackinnon
- Black Dog Institute and University of New South Wales, Prince of Wales Hospital, Sydney, Australia
- Center for Mental Health, University of Melbourne, Melbourne, Australia
| | - Björn Meyer
- Research Department, Germany and Department of Psychology, City University, Gaia AG, Hamburg, London, UK
| | - Cristina Botella
- Department of Psychology and Technology, Jaume University, Castellon, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Spain
| | | | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Sweden Institute for Disability Research, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institute for Disability Research, Stockholm, Sweden
| | - Helen Christensen
- Black Dog Institute and University of New South Wales, Prince of Wales Hospital, Sydney, Australia
| | - Jan P. Klein
- Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany
| | - Johanna Schröder
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Juana Bretón-López
- Department of Psychology and Technology, Jaume University, Castellon, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Spain
| | - Justine Scheider
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Kathy Griffiths
- Research School of Psychology, College of Biology, Medicine & Environment, Australian National University, Canberra, Australia
| | - Louise Farrer
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Marcus J. H. Huibers
- Department of Clinical Psychology, VU Amsterdam and Institute for Public Health Research, Amsterdam, the Netherlands
| | - Rachel Phillips
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Victor Pop
- CoRPS – Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, the Netherlands
| | - Viola Spek
- CoRPS – Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, the Netherlands
| | - Pim Cuijpers
- Department of Clinical Psychology, VU Amsterdam and Institute for Public Health Research, Amsterdam, the Netherlands
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13
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Enrique A, Bretón-López J, Molinari G, Roca P, Llorca G, Guillén V, Fernández-Aranda F, Baños RM, Botella C. Implementation of a Positive Technology Application in Patients With Eating Disorders: A Pilot Randomized Control Trial. Front Psychol 2018; 9:934. [PMID: 29942272 PMCID: PMC6004415 DOI: 10.3389/fpsyg.2018.00934] [Citation(s) in RCA: 5] [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: 02/28/2018] [Accepted: 05/22/2018] [Indexed: 01/31/2023] Open
Abstract
Background: Positive psychological interventions (PPIs) have been suggested to produce benefits in patients with eating disorders (ED) by improving well-being, which might act as a buffer of the harmful effects caused by the disorder. Best Possible Self (BPS) is a PPI which consists of writing and envisioning a future where everything has turned out in the best possible way. In this regard, positive technology (PT) can be of considerable benefit as it allows to implement specific PPIs that have already shown efficacy. Objective: This study tested the preliminary efficacy of the BPS exercise implemented through a PT application and carried out for 1 month, in improving positive functioning measures, compared to a control condition, in patients with ED. Follow-up effects were also explored at 1 and 3 months later. Methods: This is a pilot randomized controlled trial, with two experimental conditions. Participants were 54 outpatients, who were receiving ongoing specialized treatment in ED services. 29 participants were randomly allocated to the BPS intervention and 25 to the control exercise. The sample was composed mostly by females and the mean age was 27 years. In the intervention group, participants had to write about their BPS. In the control group participants had to write about their daily activities. The exercise was conducted through the Book of Life, which is a PT application that allows users to add multimedia materials to the written content. Measures of future expectations, affect, dispositional optimism, hope and self-efficacy were assessed at different time frames. Results: Findings showed that all participants improved over time and there were no statistically significant differences between conditions on the specific measures. These effects were not influenced by prior levels of ED severity. Within-group effect sizes indicate a greater benefit for the participants in the BPS condition, compared to the control condition, on nearly all the measures. Conclusion: Results indicated that PT produced modest improvements in patients with EDs that are receiving current treatment for ED. More empirical attention is needed to explore the potential benefits of PPIs as supporting tools in the prevention and treatment of EDs. Trial registration: clinicaltrails.gov Identifier: NCT03003910, retrospectively registered December 27, 2016.
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Affiliation(s)
- Angel Enrique
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Juana Bretón-López
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain.,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Guadalupe Molinari
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Pablo Roca
- Department of Personality, Assessment and Psychological Treatment, Complutense University of Madrid, Madrid, Spain
| | - Ginés Llorca
- Psychiatry Service, Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - Verónica Guillén
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
| | - Fernando Fernández-Aranda
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain.,Department of Psychiatry, University Hospital of IDIBELL - Bellvitge Biomedical Research Institute, Barcelona, Spain
| | - Rosa M Baños
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain.,Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
| | - Cristina Botella
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain.,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
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14
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Campos D, Mira A, Bretón-López J, Castilla D, Botella C, Baños RM, Quero S. The acceptability of an Internet-based exposure treatment for flying phobia with and without therapist guidance: patients' expectations, satisfaction, treatment preferences, and usability. Neuropsychiatr Dis Treat 2018; 14:879-892. [PMID: 29636613 PMCID: PMC5880416 DOI: 10.2147/ndt.s153041] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Internet-based treatments have been tested for several psychological disorders. However, few studies have directly assessed the acceptability of these self-applied interventions in terms of expectations, satisfaction, treatment preferences, and usability. Moreover, no studies provide this type of data on Internet-based treatment for flying phobia (FP), with or without therapist guidance. The aim of this study was to analyze the acceptability of an Internet-based treatment for FP (NO-FEAR Airlines) that includes exposure scenarios composed of images and real sounds. A secondary aim was to compare patients' acceptance of two ways of delivering this treatment (with or without therapist guidance). PATIENTS AND METHODS The sample included 46 participants from a randomized controlled trial who had received the self-applied intervention with (n = 23) or without (n = 23) therapist guidance. All participants completed an assessment protocol conducted online and by telephone at both pre- and posttreatment. RESULTS Results showed good expectations, satisfaction, opinion, and usability, regardless of the presence of therapist guidance, including low aversiveness levels from before to after the intervention. However, participants generally preferred the therapist-supported condition. CONCLUSION NO-FEAR Airlines is a well-accepted Internet-based treatment that can help enhance the application of the exposure technique, improving patient acceptance and access to FP treatment.
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Affiliation(s)
- Daniel Campos
- Department of Basic Psychology, Universitat Jaume I, Castellón, Spain
| | - Adriana Mira
- Department of Basic Psychology, Universitat Jaume I, Castellón, Spain.,Department of Psychology and Sociology, Facultad de Ciencias Sociales y Humanas, Universidad de Zaragoza, Campus Universitario de Teruel, Teruel, Spain
| | - Juana Bretón-López
- Department of Basic Psychology, Universitat Jaume I, Castellón, Spain.,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Barcelona, Spain
| | - Diana Castilla
- Department of Basic Psychology, Universitat Jaume I, Castellón, Spain.,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Barcelona, Spain
| | - Cristina Botella
- Department of Basic Psychology, Universitat Jaume I, Castellón, Spain.,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Barcelona, Spain
| | - Rosa Maria Baños
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Barcelona, Spain.,Department of Personality, Evaluation and Psychological Treatment, Universitat de València, Valencia, Spain
| | - Soledad Quero
- Department of Basic Psychology, Universitat Jaume I, Castellón, Spain.,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Barcelona, Spain
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15
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Karyotaki E, Riper H, Twisk J, Hoogendoorn A, Kleiboer A, Mira A, Mackinnon A, Meyer B, Botella C, Littlewood E, Andersson G, Christensen H, Klein JP, Schröder J, Bretón-López J, Scheider J, Griffiths K, Farrer L, Huibers MJH, Phillips R, Gilbody S, Moritz S, Berger T, Pop V, Spek V, Cuijpers P. Efficacy of Self-guided Internet-Based Cognitive Behavioral Therapy in the Treatment of Depressive Symptoms: A Meta-analysis of Individual Participant Data. JAMA Psychiatry 2017; 74:351-359. [PMID: 28241179 DOI: 10.1001/jamapsychiatry.2017.0044] [Citation(s) in RCA: 404] [Impact Index Per Article: 57.7] [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] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Self-guided internet-based cognitive behavioral therapy (iCBT) has the potential to increase access and availability of evidence-based therapy and reduce the cost of depression treatment. OBJECTIVES To estimate the effect of self-guided iCBT in treating adults with depressive symptoms compared with controls and evaluate the moderating effects of treatment outcome and response. DATA SOURCES A total of 13 384 abstracts were retrieved through a systematic literature search in PubMed, Embase, PsycINFO, and Cochrane Library from database inception to January 1, 2016. STUDY SELECTION Randomized clinical trials in which self-guided iCBT was compared with a control (usual care, waiting list, or attention control) in individuals with symptoms of depression. DATA EXTRACTION AND SYNTHESIS Primary authors provided individual participant data from 3876 participants from 13 of 16 eligible studies. Missing data were handled using multiple imputations. Mixed-effects models with participants nested within studies were used to examine treatment outcomes and moderators. MAIN OUTCOMES AND MEASURES Outcomes included the Beck Depression Inventory, Center for Epidemiological Studies-Depression Scale, and 9-item Patient Health Questionnaire scores. Scales were standardized across the pool of the included studies. RESULTS Of the 3876 study participants, the mean (SD) age was 42.0 (11.7) years, 2531 (66.0%) of 3832 were female, 1368 (53.1%) of 2574 completed secondary education, and 2262 (71.9%) of 3146 were employed. Self-guided iCBT was significantly more effective than controls on depressive symptoms severity (β = -0.21; Hedges g = 0.27) and treatment response (β = 0.53; odds ratio, 1.95; 95% CI, 1.52-2.50; number needed to treat, 8). Adherence to treatment was associated with lower depressive symptoms (β = -0.19; P = .001) and greater response to treatment (β = 0.90; P < .001). None of the examined participant and study-level variables moderated treatment outcomes. CONCLUSIONS AND RELEVANCE Self-guided iCBT is effective in treating depressive symptoms. The use of meta-analyses of individual participant data provides substantial evidence for clinical and policy decision making because self-guided iCBT can be considered as an evidence-based first-step approach in treating symptoms of depression. Several limitations of the iCBT should be addressed before it can be disseminated into routine care.
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Affiliation(s)
- Eirini Karyotaki
- Department of Clinical Psychology and EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Heleen Riper
- Department of Clinical Psychology and EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jos Twisk
- Department of Epidemiology and Biostatistics and EMGO Institute for Health and Care Research, Vrije Universiteit University Amsterdam, Amsterdam, the Netherlands
| | - Adriaan Hoogendoorn
- Department of Psychiatry, Geestelijke Gezondheidszorg inGeest inGeest and Vrije Universiteit University Medical Centre, Amsterdam, the Netherlands4EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Annet Kleiboer
- Department of Clinical Psychology and EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Adriana Mira
- Department of Psychology and Technology, Jaume University, Castellon, Spain
| | - Andrew Mackinnon
- Black Dog Institute and University of New South Wales, Prince of Wales Hospital, Sydney, Australia7Center for Mental Health, University of Melbourne, Melbourne, Australia
| | - Björn Meyer
- Research Department, Gaia AG, Hamburg, Germany9Department of Psychology, City University, London, England
| | - Cristina Botella
- Department of Psychology and Technology, Jaume University, Castellon, Spain10IBER of Physiopathology of Obesity and Nutrition, Santiago de Compostela, Spain
| | | | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Sweden Institute for Disability Research, Linköping University, Linköping, Sweden13Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institute for Disability Research, Stockholm, Sweden
| | - Helen Christensen
- Black Dog Institute and University of New South Wales, Prince of Wales Hospital, Sydney, Australia
| | - Jan P Klein
- Department of Psychiatry and Psychotherapy, Luebeck University, Luebeck, Germany
| | - Johanna Schröder
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Juana Bretón-López
- Department of Psychology and Technology, Jaume University, Castellon, Spain10IBER of Physiopathology of Obesity and Nutrition, Santiago de Compostela, Spain
| | - Justine Scheider
- Institute of Mental Health, University of Nottingham, Nottingham, England
| | - Kathy Griffiths
- Research School of Psychology, College of Biology, Medicine & Environment, Australian National University, Canberra, Australia
| | - Louise Farrer
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Marcus J H Huibers
- Department of Clinical Psychology and EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Rachel Phillips
- Department of Primary Care and Public Health Sciences, King's College London, London, England
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, England
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Victor Pop
- Department of Psychology and Health, Tilburg University and Diagnostic Centre Eindhoven, Eindhoven, the Netherlands
| | - Viola Spek
- Department of Psychology and Health, Tilburg University and Diagnostic Centre Eindhoven, Eindhoven, the Netherlands
| | - Pim Cuijpers
- Department of Clinical Psychology and EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands2Department of Epidemiology and Biostatistics and EMGO Institute for Health and Care Research, Vrije Universiteit University Amsterdam, Amsterdam, the Netherlands
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Mira A, Bretón-López J, García-Palacios A, Quero S, Baños RM, Botella C. An Internet-based program for depressive symptoms using human and automated support: a randomized controlled trial. Neuropsychiatr Dis Treat 2017; 13:987-1006. [PMID: 28408833 PMCID: PMC5384701 DOI: 10.2147/ndt.s130994] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [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] [Indexed: 01/23/2023] Open
Abstract
PURPOSE The purpose of this study was to analyze the efficacy of an Internet-based program for depressive symptoms using automated support by information and communication technologies (ICTs) and human support. PATIENTS AND METHODS An Internet-based program was used to teach adaptive ways to cope with depressive symptoms and daily problems. A total of 124 participants who were experiencing at least one stressful event that caused interference in their lives, many of whom had clinically significant depressive symptoms, were randomly assigned into either an intervention group with ICT support (automated mobile phone messages, automated emails, and continued feedback through the program); an intervention group with ICT support plus human support (brief weekly support phone call without clinical content); or a waiting-list control. At pre-, post-, and 12-month follow-up, they completed depression, anxiety, positive and negative effect, and perceived stress measures. Results were analyzed using both intention-to-treat and completers data. The majority were women (67.7%), with a mean age of 35.6 years (standard deviation =9.7). RESULTS The analysis showed that the two intervention groups improved significantly pre- to posttreatment, compared with the control group. Furthermore, improvements were maintained at the 12-month follow-up. Adherence and satisfaction with the program was high in both conditions. CONCLUSION The Internet-based program was effective and well accepted, with and without human support, showing that ICT-based automated support may be useful. It is essential to continue to study other ICT strategies for providing support.
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Affiliation(s)
- Adriana Mira
- Department of Basic, Clinical Psychology and Psychobiology, Labpsitec, Universitat Jaume I, Castellón de la Plana, Spain
| | - Juana Bretón-López
- Department of Basic, Clinical Psychology and Psychobiology, Labpsitec, Universitat Jaume I, Castellón de la Plana, Spain
- CIBER of Physiopathology of Obesity and Nutrition CIBERobn, CB06/03 Instituto de Salud Carlos III, Santiago de Compostela, Spain
| | - Azucena García-Palacios
- Department of Basic, Clinical Psychology and Psychobiology, Labpsitec, Universitat Jaume I, Castellón de la Plana, Spain
- CIBER of Physiopathology of Obesity and Nutrition CIBERobn, CB06/03 Instituto de Salud Carlos III, Santiago de Compostela, Spain
| | - Soledad Quero
- Department of Basic, Clinical Psychology and Psychobiology, Labpsitec, Universitat Jaume I, Castellón de la Plana, Spain
- CIBER of Physiopathology of Obesity and Nutrition CIBERobn, CB06/03 Instituto de Salud Carlos III, Santiago de Compostela, Spain
| | - Rosa María Baños
- CIBER of Physiopathology of Obesity and Nutrition CIBERobn, CB06/03 Instituto de Salud Carlos III, Santiago de Compostela, Spain
- Department of Personality, Evaluation and Psychological Treatment, Universidad de Valencia, Valencia, Spain
| | - Cristina Botella
- Department of Basic, Clinical Psychology and Psychobiology, Labpsitec, Universitat Jaume I, Castellón de la Plana, Spain
- CIBER of Physiopathology of Obesity and Nutrition CIBERobn, CB06/03 Instituto de Salud Carlos III, Santiago de Compostela, Spain
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Mira A, Farfallini L, Baños R, Bretón-López J, Botella C. Sonreír es Divertido, una intervención online para la prevención y el tratamiento de los trastornos emocionales. Psicodebate 2016. [DOI: 10.18682/pd.v16i2.597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Campos D, Bretón-López J, Botella C, Mira A, Castilla D, Baños R, Tortella-Feliu M, Quero S. An Internet-based treatment for flying phobia (NO-FEAR Airlines): study protocol for a randomized controlled trial. BMC Psychiatry 2016; 16:296. [PMID: 27544428 PMCID: PMC4992303 DOI: 10.1186/s12888-016-0996-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 08/04/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Flying phobia (FP) is a common and disabling mental disorder. Although in vivo exposure is the treatment of choice, it is linked to a number of limitations in its implementation. Particularly important, is the limited access to the feared stimulus (i.e., plane). Moreover, the economic cost of in vivo exposure should be specially considered as well as the difficulty of applying the exposure technique in an appropriate way; controlling important variables such as the duration of the exposure or the number of sessions. ICTs could help to reduce these limitations. Computer-assisted treatments have remarkable advantages in treating FP. Furthermore, they can be delivered through the Internet, increasing their advantages and reaching more people in need. The Internet has been established as an effective way to treat a wide range of mental disorders. However, as far as we know, no controlled studies exist on FP treatment via the Internet. This study aims to evaluate the efficacy of an Internet-based treatment for FP (NO-FEAR Airlines) versus a waiting list control group. Secondary objectives will be to explore two ways of delivering NO-FEAR Airlines, with or without therapist guidance, and study the patients' acceptance of the program. This paper presents the study protocol. METHODS/DESIGN The study is a randomized controlled trial. A minimum of 57 participants will be randomly assigned to three conditions: a) NO-FEAR Airlines totally self-applied, b) NO-FEAR Airlines with therapist guidance, or c) a waiting list control group (6 weeks). Primary outcomes measures will be the Fear of Flying Questionnaire-II and the Fear of Flying Scale. Secondary outcomes will be included to assess other relevant clinical measures, such as the Fear and Avoidance Scales, Clinician Severity Scale, and Patient's Improvement scale. Analyses of post-treatment flights will be conducted. Treatment acceptance and preference measures will also be included. Intention-to-treat and per protocol analyses will be conducted. DISCUSSION An Internet-based treatment for FP could have considerable advantages in managing in vivo exposure limitations, specifically in terms of access to treatment, acceptance, adherence, and the cost-effectiveness of the intervention. This is the first randomized controlled trial to study this issue. TRIAL REGISTRATION Clinicaltrials.gov: NCT02298478 . Trial registration date 3 November 2014.
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Affiliation(s)
| | - Juana Bretón-López
- Universitat Jaume I, Castellón, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Cristina Botella
- Universitat Jaume I, Castellón, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | | | | | - Rosa Baños
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
- Universitat de València, Valencia, Spain
| | | | - Soledad Quero
- Universitat Jaume I, Castellón, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
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Campos D, Cebolla A, Quero S, Bretón-López J, Botella C, Soler J, García-Campayo J, Demarzo M, Baños RM. Meditation and happiness: Mindfulness and self-compassion may mediate the meditation–happiness relationship. Personality and Individual Differences 2016. [DOI: 10.1016/j.paid.2015.08.040] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Botella C, Mira A, Moragrega I, García-Palacios A, Bretón-López J, Castilla D, Riera López del Amo A, Soler C, Molinari G, Quero S, Guillén-Botella V, Miralles I, Nebot S, Serrano B, Majoe D, Alcañiz M, Baños RM. An Internet-based program for depression using activity and physiological sensors: efficacy, expectations, satisfaction, and ease of use. Neuropsychiatr Dis Treat 2016; 12:393-406. [PMID: 27042067 PMCID: PMC4770071 DOI: 10.2147/ndt.s93315] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Computerized cognitive behavioral therapy (CCBT) has been shown to be efficacious. Moreover, CCBT can be enhanced by using physiological and activity sensors, but there is no evidence about the acceptability of all these tools. The objective of this study is to examine the efficacy, expectations, satisfaction, and ease of use of an Internet-based CCBT program for preventing depression, with and without sensors (electroencephalography, electrocardiograhpy ECG, and actigraphy), in a high-risk population (unemployed men). PATIENTS AND METHODS Sixty participants at risk of depression (unemployed men) were randomly assigned to three experimental conditions: 1) intervention program (N=22), 2) intervention program plus sensors (N=19), and 3) control group (N=19). Participants completed depression, anxiety, positive and negative affect, and perceived stress measures. Furthermore, they also completed the measures for expectation, satisfaction, and the ease of use of the program. RESULTS Results showed that the two intervention groups improved significantly more than the control group on the clinical variables, and the improvements were greater in the group that used sensors than in the group that did not use them. Furthermore, participants in both intervention groups scored high on expectations and satisfaction with the CCBT program (with and without sensors). The mean score for usability was 88 out of 100 (standard deviation =12.32). No significant differences were found between groups on any of these variables. CONCLUSION This is the first study to analyze the efficacy, expectations, satisfaction, and ease of use of an Internet-based program using physiological and activity sensors. These results suggest that an Internet program for depression with or without physiological and activity sensors is effective, satisfactory, and easy to use.
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Affiliation(s)
- Cristina Botella
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume, Castellón, Spain
- CIBER Physiopathology of Obesity and Nutrition, CIBERobn, Instituto de Salud Carlos III, Santiago de Compostela, Spain
| | - Adriana Mira
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume, Castellón, Spain
| | - Inés Moragrega
- CIBER Physiopathology of Obesity and Nutrition, CIBERobn, Instituto de Salud Carlos III, Santiago de Compostela, Spain
- Department of Personality, Evaluation and Psychological Treatment, Universidad de Valencia, Valencia, Spain
| | - Azucena García-Palacios
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume, Castellón, Spain
- CIBER Physiopathology of Obesity and Nutrition, CIBERobn, Instituto de Salud Carlos III, Santiago de Compostela, Spain
| | - Juana Bretón-López
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume, Castellón, Spain
- CIBER Physiopathology of Obesity and Nutrition, CIBERobn, Instituto de Salud Carlos III, Santiago de Compostela, Spain
| | - Diana Castilla
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume, Castellón, Spain
- CIBER Physiopathology of Obesity and Nutrition, CIBERobn, Instituto de Salud Carlos III, Santiago de Compostela, Spain
| | | | - Carla Soler
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume, Castellón, Spain
| | - Guadalupe Molinari
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume, Castellón, Spain
| | - Soledad Quero
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume, Castellón, Spain
- CIBER Physiopathology of Obesity and Nutrition, CIBERobn, Instituto de Salud Carlos III, Santiago de Compostela, Spain
| | - Verónica Guillén-Botella
- CIBER Physiopathology of Obesity and Nutrition, CIBERobn, Instituto de Salud Carlos III, Santiago de Compostela, Spain
- Department of Personality, Evaluation and Psychological Treatment, Universidad de Valencia, Valencia, Spain
| | - Ignacio Miralles
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume, Castellón, Spain
- CIBER Physiopathology of Obesity and Nutrition, CIBERobn, Instituto de Salud Carlos III, Santiago de Compostela, Spain
| | - Sara Nebot
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume, Castellón, Spain
| | - Berenice Serrano
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume, Castellón, Spain
- CIBER Physiopathology of Obesity and Nutrition, CIBERobn, Instituto de Salud Carlos III, Santiago de Compostela, Spain
| | - Dennis Majoe
- Native Systems Institute, ETH Zurich, Zurich, Switzerland
| | - Mariano Alcañiz
- CIBER Physiopathology of Obesity and Nutrition, CIBERobn, Instituto de Salud Carlos III, Santiago de Compostela, Spain
- Human-Centered Technology Institute, Universidad Politécnica de Valencia, Valencia, Spain
| | - Rosa María Baños
- CIBER Physiopathology of Obesity and Nutrition, CIBERobn, Instituto de Salud Carlos III, Santiago de Compostela, Spain
- Department of Personality, Evaluation and Psychological Treatment, Universidad de Valencia, Valencia, Spain
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Botella C, Pérez-Ara MÁ, Bretón-López J, Quero S, García-Palacios A, Baños RM. In Vivo versus Augmented Reality Exposure in the Treatment of Small Animal Phobia: A Randomized Controlled Trial. PLoS One 2016; 11:e0148237. [PMID: 26886423 PMCID: PMC4757089 DOI: 10.1371/journal.pone.0148237] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [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: 09/15/2015] [Accepted: 01/13/2016] [Indexed: 11/28/2022] Open
Abstract
Although in vivo exposure is the treatment of choice for specific phobias, some acceptability problems have been associated with it. Virtual Reality exposure has been shown to be as effective as in vivo exposure, and it is widely accepted for the treatment of specific phobias, but only preliminary data are available in the literature about the efficacy of Augmented Reality. The purpose of the present study was to examine the efficacy and acceptance of two treatment conditions for specific phobias in which the exposure component was applied in different ways: In vivo exposure (N = 31) versus an Augmented Reality system (N = 32) in a randomized controlled trial. "One-session treatment" guidelines were followed. Participants in the Augmented Reality condition significantly improved on all the outcome measures at post-treatment and follow-ups. When the two treatment conditions were compared, some differences were found at post-treatment, favoring the participants who received in vivo exposure. However, these differences disappeared at the 3- and 6-month follow-ups. Regarding participants' expectations and satisfaction with the treatment, very positive ratings were reported in both conditions. In addition, participants from in vivo exposure condition considered the treatment more useful for their problem whereas participants from Augmented Reality exposure considered the treatment less aversive. Results obtained in this study indicate that Augmented Reality exposure is an effective treatment for specific phobias and well accepted by the participants.
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Affiliation(s)
- Cristina Botella
- Department of Basic Psychology, Clinic and Psychobiology, Universitat Jaume I, Castellón, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - M. Ángeles Pérez-Ara
- Department of Basic Psychology, Clinic and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Juana Bretón-López
- Department of Basic Psychology, Clinic and Psychobiology, Universitat Jaume I, Castellón, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Soledad Quero
- Department of Basic Psychology, Clinic and Psychobiology, Universitat Jaume I, Castellón, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Azucena García-Palacios
- Department of Basic Psychology, Clinic and Psychobiology, Universitat Jaume I, Castellón, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Rosa María Baños
- Department of Personality, Evaluation and Psychological Treatment, Universitat de València, Valencia, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
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Wrzesien M, Botella C, Bretón-López J, del Río González E, Burkhardt JM, Alcañiz M, Pérez-Ara MÁ. Treating small animal phobias using a projective-augmented reality system: A single-case study. Computers in Human Behavior 2015. [DOI: 10.1016/j.chb.2015.01.065] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Quero S, Campos D, Riera Del Amo A, Bretón-López J, Tortella-Feliu M, Baños RM, Botella C. NO-FEAR Airlines: A Computer-aided Self-help Treatment for Flying Phobia. Stud Health Technol Inform 2015; 219:197-201. [PMID: 26799907] [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: 06/05/2023]
Abstract
In vivo exposure is the treatment of choice for specific phobias. However, this treatment is linked to a number of limitations in its implementation. Therefore, it is important to develop strategies for improving treatment adherence, acceptance, and dissemination of evidence-based treatments. Information and Communication Technologies, specifically, computerized programs boast advantages in treating flying phobia. NO-FEAR Airlines is a Computer-aided Self-help Treatment for this problem, which can be self-applied via Internet. NO-FEAR Airlines treatment protocol comprises three therapeutic components: psychoeducation, exposure and overlearning. Exposure is carried out through 6 scenarios that are composed by images and real sounds related to a flight in process. The aim of the present work is to describe NO-FEAR Airlines program.
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Quero S, Pérez-Ara MÁ, Bretón-López J, García-Palacios A, Baños RM, Botella C. Acceptability of virtual reality interoceptive exposure for the treatment of panic disorder with agoraphobia. British Journal of Guidance & Counselling 2013. [DOI: 10.1080/03069885.2013.852159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wrzesien M, Alcañiz M, Botella C, Burkhardt JM, Bretón-López J, Ortega M, Brotons DB. The therapeutic lamp: treating small-animal phobias. IEEE Comput Graph Appl 2013; 33:80-86. [PMID: 24807885 DOI: 10.1109/mcg.2013.12] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We all have an irrational fear or two. Some of us get scared by an unexpected visit from a spider in our house; others get nervous when they look down from a high building. Fear is an evolutionary and adaptive function that can promote self-preservation and help us deal with the feared object or situation. However, when this state becomes excessive, it might develop into psychological disorders such as phobias, producing high anxiety and affecting everyday life. The Therapeutic Lamp is an interactive projection-based augmented-reality system for treating small-animal phobias. It aims to increase patient-therapist communication, promote more natural interaction, and improve the patient's engagement in the therapy.
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Pérez-Ara MA, Quero S, Botella C, Baños R, Andreu-Mateu S, García-Palacios A, Bretón-López J. Virtual reality interoceptive exposure for the treatment of panic disorder and agoraphobia. Stud Health Technol Inform 2010; 154:77-81. [PMID: 20543274] [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: 05/29/2023]
Abstract
The efficacy of cognitive-behavioral therapy for panic disorder and agoraphobia (PDA) has been widely demonstrated. The exposure technique is the main component of these programs; interoceptive exposure also plays an important role. The virtual reality (VR) program for treating PDA developed by Botella's group can simulate physical sensations in a controlled manner while the user is immersed in the VR environments in the consultation room. These include audible effects, such as rapid heartbeat and panting, as well as visual effects, such as blurry vision, double vision and tunnel vision. This work examines the efficacy of the interoceptive exposure (IE) component in two treatment conditions: 1) VR Interoceptive Exposure Simultaneous Condition (VRIE-sim; N=14), and 2) Interoceptive Exposure Traditional Condition (IET; N=15). Results obtained showed that both treatment conditions significantly reduced the main clinical variables at post-treatment; these results were maintained or even improved at three month follow-up. Simultaneous VR interoceptive and VR external stimuli exposure is a new and effective way to apply PDA treatment.
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Baños R, Botella C, Guillen V, García-Palacios A, Quero S, Bretón-López J, Alcañiz M. An adaptive display to treat stress-related disorders: EMMA's World. British Journal of Guidance & Counselling 2009. [DOI: 10.1080/03069880902957064] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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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Bretón-López J, Buela-Casal G. [Questionnaire to assess advertising campaigns impact about HIV/AIDS prevention]. Psicothema 2006; 18:557-64. [PMID: 17296087] [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] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Present work is concerned with a questionnaire aimed to the impact evaluation of a selection of Spanish advertising campaigns about HIV/AIDS prevention. The work objective is to determine reliability and factorial structure of the instrument. It is described the designed questionnaire and its three scales (affective impact scale, cognitive impact scale and behavioural intention impact scale). The sample was composed by 405 high school teenagers to who were projected the advertising campaigns. So, teenagers filled the designed questionnaire. From a theoretical and psychometric point of view, data show the instrument is appropriate about internal consistency and factorial structure. The final goal of the questionnaire is to become useful tool to assess the persuasive effectiveness of the advertising campaigns within the HIV/AIDS network, as an intervention of primary prevention to reduce the expansion of epidemic.
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