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Sundström C, Ivanova E, Lindner P, Johansson M, Kraepelien M. Investigating the added effects of guidance in digital psychological self-care for alcohol problems (ALVA)-protocol for a randomized factorial optimization trial. Trials 2024; 25:136. [PMID: 38383426 PMCID: PMC10880249 DOI: 10.1186/s13063-024-07981-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 02/12/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND The continual development and implementation of effective digital interventions is one important strategy that may serve to bridge the well-known treatment gap related to problematic alcohol use. Research suggests that clinician guidance, provided in different ways during the digital intervention (i.e., written weekly messages, phone calls etc.), can boost intervention engagement and effects. Digital psychological self-care (DPSC) is a new delivery format wherein an unguided digital intervention is provided within the framework of a structured care process that includes initial clinical assessment and follow-up interviews. In a recent feasibility study, a DPSC intervention for problematic alcohol use, ALVA, provided without any extra guidance, was found safe and credible and to have promising within-group effects on alcohol consumption. The aim of the current study is to gather information on the effects and efficiency of different forms of guidance added to ALVA, in order to optimize the intervention. METHODS This protocol describes a randomized factorial trial where the effects of two different ways of providing guidance (mid-treatment interview, weekly written messages, respectively) in DPSC for problematic alcohol use are investigated. Optimization criteria will be applied to the results regarding how effective the intervention is at reducing alcohol consumption measured by the number of standard drinks per week together with the clinician time spent on guidance. DISCUSSION This study will investigate the added benefit of different forms of guidance to DPSC for problematic alcohol use. These added effects will be compared to the added cost of guidance, according to pre-defined optimization criteria. TRIAL REGISTRATION Clinicaltrials.gov: NCT05649982. Registered on 06 December 2022. Prospectively registered.
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Affiliation(s)
- Christopher Sundström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Ekaterina Ivanova
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
| | - Philip Lindner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
| | - Magnus Johansson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
| | - Martin Kraepelien
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden.
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Edge D, Watkins ER, Limond J, Mugadza J. The efficacy of self-guided internet and mobile-based interventions for preventing anxiety and depression - A systematic review and meta-analysis. Behav Res Ther 2023; 164:104292. [PMID: 37003138 DOI: 10.1016/j.brat.2023.104292] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Anxiety and depression are highly prevalent mental disorders which are associated with a considerable personal and economic burden. As treatment alone has a minimal impact on prevalence, there is now a growing focus on interventions which may help prevent anxiety and depression. Internet and mobile based interventions have been identified as a useful avenue for the delivery of preventative programmes due to their scalability and accessibility. The efficacy of interventions that do not require additional support from a trained professional (self-guided) in this capacity is yet to be explored. METHOD A systematic search was conducted on the Cochrane Library, PubMed, PsycARTICLES, PsycINFO, OVID, MEDline, PsycEXTRA and SCOPUS databases. Studies were selected according to defined inclusion and exclusion criteria. The primary outcome was evaluating the effect of self-guided internet and mobile based interventions on incidence of anxiety and depression. The secondary outcome was effect on symptom severity. RESULTS After identifying and removing duplicates, 3211 studies were screened, 32 of which were eligible for inclusion in the final analysis. Nine studies also reported incidence data (depression = 7, anxiety = 2). The overall Risk Ratios for incidence of anxiety and depression were 0.86 (95% CI [0.28, 2.66], p = .79) and 0.67 (95% CI [0.48, 0.93], p = .02) respectively. Analysis for 27 studies reporting severity of depressive symptoms revealed a significant posttreatment standardised mean difference of -0.27 (95% CI [ -0.37, -0.17], p < .001) for self-guided intervention groups relative to controls. A similar result was observed for 29 studies reporting severity of anxiety symptoms with a standardised mean difference of -0.21 (95% CI [-0.31, -0.10], p < .001). CONCLUSIONS Self-guided internet and mobile based interventions appear to be effective at preventing incidence of depression, though further examination of the data suggests that generalisability of this finding may be limited. While self-guided interventions also appear effective in reducing symptoms of anxiety and depression, their ability to prevent incidence of anxiety is less clear. A heavy reliance on symptom measures in the data analysed suggests future research could benefit from prioritising the use of standardised diagnostic measuring tools to assess incidence. Future systematic reviews should aim to include more data from grey literature and reduce the impact of study heterogeneity.
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Affiliation(s)
- Daniel Edge
- Mood Disorders Centre, School of Psychology, University of Exeter, United Kingdom.
| | - Edward R Watkins
- Mood Disorders Centre, School of Psychology, University of Exeter, United Kingdom
| | - Jenny Limond
- Mood Disorders Centre, School of Psychology, University of Exeter, United Kingdom
| | - Jane Mugadza
- Mood Disorders Centre, School of Psychology, University of Exeter, United Kingdom
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Hentati A, Forsell E, Ljótsson B, Kaldo V, Lindefors N, Kraepelien M. The effect of user interface on treatment engagement in a self-guided digital problem-solving intervention: A randomized controlled trial. Internet Interv 2021; 26:100448. [PMID: 34471610 PMCID: PMC8387893 DOI: 10.1016/j.invent.2021.100448] [Citation(s) in RCA: 9] [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] [Received: 05/21/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Resources are spent worldwide on the development of digital platforms and their user interfaces (UIs) for digital mental health services (DMHS). However, studies investigating the potential benefits of different UIs for DMHS are currently lacking. To fill this knowledge gap, the aim of this study was to investigate differences in treatment engagement between two different UIs for DMHS. METHODS A total of 397 participants from the Swedish general public were randomized (1:1) to use a self-guided digital problem-solving intervention during one week, either with an optimized UI (N = 198), based on user experience (UX) design principles and with automated features, or a basic UI (N = 199), analogous with a UI used in Swedish regular health care comprising elementary UI features and less automation. Primary outcome measures were self-rated usability, on the System Usability Scale, and treatment credibility, on the Credibility/Expectancy Questionnaire. Secondary outcome measures included behavioral engagement with the intervention. FINDINGS There were no significant differences between the UIs in ratings of usability or treatment credibility. However, participants who used the optimized UI were significantly more engaged with the intervention as measured by usage of the intervention at least once (odds ratio 2.54, 95% CI [1.67, 3.85]), total number of generated solutions (mean difference 1.41, 95% CI [0.72, 2.11]), and mean number of generated solutions per initiated problem-solving attempt (mean difference 1.45, 95% CI [1.06, 1.85]). Other findings included participants using the optimized UI rating the intervention as easier to understand, while feeling more overwhelmed, than those using the basic UI. INTERPRETATION Our findings indicate that an optimized UI based on UX design principles, in comparison to a basic UI comprising elementary UI features, do not affect overall self-rated usability or treatment credibility but increases some measures of behavioral engagement with a digital intervention. FUNDING Funded by the Government of Sweden, Ministry of Health and Social Affairs.
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Affiliation(s)
- Amira Hentati
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Corresponding author at: Center for Psychiatry Research, Norra Stationsgatan 69, 113 64 Stockholm, Sweden.
| | - Erik Forsell
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Brjánn Ljótsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Viktor Kaldo
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Nils Lindefors
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Martin Kraepelien
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Wootton BM, Karin E, Titov N, Dear BF. Self-guided internet-delivered cognitive behavior therapy (ICBT) for obsessive-compulsive symptoms: A randomized controlled trial. J Anxiety Disord 2019; 66:102111. [PMID: 31301476 DOI: 10.1016/j.janxdis.2019.102111] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 06/23/2019] [Accepted: 06/26/2019] [Indexed: 11/27/2022]
Abstract
Internet-delivered cognitive behavior therapy (ICBT) for obsessive-compulsive disorder (OCD) has been demonstrated to be efficacious across multiple clinical trials. However, most of these interventions include clinician support, and many individuals with OCD prefer to manage their own symptoms. Self-guided ICBT overcomes this problem, but to date the efficacy of self-guided interventions has only been studied in uncontrolled trials. The present study aims to examine the efficacy and acceptability of ICBT for OCD symptoms when delivered in a self-guided format using a randomized controlled trial design. In the present study, 190 participants were randomized to either a self-guided ICBT condition or a waitlist control group. 140 participants completed the baseline assessment, initiated treatment, and were included in the analyses. The between-group effect size at post-treatment was large on the self-report version of the Yale-Brown Obsessive-Compulsive Scale (d = 1.05; 95% CI 0.89-1.21). Twenty-seven percent of the ICBT condition met conservative criteria for clinically significant change at post-treatment, which increased to thirty-eight percent at three-month follow-up. Participants rated the program as highly acceptable. The results indicate that self-guided ICBT may be a viable treatment option for some individuals with OCD symptoms.
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Affiliation(s)
- Bethany M Wootton
- University of Technology Sydney, NSW, Australia; Macquarie University, Sydney, NSW, Australia.
| | - Eyal Karin
- Macquarie University, Sydney, NSW, Australia
| | - Nick Titov
- Macquarie University, Sydney, NSW, Australia
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Körner A, Roberts N, Steele RJ, Brosseau DC, Rosberger Z. A randomized controlled trial assessing the efficacy of a self-administered psycho-educational intervention for patients with cancer. Patient Educ Couns 2019; 102:735-741. [PMID: 30545649 DOI: 10.1016/j.pec.2018.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 10/25/2018] [Accepted: 12/02/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Bibliotherapy refers to psychological self-help interventions that utilize treatment books to improve psychological well-being. Research supports bibliotherapy as an efficacious intervention for a variety of mental health problems. Yet, few studies have investigated bibliotherapy in psychosocial oncology. The objective of this randomized controlled trial was to examine the efficacy of the NuCare intervention, delivered as a self-directed workbook, for enhancing empowerment, coping, and quality of life and reducing distress in patients with cancer. METHODS Eighty-nine adult patients with cancer were randomized to receive the workbook for 6 weeks or the control condition, usual care. Participants completed questionnaires at baseline, 6 weeks post-baseline, and 10 weeks post-baseline. RESULTS The increase of empowerment (main outcome) and quality of life and the decrease of distress in the NuCare group from pre-intervention to follow-up assessment differed significantly from the respective difference scores in the control group. CONCLUSIONS The self-administered NuCare workbook is a potentially cost-effective, minimal intervention addressing psychosocial needs of patients with cancer. PRACTICE IMPLICATIONS Evidence-based bibliotherapy can empower patients and has the promise of reducing the burden on the healthcare system while enhancing the immediacy of psychosocial support.
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Affiliation(s)
- Annett Körner
- Departments of Educational and Counselling Psychology and of Oncology, McGill University, Montreal, Canada; Louise Granofsky Psychosocial Oncology Program, Segal Cancer Center, Jewish General Hospital, Montreal, Canada; Psychosocial Oncology Program, McGill University Health Centre, Montreal, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.
| | - Nicole Roberts
- Counselling Services, McGill University, Montreal, Canada
| | - Russell J Steele
- Department of Mathematics and Statistics, McGill University, Montreal, Canada
| | | | - Zeev Rosberger
- Louise Granofsky Psychosocial Oncology Program, Segal Cancer Center, Jewish General Hospital, Montreal, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Departments of Psychology, Oncology and Psychiatry, McGill University, Montreal, Canada
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Beatty L, Kemp E, Coll JR, Turner J, Butow P, Milne D, Yates P, Lambert S, Wootten A, Yip D, Koczwara B. Finding My Way: results of a multicentre RCT evaluating a web-based self-guided psychosocial intervention for newly diagnosed cancer survivors. Support Care Cancer 2019; 27:2533-44. [DOI: 10.1007/s00520-018-4526-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/23/2018] [Indexed: 02/07/2023]
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Banerjee M, Cavanagh K, Strauss C. A Qualitative Study with Healthcare Staff Exploring the Facilitators and Barriers to Engaging in a Self-Help Mindfulness-Based Intervention. Mindfulness (N Y) 2017; 8:1653-1664. [PMID: 29201248 PMCID: PMC5693971 DOI: 10.1007/s12671-017-0740-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
In order to increase the cost-efficiency, availability and ease of accessing and delivering mindfulness-based interventions (MBIs), clinical and research interest in mindfulness-based self-help (MBSH) interventions has increased in recent years. Several studies have shown promising results of effectiveness of MBSH. However, like all self-help interventions, dropout rates and disengagement from MBSH are high. The current study explored the facilitators and barriers of engaging in a MBSH intervention. Semi-structured interviews with members of healthcare staff who took part in an MBSH intervention (n = 16) were conducted. A thematic analysis approach was used to derive central themes around engagement from the interviews. Analyses resulted in four overarching themes characterising facilitation and hindrance to engagement in MBSH. These are "attitude towards engagement", "intervention characteristics", "process of change" and "perceived consequences". Long practices, emerging negative thoughts and becoming self-critical were identified as the key hindrances, whilst need for stress reduction techniques, shorter practices and increased sense of agency over thoughts were identified as the key facilitators. Clinical and research implications are discussed.
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Affiliation(s)
- Moitree Banerjee
- School of Psychology, University of Sussex, Brighton, BN1 9QH UK
| | - Kate Cavanagh
- School of Psychology, University of Sussex, Brighton, BN1 9QH UK
| | - Clara Strauss
- School of Psychology, University of Sussex, Brighton, BN1 9QH UK
- Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Mill View Hospital, Nevill Avenue, Hove, BN3 7HY UK
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Ugalde A, Haynes K, Boltong A, White V, Krishnasamy M, Schofield P, Aranda S, Livingston P. Self-guided interventions for managing psychological distress in people with cancer - A systematic review. Patient Educ Couns 2017; 100:846-857. [PMID: 28081937 DOI: 10.1016/j.pec.2016.12.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 12/01/2016] [Accepted: 12/13/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE People with cancer can experience psychological distress but do not always desire, or engage with, professional support to assist with managing distress. Interventions that are self-directed or guided by patients may hold promise as they allow patients to engage with interventions as they need. The objective of this review is to describe and appraise the evidence for effectiveness of self-guided interventions that aim to manage psychological distress in people with cancer. METHODS A systematic search of Medline, PsychInfo and CINAHL identified 15 relevant papers, reporting on 14 studies. RESULTS Of the interventions, three studies comprised hard-copy workbooks, six studies used resource packs, four were online resources and one was a brief multimedia resource. One study was adequately powered and demonstrated a positive effect. Almost all interventions required some level of facilitation. Distressed participants may benefit more from interventions. CONCLUSION Self-guided interventions represent a potentially efficient way of delivering support for people affected by cancer, however evidence supporting them is lacking. PRACTICE IMPLICATIONS There is a need to generate evidence to understand the impact of self-guided interventions for: i) the ideal delivery point in the disease trajectory, ii) patient groups, iii) intervention content and iv) type and mode of delivery.
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Affiliation(s)
- Anna Ugalde
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia; Cancer Information and Support Service, Cancer Council Victoria, Melbourne, Victoria, Australia.
| | - Kerry Haynes
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Anna Boltong
- Cancer Information and Support Service, Cancer Council Victoria, Melbourne, Victoria, Australia; Department of Nursing, University of Melbourne, Parkville, Victoria, Australia
| | - Victoria White
- Department of Nursing, University of Melbourne, Parkville, Victoria, Australia; Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Meinir Krishnasamy
- Department of Nursing, University of Melbourne, Parkville, Victoria, Australia; Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia; Centre for Cancer Research, University of Melbourne, Parkville, Victoria, Australia
| | - Penelope Schofield
- Department of Nursing, University of Melbourne, Parkville, Victoria, Australia; Peter MacCallum Cancer Centre, Parkville, Victoria, Australia; Swinburne University, Hawthorn, Victoria, Australia
| | - Sanchia Aranda
- Department of Nursing, University of Melbourne, Parkville, Victoria, Australia; Cancer Council Australia, Sydney, New South Wales, Australia
| | - Patricia Livingston
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
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Dear BF, Staples LG, Terides MD, Fogliati VJ, Sheehan J, Johnston L, Kayrouz R, Dear R, McEvoy PM, Titov N. Transdiagnostic versus disorder-specific and clinician-guided versus self-guided internet-delivered treatment for Social Anxiety Disorder and comorbid disorders: A randomized controlled trial. J Anxiety Disord 2016; 42:30-44. [PMID: 27261562 DOI: 10.1016/j.janxdis.2016.05.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 04/22/2016] [Accepted: 05/07/2016] [Indexed: 12/14/2022]
Abstract
Disorder-specific (DS-CBT) and transdiagnostic (TD-CBT) cognitive behaviour therapy have both been used to treat social anxiety disorder (SAD). This study compared internet-delivered DS-CBT and TD-CBT for SAD across clinician-guided (CG-CBT) and self-guided (SG-CBT) formats. Participants with SAD (n=233) were randomly allocated to receive internet-delivered TD-CBT or DS-CBT and CG-CBT or SG-CBT. Large reductions in symptoms of SAD (Cohen's d≥1.01; avg. reduction≥30%) and moderate-to-large reductions in symptoms of comorbid depression (Cohen's d≥1.25; avg. reduction≥39%), generalised anxiety disorder (Cohen's d≥0.86; avg. reduction≥36%) and panic disorder (Cohen's d≥0.53; avg. reduction≥25%) were found immediately post-treatment and were maintained or further improved to 24-month follow-up. No marked differences were observed between TD-CBT and DS-CBT or CG-CBT and SG-CBT highlighting the potential of each for the treatment of SAD and comorbid disorders.
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Affiliation(s)
- B F Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - L G Staples
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - M D Terides
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - V J Fogliati
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - J Sheehan
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - L Johnston
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - R Kayrouz
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - R Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - P M McEvoy
- School of Psychology and Speech Pathology, Curtin University, Australia
| | - N Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia.
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Fogliati VJ, Dear BF, Staples LG, Terides MD, Sheehan J, Johnston L, Kayrouz R, Dear R, McEvoy PM, Titov N. Disorder-specific versus transdiagnostic and clinician-guided versus self-guided internet-delivered treatment for panic disorder and comorbid disorders: A randomized controlled trial. J Anxiety Disord 2016; 39:88-102. [PMID: 27003376 DOI: 10.1016/j.janxdis.2016.03.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/07/2016] [Accepted: 03/08/2016] [Indexed: 11/19/2022]
Abstract
Transdiagnostic cognitive behaviour therapy (TD-CBT) aims to target the symptoms of multiple disorders whereas disorder-specific CBT (DS-CBT) targets the symptoms of principal disorders. This study compared the relative benefits of internet-delivered TD-CBT and DS-CBT when provided in clinician-guided (CG-CBT) and self-guided (SG-CBT) formats for people with a principal diagnosis of Panic Disorder (PD). Participants (n=145) were randomly allocated to receive TD-CBT or DS-CBT and CG-CBT or SG-CBT. Large reductions in symptoms of PD (Cohen's d ≥ 0.71; avg. reduction ≥ 36%) and moderate-to-large reductions in symptoms of comorbid depression (Cohen's d ≥ 0.71; avg. reduction ≥ 33%), generalised anxiety disorder (Cohen's d ≥ 0.91; avg. reduction ≥ 34%) and social anxiety disorder (Cohen's d ≥ 0.50; avg. reduction ≥ 15%) were found over the 24-month follow-up period. Highlighting their efficacy and acceptability, no marked and consistent differences were observed between TD-CBT and DS-CBT or CG-CBT and DS-CBT.
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Affiliation(s)
- V J Fogliati
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - B F Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia.
| | - L G Staples
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - M D Terides
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - J Sheehan
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - L Johnston
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - R Kayrouz
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - R Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - P M McEvoy
- School of Psychology and Speech Pathology, Curtin University, Australia
| | - N Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
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Dear BF, Staples LG, Terides MD, Karin E, Zou J, Johnston L, Gandy M, Fogliati VJ, Wootton BM, McEvoy PM, Titov N. Transdiagnostic versus disorder-specific and clinician-guided versus self-guided internet-delivered treatment for generalized anxiety disorder and comorbid disorders: A randomized controlled trial. J Anxiety Disord 2015; 36:63-77. [PMID: 26460536 DOI: 10.1016/j.janxdis.2015.09.003] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/25/2015] [Accepted: 09/07/2015] [Indexed: 11/29/2022]
Abstract
Generalized anxiety disorder (GAD) can be treated effectively with either disorder-specific cognitive behavior therapy (DS-CBT) or transdiagnostic CBT (TD-CBT). The relative benefits of DS-CBT and TD-CBT for GAD and the relative benefits of delivering treatment in clinician guided (CG-CBT) and self-guided (SG-CBT) formats have not been examined. Participants with GAD (n=338) were randomly allocated to receive an internet-delivered TD-CBT or DS-CBT intervention delivered in either CG-CBT or SG-CBT formats. Large reductions in symptoms of GAD (Cohen's d ≥ 1.48; avg. reduction ≥ 50%) and comorbid major depressive disorder (Cohen's d ≥ 1.64; avg. reduction ≥ 45%), social anxiety disorder (Cohen's d ≥ 0.80; avg. reduction ≥ 29%) and panic disorder (Cohen's d ≥ 0.55; avg. reduction ≥ 33%) were found across the conditions. No substantive differences were observed between DS-CBT and TD-CBT or CG-CBT and SG-CBT, highlighting the public health potential of carefully developed TD-CBT and SG-CBT.
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Affiliation(s)
- B F Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia.
| | - L G Staples
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - M D Terides
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - E Karin
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - J Zou
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - L Johnston
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - M Gandy
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - V J Fogliati
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - B M Wootton
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia; School of Medicine (Psychology), University of Tasmania, Tasmania, Australia
| | - P M McEvoy
- School of Psychology and Speech Pathology, Curtin University, Western Australia, Australia
| | - N Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
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Beatty L, Koczwara B, Wade T. Evaluating the efficacy of a self-guided Web-based CBT intervention for reducing cancer-distress: a randomised controlled trial. Support Care Cancer 2016; 24:1043-51. [PMID: 26248651 DOI: 10.1007/s00520-015-2867-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/27/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE This study evaluated the efficacy of a self-guided Web-based cognitive behaviour therapy (CBT) intervention compared to an attention control in improving cancer-related distress, health-related quality of life (HRQOL), and maladaptive coping, among people recently diagnosed with cancer. METHODS Sixty individuals with cancer diagnosed in the previous 6 months and receiving treatment with curative intent were randomised to receive either the 6-week intervention Cancer Coping Online (CCO: n = 30) or the 6-week Web-based attention control (n = 30). Outcome measures, including cancer distress (the Posttraumatic Stress Scale - Self-Report), general distress (Depression Anxiety Stress Scale), quality of life (EORTC QLQ-C30), and coping (mini-MAC), were administered at baseline, immediately post-intervention, and at 3 and 6 months post-intervention. RESULTS Significant main effects for time were found for cancer distress, global QOL, physical function, role function, social function, and anxious preoccupation. Post hoc between-group comparisons showed CCO participants had statistically significantly higher physical functioning compared to controls at 3 months of follow-up (d = -0.52, p = 0.02). Furthermore, compared to controls, post hoc comparisons found moderate between-group effect sizes favouring CCO post-intervention for cancer distress (d = 0.43) and anxious preoccupation (d = 0.38), and at 6 months of follow-up for global QOL (d = -0.43). CONCLUSIONS These results provide preliminary support for the potential efficacy of a self-guided Web-based CBT programme in improving aspects of HRQOL, cancer-related distress, and anxious preoccupation after cancer diagnosis. This paper provides justification for, and will help inform the development of, subsequent larger multi-site studies.
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