| 441. |
- Powers, Mark B., et al.
(författare)
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Technology : Bridging the Gap from Research to Practice
- 2016
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Ingår i: Cognitive Behaviour Therapy. - : Informa UK Limited. - 1650-6073 .- 1651-2316. ; 45:1, s. 1-4
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Anxiety disorders are the most common mental disorders and they account for approximately one-third of all mental health care costs. Fortunately, meta-analyses show exposure-based therapy is effective for most patients with anxiety disorders. Based on such findings, international treatment guidelines recommend exposure therapy for anxiety disorders as the gold standard. For example, the Institute of Medicine stated “the evidence is sufficient to conclude the efficacy of exposure therapies in the treatment of PTSD” (p. 97) but they did not find sufficient evidence for any other psychotherapy or pharmacotherapy. Following these guidelines should be uncomplicated, but in general therapists seem to prefer to use their clinical experience rather than research findings to improve their practice.Although well supported for over 50 years, most people with anxiety disorders still do not receive exposure therapy. In fact, most people with emotional disorders do not receive any treatment. This gap in what is known and what is available to patients is frustrating. Examination of obstacles to dissemination reveals how recent advances in technology may help bridge the gap. Below we briefly review some of the proposed obstacles to successful dissemination and potential technological solutions for each.
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| 442. |
- Powers, M., et al.
(författare)
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Recent Advances in Virtual Reality Therapy
- 2017
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- This session will present recent advances in virtual reality therapy for mental disorders. Many of these advances are a result of a boom in personal consumer electronics. We will discuss both stationary (Virtually Better, Oculus Rift) and mobile (Samsung Gear) systems along with new stimuli and capture techniques. Together, these advances improve the efficacy and availability of high tech solutions to previous obstacles in the delivery of cognitive behavioral therapy. The first presentation will present data on the relative efficacy of enhanced (360 3D HD film) virtual reality exposure therapy (VRET) to standard VRET (animated stimuli). The second presentation will discuss the development and efficacy of gamified VRET for spider phobia compared to traditional exposure therapy along with 12-month follow-up data. The third presentation will describe combining in vivo behavioral observations to enhance in virtuo exposure. The fourth presentation will describe VR systems as a potential adjunct to treatment of stress-related disorders. The final presentation will show the relative efficacy of in vivo and in virtual exposure for social anxiety disorder. Finally, the discussant who has decades of experience in the field of VRET will cover implications and future directions in the field of VR in the treatment of mental disorders.
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| 443. |
- Price, Rebecca B., et al.
(författare)
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Less is more : Patient-level meta-analysis reveals paradoxical dose-response effects of a computer-based social anxiety intervention targeting attentional bias
- 2017
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Ingår i: Depression and anxiety (Print). - : Hindawi Limited. - 1091-4269 .- 1520-6394. ; 34:12, s. 1106-1115
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Forskningsöversikt (refereegranskat)abstract
- Background: The past decade of research has seen considerable interest in computer-based approaches designed to directly target cognitive mechanisms of anxiety, such as attention bias modification (ABM).Methods: By pooling patient-level datasets from randomized controlled trials of ABM that utilized a dot-probe training procedure, we assessed the impact of training "dose" on relevant outcomes among a pooled sample of 693 socially anxious adults.Results: A paradoxical effect of the number of training trials administered was observed for both posttraining social anxiety symptoms and behavioral attentional bias (AB) toward threat (the target mechanism of ABM). Studies administering a large (>1,280) number of training trials showed no benefit of ABM over control conditions, while those administering fewer training trials showed significant benefit for ABM in reducing social anxiety (P = .02). These moderating effects of dose were not better explained by other examined variables and previously identified moderators, including patient age, training setting (laboratory vs. home), or type of anxiety assessment (clinician vs. self-report).Conclusions: Findings inform the optimal dosing for future dot-probe style ABM applications in both research and clinical settings, and suggest several novel avenues for further research.
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| 444. |
- Price, Rebecca B., et al.
(författare)
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Pooled patient-level meta-analysis of children and adults completing a computer-based anxiety intervention targeting attentional bias
- 2016
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Ingår i: Clinical Psychology Review. - : Elsevier BV. - 0272-7358 .- 1873-7811. ; 50, s. 37-49
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Forskningsöversikt (refereegranskat)abstract
- Computer-based approaches, such as Attention Bias Modification (ABM), could help improve access to care for anxiety. Study-level meta-analyses of ABM have produced conflicting findings and leave critical questions unresolved regarding ABM's mechanisms of action and clinical potential. We pooled patient-level datasets from randomized controlled trials of children and adults with high-anxiety. Attentional bias (AB) towards threat, the target mechanism of ABM, was tested as an outcome and a mechanistic mediator and moderator of anxiety reduction. Diagnostic remission and Liebowitz Social Anxiety Scale (LSAS) were clinical outcomes available in enough studies to enable pooling. Per-patient data were obtained on at least one outcome from 13/16 eligible studies [86% of eligible participants; n = 778]. Significant main effects of ABM on diagnostic remission (ABM—22.6%, control—10.8%; OR = 2.57; p = 0.006) and AB (β* (95%CI) = − 0.63 (− 0.83, − 0.42); p < 0.00005) were observed. There was no main effect of ABM on LSAS. However, moderator analyses suggested ABM was effective for patients who were younger (≤ 37 y), trained in the lab, and/or assessed by clinicians. Under the same conditions where ABM was effective, mechanistic links between AB and anxiety reduction were supported. Under these specific circumstances, ABM reduces anxiety and acts through its target mechanism, supporting ABM's theoretical basis while simultaneously suggesting clinical indications and refinements to improve its currently limited clinical potential.
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| 445. |
- Proudfoot, Judith, et al.
(författare)
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Establishing guidelines for executing and reporting internet intervention research
- 2011
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Ingår i: Cognitive Behaviour Therapy. - : Routledge Taylor and Francis Group. - 1650-6073 .- 1651-2316. ; 40:2, s. 82-97
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Tidskriftsartikel (refereegranskat)abstract
- The field of Internet interventions is growing rapidly. New programs are continually being developed to facilitate health and mental health promotion, disease and emotional distress prevention, risk factor management, treatment, and relapse prevention. However, a clear definition of Internet interventions, guidelines for research, and evidence of effectiveness have been slower to follow. This article focuses on the quality standardization of research on Internet-delivered psychological and behavioural interventions. Although the science underpinning Internet interventions is just starting to be established, across research studies there are often conceptual and methodological difficulties. The authors argue that this situation is due to the lack of universally accepted operational guidelines and evaluation methods. Following a critical appraisal of existing codes of conduct and guidelines for Internet-assisted psychological and health interventions, the authors developed a framework of guidelines for Internet intervention research utilizing aspects of facet theory (Guttman & Greenbaum, 1998). The framework of facets, elements, and guidelines of best practice in reporting Internet intervention research was then sent to several leading researchers in the field for their comment and input, so that a consensus framework could be agreed on. The authors outline 12 key facets to be considered when evaluating and reporting Internet intervention studies. Each facet consists of a range of recommended elements, designed as the minimum features for reporting Internet intervention studies. The authors propose that this framework be utilized when designing and reporting Internet intervention research, so results across studies can be replicated, extended, compared, and contrasted with greater ease and clarity.
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| 446. |
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| 447. |
- Rafi, Jonas, 1985-
(författare)
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A Workplace Prevention Program for Problem Gambling
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Gambling is an activity that may involve harm for the gambler and others close to the gambler. Since workplaces may be negatively affected by employees who gamble during work or are at-risk problem gamblers, this setting has been proposed as a suitable arena for prevention. However, the potential effects of such initiatives have not been evaluated. This thesis explored the effects of a workplace prevention program for problem gambling. The program comprised gambling policy development and skill development training for managers.Study I used pre-intervention measures to explore gambling characteristics of employees (n=3629) in ten organizations, including both private and public sector organizations, and blue- and white-collar workers. About one in 20 employees knew someone who gambled during work, and this proportion was similar for both managers and subordinates. Another finding was that 3.5% of respondents were categorized as at-risk problem gamblers, with a higher prevalence among subordinates (3.8%) than managers (1.3%). A third finding was that 11.4% of employees stated that the organization had a gambling policy, and that this did not differ between managers and subordinates. Gambling policy knowledge was considerably lower than alcohol policy knowledge, as an alcohol policy was believed to exist by 94.3% of managers and 63.3% of subordinates. Lastly, in regression analyses, the two outcomes “knowing about a colleague who gambles during work” and “at-risk/problem gambling” were associated with each other, male gender, and young age. Taken together, the findings offer evidence that gambling may be an important topic to target in workplace settings, although more research is needed to pinpoint specific workplace harms and whether certain gambling types are associated with more workplace harms than others.Study II used a cluster-randomized design to investigate the effects of a prevention program. Ten organizations were randomized to an intervention group or a waitlist group. Individuals who were employed on any of three measurement occasions were eligible to participate. A total of n=490 (response rate 73%) managers and n = 4146 (response rate 43.3%) subordinates participated in the study by providing informed consent and responding to the survey at least once. The prevention program included two main components: policy development and skill development training for managers. The main outcome was managers’ inclination to act when worried about an employee regarding gambling or other harmful use (e.g., alcohol), together with a range of secondary outcome measures. The results showed that managers who participated in the skill development training significantly increased their inclination to act compared to the waitlist group, but this finding was not generalized to the whole intervention group. Thus, including managers in the intervention group who did not participate in the skill development training when calculating intervention effects resulted in non-significant effects. The results of secondary outcome measures showed that there were significant intervention effects regarding managers’ knowledge of a gambling policy, their confidence in how to act when concerned about an employee’s possible problem gambling or other harmful use, and the proportion of managers who had acted to provide support. Study III included semi-structured interviews with skill development participants (n=23) to inquire about their experiences of the prevention program. Interviews were transcribed and analyzed using qualitative content analysis, which yielded six distinct themes related to the participants, namely: 1) their expectations, 2) aspects of the skill development training they appreciated, 3) their experiences of PG, 4) their proposed areas of improvement, 5) whether they felt they had received a good basis for PG and other harmful use, and 6) their thoughts about the so-called “difficult conversation”. Taken together, the findings provide ideas for improving gambling-specific interventions for the workplace and corroborate earlier research findings on workplace interventions in general.To conclude, the thesis shows that a workplace preventive intervention for gambling can have positive effects on managers’ intended and performed actions to help an employee who they suspect has a problem with gambling or other harmful use. However, further program improvements and in-depth studies are needed to draw conclusions on explanations, robustness, and mechanisms of change.
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| 448. |
- Rafi, Jonas, et al.
(författare)
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Effects of a workplace prevention program for problem gambling : A cluster-randomized controlled trial
- 2022
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Ingår i: Journal of Gambling Issues. - : Concurrent Disorders Society Press. - 1910-7595. ; 50, s. 73-97
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Tidskriftsartikel (refereegranskat)abstract
- Background and Aims: This study evaluated whether a preventive intervention program for problem gambling would increase managers’ inclination to act when concerned about gambling in the workplace. Design: Cluster- randomized controlled trial. Ten workplaces were randomized to either intervention or control condition. Participants: At the 12-month endpoint, there were n = 136 managers and n = 1594 subordinates in the intervention group, and n = 137 managers and n = 1150 subordinates in the waitlist group. Intervention: The intervention consisted of (1) six hours of skill-development training for managers regarding gambling, problem gambling, gaming, and harmful use of psychoactive drugs, and (2) six to eight hours of assistance in developing or improving workplace gambling policy. Measurements: The primary outcome was the managers’ self-rated (on a 1 to 10 scale) inclination to act when concerned about an employee’s problem gambling 12 months after baseline. Findings: The between-group difference in the managers’ inclination for the full intervention group (M = 8) and the control group (M = 7.4) was not significant at the 12-month follow-up, but it was when only including managers who attended the skill- development training (M = 8.2), d = 0.31, p = .04. Conclusion: A workplace prevention program aimed to increase managers’ inclination to act when they are concerned regarding an employee’s gambling resulted in statistically significant changes for those who attended training, but not for the whole intervention group when non-attendees were included.
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| 449. |
- Rafi, Jonas, et al.
(författare)
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Effects of a workplace prevention programme for problem gambling : Study protocol for a cluster randomised controlled trial
- 2017
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 7:9
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Despite being considered a public health problem, no prevention programme for problem gambling in workplace settings has been scientifically evaluated. This study aims to fill a critical gap in the field of problem gambling by implementing and evaluating a large-scale prevention programme in organisations.Methods and analysis: Ten organisations, with a total of n=549 managers and n=8572 employees, will be randomised to either receiving a prevention programme or to a waitlist control condition. Measurements will be collected at the baseline and 3, 12 and 24 months after intervention. The primary outcome of interest is the managers’ inclination to act when worried or suspicious about an employee’s problem gambling or other harmful use. Additional outcomes of interest include the Problem Gambling Severity Index and gambling habits in both managers and employees. Furthermore, qualitative analyses of the responses from semistructured interviews with managers will be performed.Ethics and dissemination: This study has been approved by the regional ethics board of Stockholm, Sweden, and it will contribute to the body of knowledge concerning prevention of problem gambling. The findings will be published in peer-reviewed, open-access journals.Trial registration number: NCT02925286; Pre-results.
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| 450. |
- Rafi, Jonas, et al.
(författare)
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Gambling among employees in Swedish workplaces : A cross-sectional study
- 2023
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Ingår i: Environmental and Occupational Health Practice. - 2434-4931. ; 5:1
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Responsible workplaces strive to minimize the harmful effects of alcohol and drug abuse. However, gambling is still a neglected area in workplace research. This study describes workplace gambling and investigates variables associated with at-risk problem gambling and knowing about colleagues who gambles during work, using cross-sectional data from a large cluster-randomized controlled trial on gambling prevention in the workplace (N=3629).Methods: Measures included prevalence of workplace gambling policies, at-risk and problem gambling, and knowledge about colleagues who gamble during work.Results: Of the respondents, 168 (4.7%) knew of someone who gambles at work, of whom 29 (17.3%) also worried about the harmful consequences of workplace gambling. Moreover, 395 (11.2%) believed that a gambling policy existed in their workplace. Knowing about a colleague who gambles during work was more common among employees who were men (OR = 2.98), aged 16–34 (OR = 1.97), knew about a gambling policy (OR = 1.57), and who themselves were classified as at-risk problem gamblers (OR = 2.95). Similarly, being classified as an at-risk problem gambler was significantly associated with being male (OR = 2.14), aged 16–34 (OR = 2.35) or 35–44 (OR=2.36), being a subordinate (OR = 2.53), and knowing about a colleague who gambles during work (OR=4).Conclusions: Gambling during work is a prevalent phenomenon. Organizations should consider implementing gambling policies that facilitate helping workers who are problem gamblers. To determine policy contents and measures to implement, the type of gambling and its effect on employees should be explored.
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