| 1. |
- Andersson, Gerhard, et al.
(författare)
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Internet-Based Vs. Face-To-Face Cognitive Behaviour Therapy for Psychiatric and Somatic Disorders : a Systematic Review and Meta-Analysis
- 2014
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Ingår i: Abstracts from the 44th Congress of the European Association for Behavioural & Cognitive Therapies. - Utrecht : EABCT.
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Konferensbidrag (refereegranskat)abstract
- Internet-delivered cognitive behaviour therapy (ICBT) has been tested in many research trials but to a lesser extent been directly compared against face-to-face delivered cognitive behaviour therapy (CBT). We conducted a systematic review and meta-analysis on trials in which guided ICBT was directly compared against face-to-face CBT within the same trial. Studies on psychiatric and somatic conditions were included. Systematic searches resulted in 13 studies (total N=1053) that met all review criteria and were included in the review. There were 3 studies on social anxiety disorder, 3 on panic disorder, 2 on depressive symptoms, 2 on body dissatisfaction, 1 on tinnitus, 1 on male sexual dysfunction, and 1 on spider phobia. Face-to-face CBT was either in the individual format (n=6 ) or in the group format (n=7). We also assessed quality and risk of bias. Results showed a pooled effect size at post-treatment across of Hedges g = -0.01 (95% CI, -0.13 to 0.12), indicating that ICBT and face-to-face treatment produce equivalent overall effects. Study quality did not affect outcomes. While the overall results indicate equivalence, there are still few studies for each psychiatric and somatic condition and many for which guided ICBT has not been compared against face-to-face treatment. Thus, more research is needed to establish equivalence of the two treatment formats.
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| 2. |
- Ebert, D. D., et al.
(författare)
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Does Internet-based guided-self-help for depression cause harm? An individual participant data meta-analysis on deterioration rates and its moderators in randomized controlled trials
- 2016
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Ingår i: Psychological Medicine. - : Cambridge University Press. - 0033-2917 .- 1469-8978. ; 46:13, s. 2679-2693
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Forskningsöversikt (refereegranskat)abstract
- Almost nothing is known about the potential negative effects of Internet-based psychological treatments for depression. This study aims at investigating deterioration and its moderators within randomized trials on Internet-based guided self-help for adult depression, using an individual patient data meta-analyses (IPDMA) approach.Studies were identified through systematic searches (PubMed, PsycINFO, EMBASE, Cochrane Library). Deterioration in participants was defined as a significant symptom increase according to the reliable change index (i.e. 7.68 points in the CES-D; 7.63 points in the BDI). Two-step IPDMA procedures, with a random-effects model were used to pool data.A total of 18 studies (21 comparisons, 2079 participants) contributed data to the analysis. The risk for a reliable deterioration from baseline to post-treatment was significantly lower in the intervention v. control conditions (3.36 v. 7.60; relative risk 0.47, 95% confidence interval 0.29–0.75). Education moderated effects on deterioration, with patients with low education displaying a higher risk for deterioration than patients with higher education. Deterioration rates for patients with low education did not differ statistically significantly between intervention and control groups. The benefit–risk ratio for patients with low education indicated that 9.38 patients achieve a treatment response for each patient experiencing a symptom deterioration.Internet-based guided self-help is associated with a mean reduced risk for a symptom deterioration compared to controls. Treatment and symptom progress of patients with low education should be closely monitored, as some patients might face an increased risk for symptom deterioration. Future studies should examine predictors of deterioration in patients with low education.
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| 3. |
- Karyotaki, E., et al.
(författare)
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Predictors of treatment dropout in self-guided web-based interventions for depression: an individual patient data meta-analysis
- 2015
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Ingår i: Psychological Medicine. - : CAMBRIDGE UNIV PRESS. - 0033-2917 .- 1469-8978. ; 45:13, s. 2717-2726
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Tidskriftsartikel (refereegranskat)abstract
- Background. It is well known that web-based interventions can be effective treatments for depression. However, dropout rates in web-based interventions are typically high, especially in self-guided web-based interventions. Rigorous empirical evidence regarding factors influencing dropout in self-guided web-based interventions is lacking due to small study sample sizes. In this paper we examined predictors of dropout in an individual patient data meta-analysis to gain a better understanding of who may benefit from these interventions. Method. A comprehensive literature search for all randomized controlled trials (RCTs) of psychotherapy for adults with depression from 2006 to January 2013 was conducted. Next, we approached authors to collect the primary data of the selected studies. Predictors of dropout, such as socio-demographic, clinical, and intervention characteristics were examined. Results. Data from 2705 participants across ten RCTs of self-guided web-based interventions for depression were analysed. The multivariate analysis indicated that male gender [relative risk (RR) 1.08], lower educational level (primary education, RR 1.26) and co-morbid anxiety symptoms (RR 1.18) significantly increased the risk of dropping out, while for every additional 4 years of age, the risk of dropping out significantly decreased (RR 0.94). Conclusions. Dropout can be predicted by several variables and is not randomly distributed. This knowledge may inform tailoring of online self-help interventions to prevent dropout in identified groups at risk.
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| 4. |
- Ritterband, L., et al.
(författare)
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Challenges, controversies, and the future of developing, evaluating, and implementing Internet interventions
- 2016
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Konferensbidrag (refereegranskat)abstract
- Internet intervention research has been well established in the literature over the past two decades. The hundreds, if not thousands, of high quality research trials that have been conducted and published have convincingly demonstrated feasibility, efficacy and even effectiveness. The next decade will be a critical one for the field with numerous obstacles, barriers, disputes and debates to overcome. This talk will highlight many of the known challenges and controversies as well as key areas that will need to be part of future research. Furthermore, each of these areas overlap, resulting in additional topics of needed focus. Challenges include funding, recruitment, and conflict of interests to manage; controversies include best practices for iterative development, the relationship between usage and outcome, and public concerns of technology replacing jobs; issues that intersect with both challenges and controversies include how best to address the digital divide, the use of social networking, and how to determine the best control and comparison groups in ehealth research; future issues include a need to focus on deconstruction and dissemination trials, internationalization of interventions, and a greater emphasis on cost effectiveness; issues that traverse challenges and the future include a need for greater scientific underpinnings to interventions, improving the taxonomy and overall definitions used to define applications, and how best to maintain and sustain programs; controversies/future issues include the problem of so many programs continuing to be developed and made available with little to no scientific validity; and finally, issues that cross challenges, controversies and the future include the ongoing discussions of support, meta-analyses, and stepped care. Although not comprehensive, this list will provide a useful start for discussion and help guide research for the coming years.
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| 5. |
- Vernmark, K., et al.
(författare)
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Working alliance predicts outcome in blended treatment (bCBT) for depression
- 2017
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Konferensbidrag (refereegranskat)abstract
- Introduction: Blended cognitive behavior therapy (bCBT) is a treatment format that mixes internet-based modules with face-to-face sessions. It has the potential of making internet-based interventions more easily accessible and saving therapist time when delivering treatment for depression. The role of working alliance in this treatment format has not yet been thoroughly investigated. There is therefore a need to explore patient- and therapist rated alliance and the ability to predict change in depression during treatment using measurements of working alliance.Methods: We used ratings of depression and alliance from 73 participants in a study on bCBT for depression (part of the E-COMPARED project). Data were analyzed using growth curve models.Results: Both patient- and therapist rated alliance was high. The main finding was that therapist-rated alliance predicted change in depression scores during treatment.Discussion: Working alliance can be established in bCBT, which is in line with previous research on face-to-face and internet-based treatment for depression. An interesting find was that therapist-rated alliance was of greater importance than patient-rated alliance when predicting change in depression during treatment. These results point towards therapist ratings of alliance being essential when delivering bCBT and conducting research on this method in the future.
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