| 1. |
- 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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| 2. |
- Forsell, E., et al.
(författare)
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Overcoming procrastination : One-year follow-up and predictors of change in a randomized controlled trial of Internet-based cognitive behavior therapy
- 2016
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Konferensbidrag (refereegranskat)abstract
- Procrastination; the purposeful delay of an intended course of action is, for many, a persistent behavior associated with reduced mood, increased stress, and poorer performance. 20 % of adults and 50 % of students experience significant difficulties with procrastination. Internet- based cognitive behavior therapy (ICBT) shows promise for several conditions, but has never been applied to procrastination. The current study examined the efficacy of ICBT for procrastination at post treatment and one-year follow-up, and investigated predictors of change.Method: Participants (N = 150) were randomized to 10 weeks of either guided self-help, unguided self-help, or wait-list control (receiving unguided self-help after the first treatment period). Outcome measures were the Pure Procrastination Scale (PPS), the Irrational Procrastination Scale (IPS), the Susceptibility to Temptation Scale, the Montgomery Åsberg Depression Rating Scale, the Generalized Anxiety Disorder Assessment, and the Quality of Life Inventory. Intention-to-treat was used for all statistical analyses, with mixed-effects models to assess the effect of time and group.Results: Moderate to large effect sizes were obtained post treatment comparing guided and unguided self-help with wait-list control, the PPS, Cohen’s d = 0.70, 95% confidence interval (CI) [0.29, 1.10], and d = 0.50, 95% CI [0.10, 0.90], and the IPS, d = 0.81 95% CI [0.40, 1.22], and d = 0.69 95% CI [0.29, 1.09]. Clinically significant change was achieved among 31.3–40.0% for guided self-help and 24.0–36.0% for unguided self-help. Neither treatment condition was superior on any outcome measure, Fs (98, 65.17-72.55) < 1.70, p > .19. One-year follow-up data has been collected and the results will be available at the time of the conference, including predictors of change.Conclusion: ICBT could be useful for self-reported problems of procrastination, with results at one-year follow-up and predictors of change revealing the long-term benefit and variables associated with successful treatment outcome.
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| 3. |
- Heinrich, Sarah, et al.
(författare)
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Treating tinnitus distress via the Internet : A mixed methods approach of what makes patients seek help and stay motivated during Internet-based cognitive behavior therapy
- 2016
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Ingår i: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 4:2, s. 120-130
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Tidskriftsartikel (refereegranskat)abstract
- Background: Internet-based cognitive behavioral therapy (ICBT) has proven to be an effective treatment in improving patients' ability to cope with tinnitus. However, some patients prefer face-to-face therapy to ICBT, and a few studies have shown considerable dropout rates if the treatment is not guided. This renders it important to identify factors that contribute to the commencement and continuation of ICBT programs.Aims: Because treatment motivation and expectations are important factors in psychological treatment, the aim of our study was to investigate what leads tinnitus patients to seek out ICBT, what helps them to keep up with the treatment, and what (if any) impact these factors have on dropout rates and treatment outcomes.Method: 112 tinnitus patients taking part in ICBT for tinnitus responded to symptom-related questionnaires at three points in time (pre-treatment, post-treatment, and one-year-follow-up) and to a questionnaire consisting of open-ended questions about their treatment motivation and expectations before beginning treatment. Data were analyzed using qualitative content analysis, and the results were used to divide the participants into groups. The treatment outcomes of these groups were compared using t-tests, χ2-tests, and both one-factorial and mixed ANOVAs.Results: Four main categories emerged as factors conducive to starting treatment: 1) Targets participants wanted to address, 2) circumstances that led to participation, 3) attitudes towards the treatment, and 4) training features. Participants identified six facilitators for continuing the treatment: success, training, individual attitude, hope, evidence, and support. Naming specific tinnitus-associated problems as targets was associated with greater improvement from pre-treatment to 1-year-follow-up. Describing an active involvement in the treatment was related to increased improvement from post-treatment to follow-up.Conclusion: There are several motivational factors that tinnitus patients consider relevant for beginning and continuing ICBT. Particularly, focusing on specific targets that do not involve the tinnitus itself, and encouraging participants to take an active role in treatment may increase treatment effectiveness. However, further hypothesis-guided research is necessary to confirm our explorative results.
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| 4. |
- Lindner, Philip, et al.
(författare)
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Differential impact of performance and interaction related types of social anxiety symptoms on different quality of life domains
- 2016
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Ingår i: EABCT 2016 Abstract Book. ; , s. 748-748
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Konferensbidrag (refereegranskat)abstract
- Social anxiety disorder (SAD) is a common disorder associated with impaired quality of life (QoL), that indexes anxious distress and avoidance related to social situations. The DSM-5 features a specifier to delineate those with only performance-related social anxiety, yet little is known whether performance- and interaction-related anxieties have a differential impact on total QoL and on different QoL domains. To investigate this, we pooled screening data from eight intervention studies for SAD (n = 2017). Total sample mean age was 35.28 (SD = 12.26) and 69% were female. SAD symptoms were measured using the self-rated Liebowitz Social Anxiety Scale with items classified as measuring either performance or interaction anxiety. QoL, both total and across four domains, was measured using the Quality of Life Inventory. Data was analyzed using multiple regression models featuring the two anxiety scores as predictors, and by simulating the Performance-only specifier through 2˙2 median-split subgrouping and standard ANOVAs. Both interaction and performance anxieties were independently associated with lower QoL in general and across domains. Interaction anxiety had a larger negative impact on Personal Growth- and Achievement-related QoL than performance anxiety. The High-Performance/Low-Interaction-group rated higher Achievement-related QoL compared to the Low-Performance/High-Interaction-group (p = .012), yet groups were matched on total QoL and on other domains. Other group differences were in the expected direction.QoL impairments in SAD is primarily driven by number of feared social situations, and only secondarily by types of fear social situations, with interaction anxiety having a larger, negative impact on some QoL domains.
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| 5. |
- Lindner, Philip, et al.
(författare)
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Domain-specific quality of life across five European countries : Cross-cultural validation of the Brunnsviken Brief Quality of life (BBQ) scale
- 2016
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Ingår i: EABCT 2016 Abstract Book. ; , s. 590-590
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Konferensbidrag (refereegranskat)abstract
- The Brunnsviken Brief Quality of life (BBQ) scale is a valid, reliable and accessible self-report measure of subjective quality of life for use with both clinical and non-clinical populations. Although the BBQ has been professionally translated from original Swedish into over thirty languages, psychometric evaluations of other language versions are so far lacking. BBQ data was collected as part of an international study on procrastination in students and employees: n = 749 from Finland, n = 599 from Sweden, n = 542 from Norway, n = 411 from Germany, and n = 315 from Italy. Weighted satisfaction ratings (score range 0-16) for each of the BBQ’s six domains (Leisure, View on life, Creativity, Learning, Friends and friendships, and View on self), along with a total sum score and Cronbach’s alphas, were calculated and compared. Samples did not differ in BBQ total scores (F[4,2611] = 1.006, p = .403). Although there were some differences between samples on specific items, these were small (total difference M = 0.00, SD = 0.74) and confidence intervals overlapped, with the exception of the German sample that rated lower Learning than all other samples (p < .05, Bonferroni-adjusted). Cronbach’s alpha ranged from 0.752 (Finland) to 0.674 (Italy). Convergent validity (as assessed by correlations with scores on the Satisfaction With Life Scale) was high, ranging from r = .64 (Finland) to r = .42 (Italy). The BBQ is a valid measure of subjective quality of life in the examined languages. There are only minor cross-country differences in the quality of life domains measured by the BBQ.
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| 6. |
- Magnusson, Kristoffer, et al.
(författare)
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For better or worse : An individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy
- 2016
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Ingår i: EABCT 2016 Abstract Book. ; , s. 285-285
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Konferensbidrag (refereegranskat)abstract
- Objective: Psychological treatments can relieve mental distress and improve well-being, and the dissemination of evidencebased methods is believed to aid patients in gaining access to the right type of help. Meanwhile, Internet-based cognitive behavior therapy (ICBT) has shown promising results for many psychiatric disorders. However, research on the potential for negative effects of psychological treatments has been lacking. Method: An individual patient data meta-analysis of 29 clinical trials of ICBT (N = 2866) was performed using the Reliable Change Index for each of the primary outcome measures to distinguish deterioration rates among patients in treatment and control conditions. Statistical analyses of predictors were subsequently conducted using generalized linear mixed models. Missing data was handled by multiple imputation. Results: Deterioration rates were 122 (5.8%) in treatment and 130 (17.4%) in control conditions, yielding a total of 252 (8.8%). Patients in a control condition had higher odds of deteriorating, Odds Ratios (OR) 3.10, 95% Confidence Interval (CI) [2.21-4.34]. Clinical severity at pre treatment was related to lower odds, OR 0.62, 95% CI [0.50-0.77], and 0.51, 95% CI [0.51-0.80], for treatment and control conditions. In terms of sociodemographic variables, being in a relationship, 0.58, 95% CI [0.35-0.95], having at least a university degree, 0.54, 95% CI [0.33-0.88], and being older, 0.78, 95% CI, [0.62-0.98], were also associated with lower odds of deterioration, but only for patients assigned to treatment. Conclusion: Deterioration among patients receiving ICBT is not uncommon and should be monitored by researchers in order to reverse a negative treatment trend.
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| 7. |
- Rozental, Alexander, et al.
(författare)
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For better or worse : An individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy
- 2016
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Aim: During the last couple of decades research on the efficacy and effectiveness of psychological treatments has provided evidence for its use in alleviating mental distress and enhancing well-being. Meanwhile, novel ways of delivering evidence-based methods, such as, via the Internet or smartphone applications, have received increasing support, with the potential of becoming an important and widely used addition to the health care system. Internet-based cognitive behavior therapy (ICBT) has for instance been shown to be beneficial in relation to a number of psychiatric and somatic disorders. However, research has almost solely focused on the positive results, neglecting the fact that psychological treatments also might have negative effects. Investigations from face-to-face settings have found that 5-10% of all patients deteriorate, but whether this is true for ICBT has been unclear. Hence, in order to examine deterioration in cognitive behavior therapy delivered via the Internet, an individual patient data meta-analysis was performed.Method: Patient-level data from 29 clinical trials of ICBT for depression, anxiety disorders, and other problems, e.g., pathological gambling and erectile dysfunction, were aggregated, totaling 2866 participants receiving either a treatment or control condition. Deterioration was assessed using the Reliable Change Index on each of the primary outcome measures. Participants identified as having deteriorated were subsequently analyzed using logistic regression to find potential predictors of a negative treatment outcome.Results: Using only available data, a total of 89 participants (3.1%) were recognized as having reliably deteriorated from pre to post treatment assessment, with an additional 17 participants (0.6%) from pre treatment to follow-up assessment. In general, more participants (N = 56) diagnosed with an anxiety disorder deteriorated, compared to depression (N = 16), and other problems (N = 30). Results using imputed values for missing data and an exploration of predictors of deterioration will be available at the time of the conference.Conclusion: Preliminary evidence indicates that deterioration among participants receiving ICBT afflicts approximately 3.1%, with higher rates for anxiety disorders than depression and other problems. A closer inspection could reveal potential predictors for deterioration, which, in turn, might be used to prevent or reverse a negative treatment outcome.
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| 8. |
- Rozental, Alexander, 1985-
(författare)
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Negative effects of Internet-based cognitive behavior therapy : Monitoring and reporting deterioration and adverse and unwanted events
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Internet-based cognitive behavior therapy (ICBT) has the potential of providing many patients with an effective form of psychological treatment. However, despite helping to improve mental health and well-being, far from everyone seem to benefit. In some cases, negative effects may also emerge. The overall aim of the present thesis was to establish the occurrence and characteristics of such incidents in ICBT using a combination of quantitative and qualitative methods. Study I determined deterioration, non-response, and adverse and unwanted events in a sample of 133 patients undergoing ICBT for social anxiety disorder. The results indicated that up to 6.8% fared worse during the treatment period, depending on the self-report measure and time point, as determined using the Reliable Change Index (RCI), while the non-response rate was between 29.3 to 86.5% at post treatment assessment, and 12.9% experienced other negative effects. Study II investigated the responses to open-ended questions on adverse and unwanted events among 556 patients in four separate clinical trials of ICBT; social anxiety disorder, panic disorder, major depressive disorder, and procrastination. In total, 9.3% reported negative effects, with a qualitative content analysis revealing two categories and four subcategories; patient-related, i.e., gaining insight and experiencing new symptoms, and treatment-related, i.e., difficulties applying the treatment interventions and problems related to the treatment format. Study III explored the number of patients achieving reliable deterioration, as determined using the RCI on the individual raw scores of 2866 patients from 29 clinical trials of ICBT. The results showed that the deterioration rate was higher among patients in a control condition, 17.4%, in comparison to treatment, 5.8%. Predictors were related to decreased odds of deterioration for patients receiving treatment; clinical severity at pre treatment assessment, being in a relationship, having a university degree, and being older. As for the control condition, only clinical severity at pre treatment assessment was associated with decreased odds of deterioration. Study IV examined a newly developed self-report measure for monitoring and reporting adverse and unwanted events, the Negative Effects Questionnaire. The results suggested a six-factor solution with 32 items; symptoms, quality, dependency, stigma, hopelessness, and failure. One-third of the patients reported experiencing unpleasant memories, stress, and anxiety, with novel symptoms and a lack of quality in the treatment and therapeutic relationship having the greatest negative impact. The general finding of the present thesis is that negative effects do occur in ICBT and that they are characterized by deterioration, non-response, and adverse and unwanted events, similar to psychological treatments delivered face-to-face. Researchers and clinicians in ICBT are recommended to monitor and report negative effects to prevent a negative treatment trend and further the understanding of what might contribute to their incidents. Future research should investigate the relationship between negative effects and treatment outcome, especially at follow-up, to examine if they are transient or enduring. Also, interviews could be conducted with those achieving reliable deterioration to explore if and how it is experienced by the patients and to see if it is attributed to the treatment interventions or other circumstances.
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| 9. |
- Rozental, Alexander, et al.
(författare)
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Negative effects of psychological treatments : An exploratory factor analysis of the Negative Effects Questionnaire for monitoring and reporting adverse and unwanted events
- 2016
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 11:6, s. 284-284
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Tidskriftsartikel (refereegranskat)abstract
- Research conducted during the last decades has provided increasing evidence for the use of psychological treatments for a number of psychiatric disorders and somatic complaints. However, by focusing only on the positive outcomes, less attention has been given to the potential of negative effects. Despite indications of deterioration and other adverse and unwanted events during treatment, little is known about their occurrence and characteristics. Hence, in order to facilitate research of negative effects, a new instrument for monitoring and reporting their incidence and impact was developed using a consensus among researchers, self-reports by patients, and a literature review: the Negative Effects Questionnaire. Participants were recruited via a smartphone-delivered self-help treatment for social anxiety disorder and through the media (N = 653). An exploratory factor analysis was performed, resulting in a six-factor solution with 32 items, accounting for 57.64% of the variance. The derived factors were: symptoms, quality, dependency, stigma, hopelessness, and failure. Items related to unpleasant memories, stress, and anxiety were experienced by more than one-third of the participants. Further, increased or novel symptoms, as well as lack of quality in the treatment and therapeutic relationship rendered the highest self-reported negative impact. In addition, the findings were discussed in relation to prior research and other similar instruments of adverse and unwanted events, giving credence to the items that are included. The instrument is presently available in eleven different languages and can be freely downloaded and used from www.neqscale.com.
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| 10. |
- Rozental, Alexander, et al.
(författare)
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Overcoming procrastination : One-year follow-up and predictors of change in a randomized controlled trial of Internet-based cognitive behavior therapy
- 2016
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Ingår i: EABCT 2016 Abstract Book. ; , s. 542-542
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Konferensbidrag (refereegranskat)abstract
- Introduction: Procrastination is defined as the voluntary delay of an intended course of action despite resulting in negative consequences. Procrastination can become a persistent behavioral pattern associated with reduced mood, increased stress, and poorer performance. Approximately one-fifth of the adult population and more than half of the student population experience significant difficulties due to procrastination. However, despite its prevalence, it has received little attention in clinical research. Meanwhile, Internet-based cognitive behavior therapy (ICBT) has been found promising for several psychiatric conditions, but has not yet been used in relation to procrastination. The current study thus aimed to examine the efficacy of ICBT for procrastination at post treatment and one-year follow-up. Furthermore, predictors of change were investigated in order to distinguish variables that might predict at positive treatment outcome.Method: Self-recruited participants (N = 150) with severe and chronic procrastination were randomized to a ten-week treatment program administered via the Internet; guided self-help, unguided self-help, and wait-list control (receiving unguided self-help after the first treatment period). Outcome measures were administered at screening, post treatment, one-year follow-up, or weekly; the Pure Procrastination Scale (PPS), the Irrational Procrastination Scale (IPS), the Susceptibility to Temptation Scale, the Montgomery Åsberg Depression Rating Scale, the Generalized Anxiety Disorder – 7 Items, and the Quality of Life Inventory. The intention-to-treat principle was used for all statistical analyses.Results: Moderate to large effect sizes were obtained at post treatment comparing guided and unguided self-help with wait-list control, the PPS, Cohen’s d = 0.70, 95% confidence interval (CI) [0.29, 1.10], and d = 0.50, 95% CI [0.10, 0.90], and the IPS, d = 0.81 95% CI [0.40, 1.22], and d = 0.69 95% CI [0.29, 1.09]. Clinically significant change was achieved among 31.3–40.0% for guided self-help, compared with 24.0–36.0% for unguided self-help. Neither of the treatment conditions were found to be superior on any of the outcome measures, Fs (98, 65.17-72.55) < 1.70, p > .19. In terms of the outcome at the one-year follow-up, the results will be available at the time of the conference, including the analyses of predictors of change.Conclusion: ICBT could be useful for managing self-reported problems of procrastination, with results from post treatment revealing that both guided self-help and unguided self-help can be of great aid. Findings from the one-year follow-up and analyses of predictors of change will help to determine the long-term benefit and the possible variables responsible for a successful treatment outcome.
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