| 1. |
- Cuijpers, Pim, et al.
(författare)
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Personalized treatment of adult depression : medication, psychotherapy, or both? A systematic review
- 2012
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Ingår i: Depression and anxiety (Print). - : John Wiley & Sons. - 1091-4269 .- 1520-6394. ; 29:10, s. 855-864
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Personalized medicine aims to identify which characteristics of an individual predict the outcome of a specific treatment, in order to get a better match between the individual and the treatment received. We conducted a systematic review and meta-analysis of randomized trials comparing two treatments directly in a group of patients with a specific characteristic.METHODS: We searched relevant studies from bibliographical databases and included trials comparing (1) medication with psychotherapy, (2) medication with combined treatment, and (3) psychotherapy with combined treatment, in specific target groups (a) with a predefined sociodemographic characteristic, (b) a specific type of depression, (c) a comorbid mental or somatic disorder, or (d) from a specific setting (outpatients, primary care).RESULTS: We included 52 studies with 4,734 depressed patients. In these studies, 20 characteristics of the target groups were examined. The results showed that medication is probably the best treatment for dysthymia, and combined treatments are more effective in depressed outpatients, as well as in depressed older adults. However, in order to examine the 20 characteristics in the three categories of comparisons, 254 studies would be needed for having sufficient statistical power to show an effect size of g = 0.5. Currently, only 20.1% of these studies have been conducted.CONCLUSIONS: Although a considerable number of studies have compared medication, psychotherapy, and combined treatments, and some preliminary results are useful for deciding which treatment is best for which patient, the development of personalized treatment of depression has only just begun.
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| 2. |
- Cuijpers, Pim, et al.
(författare)
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Psychological treatment of depression: Results of a series of meta-analyses
- 2011
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Ingår i: Nordic Journal of Psychiatry. - : Informa Healthcare. - 0803-9488 .- 1502-4725. ; 65:6, s. 354-364
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Tidskriftsartikel (refereegranskat)abstract
- Cuijpers P, Andersson G, Donker T, van Straten A. Psychological treatment of depression: Results of a series of meta-analyses. Nord J Psychiatry 2011;65:354-364. less thanbrgreater than less thanbrgreater thanBackground: In the past few decades, a considerable number of studies have examined the effects of psychotherapies for adult depression. Aim: We described the results of a series of meta-analyses examining what this large body of research has contributed to our knowledge of these treatments of depression. Results: We found that different types of psychotherapy are efficacious in the treatment of adult depression, including cognitive behavior therapy, interpersonal psychotherapy, problem-solving therapy, non-directive supportive therapy and behavioral activation therapy. Differences between types of psychotherapy are small. The efficacy of psychotherapy for mild to moderate depression is about the same as the efficacy of pharmacotherapy, and that combined treatment is more effective than psychotherapy alone and pharmacotherapy alone. Psychotherapy is not only effective in depressed adults in general, but also in older adults, women with postpartum depression, patients with general medical disorders, in inpatients, in primary care patients, patients with chronic depression and in subthreshold depression. Conclusions: We found no evidence showing that psychotherapy is less efficacious in severe depression ( with mean baseline Hamilton Depression Rating Scale scores up to 31, mean Beck Depression Inventory scores up to 35.85 and mean Beck Depression Inventory-II scores up to 36.50), but effects are smaller in chronic depression. We also found that the effects of psychotherapy are probably overestimated because of publication bias and the relatively low quality of many studies in the field.
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| 3. |
- Cuijpers, Pim, et al.
(författare)
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Self-Guided Psychological Treatment for Depressive Symptoms: A Meta-Analysis
- 2011
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 6:6
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Tidskriftsartikel (refereegranskat)abstract
- Background: A number of trials have examined the effects of self-guided psychological intervention, without any contact between the participants and a therapist or coach. The results and sizes of these trials have been mixed. This is the first quantitative meta-analysis, aimed at organizing and evaluating the literature, and estimating effect size. Method: We conducted systematic literature searches in PubMed, PsycINFO and Embase up to January 2010, and identified additional studies through earlier meta-analyses, and the references of included studies. We identified seven randomized controlled trials that met our inclusion criteria, with a total of 1,362 respondents. The overall quality of the studies was high. A post-hoc power calculation showed that the studies had sufficient statistical power to detect an effect size of d = 0.19. Results: The overall mean effect size indicating the difference between self-guided psychological treatment and control groups at post-test was d = 0.28 (pless than0.001), which corresponds to a NNT of 6.41. At 4 to 12 months follow-up the effect size was d = 0.23. There was no indication for significant publication bias. Conclusions: We found evidence that self-guided psychological treatment has a small but significant effect on participants with increased levels of depressive symptomatology.
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| 4. |
- Donker, Tara, et al.
(författare)
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Effectiveness of Self-guided App-Based Virtual Reality Cognitive Behavior Therapy for Acrophobia : A Randomized Clinical Trial
- 2019
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Ingår i: JAMA psychiatry. - : American Medical Association (AMA). - 2168-6238 .- 2168-622X. ; 76:7, s. 682-690
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Tidskriftsartikel (refereegranskat)abstract
- Importance Globally, access to evidence-based psychological treatment is limited. Innovative self-help methods using smartphone applications and low-cost virtual reality have the potential to significantly improve the accessibility and scalability of psychological treatments.Objective To examine the effectiveness of ZeroPhobia, a fully self-guided app-based virtual reality cognitive behavior therapy (VR CBT) using low-cost (cardboard) virtual reality goggles compared with a wait-list control group and to determine its user friendliness.Design, Setting, and Participants In a single-blind randomized clinical trial, participants were enrolled between March 24 and September 28, 2017, and randomly assigned (1:1) by an independent researcher to either VR CBT app or a wait-list control group. A total of 193 individuals aged 18 to 65 years from the Dutch general population with acrophobia symptoms and access to an Android smartphone participated. The 6 animated modules of the VR-CBT app and gamified virtual reality environments were delivered over a 3-week period in participants’ natural environment. Assessments were completed at baseline, immediately after treatment, and at 3-month follow-up. Analysis began April 6, 2018, and was intention to treat.Intervention Self-guided app-based VR CBT.Main Outcomes and Measures The primary outcome measure was the Acrophobia Questionnaire. The hypothesis was formulated prior to data collection.Results In total, 193 participants (129 women [66.84%]; mean [SD] age, 41.33 [13.64] years) were randomly assigned to intervention (n = 96) or a wait-list control group (n = 97). An intent-to-treat analysis showed a significant reduction of acrophobia symptoms at posttest at 3 months for the VR-CBT app compared with the controls (b = –26.73 [95% CI, −32.12 to −21.34]; P < .001; d = 1.14 [95% CI, 0.84 to 1.44]). The number needed to treat was 1.7. Sensitivity and robustness analysis confirmed these findings. Pretreatment attrition was 22 of 96 (23%) because of smartphone incompatibility. Of the 74 participants who started using the VR-CBT app, 57 (77%) completed the intervention fully.Conclusions and Relevance A low-cost fully self-guided app-based virtual reality cognitive behavioral therapy with rudimentary virtual reality goggles can produce large acrophobia symptom reductions. To our knowledge, this study is the first to show that virtual reality acrophobia treatment can be done at home without the intervention of a therapist.Trial Registration Trialregister.nl identifier: NTR6442
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| 5. |
- Donker, Tara, et al.
(författare)
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Implementation of Internet-based preventive interventions for depression and anxiety : role of support? The design of a randomized controlled trial
- 2009
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Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 10:59
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Tidskriftsartikel (refereegranskat)abstract
- Background: Internet-based self-help is an effective preventive intervention for highly prevalent disorders, such as depression and anxiety. It is not clear, however, whether it is necessary to offer these interventions with professional support or if they work without any guidance. In case support is necessary, it is not clear which level of support is needed. This study examines whether an internet-based self-help intervention with a coach is more effective than the same intervention without a coach in terms of clinical outcomes, drop-out and economic costs. Moreover, we will investigate which level of support by a coach is more effective compared to other levels of support. Methods: In this randomized controlled trial, a total of 500 subjects (18 year and older) from the general population with mild to moderate depression and/or anxiety will be assigned to one of five conditions: (1) web-based problem solving through the internet (self-examination therapy) without a coach; (2) the same as 1, but with the possibility to ask help from a coach on the initiative of the respondent (on demand, by email); (3) the same as 1, but with weekly scheduled contacts initiated by a coach (once per week, by email); (4) weekly scheduled contacts initiated by a coach, but no web-based intervention; (5) information only (through the internet). The interventions will consist of five weekly lessons. Primary outcome measures are symptoms of depression and anxiety. Secondary outcome measures are drop-out from the intervention, quality of life, and economic costs. Other secondary outcome measures that may predict outcome are also studied, e. g. client satisfaction and problem-solving skills. Measures are taken at baseline (pre-test), directly after the intervention (post-test, five weeks after baseline), 3 months later, and 12 months later. Analysis will be conducted on the intention-to-treat sample. Discussion: This study aims to provide more insight into the clinical effectiveness, differences in drop-out rate and costs between interventions with and without support, and in particular different levels of support. This is important to know in relation to the dissemination of internet-based self-help interventions.
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| 6. |
- Ly, Kien Hoa, et al.
(författare)
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Experiences of a guided smartphone-based behavioral activation therapy for depression : a qualitative study
- 2015
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Ingår i: Internet Interventions. - Amsterdam : Elsevier. - 2214-7829. ; 2:1, s. 60-68
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Tidskriftsartikel (refereegranskat)abstract
- Recently, a number of studies have investigated treatments administered via smartphones showing that this treatment format has a potential to be effective. However, we still have limited knowledge of how patients experience this treatment format. The objective of this study was to explore participants' views of a smartphone-based behavioral activation treatment. In-depth interviews were conducted with 12 strategically (participants with different overall experiences) selected participants, suffering from major depression according to the DSM-IV. The interview data were processed with the aid of thematic analysis. The analysis generated the three main themes: Commitment, Treatment and Lack of important components, with attached subthemes. In conclusion, the findings from the current study correspond with existing knowledge in the field of internet-based treatment. Considering that this kind of treatment is still quite new, the need for further research and development is considerable. Nevertheless, its availability, assimilation into users' everyday lives and possible motivational qualities speak of its potential.
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| 7. |
- Ma, Lichen, 1988-, et al.
(författare)
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Integrating Virtual Realities and Psychotherapy : SWOT Analysis on VR and MR Based Treatments of Anxiety and Stress-related Disorders
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Ingår i: Journal of Medical Internet Research. - 1438-8871.
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Tidskriftsartikel (refereegranskat)abstract
- Background: The use of virtual reality (VR) and mixed reality (MR) technology in clinical psychology is growing. Efficacious VR-based treatments for a variety of disorders have been developed. However, the field of technology-assisted psychotherapy is constantly changing with the advancement in technology. Factors such as interdisciplinary collaboration, consumer familiarity and adoption of VR products, and progress in clinical science all need to be taken into consideration when integrating virtual technologies into psychotherapies.Aims: To present an overview of current expert opinions on the use of virtual technologies in the treatment of anxiety and stress-related disorders.Methods: An anonymous survey was distributed to a select group of researchers and clinicians, using an analytic framework known as Strengths, Weaknesses, Opportunities, and Threats (SWOT).Results: The respondents had an optimistic outlook regarding the current use as well as future development and implementation of technology-assisted interventions. VR and MR psychotherapies offer distinct advantages that can overcome shortcomings associated with traditional therapy. The respondents acknowledged and discussed current limitations of VR and MR psychotherapies. They recommended consolidation of existing knowledge and encouraged standardisation in both theory and practice.Conclusions: Continued research is needed to leverage the strengths of VR and MR to develop better psychological interventions.
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| 8. |
- Ma, Lichen, et al.
(författare)
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Integrating virtual realities and psychotherapy : SWOT analysis on VR and MR based treatments of anxiety and stress-related disorders
- 2021
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Ingår i: Cognitive Behaviour Therapy. - : Informa UK Limited. - 1650-6073 .- 1651-2316. ; 50:6, s. 509-526
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Tidskriftsartikel (refereegranskat)abstract
- The use of virtual reality (VR) and mixed reality (MR) technology in clinical psychology is growing. Efficacious VR-based treatments for a variety of disorders have been developed. However, the field of technology-assisted psychotherapy is constantly changing with the advancement in technology. Factors such as interdisciplinary collaboration, consumer familiarity and adoption of VR products, and progress in clinical science all need to be taken into consideration when integrating virtual technologies into psychotherapies. We aim to present an overview of current expert opinions on the use of virtual technologies in the treatment of anxiety and stress-related disorders. An anonymous survey was distributed to a select group of researchers and clinicians, using an analytic framework known as Strengths, Weaknesses, Opportunities, and Threats (SWOT). Overall, the respondents had an optimistic outlook regarding the current use as well as future development and implementation of technology-assisted interventions. VR and MR psychotherapies offer distinct advantages that can overcome shortcomings associated with traditional therapy. The respondents acknowledged and discussed current limitations of VR and MR psychotherapies. They recommended consolidation of existing knowledge and encouraged standardisation in both theory and practice. Continued research is needed to leverage the strengths of VR and MR to develop better treatments.
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| 9. |
- Smoktunowicz, Ewelina, et al.
(författare)
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Consensus statement on the problem of terminology in psychological interventions using the internet or digital components
- 2020
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Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 21, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- Since the emergence of psychological interventions delivered via the Internet they have differed in numerous ways. The wealth of formats, methods, and technological solutions has led to increased availability and cost-effectiveness of clinical care, however, it has simultaneously generated a multitude of terms. With this paper, we first aim to establish whether a terminology issue exists in the field of Internet-delivered psychological interventions. If so, we aim to determine its implications for research, education, and practice. Furthermore, we intend to discuss solutions to mitigate the problem; in particular, we propose the concept of a common glossary. We invited 23 experts in the field of Internet-delivered interventions to respond to four questions, and employed the Delphi method to facilitate a discussion. We found that experts overwhelmingly agreed that there were terminological challenges, and that it had significant consequences for conducting research, treating patients, educating students, and informing the general public about Internet-delivered interventions. A cautious agreement has been reached that formulating a common glossary would be beneficial for the field to address the terminology issue. We end with recommendations for the possible formats of the glossary and means to disseminate it in a way that maximizes the probability of broad acceptance for a variety of stakeholders.
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