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- Carlbring, Per, et al.
(författare)
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In session virtual reality use for public speaking anxiety : A randomized controlled trial
- 2017
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Konferensbidrag (refereegranskat)abstract
- Fear of public speaking is common and for some individuals this interferes significantly with the person's life and causes marked distress. We wanted to test a newly developed virtual reality assisted 1-session in-person treatment (3 hours). The therapist guided session consisted of a series of behavioral experiments based on the expectancy violation principle. This was followed by a 4-week booster intervention delivered via the internet. Following a diagnostic interview a total of 50 individuals with a score of ≥ 60 on the Personal Report of Public Speaking Anxiety questionnaire were randomized to a treatment or a control condition. A total of 78% also met criteria for social anxiety disorder. Considering only having had one treatment session in-person the preliminary results were promising with a between group effect size on the primary outcome (Public Speaking Anxiety Scale) of Cohen’s d=1.32 before commencing the internet-based booster program. Four weeks later the between-group effect size was d=1.90. However, on the secondary outcome measures the effect sizes were more often moderate than large. At the time of the conference 6-month follow-up data will be available in addition to the already collected post-assessment data (analyzed according to the intention-to-treat principle).
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- 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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- Geraghty, A., et al.
(författare)
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Internet-based vestibular rehabilitation for older adults with chronic dizziness : A randomised controlled trial in primary care
- 2017
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Konferensbidrag (refereegranskat)abstract
- Introduction: Vestibular dysfunction occurs in 50% of those over age 60, and with an ageing population the health burden will increase. Vestibular Rehabilitation (VR) has been shown to be effective for dizziness caused by vestibular dysfunction, but it is seldom provided in primary care. The rapid growth in internet access provides a promising vehicle for VR to achieve widespread health impact. We aimed to determine the effectiveness of internet-based VR on chronic dizziness in older adults in primary care.Method: We conducted a single centre randomised controlled trial comparing an internet-based VR intervention with usual primary care. 296 primary care patients aged 50 years and over with current dizziness exacerbated by head movements were recruited from 54 primary care practices from southern England. Patients in the intervention arm accessed an automated internet-based intervention that taught VR exercises and suggested cognitive behavioural management strategies. Dizziness was measured by the Vertigo Symptom Short-Form (VSS-SF) at baseline, 3 and 6 months. The primary outcome was VSS-SF score at 6 months (ISRCTN: 86912968).Results: The VSS-SF was completed by 250 (84%) at 3 months and 230 (78%) at 6 months. Dizziness symptoms were significantly lower in the internet-based VR group compared to usual care at 3 (2.75, 95% CI:1.39, 4.12; p<0.001 and 6 months (2.26, 95% CI: 0.39, 4.12; p=0.018). Dizziness-related disability was also significantly lower in the internet-based VR condition, at 3 (5.33, 95% CI: 1.41, 9.26; p=0.008) and 6 month (5.58 95% CI: 1.19, 10.0; p=0.013).Discussion: Internet-based VR improves dizziness and reduces dizziness-based disability in older primary care patients without requiring structured guidance. The effectiveness without the need for health professional support indicates that this intervention could be made rapidly available to GPs for provision to their patients and wider dissemination in the community.
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- 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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- 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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