| 1. |
- Karyotaki, Eirini, et al.
(author)
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Internet-Based Cognitive Behavioral Therapy for Depression : A Systematic Review and Individual Patient Data Network Meta-analysis
- 2021
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In: JAMA psychiatry. - : American Medical Association. - 2168-6238 .- 2168-622X. ; 78:4, s. 361-371
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Research review (peer-reviewed)abstract
- IMPORTANCE: Personalized treatment choices would increase the effectiveness of internet-based cognitive behavioral therapy (iCBT) for depression to the extent that patients differ in interventions that better suit them.OBJECTIVE: To provide personalized estimates of short-term and long-term relative efficacy of guided and unguided iCBT for depression using patient-level information.DATA SOURCES: We searched PubMed, Embase, PsycInfo, and Cochrane Library to identify randomized clinical trials (RCTs) published up to January 1, 2019.STUDY SELECTION: Eligible RCTs were those comparing guided or unguided iCBT against each other or against any control intervention in individuals with depression. Available individual patient data (IPD) was collected from all eligible studies. Depression symptom severity was assessed after treatment, 6 months, and 12 months after randomization.DATA EXTRACTION AND SYNTHESIS: We conducted a systematic review and IPD network meta-analysis and estimated relative treatment effect sizes across different patient characteristics through IPD network meta-regression.MAIN OUTCOMES AND MEASURES: Patient Health Questionnaire-9 (PHQ-9) scores.RESULTS: Of 42 eligible RCTs, 39 studies comprising 9751 participants with depression contributed IPD to the IPD network meta-analysis, of which 8107 IPD were synthesized. Overall, both guided and unguided iCBT were associated with more effectiveness as measured by PHQ-9 scores than control treatments over the short term and the long term. Guided iCBT was associated with more effectiveness than unguided iCBT (mean difference [MD] in posttreatment PHQ-9 scores, -0.8; 95% CI, -1.4 to -0.2), but we found no evidence of a difference at 6 or 12 months following randomization. Baseline depression was found to be the most important modifier of the relative association for efficacy of guided vs unguided iCBT. Differences between unguided and guided iCBT in people with baseline symptoms of subthreshold depression (PHQ-9 scores 5-9) were small, while guided iCBT was associated with overall better outcomes in patients with baseline PHQ-9 greater than 9.CONCLUSIONS AND RELEVANCE: In this network meta-analysis with IPD, guided iCBT was associated with more effectiveness than unguided iCBT for individuals with depression, benefits were more substantial in individuals with moderate to severe depression. Unguided iCBT was associated with similar effectiveness among individuals with symptoms of mild/subthreshold depression. Personalized treatment selection is entirely possible and necessary to ensure the best allocation of treatment resources for depression.
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| 2. |
- Forsell, Erik, et al.
(author)
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Proof of Concept for an Adaptive Treatment Strategy to Prevent Failures in Internet-Delivered CBT : A Single-Blind Randomized Clinical Trial With Insomnia Patients
- 2019
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In: American Journal of Psychiatry. - : American Psychiatric Association Publishing. - 0002-953X .- 1535-7228. ; 176:4, s. 315-323
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Journal article (peer-reviewed)abstract
- Objective: This study aimed to demonstrate proof of concept for an adaptive treatment strategy in Internet-delivered cognitive-behavioral therapy (ICBT), where risk of treatment failure is assessed early in treatment and treatment for at-risk patients is adapted to prevent treatment failure. Methods: A semiautomated algorithm assessed risk of treatment failure early in treatment in 251 patients undergoing ICBT for insomnia with therapist guidance. At-risk patients were randomly assigned to continue standard ICBT or to receive adapted ICBT. The primary outcome was self-rated insomnia symptoms using the Insomnia Severity Index in a linear mixed-effects model. The main secondary outcome was treatment failure (having neither responded nor remitted at the posttreatment assessment). Results: A total of 102 patients were classified as at risk and randomly assigned to receive adapted ICBT (N=51) or standard ICBT (N=51); 149 patients were classified as not at risk. Patients not at risk had significantly greater score reductions on the Insomnia Severity Index than at-risk patients given standard ICBT. Adapted ICBT for at-risk patients was significantly more successful in reducing symptoms compared with standard ICBT, and it decreased the risk of failing treatment (odds ratio= 0.33). At-risk patients receiving adapted ICBT were not more likely to experience treatment failure than those not at risk (odds ratio= 0.51), though they were less likely to experience remission. Adapted treatment required, on average, 14 more minutes of therapist-patient time per remaining week. Conclusions: An adaptive treatment strategy can increase treatment effects for at-risk patients and reduce the number of failed treatments. Future studies should improve accuracy in classification algorithms and identify key factors that boost the effect of adapted treatments.
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| 3. |
- Furukawa, Toshi A., et al.
(author)
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Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression : a systematic review and component network meta-analysis using individual data
- 2021
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In: Lancet psychiatry. - London, United Kingdom : Elsevier. - 2215-0374 .- 2215-0366. ; 8:6, s. 500-511
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Research review (peer-reviewed)abstract
- Findings We identified 76 RCTs, including 48 trials contributing individual participant data (11 704 participants) and 28 trials with aggregate data (6474 participants). The participants' weighted mean age was 42.0 years and 12 406 (71%) of 17 521 reported were women. There was suggestive evidence that behavioural activation might be beneficial (iMD -1.83 [95% credible interval (CrI) -2.90 to -0.80]) and that relaxation might be harmful (1.20 [95% CrI 0.17 to 2.27]). Baseline severity emerged as the strongest prognostic factor for endpoint depression. Combining human and automated encouragement reduced dropouts from treatment (incremental odds ratio, 0.32 [95% CrI 0.13 to 0.93]). The risk of bias was low for the randomisation process, missing outcome data, or selection of reported results in most of the included studies, uncertain for deviation from intended interventions, and high for measurement of outcomes. There was moderate to high heterogeneity among the studies and their components. 511
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| 4. |
- Rozental, Alexander, et al.
(author)
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Differentiating procrastinators from each other : A cluster analysis
- 2015
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In: Cognitive Behaviour Therapy. - : Informa UK Limited. - 1650-6073 .- 1651-2316. ; 44:6, s. 480-490
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Journal article (peer-reviewed)abstract
- Procrastination refers to the tendency to postpone the initiation and completion of a given course of action. Approximately one-fifth of the adult population and half of the student population perceive themselves as being severe and chronic procrastinators. Albeit not a psychiatric diagnosis, procrastination has been shown to be associated with increased stress and anxiety, exacerbation of illness, and poorer performance in school and work. However, despite being severely debilitating, little is known about the population of procrastinators in terms of possible subgroups, and previous research has mainly investigated procrastination among university students. The current study examined data from a screening process recruiting participants to a randomized controlled trial of Internet-based cognitive behavior therapy for procrastination (Rozental et al., in press). In total, 710 treatment-seeking individuals completed self-report measures of procrastination, depression, anxiety, and quality of life. The results suggest that there might exist five separate subgroups, or clusters, of procrastinators: “Mild procrastinators” (24.93%), “Average procrastinators” (27.89%), “Well-adjusted procrastinators” (13.94%), “Severe procrastinators” (21.69%), and “Primarily depressed” (11.55%). Hence, there seems to be marked differences among procrastinators in terms of levels of severity, as well as a possible subgroup for which procrastinatory problems are primarily related to depression. Tailoring the treatment interventions to the specific procrastination profile of the individual could thus become important, as well as screening for comorbid psychiatric diagnoses in order to target difficulties associated with, for instance, depression.
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| 5. |
- Rozental, Alexander, et al.
(author)
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Internet-based cognitive behavior therapy for procrastination : A randomized controlled trial
- 2015
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In: Journal of Consulting and Clinical Psychology. - : American Psychological Association (APA). - 0022-006X .- 1939-2117. ; 83:4, s. 808-824
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Journal article (peer-reviewed)abstract
- Objective: Procrastination can be a persistent behavior pattern associated with personal distress. However, research investigating different treatment interventions is scarce, and no randomized controlled trial has examined the efficacy of cognitive−behavior therapy (CBT). Meanwhile, Internet-based CBT has been found promising for several conditions, but has not yet been used for procrastination. Method: Participants (N = 150) were randomized to guided self-help, unguided self-help, and wait-list control. Outcome measures were administered before and after treatment, or weekly throughout the treatment period. They included the Pure Procrastination Scale, the Irrational Procrastination Scale, the Susceptibility to Temptation Scale, the Montgomery Åsberg Depression Rating Scale−Self-report version, the Generalized Anxiety Disorder Assessment, and the Quality of Life Inventory. The intention-to-treat principle was used for all statistical analyses. Results: Mixed-effects models revealed moderate between-groups effect sizes comparing guided and unguided self-help with wait-list control; the Pure Procrastination Scale, 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 Irrational Procrastination Scale, 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 was found to be superior on any of the outcome measures, Fs(98, 65.17−72.55)< 1.70, p >.19. Conclusion: Internet-based CBT could be useful for managing self-reported difficulties due to procrastination, both with and without the guidance of a therapist.
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| 6. |
- Rozental, Alexander, et al.
(author)
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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
- 2017
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In: Cognitive Behaviour Therapy. - : Informa UK Limited. - 1650-6073 .- 1651-2316. ; 46:3, s. 177-195
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Journal article (peer-reviewed)abstract
- Procrastination is a common self-regulatory failure that can have a negative impact on well-being and performance. However, few clinical trials have been conducted, and no follow-up has ever been performed. The current study therefore aimed to provide evidence for the long-term benefits and investigate predictors of a positive treatment outcome among patients receiving Internet-based cognitive behavior therapy (ICBT). A total of 150 self-recruited participants were randomized to guided or unguided ICBT. Self-report measures of procrastination, depression, anxiety, and quality of life were distributed at pre-treatment assessment, post-treatment assessment, and one-year follow-up. Mixed effects models were used to investigate the long-term gains, and multiple linear regression for predictors of a positive treatment outcome, using the change score on the Irrational Procrastination Scale as the dependent variable. Intention-to-treat was implemented for all statistical analyses. Large within-group effect sizes for guided and unguided ICBT, Cohen’s d = .97–1.64, were found for self-report measures of procrastination, together with d = .56–.66 for depression and anxiety. Gains were maintained, and, in some cases, improved at follow-up. Guided and unguided ICBT did not differ from each other, mean differences −.31–1.17, 95% CIs [−2.59–3.22], and none of the predictors were associated with a better result, bs −1.45–1.61, 95% CIs [−3.14–4.26]. In sum, ICBT could be useful and beneficial in relation to managing procrastination, yielding great benefits up to one year after the treatment period has ended, with comparable results between guided and unguided ICBT.
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| 7. |
- Rozental, Alexander, et al.
(author)
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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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In: EABCT 2016 Abstract Book. ; , s. 542-542
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Conference paper (peer-reviewed)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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| 8. |
- Rozental, Alexander, et al.
(author)
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Psychometric evaluation of the Swedish version of the pure procrastination scale, the irrational procrastination scale, and the susceptibility to temptation scale in a clinical population
- 2014
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In: BMC Psychology. - : Springer Science and Business Media LLC. - 2050-7283. ; 2
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Journal article (peer-reviewed)abstract
- Background: Procrastination is a prevalent self-regulatory failure associated with stress and anxiety, decreased well-being, and poorer performance in school as well as work. One-fifth of the adult population and half of the student population describe themselves as chronic and severe procrastinators. However, despite the fact that it can become a debilitating condition, valid and reliable self-report measures for assessing the occurrence and severity of procrastination are lacking, particularly for use in a clinical context. The current study explored the usefulness of the Swedish version of three Internet-administered self-report measures for evaluating procrastination; the Pure Procrastination Scale, the Irrational Procrastination Scale, and the Susceptibility to Temptation Scale, all having good psychometric properties in English.Methods: In total, 710 participants were recruited for a clinical trial of Internet-based cognitive behavior therapy for procrastination. All of the participants completed the scales as well as self-report measures of depression, anxiety, and quality of life. Principal Component Analysis was performed to assess the factor validity of the scales, and internal consistency and correlations between the scales were also determined. Intraclass Correlation Coefficient, Minimal Detectable Change, and Standard Error of Measurement were calculated for the Irrational Procrastination Scale.Results: The Swedish version of the scales have a similar factor structure as the English version, generated good internal consistencies, with Cronbach’s α ranging between .76 to .87, and were moderately to highly intercorrelated. The Irrational Procrastination Scale had an Intraclass Correlation Coefficient of .83, indicating excellent reliability. Furthermore, Standard Error of Measurement was 1.61, and Minimal Detectable Change was 4.47, suggesting that a change of almost five points on the scale is necessary to determine a reliable change in self-reported procrastination severity.Conclusions: The current study revealed that the Pure Procrastination Scale, the Irrational Procrastination Scale, and the Susceptibility to Temptation Scale are both valid and reliable from a psychometric perspective, and that they might be used for assessing the occurrence and severity of procrastination via the Internet.
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