| 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. |
- Ivanova, Ekaterina, et al.
(författare)
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Guided and unguided CBT for social anxiety disorder and/or panic disorder via the Internet and a smartphone application
- 2015
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Ingår i: Abstracts from the 7th Swedish Congress on internet interventions (SWEsrii). - Linköping : Linköping University Press. ; , s. 9-9
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: As Acceptance and Commitment Therapy (ACT) becomes a part of the clinical practice, the interest for alternative ways of providing it continue to grow. Internet-based CBT, both guided and unguided, has proved to be effective for the treatment of a wide range of psychiatric disorders, including anxiety disorders. Moreover, the tremendous accessibility of smartphones makes them a potentially powerful instrument for providing psychological treatment. The purpose of this study was to investigate the effects of an Internet-based ACT-program for social anxiety disorder and panic disorder using both computers and smartphones, and with and without therapist support. Method: The participants were recruited from the general public by filling out an online screening form, which consisted of LSAS, PDSS-SR, GAD-7, PHQ-9, QOLI (the scales later served as outcome measures) and demographic questions. The individuals who met the inclusion criteria were contacted for a diagnostic telephone interview. The 152 people chosen for participation were then randomized into two treatment groups (guided and unguided) and a waiting list control group. The participants in the treatment groups were given access to an Internet-provided ACT-based treatment program consisting of 8 modules, as well as a smartphone application with content that corresponded to the Internet treatment program. Additionally, the participants in the guided group received minimum therapist support (15 min/week) through the smartphone application from psychology students undergoing their clinical training. The participants worked with the program for 10 weeks. They were evaluated twice during treatment, once after completing treatment, and once again 12-months later as a follow-up measure. A mixed effect model was used to analyze the data. Results: Regardless of diagnosis, as a whole the treated groups showed significant decreases in anxiety, with a moderate within-group effect size. This improvement appeared to be maintained when the groups were evaluated again during the follow-up. The participants suffering primarily from social anxiety disorder showed significant improvements, with moderate within-group effect sizes in both the guided (Cohen's d = 0.79) and unguided group (Cohen's d = 0.71). This improvement also appeared to be maintained when these participants were evaluated during the follow-up. No significant changes were observed in the symptoms of the participants suffering primarily from panic disorder. Discussion: Internet-delivered ACT-based treatment provided via both computer and smartphone can be effective for reducing general anxiety symptoms, as well as social anxiety symptoms. The guided treatment was not clearly superior to the unguided treatment. Some of the study’s uncertainties are likely due to the presence of a large number of different components, which made it difficult to isolate the effects of each individual component.
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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. |
- 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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