Internet-delivered Psychological Treatments Research Articles

Results of a randomized waitlist-controlled trial of online cognitive behavioral sex therapy and online mindfulness-based sex therapy for hypoactive sexual desire dysfunction in women.

This study aimed to investigate the efficacy of two internet-delivered psychological treatments for hypoactive sexual desire dysfunction (HSDD) in women: internet-based cognitive behavioral sex therapy (iCBST) and internet-based mindfulness-based sex therapy (iMBST). Women with HSDD were randomly assigned to one of three groups: iCBST, iMBST, or a waitlist control group. The interventions consisted of eight modules delivered via an e-health platform with e-coach support to enhance adherence. Sexual desire and sexual distress were assessed at baseline and at 3-, 6-, and 12-month follow-ups (active conditions only). Per protocol, of the 266 consenting women, 106 were randomized to iCBST (Mage = 36.1, SD = 10.3), 106 to iMBST (Mage = 36.4, SD = 0.2), and 54 to the control condition (Mage = 36.7, SD = 11.0). Primary analyses utilized an intention-to-treat approach with linear mixed models. Clinical significance, assessed with clinical cutoffs and the reliable change index, was examined for active conditions. Compared to the control condition, both iCBST and iMBST demonstrated significant improvements in sexual desire and sexual distress at 3-month (d = 0.89-1.14) and 6-month follow-up (d = 0.74-1.18). Results were sustained at 12-month follow-up, with 35 and 41% demonstrating reliable improvements and additional 20 and 24% achieving clinically significant improvements in sexual desire after iCBST and iMBST. Regarding sexual distress, 49 and 42% exhibited reliable change, with an additional 37%-42% achieving clinically significant improvements. Results provide support for the overall long-term efficacy of psychological therapies in treating HSDD in women. However, fewer than one in four women showed improvements in sexual desire that met the threshold for clinically significant change. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effectiveness of internet-delivered psychological treatments for children and adolescents with anxiety and/or depressive disorders: Systematic review and network meta-analysis

BackgroundAnxiety and depression symptomatology has increased in the child and adolescent population. Internet-delivered psychological treatments (IDPT) can help to reduce this symptomatology, attending to the largest possible population. AimTo conduct a systematic review and network meta-analysis of IDPT to reduce anxiety and depression symptoms in children and adolescents. MethodsThe search for studies was conducted in SCOPUS, PsycINFO, PSICODOC, PsycARTICLES and Medline, between 2000 and 2022, in December 2022. Studies were selected if they were conducted with a sample of children and/or adolescents with previous symptoms of anxiety and depression, had applied IDPT, and included at least two comparative groups with pretest-posttest measures. Network meta-analyses were separately performed for anxiety and depression outcomes. Publication bias was analyzed using Egger's test and funnel plots, and mixed-effects meta-regression models were applied to account for heterogeneity. Results37 studies were included in the meta-analysis, providing a total of 74 comparative groups. IDPT exhibited low-to-moderate, statistically significant average effect sizes when compared to both inactive and active controls. No statistical significance was found when IDPT was compared with other types of interventions. DiscussionIDPT is recommended to reduce anxiety and depression symptomatology in children and adolescents, but more studies are needed which compare treatments with other types of interventions, such as face-to-face therapy.

Adherence Forecasting for Guided Internet-Delivered Cognitive Behavioral Therapy: A Minimally Data-Sensitive Approach.

Internet-delivered psychological treatments (IDPT) are seen as an effective and scalable pathway to improving the accessibility of mental healthcare. Within this context, treatment adherence is an especially pertinent challenge to address due to the reduced interaction between healthcare professionals and patients. In parallel, the increase in regulations surrounding the use of personal data, such as the General Data Protection Regulation (GDPR), makes data minimization a core consideration for real-world implementation of IDPTs. Consequently, this work proposes a Self-Attention-based deep learning approach to perform automatic adherence forecasting, while only relying on minimally sensitive login/logout-timestamp data. This approach was tested on a dataset containing 342 patients undergoing Guided Internet-delivered Cognitive Behavioral Therapy (G-ICBT) treatment. Of these 342 patients, 101 ( ∼30%) were considered non-adherent (dropout) based on the adherence definition used in this work (i.e. at least eight connections to the platform lasting more than a minute over 56 days). The proposed model achieved over 70% average balanced accuracy, after only 20 out of the 56 days ( ∼1/3) of the treatment had elapsed. This study demonstrates that automatic adherence forecasting for G-ICBT, is achievable using only minimally sensitive data, thus facilitating the implementation of such tools within real-world IDPT platforms.

Explainable Deep Attention Active Learning for Sentimental Analytics of Mental Disorder

With the increasing use of online mediums, Internet-delivered psychological treatments (IDPs) are becoming an essential tool for improving mental disorders. Online-based health therapies can help a large segment of the population with little resource investment. The task is greatly complicated by the overlapping emotions for specific mental health. Early adoption of a deep learning system presented severe difficulties, including ethical and legal considerations that contributed to a lack of trust. Modern models required highly interpretable, intuitive explanations that humans could understand. To achieve this, we present a deep attention model based on fuzzy classification that uses the linguistic features of patient texts to build emotional lexicons. In medical applications, a diversified dataset generates work. Active learning techniques are used to extend fuzzy rules and the learned dataset gradually. From this, the model can gain a reduction in labeling efforts in mental health applications. In this way, difficulties such as the amount of vocabulary per class, method of generation, the source of data, and the baseline for human performance level can be solved. Moreover, this work illustrates fuzzy explainability by using weighted terms. The proposed method incorporates a subset of unstructured data into the set for training and uses a similarity-based approach. The approach then updates the model training using the new training points in the subsequent cycle of the active learning mechanism. The cycle is repeated until the optimal solution is found. At this point, all unlabeled text is converted into the set for training. The experimental results show that the emotion-based enhancement improves test accuracy and helps develop quality criteria. In the blind test, the bidirectional LSTM architecture with an attention mechanism and fuzzy classification achieved an F1 score of 0.89.

Fuzzy Contrast Set Based Deep Attention Network for Lexical Analysis and Mental Health Treatment

Internet-delivered psychological treatments (IDPT) consider mental problems based on Internet interaction. With such increased interaction because of the COVID-19 pandemic, more online tools have been widely used to provide evidence-based mental health services. This increase helps cover more population by using fewer resources for mental health treatments. Adaptivity and customization for the remedy routine can help solve mental health issues quickly. In this research, we propose a fuzzy contrast-based model that uses an attention network for positional weighted words and classifies mental patient authored text into distinct symptoms. After that, the trained embedding is used to label mental data. Then the attention network expands its lexicons to adapt to the usage of transfer learning techniques. The proposed model uses similarity and contrast sets to classify the weighted attention words. The fuzzy model then uses the sets to classify the mental health data into distinct classes. Our method is compared with non-embedding and traditional techniques to demonstrate the proposed model. From the experiments, the feature vector can achieve a high ROC curve of 0.82 with problems associated with nine symptoms.

Internet-Delivered Psychological Treatments for Tinnitus: A Brief Historical Review.

Internet-delivered psychological treatments were developed more than 20 years ago, and tinnitus was among the first target conditions. The aim of this review article is to describe the history of Internet treatments for tinnitus and to comment on the evidence base. Challenges for future research and implementations will be mentioned. A narrative historical review was conducted. There are now several studies including controlled trials on Internet interventions based on cognitive behavior therapy (ICBT) for tinnitus. Effects in controlled trials are moderate to large with regard to tinnitus annoyance. While the treatment format now exists in four languages, there is a large treatment versus demand gap as very few clients with tinnitus receive ICBT. There is a lack of research on related conditions with the exception of hearing loss. However, there is substantial support for Internet interventions for comorbid conditions such as insomnia and depression but not specifically in association with tinnitus. ICBT is a promising treatment approach for tinnitus and will hopefully increase access to evidence-based treatment to reduce tinnitus distress. More research is needed for related conditions such as hyperacusis and larger trials on tinnitus.

Towards adaptive technology in routine mental health care.

This paper summarizes the information technology-related research findings after 5 years with the INTROducing Mental health through Adaptive Technology project. The aim was to improve mental healthcare by introducing new technologies for adaptive interventions in mental healthcare through interdisciplinary research and development. We focus on the challenges related to internet-delivered psychological treatments, emphasising artificial intelligence, human-computer interaction, and software engineering. We present the main research findings, the developed artefacts, and lessons learned from the project before outlining directions for future research. The main findings from this project are encapsulated in a reference architecture that is used for establishing an infrastructure for adaptive internet-delivered psychological treatment systems in clinical contexts. The infrastructure is developed by introducing an interdisciplinary design and development process inspired by domain-driven design, user-centred design, and the person based approach for intervention design. The process aligns the software development with the intervention design and illustrates their mutual dependencies. Finally, we present software artefacts produced within the project and discuss how they are related to the proposed reference architecture. Our results indicate that the proposed development process, the reference architecture and the produced software can be practical means of designing adaptive mental health care treatments in correspondence with the patients' needs and preferences. In summary, we have created the initial version of an information technology infrastructure to support the development and deployment of Internet-delivered mental health interventions with inherent support for data sharing, data analysis, reusability of treatment content, and adaptation of intervention based on user needs and preferences.

Adaptive Systems for Internet-Delivered Psychological Treatments

Internet-Delivered Psychological Treatments (IDPT) are based on evidence-based psychological treatment models adjusted for interaction through the Internet. The use of Internet technologies has the potential to increase the availability of evidence-based mental health services for a far-reaching population with the use of fewer resources. Despite evidence that Internet Interventions can be effective means in mental health morbidities, most current IDPT systems are tunnel-based, inflexible, and non-interoperable. Hence it becomes essential to understand which elements of an Internet intervention contribute to effectiveness and treatment outcomes. By analogy, adaptation is a central aspect of successful face-to-face mental health therapy. Adaptability to patient needs can be regarded as an essential outcome factor in online systems for mental health interventions as well. While some aspects of rule-based and machine-learning-based adaptation have attracted attention in recent IDPT development, systematic reporting of core components, dimensions of adaptiveness, information architecture, and strategies for adaptation in the IDPT system are still lacking. To bridge this gap, we propose a model that shows how adaptive systems are represented in classical control theory and discuss how the model can be used to specify adaptive IDPT systems. Concerning the reference model, we outline the core components of adaptive IDPT systems, the main adaptive elements, dimensions of adaptiveness, information architecture applied to adaptive systems, and strategies used in the adaptation process. We also provide comprehensive guidelines on how to develop an adaptive IDPT system based on the Person-Based Approach.

Examining an internet-delivered intervention for anxiety and depression when delivered as a part of routine care for university students: A phase IV trial

BackgroundThere has been growing interest in the potential of emerging internet-delivered psychological treatments for supporting the mental health needs of university students. However, no large-scale prospective effectiveness trials examining their real-world potential have been reported. ObjectiveThe aim of the current study was to evaluate the acceptability and effectiveness of a brief, 5-week, internet-delivered and therapist-guided intervention for anxiety and depression, when delivered as part of routine care by a university counselling service. DesignA large, prospective, single-group Phase-IV clinical trial. Students (n = 1326) engaging with the university counselling service were provided the opportunity to receive the intervention based on their preferences and identified needs. Students completed standardised measures of anxiety and depression at pre-treatment, each week of the intervention, post-treatment and 3-month follow-up. ResultsOver a 4 year period, 1081 students (10% of those presenting to the counselling service) participated in the intervention. Large clinical reductions in symptoms of both anxiety (% reduction = 41%; Cohen's d = 0.94) and depression (% reduction = 36%; Cohen's d = 0.81) were observed alongside high levels of acceptability. The intervention required relatively little counsellor time (M = 36.28 mins; SD = 20.56) per student, and symptom deterioration was observed in less than 5% of students. ConclusionThe findings of the current study are supportive of internet-delivered interventions provided as routine care to university students. Further research is needed to carefully explore whether these interventions could be used with a larger proportion of students presenting to counselling services, paying close attention to acceptability, engagement and clinical outcomes.

Internet-delivered psychological treatments: from innovation to implementation.

Internet interventions, and in particular Internet-delivered cognitive behaviour therapy (ICBT), have existed for at least 20years. Here we review the treatment approach and the evidence base, arguing that ICBT can be viewed as a vehicle for innovation. ICBT has been developed and tested for several psychiatric and somatic conditions, and direct comparative studies suggest that therapist-guided ICBT is more effective than a waiting list for anxiety disorders and depression, and tends to be as effective as face-to-face CBT. Studies on the possible harmful effects of ICBT are also reviewed: a significant minority of people do experience negative effects, although rates of deterioration appear similar to those reported for face-to-face treatments and lower than for control conditions. We further review studies on change mechanisms and conclude that few, if any, consistent moderators and mediators of change have been identified. A recent trend to focus on knowledge acquisition is considered, and a discussion on the possibilities and hurdles of implementing ICBT is presented. The latter includes findings suggesting that attitudes toward ICBT may not be as positive as when using modern information technology as an adjunct to face-to-face therapy (i.e., blended treatment). Finally, we discuss future directions, including the role played by technology and machine learning, blended treatment, adaptation of treatment for minorities and non-Western settings, other therapeutic approaches than ICBT (including Internet-delivered psychodynamic and interpersonal psychotherapy as well as acceptance and commitment therapy), emerging regulations, and the importance of reporting failed trials.

Internet-Delivered Psychological Treatment Options for Panic Disorder: A Review on Their Efficacy and Acceptability.

Background Internet-delivered psychological treatments have been suggested as a chance to expand the access to professional help. However, little is known about the usefulness of different support formats and approaches of digital treatments for panic disorder among clinicians.Objective This narrative review aimed to explore the recent evidence base on the efficacy and acceptability of different internet-delivered treatments for adults with panic disorder.MethodsA systematic search in electronic databases (Pubmed/Medline, PSYNDEX) and a hand search were performed to identify articles on randomized controlled trials published within the past five years (2012/12/10–2017/12/12) in English peer-reviewed journals.ResultsEight studies (1,013 participants) involving 10 interventions met the inclusion criteria. Nine interventions were primarly based on Cognitive Behavioral Therapy principles. Most interventions were effective, when compared to a control condition (6 of 8 comparisons). Minimal guidance was associated with improved outcomes in one study and adherence in two studies (3 comparisons). Furthermore, no differences were found based on treatment approach (2 comparisons). Regarding acceptability, the attrition rates were moderate to high, ranging from 9.8% to 42.1% of randomized participants. Adherence rates also varied largely (7.8–75%), whereas participant satisfaction of program completers was assessed overall high (5 studies).ConclusionDiverse effective internet-delivered treatments are available for the self-management of panic symptoms. Especially selfguided and transdiagnostic Cognitive Behavioral Therapy approaches appear being efficient options for the dissemination in routine care. However, due to the limited evidence base, further efforts are required to improve the actual uptake of internet-delivered treatments and identify moderators of outcomes.

Does cognitive flexibility predict treatment gains in Internet-delivered psychological treatment of social anxiety disorder, depression, or tinnitus?

Little is known about the individual factors that predict outcomes in Internet-administered psychological treatments. We hypothesized that greater cognitive flexibility (i.e. the ability to simultaneously consider several concepts and tasks and switch effortlessly between them in response to changes in environmental contingencies) would provide a better foundation for learning and employing the cognitive restructuring techniques taught and exercised in therapy, leading to greater treatment gains. Participants in three trials featuring Internet-administered psychological treatments for depression (n = 36), social anxiety disorder (n = 115) and tinnitus (n = 53) completed the 64-card Wisconsin Card Sorting Test (WCST) prior to treatment. We found no significant associations between perseverative errors on the WCST and treatment gains in any group. We also found low accuracy in the classification of treatment responders. We conclude that lower cognitive flexibility, as captured by perseverative errors on the WCST, should not impede successful outcomes in Internet-delivered psychological treatments.

Internet-Delivered Psychological Treatments.

During the past 15 years, much progress has been made in developing and testing Internet-delivered psychological treatments. In particular, therapist-guided Internet treatments have been found to be effective for a wide range of psychiatric and somatic conditions in well over 100 controlled trials. These treatments require (a) a secure web platform, (b) robust assessment procedures, (c) treatment contents that can be text based or offered in other formats, and (d) a therapist role that differs from that in face-to-face therapy. Studies suggest that guided Internet treatments can be as effective as face-to-face treatments, lead to sustained improvements, work in clinically representative conditions, and probably are cost-effective. Despite these research findings, Internet treatment is not yet disseminated in most places, and clinical psychologists should consider using modern information technology and evidence-based treatment programs as a complement to their other services, even though there will always be clients for whom face-to-face treatment is the best option.

Experiences of non-adherence to Internet-delivered cognitive behavior therapy: A qualitative study

Many trials on Internet-delivered psychological treatments have had problems with nonadherence, but not much is known about the subjective reasons for non-adhering. The aim of this study was to explore participants' experiences of non-adherence to Internet-delivered psychological treatment. Grounded theory was used to analyze data from seven in-depth interviews with persons who had non-adhered to a study on Internet-delivered cognitive behavioral therapy for generalized anxiety disorder. The process of non-adherence is described as an interaction between patient factors and treatment factors. A working model theory was generated to illustrate the experience of nonadherence. The model describes a process where treatment features such as workload, text-content complexity and treatment process don't match personal prerequisites regarding daily routines, perceived language skills and treatment expectations respectively, resulting in the decision to nonadhere. Negative effects were also stated as a reason for non-adherence. Several common strategies used for increasing adherence to Internet-delivered therapy in general are by these non-completers regarded as factors directly related to their reason for non-adherence.

Internet-delivered psychological treatments for mood and anxiety disorders: a systematic review of their efficacy, safety, and cost-effectiveness.

BackgroundGreater access to evidence-based psychological treatments is needed. This review aimed to evaluate whether internet-delivered psychological treatments for mood and anxiety disorders are efficacious, noninferior to established treatments, safe, and cost-effective for children, adolescents and adults.MethodsWe searched the literature for studies published until March 2013. Randomized controlled trials (RCTs) were considered for the assessment of short-term efficacy and safety and were pooled in meta-analyses. Other designs were also considered for long-term effect and cost-effectiveness. Comparisons against established treatments were evaluated for noninferiority. Two reviewers independently assessed the relevant studies for risk of bias. The quality of the evidence was graded using an international grading system.ResultsA total of 52 relevant RCTs were identified whereof 12 were excluded due to high risk of bias. Five cost-effectiveness studies were identified and three were excluded due to high risk of bias. The included trials mainly evaluated internet-delivered cognitive behavioral therapy (I-CBT) against a waiting list in adult volunteers and 88% were conducted in Sweden or Australia. One trial involved children. For adults, the quality of evidence was graded as moderate for the short-term efficacy of I-CBT vs. waiting list for mild/moderate depression (d = 0.83; 95% CI 0.59, 1.07) and social phobia (d = 0.85; 95% CI 0.66, 1.05), and moderate for no efficacy of internet-delivered attention bias modification vs. sham treatment for social phobia (d = −0.04; 95% CI −0.24, 0.35). The quality of evidence was graded as low/very low for other disorders, interventions, children/adolescents, noninferiority, adverse events, and cost-effectiveness.ConclusionsI-CBT is a viable treatment option for adults with depression and some anxiety disorders who request this treatment modality. Important questions remain before broad implementation can be supported. Future research would benefit from prioritizing adapting treatments to children/adolescents and using noninferiority designs with established forms of treatment.

A randomized controlled trial of internet-delivered cognitive behavior therapy and acceptance and commitment therapy in the treatment of tinnitus.

Our aim in this randomized controlled trial was to investigate the effects on global tinnitus severity of 2 Internet-delivered psychological treatments, acceptance and commitment therapy (ACT) and cognitive behavior therapy (CBT), in guided self-help format. Ninety-nine participants (mean age = 48.5 years; 43% female) who were significantly distressed by tinnitus were recruited from the community. Participants were randomly assigned to CBT (n = 32), ACT (n = 35), or a control condition (monitored Internet discussion forum; n = 32), and they were assessed with standardized self-report measures (Tinnitus Handicap Inventory; Hospital Anxiety and Depression Scale; Quality of Life Inventory; Perceived Stress Scale; Tinnitus Acceptance Questionnaire) at pre-, posttreatment (8 weeks), and 1-year follow-up. Mixed-effects linear regression analysis of all randomized participants showed significant effects on the primary outcome (Tinnitus Handicap Inventory) for CBT and for ACT compared with control at posttreatment (95% CI [-17.03, -2.94], d = 0.70, and 95% CI [-16.29, -2.53], d = 0.68, respectively). Within-group effects were substantial from pretreatment through 1-year-follow-up for both treatments (95% CI [-44.65, -20.45], d = 1.34), with no significant difference between treatments (95% CI [-14.87, 11.21], d = 0.16). Acceptance-based procedures may be a viable alternative to traditional CBT techniques in the management of tinnitus. The Internet can improve access to psychological interventions for tinnitus.

Transdiagnostic internet treatment for anxiety and depression = Tratamiento transdiagnóstico por internet de la ansiedad y la depresión

Anxiety and depression are common, chronic, disabling and frequently comorbid, but manypeople experience barriers accessing treatment. Internet-delivered psychological treatments (iPT)have considerable potential to increase access, while transdiagnostic (TD) interventions, which aimto simultaneously treat multiple disorders, represent an emerging approach that may facilitate thetreatment of comorbidity. The present paper describes a conceptual and pragmatic rationale for combiningiPT and TD approaches. It also describes the authors’ experiences in developing and evaluatingTD iPT protocols for anxiety and depression. The results of 4 randomised controlled trials and oneopen trial (N = 572) are reviewed. The results of these trials are encouraging and indicate TD iPT cansignificantly reduce symptoms of both principal and comorbid disorders. However, independent replicationof the existing findings is required and many outstanding questions remain. We watch withinterest how further conceptual and technological developments influence the content and deliveryof these interventions.