Large Within-group Effect Sizes Research Articles

Internet-delivered cognitive behavioural therapy for depression: A feasibility open trial for older adults

Depression is an important health issue amongst older adults. Internet-delivered cognitive behaviour therapy (iCBT) may help to reduce barriers and improve access to treatment, but few studies have examined its use with older adults. The present study evaluated the efficacy, acceptability and feasibility of a brief iCBT program, the Managing Your Mood Program, to treat depression amongst adults aged 60 years and older. Using an open trial design, 20 participants with elevated symptoms of depression (Patient Health Questionnaire 9-item (PHQ-9) total scores ≥ 10) received access to five educational lessons and homework summaries, additional resources, a moderated discussion forum and weekly telephone or email contact from a clinical psychologist. Eighty percent of the sample met diagnostic criteria for a major depressive episode at pre-treatment. Completion rates and response rates were high, with 16/20 participants completing the five lessons within the 8 weeks, and post-treatment and 3-month follow-up data being collected from 17/20 participants. Participants improved significantly on the PHQ-9 and Geriatric Depression Scale (GDS), with large within-group effect sizes (Cohen's d) at follow-up of 1.41 and 2.04, respectively. The clinician spent a mean time of 73.75 minutes (SD = 36.10 minutes) contacting participants within the trial and the program was rated as highly acceptable by participants. The results are encouraging and support the potential value of iCBT in the treatment of depressive symptoms amongst older adults.

Internet-Based Psychodynamic versus Cognitive Behavioral Guided Self-Help for Generalized Anxiety Disorder: A Randomized Controlled Trial

Background: Guided Internet-based cognitive behavior therapy (ICBT) has been tested in many trials and found to be effective in the treatment of anxiety and mood disorders. Generalized anxiety disorder (GAD) has also been treated with ICBT, but there are no controlled trials on guided Internet-based psychodynamic treatment (IPDT). Since there is preliminary support for psychodynamic treatment for GAD, we decided to test if a psychodynamically informed self-help treatment could be delivered via the Internet. The aim of the study was to investigate the efficacy of IPDT for GAD and to compare against ICBT and a waiting list control group. Method: A randomized controlled superiority trial with individuals diagnosed with GAD comparing guided ICBT (n = 27) and IPDT (n = 27) against a no treatment waiting list control group (n = 27). The primary outcome measure was the Penn State Worry Questionnaire. Results: While there were no significant between-group differences immediately after treatment on the main outcome measure, both IPDT and ICBT resulted in improvements with moderate to large within-group effect sizes at 3 and 18 months follow-up on the primary measure in the completer analyses. The differences against the control group, although smaller, were still significant for both PDT and CBT when conforming to the criteria of clinically significant improvement. The active treatments did not differ significantly. There was a significant group by time interaction regarding GAD symptoms, but not immediately after treatment. Conclusions: IPDT and ICBT both led to modest symptom reduction in GAD, and more research is needed.

Brief internet-delivered cognitive behavioral therapy for anxiety in older adults: A feasibility trial

This study examined the efficacy of an Internet-delivered cognitive-behavior therapy program developed for older adults. Twenty-two participants with elevated scores (≥8) on the Generalized Anxiety Disorder 7-Item Scale (GAD-7) participated in the course, which consisted of five lessons, homework tasks, additional resources, a moderated discussion forum, and weekly telephone support from a Clinical Psychologist. Ninety-five percent of the sample met diagnostic criteria for an anxiety disorder at pre-treatment. All participants completed the five lessons within the allotted eight weeks. Three-month follow-up data was collected from 95% of participants. Reductions in symptoms of anxiety and stress, with large within-group effect sizes (Cohen's d) were found on the GAD-7 (d=1.03) and the Depression, Anxiety and Stress Scales – 21 Items (d=0.98) at follow-up. Participants reported high levels of satisfaction with the program. These encouraging results provide tentative support for the online treatment of older adults with anxiety.

Internet-based cognitive behavior therapy for obsessive compulsive disorder: A pilot study

BackgroundCognitive behavior therapy (CBT) is widely regarded as an effective treatment for obsessive compulsive disorder (OCD), but access to CBT therapists is limited. Internet-based CBT (ICBT) with therapist support is a way to increase access to CBT but has not been developed or tested for OCD. The aim of this study was to evaluate ICBT for OCD.MethodAn open trial where patients (N = 23) received a 15-week ICBT program with therapist support consisting of psychoeducation, cognitive restructuring and exposure with response prevention. The primary outcome was the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), which was assessed by a psychiatrist before and immediately after treatment. Secondary outcomes were self-rated measures of OCD symptoms, depressive symptoms, general functioning, anxiety and quality of life. All assessments were made at baseline and post-treatment.ResultsAll participants completed the primary outcome measure at all assessment points. There were reductions in OCD symptoms with a large within-group effect size (Cohen's d = 1.56). At post-treatment, 61% of participants had a clinically significant improvement and 43% no longer fulfilled the diagnostic criteria of OCD. The treatment also resulted in statistically significant improvements in self-rated OCD symptoms, general functioning and depression.ConclusionsICBT with therapist support reduces OCD symptoms, depressive symptoms and improves general functioning. Randomized trials are needed to confirm the effectiveness of this new treatment format.Trial RegistrationClinicalTrials.gov: NCT01348529

Internet-Based Attention Training for Social Anxiety: A Randomized Controlled Trial

Several studies suggest that computer-based attention modification programmes can be a promising new approach for the treatment of various anxiety disorders, including social anxiety disorder (SAD). The current study investigates the efficacy of a four-week Internet-delivered version of an attentional training for SAD in a randomized controlled double-blind study. Sixty-eight individuals seeking treatment for SAD were randomly assigned to either an attention training group (ATG, N = 33) or a control group (CG, N = 35). Participants of the ATG completed modified dot-probe tasks designed to facilitate attentional disengagement from threat. Participants in the CG completed control dot-probe tasks. At post-assessment, participants in both groups showed significant symptom reductions with medium to large within-group effect sizes on social anxiety measures (ATG: Cohen’s d = .47–.80; CG: d = .56–.63). However, no significant differences between groups were found at post-treatment for any outcome measure. These findings will be discussed along with the results of a 4-months follow-up assessment.

Can the Patient Decide Which Modules to Endorse? An Open Trial of Tailored Internet Treatment of Anxiety Disorders

Internet-delivered cognitive behaviour therapy commonly consists of disorder-specific modules that are based on face-to-face manuals. A recent development in the field is to tailor the treatment according to patient profile, which has the potential to cover comorbid conditions in association with anxiety and mood disorders. However, it could be that the patients themselves are able to decide what modules to use. The authors tested this in an open pilot trial with 27 patients with mixed anxiety disorders. Modules were introduced with a brief description, and patients could choose which modules to use. The exception was the two first modules and the last, which involved psychoeducation and relapse prevention. The treatment period lasted for 10 weeks. Results showed large within-group effect sizes, with an average Cohen's d of 0.88. In a structured clinical interview, a majority (54%) had significantly improved 10 weeks after commencing treatment. Only one person dropped out. On the basis of results of this preliminary study, the authors suggest that the role of choice and tailoring should be further explored in controlled trials and that patient choice could be incorporated into Internet-delivered treatment packages.

Virtual Reality Versus Computer-Aided Exposure Treatments for Fear of Flying

Evidence is growing that two modalities of computer-based exposure therapies--virtual reality and computer-aided psychotherapy--are effective in treating anxiety disorders, including fear of flying. However, they have not yet been directly compared. The aim of this study was to analyze the efficacy of three computer-based exposure treatments for fear of flying: virtual reality exposure therapy (VRET), computer-aided exposure with a therapist's (CAE-T) assistance throughout exposure sessions, and self-administered computer-aided exposure (CAE-SA). A total of 60 participants with flying phobia were randomly assigned to VRET, CAE-T, or CAE-SA. Results indicate that the three interventions were effective in reducing fear of flying at posttreatment and at 1-year follow-up; furthermore, there were no significant differences between them in any of the outcome measure. Large within-group effect sizes were found for all three treatment conditions at both posttreatment and at follow-up. The results suggest that therapist involvement might be minimized during computer-based treatments and that CAE can be as effective as VRET in reducing fear of flying.

Changes in Neck Pain and Active Range of Motion After a Single Thoracic Spine Manipulation in Subjects Presenting with Mechanical Neck Pain: A Case Series

Objective Our aim was to report changes in neck pain at rest, active cervical range of motion, and neck pain at end-range of cervical motion after a single thoracic spine manipulation in a case series of patients with mechanical neck pain. Methods Seven patients with mechanical neck pain (2 men, 5 women), 20 to 33 years old, were included. All patients received a single thoracic manipulation by an experienced manipulative therapist. The outcome measures of these cases series were neck pain at rest, as measured by a numerical pain rating scale; active cervical range of motion; and neck pain at the end of each neck motion (eg, flexion or extension). These outcomes were assessed pre treatment, 5 minutes post manipulation, and 48 hours after the intervention. A repeated-measures analysis was made with parametric tests. Within-group effect sizes were calculated using Cohen d coefficients. Results A significant ( P < .001) decrease, with large within-group effect sizes ( d > 1), in neck pain at rest were found after the thoracic spinal manipulation. A trend toward an increase in all cervical motions (flexion, extension, right or left lateral flexion, and right or left rotation) and a trend toward a decrease in neck pain at the end of each cervical motion were also found, although differences did not reach the significance ( P > .05). Nevertheless, medium to large within-group effect sizes (0.5 < d < 1) were found between preintervention data and both postintervention assessments in both active range of motion and neck pain at the end of each neck motion. Conclusions The present results demonstrated a clinically significant reduction in pain at rest in subjects with mechanical neck pain immediately and 48 hours following a thoracic manipulation. Although increases in all tested ranges of motion were obtained, none of them reached statistical significance at either posttreatment point. The same was found for pain at the end of range of motion for all tested ranges, with the exception of pain at the end of forward flexion at 48 hours. More than one mechanism likely explains the effects of thoracic spinal manipulation. Future controlled studies comparing spinal manipulation vs spinal mobilization of the thoracic spine are required.