Self-directed Intervention Research Articles

Translating Evidence-Based Self-Management Interventions Using a Stepped-Care Approach for Patients With Cancer and Their Caregivers: A Pilot Sequential Multiple Assignment Randomized Trial Design.

Self-directed interventions are cost-effective for patients with cancer and their family caregivers, but barriers to use can compromise adherence and efficacy. Pilot a Sequential Multiple Assignment Randomized Trial (SMART) to develop a time-varying dyadic self-management intervention that follows a stepped-care approach in providing different types of guidance to optimize the delivery of Coping-Together, a dyadic self-directed self-management intervention. 48 patients with cancer and their caregivers were randomized in Stage 1 to: (a) Coping-Together (included a workbook and 6 booklets) or (b) Coping-Together+lay telephone guidance. At 6weeks, change in distress level was assessed, and non-responding dyads were re-randomized in Stage 2 to (a) continue with their Stage 1 intervention or (b) be stepped-up. Benchmarks for acceptability, feasibility, and clinical significance (anxiety and quality of life (QOL)) were assessed via surveys and study logs. Feasibility was supported by a low refusal rate at≤30% and <10% missing data. Men and women were enrolled in at least a 40:60 ratio for caregivers, but less for patients. Recruitment was slow at 1 dyad/week. Acceptability was supported by a low attrition rate (12.5%) and with 87% of participants finding the booklets helpful. Telephone guidance in Stage 1 increased adherence to Coping-Together; however, in Stage 1, participants benefited more from the self-directed format than the guidance. All patients who were stepped-up in Stage 2 benefited from their new assignment; this trend was less clear for caregivers. Findings suggest a 3-step approach to dyadic self-management support that warrants further testing. Clinical Trials Registration #: NCT04255030.

An online, father-inclusive parenting intervention for reducing child conduct problems: a randomised controlled trial of family man.

Parenting interventions are effective for improving child conduct problems (CPs), but online self-directed interventions are required to improve reach and impact. Mothers are the main users of such programmes; fathers show low participation rates despite evidence of increased efficacy when they participate. This randomised controlled trial examined the efficacy of Family Man, a brief, self-directed online parenting intervention for fathers and mothers of children with CPs. The intervention involves several innovative design features to maximise the engagement of fathers. Families (N = 103; 102 mothers, 78 fathers) seeking help with managing their 2- to 8-year-old child's CPs were randomly assigned to either the Family Man intervention condition (n = 53) or a 4-week waitlist control group (n = 50). Primary outcomes were frequency and severity of child CPs and secondary outcomes included dysfunctional parenting, parenting efficacy, parenting stress, parental psychological distress, household disorganisation and interparental conflict. Repeated measures ANOVAs/MANOVAs found that at 4-week post-assessment, parents in the intervention group reported significantly lower levels of child CPs than waitlist. Significant effects for the intervention group relative to waitlist were also found across all secondary outcomes examined. Intervention effects were maintained at 2-month follow-up for the intervention group. Outcomes did not significantly differ for mothers and fathers. Results support the efficacy of this brief, self-directed online parenting intervention in improving child CPs and a range of parent and family outcomes, both for fathers and mothers. Implications for improving the reach and impact of parenting interventions and increasing father engagement, are discussed.

A Longitudinal Multi-Method Inquiry of Educational Workers' Use of Interventions for Positive Mental Wellbeing.

Compassion fatigue and burnout are two distinct forms of mental health distress faced by educational workers. Researchers have shown a high level of both phenomena across the field of education; however, a better understanding of what educational workers already do for positive mental and emotional health is needed. This research study examined three years of data, collected via survey, inquiring into the various interventions, namely supports and resources, that educational workers use to support positive mental health. Quantitative data analysis via descriptive and inferential statistics revealed that educational workers relied heavily on their personal support network followed distantly by medical professionals and other interventions, revealing a gap that needs to be addressed by employers. Qualitative thematic analysis revealed a trend towards increased use of environmental interventions to promote positive mental wellbeing. The data analysis suggested areas of focus required to ensure workplace wellbeing, and that programs too focused on individual or self-directed interventions would not be well received by educators. Suggestions for other interventions that might be helpful for leaders and policy-makers are provided.

Abstract B049: Building rapport in navigator-delivered health insurance literacy interventions: Engagement and tone used by parents of children with cancer and patient navigators

Abstract Purpose: To explore the linguistic elements of engagement and tone used by parents of children with cancer and a patient navigator (PN) during a pilot study of a health insurance literacy (HIL) intervention. Methods: A trained PN delivered a four-session Zoom-based HIL intervention for parents of children with cancer that contained content on: Session 1 (S1) health insurance terms, (S2) using health insurance, (S3) insurance appeals/legislation, and (S4) budgeting and financial strategies. We applied Linguistic Inquiry Word Count (LIWC-22) software to analyze transcriptions of each session regarding engagement and tone. We report, in aggregate, differences in language: analytical language (e.g., formal, logical), clout language (e.g., confidence, leadership), authenticity language (e.g., degree of self-monitoring), and emotional tone (e.g., positive and negative emotion words) (all range 1-99) between S1 and S4 using paired t-tests. We also analyzed language similarities between the PN and the parent using Language Style Matching, which represents the degree to which both speakers are engaged in the conversation. Results: Of 10 participants, 9 completed 4 sessions, and 1 parent completed 3 (39 sessions total); sessions were on average 35.1 (SD=6.4) minutes. Most participants were women (80%), married (90%), white (100%), and non-Hispanic (90%); half had a college degree. The PN spoke more than parents across all four sessions (90% PN vs 8.8% parent); however, parent engagement, as represented by word count, increased as the sessions went on (mean S1: 414 words, S4: 603.8 words, p=0.21). S1 contained the most language exchange between parents and the PN (median word count: 5,533.5). The discussions became increasingly authentic (mean by session: S1:24.2; S4:28.6; p=0.02), held more clout (S1:77.8, S4: 85.8; p=0.009), and increased in emotional tone (S1:49; S4:65, p=0.002). Analytical language decreased over time (S1:24.4; S4:19.8, p=0.05). Language style matching was consistently high and trending upward across sessions (S1:0.80; S4: 0.81, p=0.3). Conclusions: In a pilot test of a HIL intervention, we saw an increase in authentic language, emotional tone, and parent word count coupled with a decrease in analytical language, indicating increased rapport between the PN and parent over the sessions. This suggests there is emotional and supportive value in PN-led interventions as compared to self-directed interventions. PNs can build trust and promote equity by deconstructing and personalizing health insurance information. Future work should explore how rapport built between parents and PNs relates to health insurance literacy and financial toxicity outcomes. Citation Format: Mary K. Killela, Anne C. Kirchhoff, Perla Vaca Lopez, Amy Chevrier, Monique Stefanou, Katie Rogers, Douglas Fair, Echo L. Warner. Building rapport in navigator-delivered health insurance literacy interventions: Engagement and tone used by parents of children with cancer and patient navigators [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B049.

Pilot trial of a new self-directed psychological intervention for infertility-related distress

BackgroundNow affecting one in six couples in Canada, infertility is defined as a lack of conception after 12 or more months of regular, unprotected heterosexual intercourse. Infertility is associated with immense psychological burden, particularly for individuals assigned female at birth. Yet existing psychological interventions are not specialized to this population and have been shown to be only marginally effective at relieving distress related to infertility. Thus, a new online self-directed psychological intervention was co-created with a panel of women experiencing infertility, and ultimately consisted of six 10-min video modules addressing the cognitive, emotional, and interpersonal aspects of infertility-related distress.MethodsIn the current study, 21 women experiencing reduced quality of life related to infertility were recruited to participate in a one-arm pre-post pilot testing the feasibility, acceptability, and preliminary efficacy of the program. Participant adherence and retention were monitored, and participants rated the credibility of the program and the helpfulness of each module as well as provided feedback on the content and format of the program. Pre-to-post changes in fertility quality of life, anxious symptoms, depressive symptoms, and relationship satisfaction were examined.ResultsThe program modules were highly rated by participants, with average helpfulness ratings ranging from 7.5 to 8.2/10. Two participants became pregnant and therefore stopped prematurely, 79% of the remaining participants completed all six modules, and participants reported completing 52.8 (SD = 82.0) min of homework per week. Participants perceived the intervention as highly credible and generally approved of the format, length, and speed; however, 68% of participants had recommendations for additional content to be included in the intervention. While relationship satisfaction did not change significantly over time, large pre-to-post improvements in fertility quality of life, depression, and anxiety were observed (p < .001; Cohen’s ds = 0.9–1.3).ConclusionsThis self-directed intervention was well received and has the potential to be highly effective in reducing infertility-related distress, informing future development and optimization.Trial registrationClinicalTrials.gov, NCT05103982.

Psychological interventions to promote self-forgiveness: a systematic review

BackgroundBeing able to forgive one’s own wrongdoings improves the health and well-being of a person. People find it difficult to forgive themselves due to different reasons. It is essential to enhance the ability to accept one’s deeds and thereby enhance self-forgiveness. The current systematic review’s objective is to comprehend the application and efficiency of numerous interventions that improve self-forgiveness.MethodsThe search was done on electronic databases such as PubMed, ERIC, Web of Science, PsycNet, Science Direct, and Google Scholar. The initial search yielded 399 articles. After the duplicate removal, 19 articles met the eligibility criteria. Two studies were identified through related references. Thus, 21 articles were finalized for review. The study adhered to the PRISMA recommendations for systematic reviews.ResultsThe 21 finalized articles varied in method, participants, research design, duration, measurement tools used, and observed outcomes. Thirteen of the 21 finalized articles followed interventions specifically designed to promote self-forgiveness. Interventions are seen to be applied at both individual and group levels.ConclusionThe review categorizes the interventions into self-directed and group. The self-directed interventions, notably those based on Enright’s process model, demonstrate its efficiency in nurturing self-forgiveness. Self-forgiveness interventions are also found to be effective in promoting other positive psychological and clinical variables. Further implications and future research avenues are outlined.

Outcomes of a Remotely Delivered Complementary and Integrative Health Partnered Intervention to Improve Chronic Pain and Posttraumatic Stress Disorder Symptoms: Randomized Controlled Trial.

Nonpharmacological interventions for veterans are needed to help them manage chronic pain and posttraumatic stress disorder (PTSD) symptoms. Complementary and integrative health (CIH) interventions such as Mission Reconnect (MR) seek to provide veterans with the option of a partnered, self-directed intervention that teaches CIH skills remotely to support symptom management. The purpose of this study was to describe the physical, psychological, and social outcomes of a self-directed mobile- and web-based CIH intervention for veterans with comorbid chronic pain and PTSD and their partners and qualitatively examine their MR user experience. A sample of veteran-partner dyads (n=364) were recruited to participate in a mixed methods multisite waitlist control randomized controlled trial to measure physical, psychological, and social outcomes, with pain as the primary outcome and PTSD, depression, stress, sleep, quality of life, and relationships as secondary outcomes. Linear mixed models were constructed for primary and secondary patient-reported outcomes. The quantitative analysis was triangulated using qualitative interviews from a subsample of dyads (n=35) to examine participants' perceptions of their program experience. Dyads were randomized to 2 groups: intervention (MR; 140/364, 38.5%) and waitlist control (136/364, 37.4%). No significant change was observed in overall pain, sleep, PTSD, quality of life, relationship satisfaction, overall self-compassion, or compassion for others. A significant reduction in pain interference in mood (P=.008) and sleep (P=.008) was observed among the veteran MR group that was not observed in the waitlist control group. We also observed a positive effect of the MR intervention on a reduction in negative affect associated with pain (P=.049), but this effect did not exceed the adjusted significance threshold (P=.01). Significant improvements were also observed for partners in the affection (P=.007) and conflict (P=.001) subdomains of the consensus and satisfaction domains. In contrast to quantitative results, qualitative data indicated that intervention impacts included improved sleep and reduced pain, anxiety, and stress and, in contrast to the survey data, overall improvement in PTSD symptoms and social relationships. Participants' overall impressions of MR highlight usability and navigation, perceptions on packaging and content, and barriers to and facilitators of MR use. Adjunctive CIH-based modalities can be delivered using web and mobile apps but should be developed and tailored using established best practices. MR may be beneficial for veterans with pain and PTSD and their partners. Further pragmatic trials and implementation efforts are warranted. ClinicalTrials.gov NCT03593772; https://clinicaltrials.gov/study/NCT03593772. RR2-10.2196/13666.

Implementation of a Digital CBT Intervention for Medical Students

Medical school is a period of high psychological distress for many students, yet fewer than 16% of students with depressive symptoms seek treatment. While some of the barriers are common to most who seek mental health care (e.g., time, cost), others are unique to their student position in the healthcare system, such as privacy concerns or concerns about reporting requirements for licensure. Digital mental health interventions offer a unique opportunity to provide evidence-based mood intervention tailored to the specific needs of medial students. The ThinkFeelDo – Medical Student Intervention (TFD-MSI) was previously designed and tested with students in two published feasibility trials. TFD-MSI is a mobile accessible web application consisting of 16 lessons (e.g., behavioral activation, cognitive restructuring) and five tools (e.g., activity scheduling, goal setting). Based on feedback from a pilot with medical students, the self-directed intervention was rewritten to focus on stress management and coping skills with medical student specific examples and content, such as managing text anxiety and preventing burnout. The intervention has been available to students since December 2019, and results indicate that medical students are interested in and will utilize digital mental health tools. 149 students have signed up and 98 (68%) have accessed the intervention. The mean number of logins was 3.24 (SD=3.30) with a range of 1-16 logins, with a mean of 3.75 lessons read, ranging from 1-18. Of students who sought mental health services at the university, 23% were aware of the digital tool and 32% endorsed interest in coached support to use a digital tool. Given the need for medical student health services and these results, more work is merited to better integrate digital modes of care into available services for medical student mental health, along with improving adherence.

Abstract 14370: Educate: A Randomized Controlled Trial of Education Curriculum Assessment for Teaching Electrocardiography

Background: Gaps in ECG interpretation competency among medical professionals exist, with a need for practical, evidence-based, and accessible learning solutions. We conducted an international, prospective, randomized controlled trial to assess the effectiveness of web-based, self-directed ECG learning. Methods: A total of 1206 diverse medical learners and professionals underwent an initial test, followed by random assignment to one of four groups: (i) online question-bank (questions), (ii) online lectures (lectures), (iii) online, question-bank and lectures (hybrid), or (iv) no resources (control). After 4 months, a post-test was administered to evaluate the overall change in performance. Results: Of all participants, 863 (72%) completed the trial. After the 4-month follow-up, all three online, self-directed intervention groups (questions, lectures, and hybrid) showed significant improvement in overall performance (P&lt;0.001), while the control group did not (P=0.544). The questions, lectures, and hybrid interventions demonstrated score improvements of +11.4% (95% CI, 9.1-13.7; P&lt;0.001), +9.8% (95% CI, 7.8-11.9; P&lt;0.001), and +11.0% (95% CI, 9.2-12.9; P&lt;0.001) respectively, compared to +0.8% (95% CI, -1.2-2.8; P=0.544) for the control group. These improvements were consistent across medical professional groups (Figure 1) . Conclusions: Web-based, self-directed learning resources effectively improved ECG interpretation proficiency for diverse medical learners and professionals.

Applying Regulatory Focus Theory to Encourage Weight Loss in a Self-directed Intervention.

Regulatory focus theory proposes two self-regulatory systems: promotion focus-related to fulfilling aspirations and maximizing positive outcomes-and prevention focus-related to fulfilling responsibilities and avoiding negative outcomes. Building on research demonstrating associations between regulatory focus and weight outcomes, a proof-of-concept weight control intervention framed intervention procedures in terms of promotion or prevention focus and descriptively examined whether the impact of the intervention conditions depended on dispositional regulatory focus. After random assignment to control (received pamphlet on diet and physical activity), promotion, or prevention conditions (1.5-hour baseline sessions; detailed manuals; 1-hour sessions at 3 months), community participants from a metropolitan area in the United States (N = 57; age M = 40; BMI M = 30.9) completed the Regulatory Focus Questionnaire and were weighed at baseline, 3 months, and 6 months. Longitudinal analysis was conducted with SAS Proc Mixed using restricted maximum likelihood estimation. Estimated weight change was -2.99 kg, 95% CI [-4.65, -1.32], in the promotion condition, -1.70 kg, 95% CI [-3.29, -0.12], in the prevention condition, and -0.18 kg, 95% CI [-1.42, 1.05], in the control condition. Exploratory analyses revealed that for relatively more promotion-focused participants, estimated weight change was -1.43 kg, 95% CI [-3.38, 0.51], in the promotion condition, +0.48 kg, 95% CI [-1.01, 1.97], in the prevention condition, and -1.09 kg, 95% CI [-2.32, 0.14], in the control condition. For relatively more prevention-focused participants, estimated weight change was -5.19 kg, 95% CI [-7.14, -3.25], in the promotion condition, -3.35 kg, 95% CI [-4.83, -1.86], in the prevention condition, and +0.42 kg, 95% CI [-0.81, 1.65], in the control condition. Results suggest that self-directed, promotion-focused interventions may be effective and that tailoring to self-regulatory dispositions may not be of additional benefit in initiating weight loss.

Where'd the Dyads Go? Enrolling Veteran-Centric Dyads into Virtual Complementary and Integrative Health Research Studies

<h3>Research Objectives</h3> The increase in complementary and integrative health (CIH) treatments and changes to healthcare delivery due to COVID-19 have expanded the need for remotely accessible, non-pharmacological treatments for chronic illnesses. This presentation describes attrition while recruiting dyads of Veterans with chronic pain and PTSD and their partners, to a study of a remotely delivered, CIH program. It also provides baseline characteristics of successfully enrolled participants and offers recommendations for effective enrollment. <h3>Design</h3> This RCT randomized 364 dyads to either an intervention or a wait-list control arm. <h3>Setting</h3> Three Department of Veterans Affairs Medical Centers recruited participants between October 2019 and December 2021. <h3>Participants</h3> Veterans with chronic pain and PTSD, and their self-elected partners (e.g., spouse). <h3>Interventions</h3> Mission Reconnect is a partnered, self-directed intervention that teaches CIH skills (e.g., meditation, partnered massage) remotely using mobile and web-based platforms. Main Outcome Measure(s): Reported outcomes include: recruitment methods; number of participants screened and onboarded; and participation barriers. Baseline characteristics of successfully enrolled participants will also be presented. <h3>Results</h3> Of the 364 recruited dyads, 97 (26.6%) failed to complete onboarding activities, including submission of baseline data. Reported reasons for failure to complete onboarding include loss of self-elected partner buy-in (8.2%), difficulties with using remote data collection methods and interventions (30.9%), and adverse health experiences unrelated to study activities (17.5%). Despite the high attrition rate, Veterans were successfully enrolled from 35 states and 1 US territory with nearly a fifth of successfully enrolled participants drawn from rural zip codes (18.0%). Successful enrollees represent a pool of Veterans with diverse socioeconomic characteristics and moderate-to-severe pain severity. Lessons learned from project challenges relate to recruitment, onboarding, intervention delivery, and data collection processes.Conclusion: Successful enrollment of Veterans with chronic pain and PTSD, and their partners, to studies of remotely delivered CIH treatments requires careful examination of recruitment and onboarding methodologies and simplification of processes. Accommodating the targeted study participants' symptom burden is essential for identifying and addressing possible sources of attrition. <h3>Author(s) Disclosures</h3> None disclosed.

Promoting self-change in cannabis use disorder: Findings from a randomized trial.

A growing body of literature supports the efficacy of cognitive-behavioral therapy (CBT) and motivational interviewing (MI) for the treatment of problematic cannabis use, diagnostically referred to as cannabis use disorder, though most individuals do not access formal treatment. Stepped-care-type models emphasize interventions across a continuum of severity and there is a need for more treatment options across this continuum. This project focused on the evaluation of the least intensive of the individual interventions - promotion of self-directed recovery. Using a three-arm randomized control trial design, adults (N = 186) with problematic cannabis use and who wished to recover with minimal professional support were recruited from across Canada and randomized to receive a self-directed treatment workbook based on CBT and MI principles (WB; n = 61), the workbook plus a single MI session (WMI; n = 61) or a delayed treatment control (DT; n = 65) condition. Participants completed 3-month and 6-month follow-up assessments. Across conditions, GEE modeling revealed that the baseline to 3-month slopes differed significantly from zero, ps < 0.001. Participants in the WMI condition reduced their frequency of use to a greater extent than the WB alone, p = 0.005, and DT groups, p = 0.02. Chi-square analysis revealed that participants in the WMI condition also showed greater rates of abstinence at 3-months follow-up than participants in the WB or DT condition, p = 0.046. Changes in the frequency of cannabis use between 3-months and 6-months did not differ significantly between groups, ps > 0.05. For quantity of cannabis use, a significant effect of time emerged, p = 0.002. However, no between-group effects were significant from baseline to 3-months, or from 3- to 6-months, ps > 0.06. Overall, results support the utility of a brief self-directed workbook in combination with a single MI session at promoting changes in cannabis use. This self-directed intervention has the potential to fill an important need in that the self-directed intervention can attract individuals who wish to recover with minimal professional support. [https://www.isrctn.com/], identifier [ISRCTN426 32893].

"There is always a waitlist": The experiences of perinatal women randomized to a waitlist condition in a trial evaluating a novel online self-directed intervention for perinatal anxiety.

Pregnant and postpartum women are at a heightened risk for the development or worsening of mental health problems, with elevated rates of mood and anxiety disorders noted across studies. Timely access to mental health supports is critical during the perinatal period (spanning pregnancy to 1 year postpartum), to mitigate potential negative impacts on mother and child. In general adult populations, a small body of research has highlighted the association between being waitlisted for mental health services with a deterioration in mental health. Given the influx of changes experienced in the perinatal period, this population may face unique challenges around being waitlisted. There is a lack of research exploring the experiences of perinatal women waitlisted for psychological services. The current study seeks to understand the experiences of perinatal women randomized to the waitlist condition of a randomized controlled trial. N = 20 participants (4 pregnant, 16 postpartum) from Central Canada who were enrolled in a novel online self-directed intervention for perinatal anxiety completed a virtual qualitative interview concerning their experience during the 6-week waitlist period for this randomized controlled trial. Interviews were audio-recorded, transcribed, and analyzed according to reflexive thematic analysis. Seven main themes were identified, depicting the waitlist experiences of perinatal participants: (a) "There is always a waitlist" (sub-themes: service availability, need to seek out services pre-emptively); (b) Timing of support access is vital during the perinatal period (sub-themes: prenatal, postpartum); (c) Responses to being waitlisted (sub-themes: disappointment, neutral, relief, "there's probably somebody that needs it more than I do"); (d) Identification of helpful supports during the waitlist period (sub-themes: formal supports, informal supports); (e) Connections with research team (sub-themes: communication, resource provision); (f) Impact of waitlist experience on desire to start program (sub-themes: excitement, "out of sight, out of mind," nervousness); and (g) Improving the waitlist experience (sub-themes: communication, resource provision, triaging). Findings highlight the need for timely access to mental health supports during the perinatal period and offer several recommendations for improving the waitlist experience, including providing more frequent waitlist status updates, providing more direct access to intermediate interventions, and triaging patients based on clinical need.

A pilot study on the feasibility, acceptability, and preliminary efficacy of a brief text message intervention for co-occurring alcohol misuse and PTSD symptoms in a community sample

Accessible, brief, and self-directed intervention are needed to improve treatment access for individuals with co-occuring PTSD and alcohol misuse. This pilot study tests the feasibility, acceptability, and preliminary efficacy of a brief text message intervention based on cognitive behavioral therapy plus message framing (CBT + Framing) compared to active control providing kind support and attention (KAM), to reduce PTSD symptoms and alcohol use. Two waves of community-based data collection (Wave 1 n = 50; Wave 2 n = 59) were completed. Participants self-reported symptoms at baseline, post-intervention, and 8-week follow-up. Engagement and retention were high, suggesting messages were feasible and acceptable. Across waves and conditions, from baseline to follow-up primary outcomes of PTSD symptoms (medium to large effects), weekly drinks (medium effects), and heavy episodic drinking (small to medium effects) decreased. Consistent with hypotheses, CBT + Framing outperformed KAM for PTSD at post in Wave 2 and for number of heavy drinking episodes at both post and follow-up in Wave 1. Contrary to hypotheses, KAM outperformed CBT + Framing for PTSD at post in Wave 1, and minimal differences were observed between conditions for weekly drinks in both waves. Future studies should continue to develop and test brief, accessible interventions.

External proficiency testing improves inter-scorer reliability of polysomnography scoring.

This study evaluated whether or notpolysomnography (PSG) inter-scorer reliability (ISR) across sleep centres could be improved by external proficiency testing (EPT), or by EPT combined with method alignment training. Experienced scorers form 15 sleep centres were randomised to the following: (1) a control group, (2) a group that received a self-directed intervention of EPT reports (EPTPassive) or (3) a group that received an active intervention of method alignment training and EPT reports (EPTActive). Respiratory, arousal and sleep scoring ISR from sixteen PSG fragments were compared between groups across time. Among 30 scorers, there were no ISR changes in controls between baseline (BL) and 6months (6m). Both EPT groups showed ISR improvement from BL to 6m for respiratory, arousal and sleep scoring (p < 0.05). Respiratory scoring back-transformed mean (95CI) proportion of specific agreement (PSA) for the EPTPassive group improved from 0.78 (0.72-0.84) to 0.80 (0.74-0.86) and for the EPTActive group from 0.80 (0.74-0.85) to 0.82 (0.76-0.88). Arousal scoring PSA for the EPTPassive group improved from 0.72 (0.66-0.77) to 0.74 (0.69-0.79) and for the EPTActive group from 0.71 (0.65-0.76) to 0.77 (0.72-0.82). Sleep scoring kappa for the EPTPassive group improved from 0.64 (0.58-0.69) to 0.73 (0.68-0.77) and for the EPTActive group from = 0.75 (0.71-0.80) to 0.80 (0.76-0.85). Overall, poorer performers achieved greater improvement. External proficiency testing produced modest, statistically significant PSG inter-scorer reliability improvements among experienced scorers across sleep centres, with potential to improve clinical management of individual patients and increase research study statistical power.

Teacher Evaluation of a Self-Directed Career Guidance Intervention for South African Secondary School Learners Amidst Severe COVID-19 Restrictions.

The South African government’s COVID-19 pandemic risk mitigation strategies significantly limited social contact, which necessitated a novel approach to existing face-to-face career guidance practices. The Grade 9 Career Guidance Project, originally developed as a group-based career development intervention, required radical adaptation into a self-directed, manualized format to offer career guidance to Grade 9 learners from low-income communities amid a global pandemic. The adaptation and continuation of the project was deemed essential as secondary school learners in low-income communities have limited career guidance support. Furthermore, a close collaboration with the teachers at eight resource-constrained South African secondary schools was vital for successful implementation. To assess the success of the adaptation to a self-directed format, a mixed-methods design was employed, and Life Orientation teachers’ evaluative feedback was solicited (n = 11). Favorable quantitative results were obtained; majority of teachers agreed that learners enjoyed the booklet (manualized format) and that it was deemed an adequate substitute to the previous contact-based format of the Career Guidance Project. This was also confirmed by the qualitative findings revealing teachers’ satisfaction with the booklet’s content, specifically that the booklet is complementary to the Life Orientation curriculum. Qualitative findings identified specific contextual barriers that contributed to some learners struggling to use the booklet optimally. The results suggest that it is feasible and acceptable to implement a self-directed career guidance intervention among secondary school learners amid a global pandemic. Teachers recommended ways to integrate the booklet, resources, and contact sessions as a preferred way forward. These findings have important implications for similar resource-constrained settings that may not have readily access to in-person career guidance and counseling human development.

A Critical Review of the Scholarly Discourse on Gambling Disorder Treatment

This article presents a critical systematic review of the literature on disordered gambling treatment, with a focus on the “how” of treatment delivery. A review of six peer-reviewed research databases was performed, along with hand searches of select journals. Peer-reviewed articles that discussed or evaluated psychological and relational treatments of gambling disorder were selected for a review and coded independently by all members of the research team. The sample for this study included 445 articles that were published in the English language over the past 50 years, through June 2019. The sample included not only evaluations and case studies (k = 231) but also descriptive research (k = 49), meta-analyses (k = 10), and literature reviews (k = 155). The results showed that face-to-face, professionally facilitated treatment of individuals has remained the primary focus of problem gambling literature during the period under study. That said, a number of alternative treatment modalities have emerged, particularly in the last two decades. This includes increased reliance on technology (i.e., internet and telephone/text) as an adjunct to face-to-face treatment or as a means for delivering stand-alone professionally facilitated or self-directed interventions. Our discussion includes the benefits of these approaches as reflected in the literature while also situating findings within discourses on Western-dominated trends toward the use of technology, prioritization of efficiency, and individual focus in mental health treatment.

Application of a Quality Improvement Process to Evaluate Self-Directed Therapy for Patients on a Waitlist in an Outpatient Anxiety Disorders Specialty Clinic

The demand for psychological services in the United States is higher than the available supply of qualified mental health professionals. As a result, there is a substantial need for low-cost interventions that are more accessible and amenable to scale-up independent of the availability of clinicians. Previous studies have found that self-directed bibliotherapy can be an effective intervention with minimal therapist contact. Using the Plan-Do-Study-Act (PDSA) improvement process framework, we implemented self-directed therapy in our outpatient anxiety disorders specialty clinic. We identified four self-directed therapy resources (two books and two smartphone apps) based on cognitive behavioral or acceptance and mindfulness principles. We conducted initial 30-minute billable bibliotherapy consultations with six patients on our waitlist, where we provided the rationale for self-guided treatment, introduced the four resources, helped the patient identify one resource to use, and answered any questions. Eight weeks later, we met with five of these patients for a second billable 30-minute consultation (one had already started individual therapy) and gathered information regarding feasibility and acceptability of these resources as well as helped the patient make continued or better use of the resource until beginning therapy. This case series suggests that self-directed interventions can be effectively implemented in this manner, though with mixed outcomes and effects on patients and their course of care. We describe improvements we intend to implement in future iterations of self-directed therapy.

Effects of the WRITE Symptoms Interventions on Symptoms and Quality of Life Among Patients With Recurrent Ovarian Cancers: An NRG Oncology/GOG Study (GOG-0259).

GOG-259 was a 3-arm randomized controlled trial of two web-based symptom management interventions for patients with recurrent ovarian cancer. Primary aims were to compare the efficacy of the nurse-guided (Nurse-WRITE) and self-directed (SD-WRITE) interventions to Enhanced Usual Care (EUC) in improving symptoms (burden and controllability) and quality of life (QOL). Patients with recurrent or persistent ovarian, fallopian, or primary peritoneal cancer with 3+ symptoms were eligible for the study. Participants completed baseline (BL) surveys (symptom burden and controllability and QOL) before random assignment. WRITE interventions lasted 8 weeks to develop symptom management plans for three target symptoms. All women received EUC: monthly online symptom assessment with provider reports; online resources; and every 2-week e-mails. Outcomes were evaluated at 8 and 12 weeks after BL. Repeated-measures modeling with linear contrasts evaluated group by time effects on symptom burden, controllability, and QOL, controlling for key covariates. Participants (N = 497) reported mean age of 59.3 ± 9.2 years. At BL, 84% were receiving chemotherapy and reported a mean of 14.2 ± 4.9 concurrent symptoms, most commonly fatigue, constipation, and peripheral neuropathy. Symptom burden and QOL improved significantly over time (P < .001) for all three groups. A group by time interaction (P < .001) for symptom controllability was noted whereby both WRITE intervention groups had similar improvements from BL to 8 and 12 weeks, whereas EUC did not improve over time. Both WRITE Intervention groups showed significantly greater improvements in symptom controllability from BL to 8 and BL to 12 weeks compared with EUC. There were no significant differences between Nurse-WRITE and SD-WRITE. SD-WRITE has potential as a scalable intervention for a future implementation study.

An online self-directed program combining Community Reinforcement Approach and Family Training and parenting training for concerned significant others sharing a child with a person with problematic alcohol consumption: a randomized controlled trial

BackgroundThere is an urgent need for interventions helping children affected by parental problematic alcohol consumption (PAC). Such interventions could target partners to individuals with PAC, partners who often themselves show impaired quality of life and mental health. The aim of this study was to investigate the efficacy of an online self-directed intervention combining components from Community Reinforcement Approach and Family Training (CRAFT) with a parenting training program for concerned significant others (CSOs) sharing a child with a co-parent with PAC.MethodsA randomized controlled parallel-group superiority trial compared the efficacy of the online intervention for CSOs sharing a child (3–11 y/o) with a co-parent with PAC (N = 37), to an active control group (N = 39) receiving written psychoeducational material. Assessment of outcomes was conducted at baseline, 3 weeks, 8 weeks and 12 weeks. Primary outcome was children’s mental health, while secondary outcomes included parental self-efficacy, CSO mental health and co-parent alcohol consumption and level of dependence. Linear mixed effect models with a factorial time variable were used to model time by group interaction effects.ResultsRecruitment rate was slow and a vast majority of interested CSOs were excluded at baseline assessment, mainly due experience of co-parent violence. The target sample size was not met. The intention to treat analysis did not show any significant time by group effects on either the primary or secondary outcomes during the follow-up period: the CSOs reported a significant reduction in co-parent alcohol consumption and severity of alcohol dependence and showed significant improvements in parental self-efficacy for how to handle effects of co-parent alcohol consumption, but no differences were found between the two conditions.ConclusionsThe current study found no evidence supporting efficacy of a novel, online self-directed intervention on children’s mental health, CSO mental health and co-parent alcohol related outcomes. Engaging in a support program or receiving information appears to initiate behavior change in the CSOs which affects the alcohol consumption and severity of dependence for co-parents with PAC. It is suggested that future studies may preferably focus on CSOs in more severely affected contexts.Trial registration The trial was pre-registered at isrctn.com reference number ISRCTN38702517, November 28, 2017.