Self-help Program Research Articles

Why urban Indians are interested in an internet based self-care app for depression? a brief pilot survey

Background: Digital technology has emerged as a powerful approach to bridge treatment gap in the field of mental health. However, public health impact of e-interventions is unlikely without large scale uptake of such services. Hence it becomes important to understand motives of potential users in order to design programs that address such needs as well as disseminate information about the same in ways that appeal to the users. Methods: Reasons underlying interest in an internet based self-care program for depression were explored through a brief survey of potential users who had explicitly shown interest in such a program. Responses to an online survey were received from 120 respondents out of which about 69% were in 18-35 years of age-range and 12% were above 50 years of age. Results: Preference for flexibility in terms of ‘when I do things to help myself’, ‘not having time to go for face to face counselling/therapy’ and ‘wanting to learn and do something to prevent problems in future even though I am currently on treatment’ emerged as the top 3 reasons underlying interest in internet based self-help programs for depression. Not having the finances to seek face to face mental health consultation emerged as one of the top 3 reasons in the older group. Conclusions: Incorporating maximal flexibility, providing pointers to the most relevant components thereby minimizing time required, and focusing on preventive strategies (even for those who are currently seeking treatment) are aspects that need to be considered in development and dissemination of internet based self-help programs for depression in urban India.

Trait mindfulness at work: A meta-analysis of the personal and professional correlates of trait mindfulness

ABSTRACTPopular and academic press alike have concluded that mindfulness significantly benefits healthy individuals as well as those suffering from physical and psychological problems. Workplace interventions, clinical therapies, and popular self-help programs aimed at enhancing mindfulness abound, and research has demonstrated the efficacy of such mindfulness interventions in enhancing mindful states. It is of importance to note that research also suggests the average frequency with which individuals experience states of mindfulness varies from person to person, underscoring the existence of a dispositional tendency toward mindfulness—trait mindfulness. We meta-analytically cumulate the results of 270 independent studies (N = 58,592 adults from nonclinical samples) of trait mindfulness in order to explore its personal and professional correlates. Results suggest the benefits of trait mindfulness extend to both personal and professional domains. With regards to personal benefits, trait mindfulness was found to be positively correlated with confidence (ρ = .39), mental health (ρ = .38), emotional regulation (ρ = .40), and life satisfaction (ρ = .36), and negatively correlated with perceived life stress (ρ = –.43), negative emotions (ρ = –.40), anxiety (ρ = –.34), and depression (ρ = –.38). Professionally, results suggest trait mindfulness may benefit job satisfaction (ρ = .29), performance (ρ = .34), and interpersonal relations (ρ = .31), while also reducing burnout (ρ = –.48) and work withdrawal (ρ = –.17). Meta-analytic regressions also suggest trait mindfulness adds incremental predictive variance over more traditional predictors of employee burnout and work performance.

A protocol for a cluster-randomized controlled trial of a self-help psycho-education programme to reduce diagnosis delay in women with breast cancer symptoms in Indonesia

BackgroundBreast cancer (BC) is the most frequent cancer occurring in women across the world. Its mortality rate in low-middle income countries (LMICs) is higher than in high-income countries (HICs), and in Indonesia BC is the leading cause of cancer deaths among women. Delay in breast cancer diagnosis negatively impacts cancer prognosis. Only about 30% of patients who come to the hospital to check on their breast abnormalities, continue thorough examination to biopsy to get a diagnosis based on the results of anatomical pathology. Many Indonesian women with breast cancer were already in an advanced stage when starting treatment. Therefore, delay in diagnosis is a serious problem that needs to be addressed. The present study will investigate whether our newly developed self-help psycho-educational programme, “PERANTARA”, for women with breast cancer symptoms is effective to reduce patient diagnosis delay in Indonesia.MethodsA cluster-randomized controlled trial will be conducted in 106 patients in four hospitals in Bandung, West Java, Indonesia. Data will be collected at baseline (pre-assessment), 7 days after the intervention (post-assessment), and at 3 months (follow-up assessments). The primary outcome is delay in diagnosis and treatment. Secondary outcomes are breast cancer knowledge, anxiety and depression, and quality of life. Exploratively, adherence with treatment will be measured too. Data will be analysed by hierarchical linear modelling (HLM) to assess differential change over time.DiscussionIf proven effective, PERANTARA will be evaluated and implemented in a diversity of settings for local cares (such as in POSYANDU, PUSKESMAS) that provide health education/psycho-education for women with breast symptoms.Trial registrationISRCTN12570738. Date: November 19th, 2016.

New technologies in suicide prevention

IntroductionThe use of new technologies is beginning to be embraced by volunteers and professionals, from crisis lines, suicide prevention centers, mental health centers, researchers and politicians.ObjectivesNew technologies have entered the field of suicide prevention with high expectations for the future, despite a relatively slow start. Internet, smartphones, apps, social networks and self-help computer programs have a strong potential to achieve, sustain and help people at risk of suicide, their families, teachers, health professionals and for the survivors.AimsTo provide comprehensive overview on the role of new technologies in suicide prevention.MethodsGiven the relatively early and underdeveloped state of this area of inquiry, the author viewed his task as gathering and critically appraising the available research relevant to the topic, with the aim of formulating a hypothesis to be tested with further research.ResultsNew cheaper services will soon be available to effectively reach and assist the most vulnerable people and prevent suicides. The potential to help vulnerable people who do not use conventional mental health services and people in regions with inadequate psychiatric facilities represents an attractive target with favourable perspectives for suicide prevention Smartphone, apps, websites, avatar coach, and virtual suicidal subjects are important for both delivering help as well as to educate mental health professionals as in the case of role playing.ConclusionsShadows and lights are emerging through the use of new technologies. If more people can be reached there are however concern for improper use of social network and pro-suicide websites.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Group behaviour therapy programmes for smoking cessation.

Group therapy offers individuals the opportunity to learn behavioural techniques for smoking cessation, and to provide each other with mutual support. To determine the effect of group-delivered behavioural interventions in achieving long-term smoking cessation. We searched the Cochrane Tobacco Addiction Group Specialized Register, using the terms 'behavior therapy', 'cognitive therapy', 'psychotherapy' or 'group therapy', in May 2016. Randomized trials that compared group therapy with self-help, individual counselling, another intervention or no intervention (including usual care or a waiting-list control). We also considered trials that compared more than one group programme. We included those trials with a minimum of two group meetings, and follow-up of smoking status at least six months after the start of the programme. We excluded trials in which group therapy was provided to both active therapy and placebo arms of trials of pharmacotherapies, unless they had a factorial design. Two review authors extracted data in duplicate on the participants, the interventions provided to the groups and the controls, including programme length, intensity and main components, the outcome measures, method of randomization, and completeness of follow-up. The main outcome measure was abstinence from smoking after at least six months follow-up in participants smoking at baseline. We used the most rigorous definition of abstinence in each trial, and biochemically-validated rates where available. We analysed participants lost to follow-up as continuing smokers. We expressed effects as a risk ratio for cessation. Where possible, we performed meta-analysis using a fixed-effect (Mantel-Haenszel) model. We assessed the quality of evidence within each study and comparison, using the Cochrane 'Risk of bias' tool and GRADE criteria. Sixty-six trials met our inclusion criteria for one or more of the comparisons in the review. Thirteen trials compared a group programme with a self-help programme; there was an increase in cessation with the use of a group programme (N = 4395, risk ratio (RR) 1.88, 95% confidence interval (CI) 1.52 to 2.33, I2 = 0%). We judged the GRADE quality of evidence to be moderate, downgraded due to there being few studies at low risk of bias. Fourteen trials compared a group programme with brief support from a health care provider. There was a small increase in cessation (N = 7286, RR 1.22, 95% CI 1.03 to 1.43, I2 = 59%). We judged the GRADE quality of evidence to be low, downgraded due to inconsistency in addition to risk of bias. There was also low quality evidence of benefit of a group programme compared to no-intervention controls, (9 trials, N = 1098, RR 2.60, 95% CI 1.80 to 3.76 I2 = 55%). We did not detect evidence that group therapy was more effective than a similar intensity of individual counselling (6 trials, N = 980, RR 0.99, 95% CI 0.76 to 1.28, I2 = 9%). Programmes which included components for increasing cognitive and behavioural skills were not shown to be more effective than same-length or shorter programmes without these components. Group therapy is better for helping people stop smoking than self-help, and other less intensive interventions. There is not enough evidence to evaluate whether groups are more effective, or cost-effective, than intensive individual counselling. There is not enough evidence to support the use of particular psychological components in a programme beyond the support and skills training normally included.

The Self-help Online against Suicidal thoughts (SOS) trial: study protocol for a randomized controlled trial

BackgroundSuicidal thoughts are common, causing distress for millions of people all over the world. However, people with suicidal thoughts might not access support due to financial restraints, stigma or a lack of available treatment offers. Self-help programs provided online could overcome these barriers, and previous efforts show promising results in terms of reducing suicidal thoughts. This study aims to examine the effectiveness of an online self-help intervention in reducing suicidal thoughts among people at risk of suicide.The Danish Self-help Online against Suicidal thoughts (SOS) trial is a partial replication of a previously conducted Dutch trial.Methods and designA randomized, waiting-list controlled trial with 1:1 allocation ratio will be carried out. A total of 438 people with suicidal thoughts will be recruited from the Danish suicide hotline, The Lifeline’s, website and allocated to the intervention condition (N = 219) or the control condition (N = 219).The intervention condition consists of a 6-week, Internet-based self-help therapy intervention. The format of the intervention is self-help, but the participants can be guided by the trial manager. The control condition consists of a waiting-list assignment for 32 weeks.The primary outcomes are frequency and intensity of suicidal thoughts. Secondary outcome measures include depressive symptoms, hopelessness, worrying, quality of life, costs related to health care utilization and production loss. Number of deliberate self-harm episodes, suicides and deaths will, as well as the participant’s evaluation of the intervention and the experience of negative effects, be investigated. Assessments will be conducted over the intervention website through self-report questionnaires at baseline, 2 weeks, 4 weeks, 6 weeks and 32 weeks (6 months post intervention).DiscussionIf we find the intervention to be linked to reductions in suicidal thoughts, this will strengthen the evidence that online self-help interventions are relevant tools for people with suicidal thoughts.Trial registrationClinicalTrials.gov, NCT02872610. Registered on 9 August 2016.

A Web-Disseminated Self-Help and Peer Support Program Could Fill Gaps in Mental Health Care: Lessons From a Consumer Survey.

BackgroundSelf-guided mental health interventions that are disseminated via the Web have the potential to circumvent barriers to treatment and improve public mental health. However, self-guided interventions often fail to attract consumers and suffer from user nonadherence. Uptake of novel interventions could be improved by consulting consumers from the beginning of the development process in order to assess their interest and their preferences. Interventions can then be tailored using this feedback to optimize appeal.ObjectiveThe aim of our study was to determine the level of public interest in a new mental health intervention that incorporates elements of self-help and peer counseling and that is disseminated via a Web-based training course; to identify predictors of interest in the program; and to identify consumer preferences for features of Web-based courses and peer support programs.MethodsWe surveyed consumers via Amazon’s Mechanical Turk to estimate interest in the self-help and peer support program. We assessed associations between demographic and clinical characteristics and interest in the program, and we obtained feedback on desired features of the program.ResultsOverall, 63.9% (378/592) of respondents said that they would try the program; interest was lower but still substantial among those who were not willing or able to access traditional mental health services. Female gender, lower income, and openness to using psychotherapy were the most consistent predictors of interest in the program. The majority of respondents, although not all, preferred romantic partners or close friends as peer counselors and would be most likely to access the program if the training course were accessed on a stand-alone website. In general, respondents valued training in active listening skills.ConclusionsIn light of the apparent public interest in this program, Web-disseminated self-help and peer support interventions have enormous potential to fill gaps in mental health care. The results of this survey can be used to inform the design of such interventions.

Patients’ experiences of a computerised self-help program for treating depression – a qualitative study of Internet mediated cognitive behavioural therapy in primary care

Objective: The objective of this study was to explore primary care patients’ experiences of Internet mediated cognitive behavioural therapy (iCBT) depression treatment.Design: Qualitative study. Data were collected from focus group discussions and individual interviews.Setting: Primary care.Method: Data were analysed by systematic text condensation by Malterud.Subjects: Thirteen patients having received iCBT for depression within the PRIM-NET study.Main outcome measures: Analysis presented different aspects of patients’ experiences of iCBT.Results: The informants described a need for face-to-face meetings with a therapist. A therapist who performed check-ups and supported the iCBT process seemed important. iCBT implies that a responsibility for the treatment is taken by the patient, and some patients felt left alone, while others felt well and secure. This was a way to work in privacy and freedom with a smoothly working technology although there was a lack of confidence and a feeling of risk regarding iCBT.Conclusion: iCBT is an attractive alternative to some patients with depression in primary care, but not to all. An individual treatment design seems to be preferred, and elements of iCBT could be included as a complement when treating depression in primary care. Such a procedure could relieve the overall treatment burden of depression.Key pointsInternet mediated cognitive behavioural therapy (iCBT) can be effective in treating depression in primary care, but patients’ experiences of iCBT are rarely studied• Most patients express a need for human contact, real-time interaction, dialogue and guidance when treated for depression.• The patient’s opportunity to influence the practical circumstances about iCBT is a success factor, though this freedom brings a large responsibility upon the receiver.• An individual treatment design seems to be crucial, and elements of iCBT could be included as a complement to face-to-face meetings.

Which Drivers of User Engagement Support the Cost-Effectiveness of Online Self-Help Programs? Amazon Turkers Tell Web Managers What Matters.

Open Forest is a provider of online mental health self-help programs and, in this context, it is crucial to understand the needs of potential users. With a high prevalence of ADHD, user needs to establish commitment and loyalty centered on the ability to engage with others online. Access of care, purported cost savings and convenience for both clients and healthcare professionals are but some of the reasons why there is a lot of interest in the development of effective, evidence-based telemental health services. Even more than in “classical” face-to-face therapy, online mental health programs (“telemental health” and/or online self-help programs) must focus on client retention. The online self-help mental health programs have huge efficiency and scalability potentials, but to be effective, clients will have to actively participate in these programs. To address the client retention issue, this study aims to replicate previous research in user commitment to User Generated Content (UGC) websites, and create a framework for enhancing user engagement in online mental health self-help websites.

Guided internet-administered self-help to reduce symptoms of anxiety and depression among adolescents and young adults diagnosed with cancer during adolescence (U-CARE: YoungCan): a study protocol for a feasibility trial

IntroductionA subgroup of adolescents and young adults diagnosed with cancer during adolescence reports elevated levels of anxiety and depressive symptoms and unmet needs for psychological support. Evidence-based psychological treatments tailored...

Internet-based information and support program for parents of children with burns: A randomized controlled trial

BackgroundThe aim of the study was to evaluate the feasibility and effects of an internet-based information and self-help program with therapist contact for parents of children and adolescents with burns. The program aimed to reduce parents’ symptoms of general and posttraumatic stress. MethodsParticipants were parents of children treated for burns between 2009–2013 at either of the two specialized Swedish Burn centers. Sixty-two parents were included in a two-armed, randomized controlled trial with a six-week intervention group and a wait-list control group, including a pre and post-assessment, as well as a 3 and 12-month follow-up. The intervention contained psychoeducation, exercises and homework assignments, and the intervention group received weekly written feedback from a therapist. The main outcome was stress (post-traumatic stress, general stress and parental stress). ResultsThe program had a beneficial effect on posttraumatic stress in the short term, but did not affect general stress or parental stress. The parents rated the program as being informative and meaningful, but some of them thought it was time-consuming. ConclusionThe program has the potential to support parents of children with burns. The intervention is easily accessible, cost-effective and could be implemented in burn care rehabilitation.

Computer-based self-help therapy: A qualitative analysis of attrition.

The impact of computer-based cognitive-behavioral self-help therapy programs is limited by high attrition. This study explored reactions to computer-based cognitive-behavioral self-help therapy use among individuals not completing a full treatment course. Individuals receiving outpatient substance use disorder treatment at a Veterans Health Administration clinic who enrolled in a study implementing a computer-based cognitive-behavioral self-help therapy for insomnia, but subsequently dropped out prior to completion, were interviewed. Reactions to use and reasons for attrition were explored through thematic analysis of interviews. Among barriers to use, themes of competing demands, personal attributes, the computer-based format of computer-based cognitive-behavioral self-help therapies, and negative experiences with the specific program used were identified. Among facilitators of use, themes of personal support, the computer-based cognitive-behavioral self-help therapy format, and personal attributes were identified. Recommendations for future implementation efforts to include additional person-to-person contact during computer-based cognitive-behavioral self-help therapy participation were made. These themes may be employed to develop strategies for computer-based cognitive-behavioral self-help therapy implementation in order to maximize program engagement and completion.

Web-Based Psychoeducation Program for Caregivers of First-Episode of Psychosis: An Experience of Chinese Population in Hong Kong

Caregivers of patients with first-episode psychosis are often with little knowledge about the illness and experience more burden of care. Psychoeducation to caregivers has shown to be effective in improving outcomes of patients and possibly reduce stress of the caregivers. This has been recommended as one of the key psychosocial interventions for specific early intervention for psychosis service. However, the accessibility of the service, high case load of the health care professionals and self-stigma of caregivers are often the barriers of implementation of these programs in the real world. Incorporating the convenience of information access via internet and the concept of self-management approach, an interactive internet-based self-help psychoeducation program (iPEP) (www.ipep.hk) for the caregivers of patients with psychosis was established targeting the caregivers of patients with psychosis at early stage in Hong Kong. It provides a comprehensive online resource center in both written and video format on knowledge about psychosis, skills of care, and information of local resources. It also has a forum facilitate information exchange between healthcare professionals and the caregivers, allowing for self-management. Over 800 caregivers have joined the program as members. The evaluation of the subset of the members/users of the iPEP suggested that the iPEP program has been well received and appreciated by the caregivers of patients with first episode psychosis locally. It can potentially serve as a platform for future development of specific manual-based psychoeducation program for caregivers targeting at the needs of different groups.

The Quest for the Spiritual Self: Anti-Capitalist and Neo-Liberal Forms of Spirituality in Contemporary Romania

AbstractIn line with socio-anthropological theories meant to deconstruct the secularization teleology (Berger, 1997; Luckmann, 1967; Shah, 2015), this paper aims to document recent transformations in the field of Spirituality and Religion. Inheriting the analytical dichotomy between neo-liberal and anti-capitalist forms of spirituality, introduced by Carette and King (2005), I aim to emphasize both the common points and the ruptures between the subjectification technologies used within transformative self-development and self-help programmes, on the one hand, and a form of alternative Neo-Pagan spirituality, which opposes the capitalist way of organizing social, economic, political and cultural life, on the other hand. The rupture between anti-capitalist and neo-liberal forms of spirituality rests on identifying the extent to which the spiritual domain is colonized by an economically mundane ideology, in which the subject is invited to look upon spirituality as an internal resource meant to satisfy all the tropes of the neo-liberal economic imagery: optimization, efficiency, amplified productivity, abundance and prosperity. In addition to the ethnographic justification of this theoretical construct that supports the existence of two opposed poles of constituting a spiritual self, I will adjoin the cultural relationship between spirituality and capitalism to the wider problem of secularization, by arguing that spirituality is a byproduct of late modernity and a leitmotif of the power technologies through which the neo-liberal subject is produced. 2

Bastón, andador y silla: estudio cualitativo desde la perspectiva de informantes clave sobre el GES de ayudas técnicas en tres comunas urbanas, Región Metropolitana 2014-15

Bastón, andador y silla: estudio cualitativo desde la perspectiva de informantes clave sobre el GES de ayudas técnicas en tres comunas urbanas, Región Metropolitana 2014-15

Mindfulness and Psychology Based Self–help Mobile Application: A Promising New Approach in Reducing Work Stress and Anxiety

<div><p><em>Nearly one–third of the working populations in most developed countries report high or extreme levels of negative stress. Over the last decade, the escalating costs associated with workplace stress indicate an international trend among industrialized nations. Stress is considered as one of the root causes for many psychological disorders. Anxiety is one of the common disorders that can rise due to negative stress. Consulting health professionals to overcome mental health problem is time-consuming, expensive, and may affect the privacy for many people. To overcome these limitations, we are presenting a model for a self-help mobile app program that can be a powerful, cost–effective, personalized, and convenient tool to overcome mild to moderate stress and anxiety. Mindfulness Meditation is a scientifically proven and standardized technique for many mental health problems. Many professionals have developed Mindfulness-based mobile applications. However, they do not address the core root causes of the mental health problem as the conventional psychological therapy does. Therefore, the proposed self-help mobile app merges mainstream psychological process and mindfulness in reducing minor to moderate stress, and anxiety.</em></p></div>

A web-based group course intervention for 15-25-year-olds whose parents have substance use problems or mental illness: study protocol for a randomized controlled trial.

BackgroundDepending on the definitions used, between 5 and 20 % of all Swedish children grow up with at least one parent suffering from alcohol problems, while 6 % have at least one parent who has received inpatient psychiatric care, conditions that may affect the children negatively. Nine out of ten Swedish municipalities therefore provide support resources, but less than 2 % of these children are reached by such support. Delivering intervention programs via the Internet is a promising strategy. However, web-based programs targeting this at-risk group of children are scarce. We have previously developed a 1.5-h-long web-based self-help program, Alcohol & Coping, which appears to be effective with regards to adolescents’ own alcohol consumption. However, there is a need for a more intense program, and therefore we adapted Kopstoring, a comprehensive Dutch web-based psycho-educative prevention program, to fit the Swedish context. The purpose of the program, which in Swedish has been called Grubbel, is to strengthen protective factors, such as coping skills and psychological well-being, prevent the development of psychological disorders, and reduce alcohol consumption.Methods/designThe aim of the current study is to evaluate the effectiveness of Grubbel, which targets 15–25-year-olds whose parents have substance use problems and/or mental illness. Specific research questions relate to the participants’ own coping strategies, mental health status and substance use. The study was initiated in the spring of 2016 and uses a two-armed RCT design. Participants will be recruited via social media and also through existing agencies that provide support to this target group. The assessment will consist of a baseline measurement (t0) and three follow-ups after six (t1), 12 (t2), and 24 months (t3). Measures include YSR, CES-DC, Ladder of Life, Brief COPE, AUDIT-C, and WHOQOL-BREF.DiscussionStudies have revealed that the majority of children whose parents have substance use or mental health problems are not reached by the existing support. Thus, there is an urgent need to develop, implement, and evaluate novel intervention programs and disseminate successful programs to a broader audience. This study, investigating the effects of a web-based intervention, therefore makes an important contribution to this field of research.Trial registration ISRCTN10099247. Retrospectively registered on August 31, 2016.

An RCT of an Online Parenting Program for Parents of Preschool-Aged Children With ADHD Symptoms

Objective: This randomized control trial evaluated the efficacy of an online self-help program in a sample of parents of preschoolers with ADHD symptoms. Method: Parents were randomly assigned to the intervention group (n = 27) or the delayed intervention group (n = 26). Child behavior measures were completed by mothers, fathers, and teachers, and parenting measures were completed by mothers. Results: Intent-to-treat analyses indicated significant post-intervention improvements in mother-rated child hyperactivity/inattention, restlessness/impulsivity, defiance/aggression, social functioning, and teacher-rated prosocial behavior, as well as significant improvements in maternal over-reactivity, verbosity, laxness, positive parenting, parenting satisfaction, self-efficacy, stress, and depression. At 6-month follow-up, effects were maintained for maternal over-reactivity and verbosity, parenting satisfaction and self-efficacy, and parental stress and depression. Conclusion: This study provides evidence for the effectiveness of an online self-help parenting program in reducing preschool inattentive behavior difficulties, and in increasing parenting competence, satisfaction in the parenting role, and maternal well-being.

The Effect of Guided Web-Based Cognitive Behavioral Therapy on Patients With Depressive Symptoms and Heart Failure: A Pilot Randomized Controlled Trial.

BackgroundDepressive symptoms, and the associated coexistence of symptoms of anxiety and decreased quality of life (QoL), are common in patients with heart failure (HF). However, treatment strategies for depressive symptoms in patients with HF still remain to be established. Internet-based cognitive behavioral therapy (ICBT), as guided self-help CBT programs, has shown good effects in the treatment of depression. Until now, ICBT has not been evaluated in patients with HF with depressive symptoms.ObjectiveThe aims of this study were to (1) evaluate the effect of a 9-week guided ICBT program on depressive symptoms in patients with HF; (2) investigate the effect of the ICBT program on cardiac anxiety and QoL; and (3) assess factors associated with the change in depressive symptoms.MethodsFifty participants were randomized into 2 treatment arms: ICBT or a Web-based moderated discussion forum (DF). The Patient Health Questionnaire-9 was used to measure depressive symptoms, the Cardiac Anxiety Questionnaire (CAQ) was used to measure cardiac-related anxiety, and the Minnesota Living with Heart Failure questionnaire was used to measure QoL. Data were collected at baseline and at follow-up at the end of the 9-week intervention. Intention-to-treat analysis was used, and missing data were imputed by the Expectation-Maximization method. Between-group differences were determined by analysis of covariance with control for baseline score and regression to the mean.ResultsNo significant difference in depressive symptoms between the ICBT and the DF group at the follow-up was found, [F(1,47)=1.63, P=.21] and Cohen´s d=0.26. Secondary within-group analysis of depressive symptoms showed that such symptoms decreased significantly in the ICBT group from baseline to the follow-up (baseline M=10.8, standard deviation [SD]=5.7 vs follow-up M=8.6, SD=4.6, t(24)=2.6, P=.02, Cohen´s d=0.43), whereas in the DF group, there was no significant change (baseline M=10.6, SD=5.0, vs follow-up M=9.8, SD=4.3, t(24)=0.93, P=.36. Cohen´s d=0.18). With regard to CAQ and QoL no significant differences were found between the groups (CAQ [d(1,47)=0.5, P=.48] and QoL [F(1,47)=2.87, P=.09]). In the ICBT group in the CAQ subscale of fear, a significant within-group decrease was shown (baseline M=1.55 vs follow-up M=1.35, P=.04). In the ICBT group, the number of logins to the Web portal correlated significantly with improvement in depressive symptoms (P=.02), whereas higher age (P=.01) and male sex (P=.048) were associated with less change in depressive symptoms. This study is underpowered because of difficulties in the recruitment of patients.ConclusionsGuided ICBT adapted for persons with HF and depressive symptoms was not statistically superior to participation in a Web-based DF. However, within the ICBT group, a statically significant improvement of depressive symptoms was detected.ClinicalTrialClinicaltrials.gov NCT01681771; https://clinicaltrials.gov/ct2/show/NCT01681771 (Archived by WebCite at http://www.webcitation.org/6ikzbcuLN)

Behavioral and Nondirective Guided Self-Help for Parents of Children with Externalizing Behavior: Mediating Mechanisms in a Head-To-Head Comparison.

Parent training (PT) delivered as a guided self-help intervention may be a cost- and time-effective intervention in the treatment of children with externalizing disorders. In face-to-face PT, parenting strategies have repeatedly been identified as mediating mechanisms for the decrease of children's problem behavior. Few studies have examined possible mediating effects in guided self-help interventions for parents. The present study aimed to investigate possible mediating variables of a behaviorally oriented guided self-help program for parents of children with externalizing problems compared to a nondirective intervention in a clinical sample. A sample of 110 parents of children with externalizing disorders (80% boys) were randomized to either a behaviorally oriented or a nondirective guided self-help program. Four putative mediating variables were examined simultaneously in a multiple mediation model using structural equation modelling. The outcomes were child symptoms of ADHD and ODD as well as child externalizing problems, assessed at posttreatment. Analyses showed a significant indirect effect for dysfunctional parental attributions in favor of the group receiving the behavioral program, and significant effects of the behavioral program on positive and negative parenting and parental self-efficacy, compared to the nondirective intervention. Our results indicate that a decrease of dysfunctional parental attributions leads to a decrease of child externalizing problems when parents take part in a behaviorally oriented guided self-help program. However, none of the putative mediating variables could explain the decrease in child externalizing behavior problems in the nondirective group. A change in dysfunctional parental attributions should be considered as a possible mediator in the context of PT.