Web-based Cognitive Behavioral Intervention Research Articles

Web-Based Cognitive Behavioral Treatment for Bulimia Nervosa

Despite the existence of effective treatments, many individuals with bulimia nervosa (BN) do not receive evidence-based therapies. Integrating digital interventions into routine care might reach more patients and reduce the clinical burden of BN. To evaluate the effectiveness of a web-based cognitive behavioral self-help intervention for individuals with BN. A 2-group randomized clinical trial without follow-up was conducted between February 2, 2021, and July 9, 2022, in Germany. Participants aged between 18 and 65 years who met the diagnostic criteria for BN were enrolled online via self-referral. Data analyses were conducted from October 24, 2022, to December 23, 2023. A web-based cognitive behavioral self-help intervention including 12 weekly modules was compared with a waiting-list control group only having access to routine care. The primary outcome was the change in the number of bulimic episodes between baseline and posttreatment. Secondary outcomes included changes in global eating disorder symptoms, clinical impairment, well-being, work capacity, comorbid symptoms, self-esteem, and emotion regulation complemented by weekly measures and ecological momentary assessment. Intention-to-treat analyses were performed. Participants (N = 154; mean [SD] age, 29.6 [8.6] years; 149 [96.8%] female) receiving the web-based intervention demonstrated a significantly greater decrease in bulimic episodes compared with the control group (Cohen d = -0.48; 95% CI, -0.75 to -0.20; P < .001), representing a significant change in binge-eating episodes (Cohen d = -0.61; 95% CI, -0.89 to -0.33; P < .001), but not in compensatory behaviors (Cohen d = -0.25; 95% CI, -0.51 to 0.02; P = .21). The intervention was superior in improving global eating disorder symptoms (Cohen d = -0.61; 95% CI, -0.89 to -0.32; P < .001) and clinical impairment (Cohen d = -0.62; 95% CI, -0.92 to -0.33; P < .001). No significant effects were found for well-being (Cohen d = -0.08; 95% CI, -0.37 to 0.22; P > .99) and work capacity (Cohen d = -0.01; 95% CI, -0.68 to 0.66; P = .99). Exploratory analyses indicated significant changes in self-esteem and emotion regulation difficulties, but not in comorbid symptoms. In this randomized clinical trial, a web-based cognitive behavioral self-help intervention effectively decreased eating disorder symptoms and illness-related burden in individuals with BN, underlining the potential of digital interventions to complement established treatments. ClinicalTrials.gov Identifier: NCT04876196.

Effectiveness of a Web-Based Cognitive Behavioral Self-Help Intervention for Binge Eating Disorder: A Randomized Clinical Trial.

Binge eating disorder (BED) is one of the most frequent eating pathologies and imposes substantial emotional and physical distress, yet insufficient health care resources limit access to specialized treatment. Web-based self-help interventions emerge as a promising solution, offering more accessible care. To examine the effectiveness of a web-based cognitive behavioral self-help intervention for individuals with BED. This 2-arm, parallel-group randomized clinical trial conducted from January 15, 2021, to August 3, 2022, in Germany and other German-speaking countries enrolled patients aged 18 to 65 years who met the diagnostic criteria for BED (according to the Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]). Data analysis occurred between January 27 and September 4, 2023, following our statistical analysis plan. Participants were randomized to a web-based self-help intervention or a waiting-list control condition. The primary outcome was a change in objective binge eating episodes from baseline to after treatment. Secondary outcomes included global eating pathology, clinical impairment, work capacity, well-being, comorbid psychopathology, self-esteem, and emotion regulation. A total of 1602 patients were screened, of whom 154 (mean [SD] age, 35.93 [10.59] years; 148 female [96.10%]) fulfilled the criteria for BED and were randomized (77 each to the intervention and control groups). The web-based intervention led to significant improvements in binge eating episodes (Cohen d, -0.79 [95% CI, -1.17 to -0.42]; P < .001), global eating psychopathology (Cohen d, -0.71 [95% CI, -1.07 to -0.35]; P < .001), weekly binge eating (Cohen d, -0.49 [95% CI, -0.74 to -0.24]; P < .001), clinical impairment (Cohen d, -0.75 [95% CI, -1.13 to -0.37]; P < .001), well-being (Cohen d, 0.38 [95% CI, 0.01 to 0.75]; P = .047), depression (Cohen d, -0.49 [95% CI, -0.86 to -0.12]; P = .01), anxiety (Cohen d, -0.37 [95% CI, -0.67 to -0.07]; P = .02), self-esteem (Cohen d, 0.36 [95% CI, 0.13 to 0.59]; P = .003), and emotion regulation (difficulties: Cohen d, -0.36 [95% CI, -0.65 to -0.07]; P = .01 and repertoire: Cohen d, 0.52 [95% CI, 0.19 to 0.84]; P = .003). In this randomized clinical trial of a web-based self-help intervention for patients with BED, the findings confirmed its effectiveness in reducing binge eating episodes and improving various mental health outcomes, highlighting a scalable solution to bridge the treatment gap for this condition. ClinicalTrials.gov Identifier: NCT04876183.

Implementing an Acute Text-Based Wellness Alert System for Pediatric Residents: A Pilot Study.

Residency training presents a unique combination of factors affecting well-being. Studies suggest that mental/emotional distress is pervasive among residents, caused by contextual factors affecting emotional resilience (eg, sleep deprivation) and abrupt, stressful triggers (eg, patient deaths). 1 Moore KA O'Brien BC Thomas LR. “I wish they had asked”: a qualitative study of emotional distress and peer support during internship. J Gen Intern Med. 2020; 35: 3443-3448https://doi.org/10.1007/s11606-020-05803-4 Crossref PubMed Scopus (12) Google Scholar Interventions including positive psychology coaching, peer support, mindfulness curricula, and web-based cognitive behavioral therapy have demonstrated modest but inconsistent improvements in well-being; however, they may be considered burdensome. 2 Guille C Zhao Z Krystal J et al. Web-based cognitive behavioral therapy intervention for the prevention of suicidal ideation in medical interns: a randomized clinical trial. JAMA Psychiatr. 2015; 72: 1192-1198https://doi.org/10.1001/jamapsychiatry.2015.1880 Crossref PubMed Scopus (91) Google Scholar , 3 Ireland MJ Clough B Gill K et al. A randomized controlled trial of mindfulness to reduce stress and burnout among intern medical practitioners. Med Teach. 2017; 39: 409-414https://doi.org/10.1080/0142159X.2017.1294749 Crossref PubMed Scopus (72) Google Scholar , 4 Bommarito S Hughes M. Intern mental health interventions. Curr Psychiatry Rep. 2019; 21: 55https://doi.org/10.1007/s11920-019-1035-y Crossref PubMed Scopus (3) Google Scholar , 5 Meeks LM Ramsey J Lyons M et al. Wellness and work: mixed messages in residency training. J Gen Intern Med. 2019; 34: 1352-1355https://doi.org/10.1007/s11606-019-04952-5 Crossref PubMed Scopus (19) Google Scholar By contrast, mobile phone-based interventions are less onerous and have been well-accepted. 6 Scielzo SA Weigle DC Kazi SD. Resident fuel levels: reframing, assessing, and addressing well-being. J Grad Med Educ. 2018; 10: 198-202https://doi.org/10.4300/JGME-D-17-00536.1 Crossref PubMed Scopus (3) Google Scholar , 7 Weis HB Clark AT Scielzo SA et al. The fuel gauge: a simple tool for assessing general surgery resident well-being. J Surg Educ. 2020; 77: 27-33https://doi.org/10.1016/j.jsurg.2019.07.011 Crossref PubMed Scopus (7) Google Scholar , 8 Nathan J McCray L Feldman N. The text effect: stress management and resiliency training pilot for resident physicians. Fam Med. 2021; 53: 139-144https://doi.org/10.22454/FamMed.2021.847102 Crossref PubMed Scopus (2) Google Scholar No interventions, however, address abrupt or acute distressing events.

Therapist-Assisted Web-Based Intervention for Prolonged Grief Disorder After Cancer Bereavement: Randomized Controlled Trial.

BackgroundBereavement due to cancer increases the risk of prolonged grief disorder. However, specialized treatment options for prolonged grief after a loss due to illness are still scarce.ObjectiveThe aim of this study is to extend previous findings by evaluating a web-based cognitive behavioral intervention with asynchronous therapist support, consisting of structured writing tasks adapted specifically for prolonged grief after cancer bereavement.MethodsThe intervention was evaluated in a purely web-based randomized waitlist-controlled trial. Open-access recruitment of participants was conducted on the web. Prolonged grief (Inventory of Complicated Grief), depression, anxiety, posttraumatic stress, posttraumatic growth, somatization, sleep quality, and mental and physical health were assessed on the web via validated self-report measures.ResultsA total of 87 participants were randomized into the intervention group (IG; 44/87, 51%) or the waitlist control group (43/87, 49%). Of the participants, 7% (6/87) dropped out of the study (5/44, 11%, in the IG). Of the 39 completers in the IG, 37 (95%) completed all intervention tasks. The intervention reduced symptoms of prolonged grief (intention-to-treat: P<.001; η2=0.34; Cohen d=0.80) to a clinically significant extent. It had favorable effects on depression, anxiety, posttraumatic stress, posttraumatic growth, and overall mental health but not on somatization, sleep quality, or physical health.ConclusionsThe web-based intervention for prolonged grief after cancer bereavement is effective in reducing symptoms of prolonged grief disorder and accompanying syndromes in a timely, easily realizable manner and addresses specific challenges of bereavement to illness. Considering web-based approaches in future mental health care policy and practice can reduce health care gaps for those who are bereaved to cancer.Trial RegistrationGerman Clinical Trial Register U1111–1186-6255; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011001

Cost-utility of a web-based intervention to promote maternal mental health among postpartum women presenting low risk for postpartum depression.

Web-based interventions for the promotion of maternal mental health could represent a cost-effective strategy to reduce the burden associated with perinatal mental illness. This study aimed to evaluate the cost-utility of Be a Mom, a self-guided web-based cognitive behavioral therapy intervention, compared with a waiting-list control. The economic evaluation alongside a randomized controlled trial was conducted from a societal perspective over a 14-month time frame. Postpartum women presenting low risk for postpartum depression were randomized to the intervention (n=191) or control (n=176) group and assessed at baseline, postintervention and 4 and 12months after postintervention. Data regarding healthcare use, productive losses and quality-adjusted life years (QALYs) were collected and used to calculate incremental cost-effectiveness ratios (ICERs). Uncertainty was accounted for with nonparametric bootstrapping and sensitivity analyses. At 14months, and after accounting for a 3.5 percent discount rate, the intervention resulted in a yearly cost-saving of EUR 165.47 (-361.77, 28.51) and a QALY gain of 0.0064 (-0.0116, 0.0244). Bootstrapping results revealed a dominant ICER for the intervention group. Although results were statistically nonsignificant, cost-effectiveness acceptability curves showed that at a EUR 0 willingness to pay threshold, there is a 96 percent probability that the intervention is cost-effective when compared with the control group. The sensitivity analyses generally supported the acceptable likelihood of the intervention being more cost-effective than the control group. From a societal perspective, the implementation of Be a Mom among low-risk postpartum women could be a cost-effective way to improve perinatal mental health.

Detecting and Treating Psychosocial and Lifestyle-Related Difficulties in Chronic Disease: Development and Treatment Protocol of the E-GOAL eHealth Care Pathway.

Many patients with lifestyle-related chronic diseases find it difficult to adhere to a healthy and active lifestyle, often due to psychosocial difficulties. The aim of the current study was to develop an eHealth care pathway aimed at detecting and treating psychosocial and lifestyle-related difficulties that fits the needs and preferences of individual patients across various lifestyle-related chronic diseases. Each intervention component was developed by (1) developing initial versions based on scientific evidence and/or the Behavior Change Wheel; (2) co-creation: acquiring feedback from patients and health professionals; and (3) refining to address users’ needs. In the final eHealth care pathway, patients complete brief online screening questionnaires to detect psychosocial and lifestyle-related difficulties, i.e., increased-risk profiles. Scores are visualized in personal profile charts. Patients with increased-risk profiles receive complementary questionnaires to tailor a 3-month guided web-based cognitive behavioral therapy intervention to their priorities and goals. Progress is assessed with the screening tool. This systematic development process with a theory-based framework and co-creation methods resulted in a personalized eHealth care pathway that aids patients to overcome psychosocial barriers and adopt a healthy lifestyle. Prior to implementation in healthcare, randomized controlled trials will be conducted to evaluate its cost-effectiveness and effectiveness on psychosocial, lifestyle, and health-related outcomes.

Exploring Participants' Experiences of a Web-Based Program for Bulimia and Binge Eating Disorder: Qualitative Study.

BackgroundGuided cognitive behavioral self-help is a recommended first-line treatment for eating disorders (EDs) such as bulimia nervosa (BN) or binge eating disorder (BED). Online versions of such self-help programs are increasingly being studied in randomized controlled trials (RCTs), with some evidence that they can reduce ED symptoms, although intervention dropout is variable across interventions. However, in-depth research into participants’ experiences and views on the acceptability of web-based interventions is limited.ObjectiveThis is a qualitative process study of participants’ experiences of everyBody Plus, a web-based cognitive behavioral intervention, integrated into a large RCT to aid the interpretation of the main trial’s results. To our knowledge, this is the first such study in digital intervention for EDs research to include real-time feedback into the qualitative analysis. This study aims to build upon the emerging literature by qualitatively exploring participants’ experiences of a web-based intervention for BN and BED.MethodsParticipants were those who took part in the UK arm of a larger RCT investigating the efficacy of the everyBody Plus intervention. Reflexive thematic analysis was completed on 2 sources of data from the online platform: real-time feedback quotes provided at the end of completing a module on the platform (N=104) and semistructured telephone interview transcripts (n=12).ResultsFour main themes were identified. The first theme identified positive and negative user experiences, with a desire for a more customized and personalized intervention. Another theme positively reflected on how flexible and easy the intervention was to embed into daily life, compared with the silo of face-to-face therapy. The third theme identified how the intervention had a holistic impact cognitively, emotionally, interpersonally, and behaviorally. The final theme was related to how the intervention was not a one size fits all and how the perceived usefulness and relevance were often dependent on participants’ demographic and clinical characteristics.ConclusionsOverall, participants reported positive experiences with the use of the everyBody Plus web-based intervention, including flexibility of use and the potential to holistically impact people’s lives. The participants also provided valuable suggestions for how similar future web-based interventions could be improved and, in the context of EDs, how programs can be designed to be more inclusive of people by encompassing different demographic and clinical characteristics.

Web-based cognitive-behavioral intervention for pain in pediatric acute recurrent and chronic pancreatitis: Protocol of a multicenter randomized controlled trial from the study of chronic pancreatitis, diabetes and pancreatic cancer (CPDPC)

IntroductionAbdominal pain is common and is associated with high disease burden and health care costs in pediatric acute recurrent and chronic pancreatitis (ARP/CP). Despite the strong central component of pain in ARP/CP and the efficacy of psychological therapies for other centralized pain syndromes, no studies have evaluated psychological pain interventions in children with ARP/CP. The current trial seeks to 1) evaluate the efficacy of a psychological pain intervention for pediatric ARP/CP, and 2) examine baseline patient-specific genetic, clinical, and psychosocial characteristics that may predict or moderate treatment response. MethodsThis single-blinded randomized placebo-controlled multicenter trial aims to enroll 260 youth (ages 10–18) with ARP/CP and their parents from twenty-one INSPPIRE (INternational Study Group of Pediatric Pancreatitis: In search for a cuRE) centers. Participants will be randomly assigned to either a web-based cognitive behavioral pain management intervention (Web-based Management of Adolescent Pain Chronic Pancreatitis; WebMAP; N = 130) or to a web-based pain education program (WebED; N = 130). Assessments will be completed at baseline (T1), immediately after completion of the intervention (T2) and at 6 months post-intervention (T3). The primary study outcome is abdominal pain severity. Secondary outcomes include pain-related disability, pain interference, health-related quality of life, emotional distress, impact of pain, opioid use, and healthcare utilization. ConclusionsThis is the first clinical trial to evaluate the efficacy of a psychological pain intervention for children with CP for reduction of abdominal pain and improvement of health-related quality of life. Findings will inform delivery of web-based pain management and potentially identify patient-specific biological and psychosocial factors associated with favorable response to therapy.Clinical Trial Registration #: NCT03707431.

Health economic evaluation of a web-based intervention for depression: the EVIDENT-trial, a randomized controlled study

BackgroundDepression often remains undiagnosed or treated inadequately. Web-based interventions for depression may improve accessibility of treatment and reduce disease-related costs. This study aimed to examine the potential of the web-based cognitive behavioral intervention “deprexis” in reducing disease-related costs.MethodsParticipants with mild to moderate depressive symptoms were recruited and randomized to either a 12-week web-based intervention (deprexis) in addition to care as usual (intervention group) or care as usual (control group). Outcome measures were health-related resource use, use of medication and incapacity to work as well as relating direct health care costs. Outcomes were assessed on patients’ self-report at baseline, three months and six months.ResultsA total of 1013 participants were randomized. In both groups total direct health care costs decreased during the study period, but changes from baseline did not significantly differ between study groups. Numeric differences between study groups existed in outpatient treatment costs. They could be attributed to differences in changes of costs for psychotherapeutic treatment from baseline. Whereas costs for psychotherapeutic treatment decreased in the intervention group, costs increased in the control group (− 16.8% (€80) vs. + 14.7% (€60)) (tdf = 685 = 2.57; p = 0.008).ConclusionThe study indicates the health economic potential of innovative e-mental-health programs. There is evidence to suggest that the use of deprexis over a period of 12 weeks leads to a decrease in outpatient treatment cost, especially in those related to different types of psychotherapeutic treatment.

Potential mediators of improvement in painful chemotherapy-induced peripheral neuropathy via a web-based cognitive behavioural intervention

Objet : Des donnees preliminaires ont revele qu’une intervention autoguidee cognitivocomportementale de gestion de la douleur (PROSPECT) etait efficace contre la neuropathie peripherique chronique douloureuse induite par chimiotherapie (NPCI), mais le mecanisme d’action demeure inconnu. L’objectif de cette analyse secondaire a consiste a determiner si les changements par rapport a l’anxiete, a la depression, aux troubles du sommeil ou a la fatigue diminuaient la douleur apres l’utilisation de PROSPECT chez les patients atteints de NPCI. Methodologie : En tout, 60 participants ont ete selectionnes au hasard pour recevoir soit l’intervention autoguidee cognitivocomportementale contre la douleur (acces pendant huit semaines), soit le traitement habituel. Un journal sur sept jours de suivi de la douleur due a la NPCI et le systeme PROMIS (Patient Reported Outcomes Measurement Information System) de mesure de l’anxiete, de la depression, de la fatigue et des troubles du sommeil ont ete utilises avant et apres l’etude (huit semaines). L’analyse de la mediation causale a ete utilisee pour quantifier les mediateurs d’amelioration quant aux douleurs les plus intenses. Resultats : Aucun des mediateurs hypothetiques n’a eu un effet statistiquement important sur les douleurs les plus fortes (n = 38). Implications : D’autres recherches sont necessaires pour determiner les mediateurs potentiels d’intensite de la douleur qui peuvent etre cibles par des strategies cognitivocomportementales specifiques afin d’ameliorer la gravite de la douleur de la CIPN. Mots cles : Douleur chronique, neuropathie peripherique chimio-induite, intervention cognitivocomportementale, maladie du systeme nerveux peripherique/chimio-induite

Potential mediators of improvement in painful chemotherapy-induced peripheral neuropathy via a web-based cognitive behavioural intervention.

Preliminary evidence suggests that a self-guided cognitive and behaviourally-based pain management intervention (PROSPECT) is effective for chronic painful chemotherapy-induced peripheral neuropathy (CIPN), but its mechanism of action is unknown. The purpose of this secondary analysis was to explore if changes in anxiety, depression, sleep-related impairment, or fatigue mediated improvements in worst pain following PROSPECT in individuals with chronic painful CIPN. Sixty participants were randomized to receive self-guided cognitive behavioural pain management (access for eight weeks) or treatment as usual. A seven-day worst CIPN pain diary and the PROMIS measures of anxiety, depression, fatigue, and sleep-related impairment were administered pre/posttest (eight-weeks). Causal mediation analysis was used to quantify mediators of worst pain improvement. None of the hypothesized mediators had a statistically significant effect on worst pain (n=38). Further research is needed to identify potential mediators of pain intensity that can be targeted by specific cognitive behavioural strategies to improve painful CIPN severity.

Commencing and Persisting With a Web-Based Cognitive Behavioral Intervention for Insomnia: A Qualitative Study of Treatment Completers

BackgroundComputerized cognitive behavioral therapy for insomnia (CCBT-I) has a growing evidence base as a stand-alone intervention, but it is less clear what factors may limit its acceptability and feasibility when combined with clinical care.ObjectiveThe purpose of this study was to explore barriers and facilitators to use of an adjunctive CCBT-I program among depressed patients in a psychiatric clinic by using both quantitative and qualitative approaches.MethodsWe conducted the qualitative component of the study using face-to-face or telephone interviews with participants who had enrolled in a clinical trial of a CCBT-I program as an adjunctive treatment in a psychiatric clinical setting. In line with the grounded theory approach, we used a semistructured interview guide with new thematic questions being formulated during the transcription and data analysis, as well as being added to the interview schedule. A range of open and closed questions addressing user experience were asked of all study participants who completed the 12-week trial in an online survey.ResultsThree themes emerged from the interviews and open questions, consistent with nonadjunctive CCBT-I implementation. Identification with the adjunctive intervention’s target symptom of insomnia and the clinical setting were seen as key reasons to engage initially. Persistence was related to factors to do with the program, its structure, and its content, rather than any nonclinical factors. The survey results showed that only the key active behavioral intervention, sleep restriction, was rated as a major problem by more than 15% of the sample. In this clinical setting, the support of the clinician in completing the unsupported program was highlighted, as was the need for the program and clinical treatment to be coordinated.ConclusionsThe use of a normally unsupported CCBT-I program as an adjunctive treatment can be aided by the clinician’s approach. A key behavioral component of the intervention, specific to insomnia treatment, was identified as a major problem for persistence. As such, clinicians need to be aware of when such components are delivered in the program and coordinate their care accordingly, if the use of the program is to be optimized.ClinicalTrialAustralian and New Zealand Clinical Trials Registry ACTRN12612000985886; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362875&isReview=true (Archived by WebCite at http://www.webcitation.org/6njjhl42X)

Web-Based Cognitive Behavioral Therapy Intervention for the Prevention of Suicidal Ideation in Medical Interns: A Randomized Clinical Trial.

In the United States, approximately 1 physician dies by suicide every day. Training physicians are at particularly high risk, with suicidal ideation increasing more than 4-fold during the first 3 months of internship year. Despite this increase, to our knowledge, very few efforts have been made to prevent the escalation of suicidal thoughts among training physicians. To assess the effectiveness of a web-based cognitive behavioral therapy (wCBT) program delivered prior to the start of internship year in the prevention of suicidal ideation in medical interns. A randomized clinical trial conducted at 2 university hospitals with 199 interns from multiple specialties during academic years 2009-2010 or 2011-2012. The current study was conducted from May 2009 to June 2010 and May 2011 to June 2012, and data were analyzed using intent-to-treat principles, including last observation carried forward. Interns were randomly assigned to 2 study groups (wCBT and attention-control group [ACG]), and completed study activities lasting 30 minutes each week for 4 weeks prior to starting internship year. Participants assigned to wCBT completed online CBT modules and those assigned to ACG received emails with general information about depression, suicidal thinking, and local mental health professionals. The Patient Health Questionnaire-9 was used to assess suicidal ideation (ie, "thoughts that you would be better off dead or hurting yourself in some way") prior to the start of intern year and at 3-month intervals throughout the year. A total of 62.2% of interns (199 of 320) agreed to take part in the study; 100 were assigned to the wCBT group and 99 to the ACG. During at least 1 point over the course of internship year, 12% of interns (12 of 100) assigned to wCBT endorsed suicidal ideation compared with 21.2% of interns (21 of 99) assigned to ACG. After adjusting for covariates identified a priori that have previously shown to increase the risk for suicidal ideation, interns assigned to wCBT were less likely to endorse suicidal ideation during internship year (relative risk, 0.40; 95% CI, 0.17- 0.91; P = .03) compared with those assigned to ACG. This study demonstrates that a free, easily accessible, brief wCBT program is associated with reduced likelihood of suicidal ideation among medical interns. Prevention programs with these characteristics could be easily disseminated to medical training programs across the country. anzctr.org.au Identifier: ACTRN12610000628044.

Effectiveness of a Web-Based Cognitive Behavioural Intervention for Subthreshold Depression: Pragmatic Randomised Controlled Trial

Background: Research on the effectiveness of treatments for subthreshold depression (sD) is still scarce. The aim of the study was to evaluate the efficacy of a web-based guided self-help intervention (GET.ON Mood Enhancer) in the treatment of sD. Methods: Participants with sD (n = 406) recruited from the general population via a large health insurance company were randomly allocated to a web-based cognitive behavioural intervention or to enhanced care-as-usual. The primary outcome was the reduction in depressive symptom severity as measured with the Center for Epidemiological Studies Depression Scale at post-treatment and at 6-month follow-up. Results: Participants in the intervention group showed a significantly greater pre-post reduction in depressive symptom severity (d = 1.06; 95% CI: 0.86-1.27) compared to the control condition (d = 0.29; 95% CI: 0.10-0.49). The corresponding between-group effect size was d = 0.69 (95% CI: 0.49-0.89). At 6-month follow-up the effect was reduced to d = 0.28 (95% CI: 0.09-0.48) but was still statistically significant (F_{1, 403} = 9.240, p = 0.003). Conclusions: This study lends support to the idea that problem solving coupled with behavioural activation is an effective treatment for sD. In addition, the delivery of this intervention over the Internet might be a promising strategy for the dissemination of psychological interventions for sD on a large scale.

Interventions for Enhancing Adherence to Antiretroviral Therapy (ART): A Systematic Review of High Quality Studies.

We sought to review the effectiveness of interventions designed to improve adherence to antiretroviral therapy (ART) from studies included in a recent Cochrane review that reported a clinical and an adherence outcome, with at least 80% follow-up for 6 months or more. Data were extracted independently and in duplicate, with an adjudicator for disagreements. Risk of bias was assessed using the Cochrane Risk of Bias tool. Of 182 relevant studies in the Cochrane review, 49 were related to ART. Statistical pooling was not warranted due to heterogeneity in interventions, participants, treatments, adherence measures and outcomes. Many studies had high risk of bias in elements of design and outcome ascertainment. Only 10 studies improved both adherence and clinical outcomes. These used the following interventions: adherence counselling (two studies); a once-daily regimen (compared to twice daily); text messaging; web-based cognitive behavioral intervention; face-to-face multi-session intensive behavioral interventions (two studies); contingency management; modified directly observed therapy; and nurse-delivered home visits combined with telephone calls. Patient-related adherence interventions were the most frequently tested. Uniform adherence measures and higher quality studies of younger populations are encouraged.

Fear of disease progression questionnaire for parents: Psychometric properties based on a sample of caregivers of children and adolescents with cystic fibrosis

BackgroundParents caring for a child with a chronic somatic condition are at risk of increased distress and impaired quality of life. Fear of disease progression (FoP) is known to be an important source of distress in patients and their partners, and may be of relevance for parents as well. Existing measures are not applicable to parents. This study describes the adaptation of the FoP questionnaire for parental caregivers and investigated its psychometric properties. MethodsSixteen items appropriate for parents were derived from existing measures and from interviews with clinical experts in family-oriented psychosocial care. Factor structure, internal consistency, validity and sensitivity to change were analyzed in a clinical sample of 162 caregivers (Mage=42.07years, SD=6.0years, 87.8% female) of a child with cystic fibrosis. ResultsThe exploratory factor analysis revealed a two-factor structure, which was not supported by confirmatory analysis. Cronbach's α was examined for total score (.91) and significant positive correlations of the total score with anxiety (HADS: r=.70) and depression (CES-D: r=.60, BDI-II: r=.59), and a significant negative correlations with quality of life (r=−.66) could be demonstrated. A significant decrease in FoP was found (d=1.11) in a group of highly distressed caregivers undergoing web-based cognitive behavioral intervention. ConclusionsThe FoP questionnaire is a reliable and valid instrument for parents of children with CF. Further studies in larger samples are needed to clarify dimensionality and validity among parents of children with other chronic conditions.

Web-Based Cognitive Behavioral Self-Help Intervention to Reduce Cocaine Consumption in Problematic Cocaine Users: Randomized Controlled Trial

BackgroundWeb-based self-help programs that reduce problematic substance use are able to reach hidden consumer groups in the general population. These programs are characterized by their low treatment threshold and nonrestrictive intervention settings. They are also cost effective, making them of interest to both low-income and high-income industrialized countries with ever-increasing health costs.ObjectiveTo test the feasibility and effectiveness of an anonymous, fully automated, Web-based self-help intervention as an alternative to outpatient treatment services for cocaine users.MethodsA total of 196 cocaine-using participants were recruited through various online and offline media for a randomized controlled trial. Participants in the intervention group received interactive cognitive behavioral modules and a consumption diary to reduce cocaine use, whereas participants in the control group received online psychoeducative information modules. Web-based follow-up assessments were conducted after 4 weeks, 6 weeks, and 6 months. Treatment retention was examined and compared between the intervention and control groups. Severity of cocaine dependence was the main outcome measure. Secondary outcomes were cocaine craving, depression symptoms, and alcohol and other substance use.ResultsThis Web-based intervention attracted older and more educated participants than existing outpatient treatment programs for which cocaine is the primary substance of abuse. Participants in the intervention group showed greater treatment retention compared with the control group (P = .04). Low response rates at the follow-up assessments restricted the explanatory power of the analyses. At the follow-up assessments, the severity of cocaine dependence did not differ between the intervention and control groups (P = .75). Furthermore, there were no differences in cocaine craving, depression, or alcohol and other substance use. Using the consumption diaries, the average number of cocaine-free days per week did not change significantly, whereas the weekly quantity of cocaine used decreased equally in both groups (P = .009).ConclusionsFor cocaine users with low dependence severity, a fully automated Web-based cognitive behavioral self-help intervention is a feasible alternative with limited effectiveness in outpatient treatment services. However, this type of intervention may attract specific user groups that are rarely reached by existing outpatient treatment and may help them to control their cocaine consumption anonymously.Trial RegistrationISRCTN93702927; http://www.controlled-trials.com/ISRCTN93702927 (Archived by WebCite at http://www.webcitation.org/6CTMM10MR)

Web-based cognitive-behavioral therapy for perfectionism: A randomized controlled trial

This study assessed the effectiveness of a web-based cognitive behavioral intervention (CBT) in reducing perfectionism and psychological distress in post-secondary students. Participants assessed as high in perfectionism (n=77) were randomized to one of three 10-week, web-based, intervention conditions (no treatment [NT], general stress management [GSM], or CBT). Results indicated the CBT condition was effective in reducing perfectionism, and supported a pattern of significantly greater improvement than observed in participants in the GSM or NT conditions. While both CBT and GSM demonstrated capacities to significantly reduce distress, for CBT participants changes in perfectionism were significantly correlated with changes in depression and anxiety. Results offer support for the effectiveness of web-based CBT in positively affecting perfectionist-related problems. Given the considerable proportion of individuals who suffer from perfectionism-related distress, the intervention's apparent effectiveness, cost-effectiveness and ease of dissemination warrant future replication studies.

Establishing Treatment Fidelity in a Web-Based Behavioral Intervention Study

: Treatment fidelity pertains to the methodological strategies used to monitor and enhance the reliability and validity of behavioral interventions. Approaches to establishing treatment fidelity in Web-based interventions differ from those used in interventions that are delivered in person. : The aim of this study was to describe a methodology for ensuring treatment fidelity in a Web-based cognitive behavioral stress management intervention. : The intervention Coping With Cancer Workbook, adapted for Web-based delivery from an in-person intervention, was tested in a randomized controlled trial with 123 breast cancer survivors. Strategies for ensuring treatment fidelity were implemented and assessed. : The National Institutes of Health Behavior Change Consortium Treatment Fidelity Guidelines were relevant to establishing treatment fidelity for the Web-based intervention. : Web-based delivery of behavioral interventions is both a strength and a threat to treatment fidelity. Investigators must be cognizant of the elements of treatment fidelity and implement strategies to monitor and improve the reliability and validity of Web-based interventions.

Young people's perceptions of and reasons for accessing a web‐based cognitive behavioural intervention for bulimia nervosa

The aim of the present study was to explore young people's experience of accessing and utilising a web-based cognitive behavioural intervention for bulimic disorders. Young people (N = 11) with bulimia nervosa or atypical bulimia nervosa completed a qualitative interview. Interviews were analysed and themes were identified. Young people liked the programme for its accessibility, flexibility, support and information. Some participants used the intervention as a stepping stone to further treatment. Web-based interventions have the potential to provide accessible, effective treatment to young people with bulimia nervosa (BN). More research is needed to determine which components are effective and for whom.