My Disaster Recovery: a pilot randomized controlled trial of an Internet intervention

Abstract

This pilot study tested the efficacy of the My Disaster Recovery (MDR) website to decrease negative affect and increase coping self-efficacy. Fifty-six survivors of Hurricane Ike were recruited from a larger study being conducted at the University of Texas Medical Branch at the first anniversary of the storm. Restricted randomization was used to assign participants to the MDR website, an information-only website, or a usual care condition. Group×time interactions indicated that MDR reduced participant worry more than the other conditions. A similar trend was also identified for depression. Both websites were accessed a small to moderate amount and participants reported mixed satisfaction for both websites. Although the effect sizes for worry and depression were in the moderate to large range, small sample size and timing of the intervention qualify the findings. These preliminary findings encourage further evaluation of MDR with a larger, demographically diverse sample and indicate that the MDR website might be helpful in reducing worry and depression.     

Effects of an Internet-based intervention for subthreshold eating disorders: a randomized controlled trial

BackgroundWomen reporting initial eating disorder (ED) symptoms are at highest risk for the development of an eating disorder. Preventive interventions should, therefore, be specifically tailored for this subgroup.AimsTo adapt and evaluate the effects of the Internet-based prevention program “Student Bodies?” for women with symptoms of disordered eating and/or subthreshold eating disorder (ED) syndromes.Method126 women, reporting subthreshold ED symptoms (high weight and shape concerns and below threshold bingeing, purging, chronic dieting or several of these symptoms) were randomly assigned to a Student Bodies?+ (SB+) intervention or a wait-list control group and assessed at pre-intervention, post-intervention, and 6-month follow-up. “Student Bodies?” was adapted to be suitable for subthreshold EDs. Main outcome measures were attitudes and symptoms of disordered eating. Pre-follow-up data were analyzed by ANCOVAS with mixed effects.ResultsAt 6-month follow-up, compared to participants in the control group, participants in the intervention group showed significantly greater improvements on ED-related attitudes. Intervention participants also showed 67% (95% CI = 20–87%) greater reductions in combined rates of subjective and objective binges, and 86% (95% CI = 63–95%) greater reduction in purging episodes. Also, the rates of participants abstinent from all symptoms of disordered eating (restrictive eating, binge eating and any compensatory behavior) were significantly higher in the intervention group (45.1% vs. 26.9%). Post-hoc subgroup analyses revealed that for participants with binge eating the effect on EDE-Q scores was larger than in the pure restricting subgroup.ConclusionThe adapted “SB+” program represents an effective intervention for women with subthreshold EDs of the binge eating subtype.     

Efficacy of an internet-based intervention for burnout: a randomized controlled trial in the German working population

Background and Objectives: Internet-based interventions are a viable treatment option for various mental problems. However, their effects on the burnout syndrome yielded mixed results. In this paper, we examine the efficacy of a structured and therapist-guided internet intervention, based on solution-focused and cognitive-behavioral therapy, for individuals with symptoms of burnout.

Design: Two-arm, Internet-based, randomized, wait-list controlled trial (RCT).

Methods: Participants were recruited through in-house events and online advertising. They were randomly assigned to the intervention or a wait-list. Group comparison was conducted three months after randomization. Outcomes were the burnout level according to the Maslach Burnout Inventory (MBI-GS) and the levels of depression, anxiety and stress according to the DASS-21.

Results: Thirty-nine participants were included in the trial; 36 (92.3%) took part at the 3-months-follow-up. Intention-to-treat analyses revealed significant group differences in favor of the intervention group in depression (d?=?0.66), cynicism (d?=?0.87) and personal accomplishment (d?=?0.75).

Conclusions: The intervention helped ameliorate symptoms of work-related stress and burnout. Although limited by a small sample size, the study suggests that the program provides effective support for affected individuals. However, further studies with bigger sample sizes should be conducted to examine the effects of such programs more precisely.     

Home-based family intervention for low-income children with asthma: a randomized controlled pilot study

Low-income African American children have disproportionately higher asthma morbidity and mortality. Education alone may not address barriers to asthma management due to psychosocial stress. This study evaluated the efficacy of a home-based family intervention integrating asthma education and strategies to address stress using a community-based participatory research model. Children age 8 to 13 with poorly controlled asthma and their caregivers were recruited from an urban hospital and an asthma camp. Caregivers with elevated scores on a stress measure were enrolled. Forty-three families were randomized to the 4- to 6-session Home Based Family Intervention (HBFI) or the single session of Enhanced Treatment as Usual (ETAU). All families received an asthma action plan and dust mite covers; children performed spirometry and demonstrated MDI/spacer technique at each home visit. The HBFI addressed family-selected goals targeting asthma management and stressors. Asthma management, morbidity, family functioning, and caregiver stress were assessed at baseline, postintervention, and 6 months after the intervention. ED visits and hospitalizations were ascertained by medical record review for a year after intervention completion. Only one child (5%) in HBFI had an asthma-related hospitalization compared to 7 patients (35%) in ETAU in the year following intervention. Participants in both groups demonstrated improved asthma management and family functioning, and reduced ED visits, symptom days, missed school days, and caregiver stress, but there were no differential treatment effects. The results suggest that a home-based intervention addressing medical and psychosocial needs may prevent hospitalizations for children with poorly controlled asthma and caregivers under stress.     

Cognitive-behavioral therapy for insomnia in alcohol dependent patients: a randomized controlled pilot trial

In a randomized controlled trial, we evaluated the efficacy of cognitive-behavioral treatment for insomnia to improve sleep and daytime symptoms, and to reduce relapse in recovering alcohol dependent (AD) participants. Seventeen abstinent AD patients with insomnia (6 women, mean age 46.2 ± 10.1 years) were randomized to 8 sessions of cognitive-behavioral treatment for insomnia for AD (CBTI-AD, n = 9) or to a behavioral placebo treatment (BPT, n = 8). Subjective measures of sleep, daytime consequences of insomnia and AD, alcohol use, and treatment fidelity were collected at baseline and post-treatment. Diary-rated sleep efficiency and wake after sleep onset, and daytime ratings of General Fatigue on the Multidimensional Fatigue Inventory improved more in the CBTI-AD compared to the BPT group. In addition, more subjects were classified as treatment responders following CBTI-AD. No group differences were found in the number of participants who relapsed to any drinking or who relapsed to heavy drinking. The findings suggest that cognitive-behavioral insomnia therapy benefits subjective sleep and daytime symptoms in recovering AD participants with insomnia more than placebo. The benefits of treating insomnia on drinking outcomes are less apparent.     

Transdiagnostic Internet treatment for anxiety disorders: A randomized controlled trial

Clinician-guided Internet-based cognitive behavioural therapy (iCBT) programs are clinically effective at treating specific anxiety disorders. The present study examined the efficacy of a transdiagnostic Internet-based cognitive behavioural treatment (iCBT) program to treat more than one anxiety disorder within the same program (the Anxiety Program). Eighty six individuals meeting diagnostic criteria for generalized anxiety disorder (GAD), panic disorder, and/or social phobia were randomly assigned to a treatment group, or to a waitlist control group. Treatment consisted of CBT based online educational lessons and homework assignments, weekly email or telephone contact from a clinical psychologist, access to a moderated online discussion forum, and automated emails. An intention-to-treat model using the baseline-observation-carried-forward principle was employed for data analyses. Seventy-five percent of treatment group participants completed all 6 lessons within the 8 week program. Post-treatment data was collected from 38/40 treatment group and 38/38 control group participants, and 3-month follow-up data was collected from 32/40 treatment group participants. Relative to controls, treatment group participants reported significantly reduced symptoms of anxiety as measured by the Generalized Anxiety Disorder - 7 Item, Social Phobia Screening Questionnaire, and the Panic Disorder Severity Rating Scale - Self Report Scale, but not on the Penn State Worry Questionnaire, with corresponding between-groups effect sizes (Cohen’s d) at post-treatment of 0.78, 0.43, 0.43, and 0.20, respectively. The clinician spent a total mean time of 46 min per person over the program, participants rated the procedure as moderately acceptable, and gains were sustained at follow-up. Modifications to the Anxiety program, based on post-treatment feedback from treatment group participants, were associated with improved outcomes in the control group. These results indicate that transdiagnostic programs for anxiety disorders may be successfully administered via the Internet.     

The effects of an authentic coaching intervention on athlete outcomes: A pilot randomised controlled trial

ObjectivesAuthentic leadership has been found to be related to promising outcomes in sport. However, no intervention designed to increase coaches' authentic leadership exists. The aim of this study was to develop and evaluate such an intervention.DesignThe study was a pilot randomised controlled trial. We used a mixed design with Group (Intervention, Control) as between- and Time (pre, post) as within-participants factors.MethodA total of 18 coaches (M_age = 37.89; 83% males) and their athletes (N = 153; M_age = 20.48; 50.3% females) were randomly allocated, via block randomisation, into either an intervention (coaches n = 9, athletes n = 90) or a control group (coaches n = 9, athletes n = 63). The coaches in the intervention group received a 2-h-long workshop and completed weekly coaching logs. Data were collected via questionnaires, which were administered to both the coaches and their athletes prior to the workshop and two months after the workshop.ResultsThe results revealed that the intervention group reported higher authentic leadership compared to the control group. A mixed-design analysis of variance indicated that athletes in the intervention group reported significantly higher enjoyment and prosocial behaviour from pre- to post-intervention compared to the control group.ConclusionsThe findings suggest that an authentic coaching intervention can be effective in improving coaches' authentic behaviours and promoting positive athlete outcomes.     

Cognitive behavior therapy for driving fear: A pilot randomized controlled trial

Fear of driving is common in clinical practice, while its treatment programs are understudied. This is the first randomized controlled trial to evaluate a newly developed protocol for cognitive behavior therapy (CBT) for driving fear compared with a wait list and to use specific assessment scales. 34 participants (30 women, 4 men) in an outpatient psychotherapy clinic were randomly allocated to either 18 sessions of CBT or a wait list (n = 17 each). After treatment, CBT was significantly more efficacious than the wait list with large effect sizes on the Instrument for Fear of Driving (IFD) (Cohen’s d = 2.58) and on the Driving Cognitions Questionnaire (DCQ) (Cohen’s d = 2.14). Driving fear is a condition treatable by CBT and the suggested protocol is safe, feasible and acceptable. Further studies with larger samples and active controls (e.g., virtual reality therapy) are required to draw generalizable conclusions on effect sizes.     

Work-anxiety-coping intervention improves work-coping perception while a recreational intervention leads to deterioration: Results from a randomized controlled trial

Work-anxieties are costly and need early intervention. The perception of being able to cope with work is a basic requirement for work ability. This randomized controlled trial investigates whether a cognitive behavioural, work-anxiety-coping group (WAG) intervention leads to better work-coping perception than an unspecific recreational group (RG). Heterogeneous people in medical rehabilitation, who were due to return to work, were interviewed concerning their work-anxieties, and either randomly assigned to a WAG (n = 85) or a RG (n = 95). The participants (with an average of 50 years old [range 23–64]; 51% women; 70% workers or employees, 25% academics, 5% unskilled) followed the group intervention for four or six sessions. The perceived work-coping was assessed by self-rating (Inventory for Job-Coping and Return Intention JoCoRi) after each group session. Although participants had a slight temporary decrease in work-coping after group session two (from M₁ = 2.47 to M₂ = 2.28, d_Cohen = ?.22), the WAG led to the improvement of perceived work-coping over the intervention course (from M₁ = 2.47 to M₆ = 2.65, d_Cohen = .18). In contrast, participants from the RG reported lower work-coping after six group sessions (from M₁ = 2.26 to M₆ = 2.02, d_Cohen = ?.18). It is considered that people with work-anxieties need training in work-coping. By focusing on recreation only, this may lead to deterioration of work-coping. Indeed, intervention designers should be aware of temporary deterioration (side effects) when confronting participants with work-coping.     

A randomized controlled trial of a single session motivational intervention for concerned gamblers

Motivational interviewing (MI) is a promising brief intervention for people who wish to cut down or quit gambling. The study was a randomized clinical trial that tested the efficacy of a single face-to-face MI compared with a control interview (CI) for reducing gambling behaviours in individuals who expressed concerns about their gambling. Eighty-one media recruited gamblers were followed at 1, 3, 6 and 12 months post-intervention. At 12 months post-intervention participants in the MI condition spent significantly less money on gambling per month, gambled fewer days per month, and reported significantly less distress than participants in the CI condition. Participants in both conditions showed overall reduction in gambling problem severity.     

A pilot randomised controlled trial of a home-based writing intervention for individuals with seizures

Objective: We investigated the feasibility, acceptability and preliminary effectiveness of a writing intervention for individuals with epilepsy or psychogenic nonepileptic seizures.

Methods: Individuals were randomised to write about potentially ‘therapeutic’ topics (n = 43) or about their daily events (n = 25). Participants were asked to write on four separate occasions for at least 20 min. Repeated-measures analysis of variance was used to investigate change in measures of health-related quality of life (NEWQoL-6D), depression (NDDI-E), anxiety (GAD-7) and illness perception (B-IPQ) from baseline to one and three-month follow-ups. Qualitative and quantitative data taken from a Writing Task Questionnaire was analysed between the two conditions.

Results: Recruitment was acceptable with 52% of those randomised completing the full writing intervention. In both conditions, participants wrote for longer than 20 min suggesting those who completed the study engaged well with the procedure. Greater benefits were observed in the ‘therapeutic’ condition (p < 0.05), which was associated with an improvement in health-related quality of life at one-month follow-up (p = 0.02). No differences were found in the other measures.

Conclusions: A writing intervention is acceptable in this population. Self-reported benefits were modest, suggesting therapeutic writing may be more suitable as a supplement to other therapies rather than a stand-alone therapeutic intervention.     

Internet-delivered physical activity intervention for college students with mental health disorders: a randomized pilot trial

The prevalence of mental health disorders among college students is rising and the increasing rates of anxiety and depression have important societal implications. Physical activity has been proposed as an adjuvant to traditional treatment approaches (i.e. psychotherapy or pharmacotherapy), and the internet is a potentially useful means of delivering physical activity information to the college-aged population. This randomized pilot trial examined the effects of an internet-based physical activity intervention on physical activity, self-efficacy, depression, and anxiety in college students (n?=?47) receiving mental health counseling. Physical activity, depression, anxiety, exercise self-efficacy, and barriers self-efficacy were assessed at baseline and post-intervention. There was a significant time effect for physical activity, with both groups increasing their physical activity levels across the 10-week intervention but with a larger increase in the intervention condition (d?=?0.68) than the control condition (d?=?0.05). Exercise and barriers self-efficacy declined across the intervention, but more so in the control than intervention condition. Effects on depression and anxiety were nonsignificant. Finally, correlation analyses showed increases in physical activity were associated with increases in exercise self-efficacy (r?=?0.62) and barriers self-efficacy (r?=?0.63) and decreases in depression (r?=?-0.44) in the intervention condition, but not in the control condition. These results suggest that an internet-delivered physical activity intervention may be a promising approach to promoting physical activity among college students undergoing mental health counseling.     

Prevention of pathological gambling: a randomized controlled trial

Although the gambling industry is expanding rapidly throughout North America and around the world, there are only a few empirically evaluated programs aimed at the prevention of pathological gambling (PG). The purpose of this study was to measure the effectiveness of a new prevention program aimed at PG. The Stop & Think! program was designed to teach at-risk video lottery terminal (VLT) gamblers cognitive restructuring and problem-solving skills that may help to prevent the development of PG. These skills were taught through a variety of methods - including an automated educational presentation, video and text vignettes, audio training tapes, and skill rehearsal. The program was evaluated using a randomized, 2-group experimental design with a wait-list control group and pre-, post-, and follow-up measures. Results indicated that, compared with the control group, the experimental group was less at risk for developing a gambling problem after the program. The experimental group endorsed fewer gambling-related cognitive distortions, engaged in less VLT gambling, and had lower scores on a measure of PG. The results of this study provide the basis for the implementation of the Stop & Think! program in the province of Prince Edward Island, Canada, and perhaps other jurisdictions too.     

The role of therapist support on effectiveness of an internet-based modular self-help intervention for adjustment disorder: a randomized controlled trial

Background: Adjustment disorder is among the most often diagnosed mental health disorders. Still, there is a lack of specific interventions available for adjustment disorder.

Objectives: The aim of this study was to test if an internet-based self-help intervention for adjustment disorder could be effective without therapist involvement.

Design: A parallel group randomized controlled trial design was used to test the effectiveness of the Brief Adjustment Disorder Intervention (BADI) – an internet-based intervention for adjustment disorder.

Methods: In total 1077 participants were randomized into two conditions: BADI intervention and BADI intervention with therapist support. The main outcome measures were symptoms of adjustment disorder and well-being.

Results: Pre-intervention to post-intervention adjustment disorder effect size for the BADI intervention group was d?=?0.64, and for the BADI with therapist support group the effect size was d?=?0.53.

Conclusions: The present study supported the effectiveness of the BADI intervention. Our findings also indicated that adding therapist support to the standard BADI intervention did not significantly improve the outcomes.     

Mindfulness training for loneliness among Chinese college students: A pilot randomized controlled trial

Loneliness has been found to predict a wide range of physical and mental health problems. It is suggested that China's One‐Child Policy places young Chinese people at a particularly high risk for loneliness. Although loneliness is most prevalent in late adolescence and early adulthood, interventions have primarily targeted children or older adults with limited success. The current study examines a pilot randomized controlled trial of a mindfulness training program among Chinese college students. Participants with elevated loneliness (N = 50, ages 17–25) were randomized into either an 8‐week mindfulness training or a control group. Self‐reported measures of loneliness and mindfulness were administered at baseline and posttest. The training group also completed a program evaluation form and a 3‐month follow‐up assessment. Results provided preliminary evidence indicating that the intervention was feasible and effective at reducing loneliness among Chinese college students. Limitations and future directions were discussed.     

Working with parents to counteract bullying: A randomized controlled trial of an intervention to improve parent-school cooperation

This study examined the effectiveness of an intervention aimed at improving parent-school cooperation in counteracting bullying. Using a randomized controlled trial, data of teachers, parents of non-victimized children, and children themselves were collected at 13 intervention and 14 control schools (grades 3–6, N at post-assessment: teachers = 83, parents = 153, children = 2,510) at two time points (time lag about 6 months). Results showed positive effects of the intervention for some aspects of the primary outcomes: parents’ and teachers’ attitudes and efforts, whereas no effects were found of teachers’ or parents’ competences in counteracting bullying. No intervention effects were found for secondary outcomes: children's self-reported bullying, victimization, well-being, and self-esteem. The findings indicate that, due to the intervention, teachers and parents were more aligned and able to cooperate, even within the short time of the intervention: one school year. This is the first essential step to systematically addressing parents’ role in tackling bullying; future research is needed to examine the long-term effects of parent and school interventions in enhancing the effectiveness of anti-bullying programs.     

Effectiveness of an attachment-based intervention for the assessment of parenting capacities in maltreating families: A randomized controlled trial

Even though Parenting Capacity Assessments (PCAs) are essential for child protection services to support placement decisions for maltreating families, presently no evidence-based PCA protocols are available. In this randomized controlled trial, we tested the quality of an attachment-based PCA protocol based on Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD). We recruited 56 parent-child dyads (M_age children = 3.48 years) in Dutch family residential clinics that conduct PCAs to support placement decisions. After pretest, families were randomized to receive the Regular Assessment Procedure (RAP) (n = 28), or an additional assessment based on VIPP-SD (n = 28). An immediate post-test and a 10-month follow-up were conducted. Multilevel models showed that therapists felt equally confident about their recommendations regarding child placement for both groups and that they equally often modified their initial placement recommendations. Moreover, children in the VIPP-SD group did not show fewer behavior problems and did not experience recurring child maltreatment less often than children in the RAP group. Thus, we found no evidence that PCAs incorporating the VIPP-SD protocol outperformed PCAs as usual. We discuss possible explanations why in the current study VIPP-SD did not seem to add to the quality of the RAP.