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.     

Mindfulness-based cognitive therapy improves emotional reactivity to social stress: results from a randomized controlled trial

The high likelihood of recurrence in depression is linked to a progressive increase in emotional reactivity to stress (stress sensitization). Mindfulness-based therapies teach mindfulness skills designed to decrease emotional reactivity in the face of negative affect-producing stressors. The primary aim of the current study was to assess whether Mindfulness-Based Cognitive Therapy (MBCT) is efficacious in reducing emotional reactivity to social evaluative threat in a clinical sample with recurrent depression. A secondary aim was to assess whether improvement in emotional reactivity mediates improvements in depressive symptoms. Fifty-two individuals with partially remitted depression were randomized into an 8-week MBCT course or a waitlist control condition. All participants underwent the Trier Social Stress Test (TSST) before and after the 8-week trial period. Emotional reactivity to stress was assessed with the Spielberger State Anxiety Inventory at several time points before, during, and after the stressor. MBCT was associated with decreased emotional reactivity to social stress, specifically during the recovery (post-stressor) phase of the TSST. Waitlist controls showed an increase in anticipatory (pre-stressor) anxiety that was absent in the MBCT group. Improvements in emotional reactivity partially mediated improvements in depressive symptoms. Limitations include small sample size, lack of objective or treatment adherence measures, and non-generalizability to more severely depressed populations. Given that emotional reactivity to stress is an important psychopathological process underlying the chronic and recurrent nature of depression, these findings suggest that mindfulness skills are important in adaptive emotion regulation when coping with stress.     

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.     

Predictors of attrition and weight loss success: Results from a randomized controlled trial

Attrition is a common problem in weight loss trials. The present analysis examined several baseline and early-treatment process variables, as predictors of attrition and outcome in a clinical trial that combined pharmacotherapy and behavior therapy for weight loss. Participants were 224 obese adults who were treated with sibutramine alone, lifestyle modification alone, combined therapy, or sibutramine plus brief lifestyle modification. Predictors included baseline characteristics (e.g., demographic, weight-related, psychological, and consumption-related variables), plus attendance, adherence, and weight loss in the early weeks of treatment. Outcomes were attrition and weight loss success (i.e., ≥5% reduction in body weight) at 1 year. Multivariable models, adjusting for other relevant variables, found that younger age and greater baseline depressive symptoms were related to increased odds of attrition (ps ≤ 0.003). Greater early weight loss marginally reduced the odds of attrition (p = 0.06). Predictors of weight loss success at 1 year were Caucasian ethnicity (p = 0.04), lower baseline depressive symptoms (p = 0.04), and weight loss during the first 3 weeks of treatment (p < 0.001). Thus, depressive symptoms at baseline were a significant predictor of both attrition and weight loss success. As a process variable, early weight loss appears to have more predictive value than early attendance at treatment sessions or early adherence.     

Enhancing the language development of toddlers in foster care by promoting foster parents’ sensitivity: Results from a randomized controlled trial

Young children in foster care are at increased risk for problematic language development, making early intervention a critical tool in enhancing these children's foundational language abilities. This study examined the efficacy of an early preventative intervention, Attachment and Biobehavioral Catch‐up for Toddlers (ABC‐T), in improving the receptive vocabulary abilities of toddlers placed in foster care. All the children had been removed from their biological parents’ care and placed into foster care. When children were between 24 and 36 months old, foster parents were contacted by research staff and consented to participate. Parents were randomly assigned using a random number generator to receive either ABC‐T (n = 45), which aimed to promote sensitive parenting for children who have experienced early adversity, or a control intervention (n = 43). Foster children's receptive vocabulary skills were assessed post‐intervention using the Peabody Picture Vocabulary Test, Third Edition, when children were between 36 and 60 months old. Children whose foster parents received ABC‐T demonstrated more advanced receptive vocabulary abilities than children whose foster parents received the control intervention. The positive effect of ABC‐T on foster children's receptive vocabulary was mediated by increases in foster parents’ sensitivity during parent–child interactions. Trial registration: ClinicalTrials.gov NCT01261806.     

Revisiting self-regulatory techniques to promote physical activity in older adults: null-findings from a randomised controlled trial

Objective. A randomised controlled trial (RCT) was conducted to evaluate a three-hour face-to-face physical activity (PA) intervention in community-dwelling older German adults with four groups: The intervention group (IG) received behaviour change techniques (BCTs) based on the health action process approach plus a views-on-ageing component to increase PA. The second intervention group ‘planning’ (IGpl) contained the same BCTs, only substituted the views-on-ageing component against an additional planning task. An active control group received the same BCTs, however, targeting volunteering instead of PA. A passive control group (PCG) received no intervention.

Design. The RCT comprised 5 time-points over 14 months in N = 310 participants aged 64+.

Main outcome measures. Self-reported as well as accelerometer-assessed PA.

Results. Neither PA measure increased in the IG as compared to the other groups at any point in time. Bayes analyses supported these null-effects.

Conclusion. A possible explanation for this null-finding in line with a recent meta-analysis is that some self-regulatory BCTs may be ineffective or even negatively associated with PA in interventions for older adults as they are assumed to be less acceptable for older adults. This interpretation was supported by observed reluctance to participate in self-regulatory BCTs in the current study.     

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.     

A randomised controlled trial of a brief online mindfulness-based intervention

ObjectivesThere is growing evidence that mindfulness has positive consequences for both psychological and physical health in both clinical and non-clinical populations. The potential benefits of mindfulness underpin a range of therapeutic intervention approaches designed to increase mindfulness in both clinical and community contexts. Self-guided mindfulness-based interventions may be a way to increase access to the benefits of mindfulness. This study explored whether a brief, online, mindfulness-based intervention can increase mindfulness and reduce perceived stress and anxiety/depression symptoms within a student population.MethodOne hundred and four students were randomly allocated to either immediately start a two-week, self-guided, online, mindfulness-based intervention or a wait-list control. Measures of mindfulness, perceived stress and anxiety/depression were administered before and after the intervention period.ResultsIntention to treat analysis identified significant group by time interactions for mindfulness skills, perceived stress and anxiety/depression symptoms. Participation in the intervention was associated with significant improvements in all measured domains, where no significant changes on these measures were found for the control group.ConclusionsThis provides evidence in support of the feasibility and effectiveness of shorter self-guided mindfulness-based interventions. The limitations and implications of this study for clinical practice are discussed.     

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

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.     

Effect of early intervention on social interaction between mothers and preterm infants at 12 months of age: a randomized controlled trial

In a randomized controlled trial at 12-months of age, the effect of the Mother Infant Transaction Program was tested on social interaction between mothers and moderately and late preterm infants with gestational age ≥ 30.0 and <36 weeks. Ninety-three play sessions were videotaped and coded, 46 mothers-infants in the intervention group and 47 mothers-infants in the control group. The intervention mothers scored higher on maternal sensitivity/responsiveness (p = .05). Being a first-time mother was a moderator that enhanced the effects of the intervention. First-time mothers were more sensitive/responsive to their infant's cues (p = .01), and the dyads evinced higher level of synchrony (p = .02) as compared with experienced mothers. More positive mood was observed among their infants (p = .04). The findings suggest that the intervention contributes to better mother-infant interactions in moderately and late preterm infants of first-time mothers.     

心理健康素养：概念、评估、干预与作用

心理健康素养是促进心理健康的重要途径。狭义概念指帮助人们认识、处理和预防心理疾病的相关知识和信念; 广义概念指综合运用心理健康知识、技能和态度, 保持和促进心理健康的能力。心理健康素养常采用情景案例问卷、单维或多维评估量表等进行评估, 可以通过社会运动、学校教育、自助式应用程序、心理健康急救培训等方式进行有效干预提高, 其中心理健康知识、心理疾病识别、情绪调节、减少病耻感、积极的求助态度等成分都有促进心理健康的作用。未来研究可以在建构评估指标体系、探索作用机制、扩展涵盖群体与内容、加强实证干预研究等方面深入开展。     

Decreasing influence of arbitrarily applicable verbal relations of recreational gamblers: A randomized controlled trial

Twenty‐one recreational gamblers were randomly assigned to two groups; one group was exposed to a conditional discrimination relational training task to bias choice allocation to a black machine presented concurrently with a red machine, and the other group underwent the same relational training task immediately followed by a defusion procedure, designed to expand upon the relations developed in the initial relational task. Both groups completed a simulated slot‐machine task before and after the relational training task, with or without the defusion procedure. Results showed that 9 of 11 participants in the relational training only group showed an increased bias toward the black machine, compared to only 4 of 10 in the relational training plus defusion group; this latter group also showed greater matched responding. Results suggest that expanding verbal–relational networks may reduce the influence of any single verbal relation on gambling choice behavior.     

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.     

Activity experiences shape perceived fitness trajectories: Results from a 6-month randomized controlled trial in older women

ABSTRACT

In this study we addressed the subjective benefits of activity interventions that were designed to improve cognitive fitness in old age. Two hundred and fifty-nine women (aged 70–93 years) were randomized to participate in an exercise or a computer course or a control condition for 6 months. Subjective ratings of the perceived change of cognitive and physical fitness components were captured before, during, after the intervention interval, and at a 10-month follow-up. Positive and negative affect levels and objective cognitive fitness parameters served as possible covariates. Multilevel modeling revealed that the computer group rated memory and concentration as having improved at 4 months and again at 6 months. The exercise group, in contrast, perceived physical capacities as maintained or improved. The characteristics of the activity experience seem to determine the perceived fitness changes. We conclude that actual learning experiences improve one's self-concept of abilities.