Internet-based treatment of depression: a randomized controlled trial comparing guided with unguided self-help

Internet-delivered self-help for depression with therapist guidance has shown efficacy in several trials. Results from meta-analyses suggest that guidance is important and that self-help programs without support are less effective. However, there are no direct experimental comparisons between guided and unguided internet-based treatments for depression. The present study compared the benefits of a 10-week web-based unguided self-help treatment with the same intervention complemented with weekly therapist support via e-mail. A waiting-list control group was also included. Seventy-six individuals meeting the diagnostic criteria of major depression or dysthymia were randomly assigned to one of the three conditions. The Beck Depression Inventory (BDI-II) was used as the primary outcome measure. Secondary outcomes included general psychopathology, interpersonal problems, and quality of life. Sixty-nine participants (91%) completed the assessment at posttreatment and 59 (78%) at 6-month follow-up. Results showed significant symptom reductions in both treatment groups compared to the waiting-list control group. At posttreatment, between-group effect sizes on the BDI-II were d = .66 for unguided self-help versus waiting-list and d = 1.14 for guided self-help versus waiting-list controls. In the comparison of the two active treatments, small-to-moderate, but not statistically significant effects in favor of the guided condition were found on all measured dimensions. In both groups, treatment gains were maintained at 6-month follow-up. The findings provide evidence that internet-delivered treatments for depression can be effective whether support is added or not. However, all participants were interviewed in a structured diagnostic telephone interview before inclusion, which prohibits conclusions regarding unguided treatments that are without any human contact.     

Cost-effectiveness of Internet-based cognitive behavior therapy vs. cognitive behavioral group therapy for social anxiety disorder: results from a randomized controlled trial

Social anxiety disorder (SAD) is highly prevalent and associated with a substantial societal economic burden, primarily due to high costs of productivity loss. Cognitive behavior group therapy (CBGT) is an effective treatment for SAD and the most established in clinical practice. Internet-based cognitive behavior therapy (ICBT) has demonstrated efficacy in several trials in recent years. No study has however investigated the cost-effectiveness of ICBT compared to CBGT from a societal perspective, i.e. an analysis where both direct and indirect costs are included. The aim of the present study was to investigate the cost-effectiveness of ICBT compared to CBGT from a societal perspective using a prospective design. We conducted a randomized controlled trial where participants with SAD were randomized to ICBT (n = 64) or CBGT (n = 62). Economic data were assessed at pre-treatment, immediately following treatment and six months after treatment. Results showed that the gross total costs were significantly reduced at six-month follow-up, compared to pre-treatment in both treatment conditions. As both treatments were equivalent in reducing social anxiety and gross total costs, ICBT was more cost-effective due to lower intervention costs. We conclude that ICBT can be more cost-effective than CBGT in the treatment of SAD and that both treatments reduce societal costs for SAD.     

Exploring Latent Profiles of Psychopathology in a Sample of Lonely People Seeking Treatment

Journal of Psychopathology and Behavioral Assessment - Loneliness is a common experience in populations experiencing mental health problems. Associations with symptoms of psychopathology are...     

Individually tailored internet-based cognitive behaviour therapy for older adults with anxiety and depression: a randomised controlled trial

Mixed anxiety and depression is common among older adults. The aim of the study was to compare the effects of an eight-week-long tailored internet-supported cognitive behaviour therapy (ICBT) programme and to compare against the provision of weekly general support. A second aim was to investigate if pre-treatment cognitive flexibility and self-reported cognitive problems would predict outcome. We included 66 older adults (aged over 60 years) with mixed anxiety/depression following media recruitment and randomised them into treatment and control groups. We also included a one-year follow-up. As a measure of executive function, we used the Wisconsin Card Sorting Test (perseverative errors) and the Cognitive Failures Questionnaire during the pre-treatment phase. Results showed a moderate between-group effect on the main outcome measure, the Beck Anxiety Inventory (BAI) (d= .50), favouring the treatment group. Nearly half (45.5%) of that group were classified as responders. One person (3%) in the treatment group deteriorated. There were significant correlations between perseverative errors and outcome (on the BAI r = ?.45), but not among self-reported cognitive function. We conclude that guided, tailored ICBT may be effective for some older adults and that the role of cognitive function needs to be investigated further.     

Religious versus Conventional Internet-based Cognitive Behavioral Therapy for Depression

The accessibility and efficacy of two Internet-supported interventions for depression: conventional cognitive behavioral therapy (C-CBT) and religious CBT (R-CBT) were investigated. Depressed participants (N = 79) were randomly assigned to either active treatment or wait-listed control group. Self-report measures of depression, anxiety, and life quality were collected before, immediately after, and 6 months after the intervention. Significant differences among the three conditions emerged at post-intervention with medium to large effect sizes (Cohen’s d between 0.45 and 1.89), but no differences between the R-CBT and C-CBT were found. However, the addition of religious components to CBT contributed to the initial treatment appeal for religious participants, thus increasing the treatment accessibility.     

The relationship between cognitive abilities and maternal ratings of externalizing behaviors in preschool children

The association between child cognitive abilities and maternal ratings of child externalizing behaviors was investigated in a randomly selected sample of 290 preschool children. Child cognitive abilities were assessed by the WPPSI-R, whereas mothers completed the Yale Children's Inventory for the assessment of child externalizing behaviors. Maternal education, and maternal child-rearing style, as defined by scores on the Child Rearing Practices Report, was significantly related to perceived externalizing child behavior. Hierarchical regression analyses revealed that for girls, low child IQ remained a significant predictor of perceived externalizing behavior when effects of maternal education and child-rearing style were controlled for (p < 0.01). Maternal child-rearing style made independent contributions to explaining variance in girls' and boys' behavior score. The results are discussed in terms of differential gender socialization practices and gender stereotypes.     

Achievement of specificational information usage with true and false feedback in learning a visual relative-mass discrimination task

Participants' usage of informational variables in learning visual relative-mass discrimination in collisions was tracked by means of PROBIT correlations. Four groups received feedback that was true or accorded with either of three nonspecificational cue variables. A majority in each group adopted the feedback, but several participants defied the false feedback. Unlike in previous research, the fit to data of the relative-mass invariant could not be bettered by post hoc linear combinations of the cues. Discriminability was lower in the use of the invariant. Analytic complexity was rejected as an explanation for discriminability differences. A "smart mechanism" for pickup of the relative-mass invariant was developed as an extension of G. Johansson's (1950/1994) vector model.     

Fatigue, cognitive functioning and psychological distress in Marfan syndrome, a pilot study

Marfan patients report fatigue as a major subjective complaint. We found no studies exploring the subject. The aim of this study was in a strictly defined Marfan population to assess self-reported fatigue, cognitive functions and psychological distress, correlations among them and correlations to visual acuity, joint hypermobility and use of beta-blockers. Sixteen subjects aged 18 - 30 years, fulfilling the Gent criteria, were assessed with the Fatigue Severity Scale, Fatigue Questionnaire, a comprehensive battery of neuropsychological tests and the General Health Questionnaire (GHQ). Self-reported fatigue was comparable with fatigue reported in other severe chronic diseases and disabilities, and was primarily in the mental/psychological domain. Psychological distress was higher than expected compared with the population at large. All neuropsychological test results were within the normal range, except for tests of visuo-motor coordination and speed of information processing. There was a significant inverse correlation between Fatigue Questionnaire ratings and some neuropsychological tests. Fatigue seems to be a serious problem for persons with Marfan syndrome and seems related to some areas of cognitive functioning. We found no overall impairment in cognitive functioning, but slightly reduced speed of information processing. Reduced visuo-motor coordination could be explained by impaired visual acuity.     

Therapeutic alliance in guided internet-delivered cognitive behavioural treatment of depression, generalized anxiety disorder and social anxiety disorder

Guided internet-delivered cognitive behaviour therapy (ICBT) has been found to be effective in several controlled trials, but the mechanisms of change are largely unknown. Therapeutic alliance is a factor that has been studied in many psychotherapy trials, but the role of therapeutic alliance in ICBT is less well known. The present study investigated early alliance ratings in three separate samples. Participants from one sample of depressed individuals (N = 49), one sample of individuals with generalized anxiety disorder (N = 35), and one sample with social anxiety disorder (N = 90) completed the Working Alliance Inventory (WAI) modified for ICBT early in the treatment (weeks 3-4) when they took part in guided ICBT for their conditions. Results showed that alliance ratings were high in all three samples and that the WAI including the subscales of Task, Goal and Bond had high internal consistencies. Overall, correlations between the WAI and residualized change scores on the primary outcome measures were small and not statistically significant. We conclude that even if alliance ratings are in line with face-to-face studies, therapeutic alliance as measured by the WAI is probably less important in ICBT than in regular face-to-face psychotherapy.