Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis

During the last two decades, Internet-delivered cognitive behavior therapy (ICBT) has been tested in hundreds of randomized controlled trials, often with promising results. However, the control groups were often waitlisted, care-as-usual or attention control. Hence, little is known about the relative efficacy of ICBT as compared to face-to-face cognitive behavior therapy (CBT). In the present systematic review and meta-analysis, which included 1418 participants, guided ICBT for psychiatric and somatic conditions were directly compared to face-to-face CBT within the same trial. Out of the 2078 articles screened, a total of 20 studies met all inclusion criteria. Results showed a pooled effect size at post-treatment of Hedges g = .05 (95% CI, ?.09 to .20), indicating that ICBT and face-to-face treatment produced equivalent overall effects. Study quality did not affect outcomes. While the overall results indicate equivalence, there have been few studies of the individual psychiatric and somatic conditions so far, and for the majority, guided ICBT has not been compared against face-to-face treatment. Thus, more research, preferably with larger sample sizes, is needed to establish the general equivalence of the two treatment formats.     

Mapping Uncertainties in the Upstream: The Case of PLGA Nanoparticles in Salmon Vaccines

The diversity of nanotechnologies and of the governance challenges that their applications raise calls for exploration and learning across different cases. We present an Upstream Oversight Assessment (UOA) of expected benefits and potential harms of nanoparticles made of a synthetic polymer (PLGA) to improve vaccines for farmed salmon. Suggested by Jennifer Kuzma and colleagues, an UOA may help identify and prioritise research needs, and it may support evaluations of the adequacy of relevant existing regulatory frameworks. In this work, the UOA approach is modified and supported with elements from the uncertainty analysis framework developed by Warren Walker and colleagues. Empirically, we draw on relevant available published literature and insights generated in an ongoing nanoparticle salmon vaccine project, in which one of the authors participates. Nanotechnologies have not previously been encountered in the regulatory context of fish vaccines, which in part raises unique challenges due to prospective large scale vaccine use in semi-open aquatic systems. Strengthened through cooperation between ELSA and technology researchers we found the UOA useful for an early mapping of benefits and concerns, and for identifying areas in need of further research prior to a nanoparticle based salmon vaccine is developed and taken into use. We consider our approach to represent one among several complementing initiatives that seek to contribute to early stage evaluations of possible negative side effects, broadly conceived, in order to facilitate a more robust nanotechnology development.     

Eating-related problems among 13-15 year old Swedish adolescents: Frequency and stability over a one-year period

Viborg, N., Wångby‐Lundh, M., Lundh, L.‐G. & Johnsson P. (2012). Eating‐related problems among 13‐15 year old Swedish adolescents: Frequency and stability over a one‐year period. Scandinavian Journal of Psychology 53, 401–406. The frequency of eating‐related problems in young adolescents, and their stability over a one‐year period, was studied by the RiBED‐8 (Risk Behaviours related to Eating Disorders, 8 items) in a community sample of 13–15 year old adolescents who took part in a prospective study with a 2‐wave longitudinal design. The RiBED‐8 was found to have good reliability and construct validity among the girls, although it did not show equally convincing psychometric properties among boys. With a cut‐off of at least three critical answers on the RiBED‐8, 28.5–31.0% of the girls were seen as risk cases for the development of eating disorder. Of those girls who were risk cases at Time 1, a majority (68.8%) remained so at Time 2; of those girls who were not risk cases at Time 1, 16.1% became risk cases at Time 2. It is suggested that the RiBED‐8 is a brief, easily administered instrument that may be potentially useful in screening for eating‐related problems among girls.     

Treatment of panic disorder: live therapy vs. self-help via the Internet

A randomized trial was conducted comparing 10 individual weekly sessions of cognitive behaviour therapy for panic disorder (PD) with or without agoraphobia with a 10-module self-help program on the Internet. After confirming the PD diagnosis with an in-person structured clinical interview (SCID) 49 participants were randomized. Overall, the results suggest that Internet-administered self-help plus minimal therapist contact via e-mail can be equally effective as traditional individual cognitive behaviour therapy. Composite within-group effect sizes were high in both groups, while the between-group effect size was small (Cohen's d=16). One-year follow-up confirmed the results, with a within-group effect size of Cohen's d=0.80 for the Internet group and d=0.93 for the live group. The results from this study generally provide evidence to support the continued use and development of Internet-distributed self-help programs.     

Stuttering, emotions, and heart rate during anticipatory anxiety: a critical review

Persons who stutter often report their stuttering is influenced by emotional reactions, yet the nature of such relation is still unclear. Psychophysiological studies of stuttering have failed to find any major association between stuttering and the activity of the sympathetic nervous system. A review of published studies of heart rate in relation to stressful speech situations indicate that adults who stutter tend to show a paradoxical reduction of heart rate compared with nonstuttering persons. Reduction of heart rate has also been observed in humans and mammals during anticipation of an unpleasant stimulus, and is proposed to be an indication of anticipatory anxiety resulting in a "freezing response" with parasympathetic inhibition of the heart rate. It is suggested that speech-related anticipatory anxiety in persons who stutter is likely to be a secondary, conditioned reaction based on previous experiences of stuttering. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe how the autonomic nervous system is modulated by emotional responses; (2) explain how anticipatory fear often results in inhibition of heart rate due to parasympathetic activation; (3) discuss why emotional reactions in persons who stutter may be secondary to negative experiences of speech problems.     

High-fidelity perceptual long-term memory revisited--and confirmed

Experiments on short-term perceptual memory for elemental visual attributes, such as contrast, motion, orientation, and spatial frequency, have relied on a delayed discrimination technique in which the subject compares two stimuli presented at different points in time and memory is indexed by discrimination thresholds measured for the different time intervals between reference and test. In a variant of this procedure, used in experiments on long-term memory, the presentation of a single reference is followed by a memory test that combines two-alternative forced-choice decisions with the method of constant stimuli. With this procedure, it is impossible to distinguish the effects of criterion-setting processes and memory on performance, but this confound can be eliminated by testing many subjects and having each subject make a single decision. The resulting "group thresholds" are stable across time intervals of 24 hr, confirming previous findings of high-fidelity storage in the long-term memory range.     

Gender differences and the Defense Mechanism Test: A comparative study of adolescents in psychiatric care and healthy controls

The aim of this paper was to study gender differences in the percept-genetic method Defense Mechanism Test (DMT) among a group of 60 adolescent subjects. Three subgroups were used: patients with psychotic disorders (Axis 1); borderline personality disorder (Axis 2) according to the DSM-IV classification system, and a non-patient group. The test protocols were scored with respect to 124 DMT variables and analyzed by means of the multivariate projection method Partial Least Squares (PLS) in latent structures. The overall results showed considerable gender differences in the whole group as well as in the subgroups. The most striking finding was that girls compared to boys were characterized by the perceptual defense identification with the opposite sex, which means that they perceived male gestalts instead of females in the stimulus picture. When both gender and diagnostic group membership were considered simultaneously, the influence of diagnostic group membership seemed to be stronger than gender even if there was an interaction between diagnoses and gender. It was concluded that gender must be considered when the DMT is used on adolescent populations.