Internet-delivered transdiagnostic and tailored cognitive behavioral therapy for anxiety and depression: a systematic review and meta-analysis of randomized controlled trials

Anxiety and depressive disorders are often comorbid. Transdiagnostic and tailored treatments seem to be promising approaches in dealing with comorbidity. Although several primary studies have examined the effects of Internet-delivered cognitive behavior therapy (iCBT) for anxiety and depression, no meta-analysis including different types of iCBT that address comorbidity has been conducted so far. We conducted systematic searches in databases up to 1 July 2016. Only randomized trials comparing transdiagnostic/tailored iCBT for adult anxiety and/or depression with control groups were included. Nineteen randomized trials with a total of 2952 participants that met inclusion criteria were analyzed. The quality of the studies was high, however the blinding criteria were not fulfilled. The uncontrolled effect size (Hedges’ g) of transdiagnostic/tailored iCBT on anxiety and depression outcomes was large and medium for quality of life. The controlled effect size for iCBT on anxiety and depression outcomes was medium to large (anxiety: g = .82, 95% CI: .58–1.05, depression: g = .79, 95% CI: .59–1.00) and medium on quality of life (g = .56, 95% CI: .37–.73). Heterogeneity was small (quality of life) to moderate (anxiety, depression). There was a large effect on generic outcome measures and a moderate effect on comorbidities. When compared to disorder-specific treatments there were no differences on anxiety and quality of life outcomes, however there were differences in depression outcomes. Transdiagnostic and tailored iCBT are effective interventions for anxiety disorders and depression. Future studies should investigate mechanisms of change and develop outcome measures for these interventions.     

Differences in baseline and process variables between non-responders and responders in Internet-based cognitive behavior therapy for chronic tinnitus

Although Internet-based cognitive behavior therapy (iCBT) is an effective treatment for chronic tinnitus, several patients do not improve. In the current study, baseline and process variables were compared between non-responders and responders. Data from patients participating in two randomized controlled trials on iCBT for chronic tinnitus were re-analyzed. Based on the literature, a pre-post difference on the “Tinnitus Handicap Inventory” (THI) of less than seven points improvement was used to operationalize non-response. Associations between non-response and baseline variables (age, gender, and questionnaire scores), patient progress (THI), the process of the therapeutic alliance (“Working Alliance Inventory-Short Revised”; WAI-SR), as well as other process variables (number of logins, amount of messages sent from therapists to patients) were investigated. The results showed that non-responders had a less favorable change on the THI than responders already at mid-treatment (p < .05). The alliance (WAI-SR) during iCBT was not associated with non-response. Non-responders showed more severe sleep disturbances, logged in less in the iCBT platform, and received fewer messages from the therapists than responders, but these differences were mostly not significant anymore when correcting for multiple testing. To conclude, no symptom change in the first half of iCBT for chronic tinnitus patients is a risk factor of not benefiting from iCBT.     

Faithfulness for naive validity

Nontransitive responses to the validity Curry paradox face a dilemma that was recently formulated by Barrio, Rosenblatt and Tajer. It seems that, in the nontransitive logic ST enriched with a validity predicate, either you cannot prove that all derivable metarules preserve validity, or you can prove that instances of Cut that are not admissible in the logic preserve validity. I respond on behalf of the nontransitive approach. The paper argues, first, that we should reject the detachment principle for naive validity. Secondly, I show how to add a validity predicate to ST while avoiding the dilemma.

     

Effects of social isolation and environmental enrichment on atherosclerosis in ApoE-/- mice

Social support and a stimulating environment have been suggested to reduce stress reactions and cardiovascular risk. The aim of this study was to assess the role of environmental enrichment and social interaction for development of atherosclerosis in atherosclerosis prone mice. Male ApoE-/- mice were divided into four groups and followed during 20 weeks: (i) enriched environment (E, n=12), (ii) deprived environment (ED, n=12), (iii) enriched environment with exercise (E-Ex, n=12) and (iv) socially deprived by individual housing (SD, n=10). Plasma lipid and cytokine concentrations were measured. Atherosclerosis was quantified in cross-sections of innominate artery and en face in thoracic aorta. Plaque area was significantly increased in SD mice in the innominate artery (P<0.05 vs. all other groups), but not in the thoracic aorta. Plasma lipids were increased in SD mice (P<0.001 vs. all for total cholesterol, P<0.05 vs. E and P<0.01 vs. ED for triglycerides). Plasma concentration of granulocyte-colony stimulating factor (G-CSF) was decreased in SD mice compared to E mice (P<0.05). Thus, social isolation increased atherosclerosis and plasma lipids in ApoE-/- mice. Reduction in plasma G-CSF levels may hamper endothelial regeneration in the atherosclerotic process. While environmental enrichment did not affect atherosclerosis, social isolation accelerated atherosclerosis.     

The relation between employee organizational and professional development activities

A model is presented showing hypothesized common and parallel antecedents of employee organizational development activity (ODA) versus professional development activity (PDA). A common antecedent is expected to affect both ODA and PDA, while a parallel antecedent is expected to affect its corresponding work referent. This model was tested using a sample of 197 medical technologists over a four year time period. Prior ODA and PDA were controlled for before testing hypotheses. Results showed that the common antecedent of learning motivation was a robust indicator of both ODA and PDA. Looking at parallel antecedents, job satisfaction and affective organizational commitment had a positive impact on ODA, while occupational satisfaction and affective occupational commitment had a positive impact on PDA. ODA had a negative impact on subsequent intent to leave organization, but PDA did not have a similar impact on intent to leave profession. Study limitations, issues around operationalizing ODA and PDA, and future research directions are discussed.     

Long-term outcome of Internet-delivered cognitive-behavioural therapy for social phobia: A 30-month follow-up

Internet-delivered guided cognitive behaviour therapy for social anxiety disorder has been found to generate promising short-term results, up to one year posttreatment. No study has however documented longer follow-up periods. In this 30-month follow-up we contacted 57 participants from the original study of which 77.2% (44/57) responded to the Internet-administered outcome measures and 66.7% (38/57) completed a telephone interview. Results showed large pretreatment to follow-up within-group effect sizes for the primary outcome measures (Cohen's d 1.10-1.71), and a majority (68.4%; 26/38) reported improvements in the interview. The findings suggest that the long-term effects seen in previous live treatment CBT trials can occur in Internet-delivered treatment as well.     

Social influence on predictions of simulated stock prices

Herding in financial markets refers to that investors are influenced by others. This study addresses the importance of consistency for herding. It is suggested that, in financial markets perceptions of consistency are based on repeated observations over time. Consistency may then be perceived as the agreement across time between investors' predictions. In addition, consistency may be related to variance over time in each investor's predictions. In an experiment using a Multiple Cue Probability Learning paradigm, 96 undergraduates made multi‐trial predictions of future stock prices given information about the current price and the predictions made by five fictitious others. Consistency was varied between the others' predictions (correlation) and within the others' predictions (variance). The results showed that the predictions were significantly influenced by the others' predictions when these were correlated. No effect of variance was observed. Hence, participants were influenced by the others when they were in agreement, regardless of whether they varied their predictions over trials or not. Copyright © 2008 John Wiley & Sons, Ltd.     

Pro-Environmental Habits: Propensity Levels in Behavioral Change1

A proposed model for behavioral change is described as a process in several steps from habitual nonenvironmentally friendly behavior to environmentally friendly behavior. Every step is linked to factors promoting or impeding further progress. Data from a questionnaire addressed to a random sample of 500 Swedish adults supported the hypothesis that general factors such as environmental values and a sense of responsibility for the environment will be more influential in an early phase rather than in a later phase of changing established habits regarding purchases of washing and washing-up detergents, respectively. Furthermore, in a later phase of transition, specific beliefs about particular products will affect the testing and evaluation of a new behavior.     

Sex-role orientation as related to psychological and physiological responses during achievement and orthostatic stress

The Bem sex-role inventory was used to select, from an Irish student population, females and males who differed with regard to feminine and masculine personality characteristics. Four groups were established for each sex: (1) subjects with low scores in both femininity and masculinity, i.e., undifferentiated subjects; (2) subjects with high scores in both femininity and masculinity, i.e., androgynous subjects; (3) subjects with high scores in femininity and low scores in masculinity; (4) subjects with high scores in masculinity and low scores in femininity. The Cattell 16 PF scale showed that the undifferentiated groups were more reserved and detached and more cautious and taciturn than the androgynous groups. Each subject was exposed to mental stress in one session and orthostatic stress in another session. Mental stress was induced by five different intellectual performance tests. Males and females differed significantly only on a test of perceptual speed, with females performing better than males, as expected. The group of androgynous females was superior to all other groups on four of the five performance tasks. The group of androgynous males was not superior in terms of objective performance but reported feeling more confident andThis collaboration was made possible by a twinning grant to Dr. John Cullen and Professor Marianne Frankenhaeuser from the European Training Programme in Brain and Behaviour Research, European Science Foundation. Financial support was also obtained by grants from the Swedish Medical Research Council (Project No. 997) and the Swedish Council for Research in the Humanities and Social Sciences. satisfied with their performance than most other groups, particularly the undifferentiated males. Blood pressure and heart rate were significantly elevated in all groups during both stress conditions. Heart rate was significantly higher in the high-femininity and androgynous females than in the other female groups.