Online self‐help: Developing a student‐focused website for depression

Many depressed people, young men in particular, do not seek professional help. This social constructionist action research project aimed to construct a comprehensive self‐help website for students. Its goal was to give a multi‐layered (‘thick’) account of depression to website users offering empowering perspectives and strategies while challenging barriers to help‐seeking. Thirteen student interviewees, representing diverse demographics and depression experiences, attended semi‐structured interviews to elicit ‘coping’ narratives. Ten of them then formed an ongoing e‐mail focus group. An evaluative action research spiral was used to analyse and act upon public health guidelines, student interviews and student focus group commentary. Triangulation was provided via the specifications and ongoing feedback from the other project stakeholders. These were the funding charity steering group (including heads of university counselling services); the university providing programme/ethical approval; and the expert group offering clinical validation. The final site at www.studentdepression.org has nearly 100 pages of information and self‐help resources cross‐referenced with personal narratives. It provides a rich, complex account of how depression may be tackled and resisted. Both student and expert groups were impressed with final site quality and usefulness. Collaborative development with user‐group representatives is likely to have produced a far richer, more accessible and more comprehensive resource than counsellor authorship alone. 1 ¹Formerly at the Counselling Service, Royal Holloway University of London, UK.
     

Asking, Witnessing, Interpreting, Knowing: Conducting Qualitative Research in Community Psychology

We present a framework to describe the process of conducting community-based qualitative research. Qualitative research activities are presented as a series of interrelated acts called asking, witnessing, interpreting, and knowing. Each act in the research process is described in terms of current qualitative research practices, and illustrated with examples from our own research projects on families with schizophrenia and men's mutual support and batterer intervention groups. We critically examine the assumption that qualitative research serves to reveal or amplify the voices of participants. We examine connections between qualitative research and social change and describe the use of qualitative research to not only empower marginalized groups, but also to critique and transform privileged groups. The framework is intended to help community researchers to more fully conceptualize, understand, and engage in the practice of qualitative research.     

Barriers and Bridges to Intimacy and Mutuality: A Critical Review of Sexual Advice Found in Self-Help Bestsellers

Sexuality in a committed relationship is based ideally on both intimacy and mutuality. Gender socialization may limit women's and men's capacities in these two important areas of sexual relationships. This article describes the results of a content analysis of nine best-selling popular press books on the New York Times Bestseller List between 1988 and 1998 according to their advice related to sexual intimacy and mutuality. Books were analyzed to determine the degree to which they built barriers or bridges to the development of intimacy and mutuality. Results indicate that while most authors offered advice that built bridges to intimacy, several built barriers to the development of mutuality. Implications for therapists are discussed.     

Individual and contextual predictors of involvement in twelve-step self-help groups after substance abuse treatment

Drawing on ecological and narrative theories of self-help groups, this study tests a multilevel model predicting self-help group involvement among male veterans who received inpatient substance abuse treatment. Following K. Maton (1993), the study moves beyond the individual-level of analysis to encompass variables in the treatment and post-treatment social ecology. Surveys administered to patients (N = 3,018) and treatment staff (N = 329) assessed these predictor domains and self-help group involvement 1 year after discharge. A hierarchical linear model fit to the data indicates that greater involvement in 12-step groups after discharge is predicted by the compatibility between personal and treatment belief systems. The implications of these findings for efforts to facilitate transitions between inpatient professional treatment and community-based self-help groups are discussed.     

Randomized Effectiveness Trial of an Internet,Pure Self-Help,Cognitive Behavioral Intervention for Depressive Symptoms in Young Adults

This study evaluated an Internet-delivered, cognitive behavioral skills training program versus a treatment-as-usual (TAU) control condition targeting depression symptoms in young adults aged 18 to 24 years. Potential participants were mailed a recruitment brochure; if interested, they accessed the study website to complete an online consent and baseline assessment. Intervention participants could access the website at their own pace and at any time. Reminder postcards were mailed periodically to encourage return use of the intervention. The pure self-help intervention was delivered without contact with a live therapist. The primary depression outcome measure was the Patient Health Questionnaire, administered at 0, 5, 10, 16, and 32 weeks after enrollment. A small but significant between-group effect was found from Week 0 to Week 32 for the entire sample (N = 160, d = .20, 95% confidence interval [CI] 0.00–0.50), with a moderate effect among women (n = 128, d .42, 95%C1 = 0.09–0.77). Greater depression reduction was associated with two measures of lower website usage, total minutes, and total number of page hits. Although intervention effects were modest, they were observed against a background of substantial TAU depression pharmacotherapy and psychosocial services. Highly disseminable, low-cost, and self-help interventions such as this have the potential to deliver a significant public health benefit.     

Competitive Memory Training (COMET) for OCD: A Self-treatment Approach to Obsessions

Competitive Memory Training (COMET) is a cognitive intervention that aims to change the maladaptive cognitive-emotional networks underlying obsessive-compulsive disorder (OCD). COMET has not been previously tried as a self-help intervention. The present study tested the preliminary feasibility, acceptability, and effectiveness of COMET for OCD implemented as a self-help intervention. Sixty-five participants with OCD recruited through online OCD self-help fora completed an online baseline assessment including measures of OCD symptoms, self-esteem, and depression. Participants were randomly assigned to either COMET or a wait-list control group. All participants were approached 4 weeks later to complete an online post-assessment. There was no evidence for a greater decline of OCD symptoms or depression under COMET. When analyses were limited to only those participants who reported reading the entire manual at least once, self-esteem was higher at post-assessment in the COMET group. Although 78.1% of patients in the COMET group rated it as appropriate for self-administration, only 56.5% performed COMET exercises regularly and 26.4% read the entire manual at least once. The feasibility and effectiveness of COMET as a self-help internet intervention for OCD was not supported in this study. Further work is needed to better understand if modifications to our implementation of COMET may yield improved outcomes.     

Effects of guided reflexivity and team feedback on team performance improvement: The role of team regulatory processes and cognitive emergent states

The effectiveness of decision-making teams depends largely on the quality of information processing. Prior research has shown that guided team reflexivity and team feedback are important means of advancing team information processing and outcomes. However, the nature of the relationships, and how these relate to team regulatory processes, cognitive emergent states, and ultimately team performance, is currently poorly understood. Drawing on reflexivity and team information-processing theory, we proposed and found that teams that received guided team reflexivity or a combination of both guided reflexivity and feedback showed higher levels of actual reflection than teams that received neither a reflexivity intervention nor feedback. Conditional process analysis showed that the effects of team reflection on team performance improvement were mediated by a path from shared team mental models to shared task mental models and to adaptation. Finally, we also expected that team reflection would be lower in virtual teams than in face-to-face teams. These hypotheses were tested experimentally among 98 student teams that communicated either face-to-face or virtual (via chat) while completing a collective decision-making task. The information distribution among team members constituted a hidden profile. The results supported all our hypotheses, except for the one relating to virtuality.     

Internet-based treatment of social phobia: a randomized controlled trial comparing unguided with two types of guided self-help

Internet-based self-help for social phobia with minimal therapist support via email have shown efficacy in several controlled trials by independent research teams. The role and necessity of therapist guidance is, however, still largely unclear. The present study compared the benefits of a 10-week web-based unguided self-help treatment for social phobia with the same intervention complemented with minimal, although weekly, therapist support via email. Further, a third treatment arm was included, in which the level of support was flexibly stepped up, from no support to email or telephone contact, on demand of the participants. Eighty-one individuals meeting diagnostic criteria for social phobia were randomly assigned to one of the three conditions. Primary outcome measures were self-report measures of symptoms of social phobia. Secondary outcome measures included symptoms of depression, interpersonal problems, and general symptomatology. Measures were taken at baseline, post-treatment, and at 6-month follow-up. Data from a telephone-administered diagnostic interview conducted at post-treatment were also included. Results showed significant symptom reductions in all three treatment groups with large effect sizes for primary social phobia measures (Cohen’s d = 1.47) and for secondary outcome measures (d = 1.16). No substantial and significant between-groups effects were found on any of the measures (Cohen’s d = 00–.36). Moreover, no difference between the three conditions was found regarding diagnosis-free status, clinically significant change, dropout rates, or adherence measures such as lessons or exercises completed. These findings indicate that Internet-delivered treatment for social phobia is a promising treatment option, whether no support is provided or with two different types of therapist guidance.