BackgroundAdjustment Disorder (AjD) is a common and disabling mental health problem. The lack of research on this disorder has led to the absence of evidence-based interventions for its treatment. Moreover, because the available data indicate that a high percentage of people with mental illness are not treated, it is necessary to develop new ways to provide psychological assistance. The present study describes a Randomized Controlled Trial (RCT) aimed at assessing the effectiveness and acceptance of a linear internet-delivered cognitive-behavioral therapy (ICBT) intervention for AjD.MethodsA two-armed RCT was designed to compare an intervention group to a waiting list control group. Participants from the intervention group will receive TAO, an internet-based program for AjD composed of seven modules. TAO combines CBT and Positive Psychology strategies in order to provide patients with complete support, reducing their clinical symptoms and enhancing their capacity to overcome everyday adversity. Participants will also receive short weekly telephone support. Participants in the control group will be assessed before and after a seven-week waiting period, and then they will be offered the same intervention. Participants will be randomly assigned to one of the 2 groups. Measurements will be taken at five different moments: baseline, post-intervention, and three follow-up periods (3-, 6- and 12-month). BDI-II and BAI will be used as primary outcome measures. Secondary outcomes will be symptoms of AjD, posttraumatic growth, positive and negative affect, and quality of life.DiscussionThe development of ICBT programs like TAO responds to a need for evidence-based interventions that can reach most of the people who need them, reducing the burden and cost of mental disorders. More specifically, TAO targets AjD and will entail a step forward in the treatment of this prevalent but under-researched disorder. Finally, it should be noted that this is the first RCT focusing on an internet-based intervention for AjD in the Spanish population.Trial registrationClinicalTrial.gov: NCT02758418. Trial registration date 2 May 2016.
Adjustment disorder (AD) and complicated grief (CG) are serious mental conditions that have a high prevalence and are associated with significant impairments in social and work functioning. Recently, these categories have been better specified in the new ICD‐11 proposal. Empirical research on the efficacy of treatments for these problems is scarce. This study aims to offer long‐term efficacy data from a between‐groups controlled study that compares two treatment conditions (AD‐protocol applied in a traditional way: N = 18 and the same protocol supported by virtual reality (VR); VR‐protocol applied in a traditional way: N = 18) and a waiting list (WL) control group (N = 18). Both treatment conditions resulted in statistically significant improvements on both primary and secondary outcome measures, with large effect sizes, and this improvement did not occur in the WL. These changes were maintained in both treatment conditions in the medium (6‐month) and long‐term (12‐month follow‐up). Larger effect sizes were achieved in the VR condition in the long term. Furthermore, clinically significant change estimations on the primary outcome measures showed an advantage for the VR condition This is the first controlled study to compare a traditional face‐to‐face protocol for the treatment of stress‐related disorders with the same protocol supported by VR and a WL control group.
Adjustment disorder (AjD) is one of the most common disorders in clinical practice, and its symptoms are severe enough to cause great distress and functional impairment. The AjD CBT protocol specifically developed for this disorder has shown positive results when delivered face to face and through virtual reality. Despite existing evidence supporting the benefits of therapeutic homework as part of a psychological intervention, little is known about how to increase homework engagement in psychotherapy. This study examines the feasibility (doability, initial efficacy and acceptability) of a digital support system to deliver homework via the Internet in the treatment of AjD. Participants were randomly assigned to a traditional homework condition or a digital support system condition. Both interventions resulted in statistically significant improvements, with large effect sizes, in all the outcome measures at post-treatment, with no significant differences between groups. At 12-month follow-up, these therapeutic gains were maintained, and an improvement was even observed in both conditions, with no significant differences between groups. Additionally, treatment satisfaction predicted efficacy in both groups separately and when the whole group was considered. This is the first study to explore the feasibility an initial efficacy of delivering a therapeutic homework component for AjD through the Internet.
Background: Adjustment Disorder (AjD) is one of the most frequently diagnosed mental disorders worldwide. However, there is still no treatment of choice for this problem. One of the first treatment programs specifically designed for AjD is the one presented in this study, a CBT protocol that uses Virtual Reality (VR) to improve patients’ adherence. Another key aspect to improve treatment outcomes is the use of between-sessions homework. However, little is known about how to increase patient engagement with these tasks. The use of Information and Communication Technologies (ICTs) can help patients to see homework as less demanding and provides greater flexibility. A previous study tested the feasibility of TEO (Online Emotional Therapy), a program to implement online homework during treatment. The aim of this study is to present session-to-session efficacy data from the homework assignment component and the patients’ preferences and opinions about this component in both formats (Traditional vs. TEO).Methods: A two-arm pilot randomised clinical trial (RCT) was conducted with 57 patients with AjD. The two groups received the same CBT intervention with VR support, but one group completed homework in the traditional way and the other using TEO. Mood, self-efficacy and positive and negative emotions were measured to test the effect of the homework component in each treatment session. Preferences about the homework format were also assessed before and after treatment.Results: Both types of administration produced significant improvements in mood, self-efficacy and emotional variables after completion of the homework component and before and after each homework session. Effect sizes ranged from small to large, with no differences between groups. Regarding the acceptability of the program, most participants preferred the TEO condition both before starting the treatment and after completing the homework assignment. Overall, participants were satisfied with all homework sessions and found them useful. Again, no significant differences were found between groups.Conclusion: This is the first time that the effect of an online homework program during AjD treatment has been tested. It is proposed that this way of implementing homework could be as effective as the traditional format, but would be preferred by patients.Clinical Trial Registration:clinicaltrials.gov, identifier NCT02452411
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