No-show was predicted by both demographic and clinical factors, whereas drop-out was predicted by demographic factors and substance abuse as the only clinical factor. Results and strategies to reduce non-attendance are discussed.
The aim of this study is to investigate the effectiveness of student counseling in Denmark and to compare the symptomatic distress among student counseling clients with that of Danish outpatients. The pre-intervention level of self-reported symptomatic distress among 1256 students closely paralleled that of psychiatric outpatients. Participants in the intervention study were the 739 student clients with two or more counseling sessions. For the 530 (71.7%) participants with both pre-and post-measurements, the mean pre-post Cohen's d effect size was 0.76 on the Global Severity Index of the Symptom Check List-90-Revised (Derogatis, 1992). An intention-to-treat analysis of all 739 clients resulted in an effect size of 0.59. The number of recovered clients according to the Jacobson and Truax (1991) criteria was 295 (68.8%) of the 429 (80.9%) clients above the clinical cutoff at preintervention, while 66 (12.5%) of the 530 clients reliably deteriorated. The mean number of sessions was 5.0. Individual counseling, number of sessions, and ending counseling in agreement predicted better outcome. In line with results from other countries, this study may indicate that in Denmark student counseling is an effective intervention for a highly needy clientele, even though a high proportion of clients deteriorated (12.5%) or droppedout (31.7%).
BackgroundInternet-based self-help psychotherapy (IBT) could be an important alternative or supplement to ordinary face-to-face therapy. The findings of randomised controlled trials indicate that the effects of various IBT programmes for anxiety disorders seem better than no intervention and in some instances are equivalent to usual therapy. In Denmark, IBT is part of future treatment plans in mental health care services, but the verification level of the current clinical scientific knowledge is insufficient. The objective of this trial is feasibility assessment of benefits and harms of the Internet-based cognitive behavioural therapy (ICBT) programme FearFighter™ versus no intervention for anxiety disorders in adults.Methods and designWe will conduct an investigator-initiated, feasibility randomised controlled trial. Sixty-four participants are expected to be recruited via an advertisement posted on the homepage of the Student Counselling Service in Denmark. The inclusion criterion for participation in the trial will be the presence of anxiety disorder as assessed with the Mini International Neuropsychiatric Interview. The exclusion criteria will be suicidal risk, an ongoing episode of bipolar disorder or psychosis, concurrent psychological treatment for the anxiety disorder, considered unable to attend the intervention as planned (due to vacation, work/study placement, sickness, or similar occurrences), or lack of informed consent. The intervention group will be offered nine sessions with the ICBT programme FearFighter™ and a weekly telephone contact to support compliance. The control group will receive no intervention. We define the feasibility outcomes as follows: the fraction of randomised participants out of the eligible people (the lower 95 % confidence interval (CI) ≥ 50 %); and the fraction of compliant participants (those receiving at least six out of nine sessions) in the intervention group (the lower 95 % CI ≥ 60 %). The exploratory clinical outcomes are the number of participants no longer meeting the diagnostic criteria for an anxiety disorder at the end of the trial and level of distress (Beck Anxiety Inventory, Symptom Checklist-90-R, WHO Well-Being Index, Sheehan Disability Scale); the number of severe adverse events; and the occurrence of any psychological treatment outside the trial.To prevent bias in design, and in the gathering and analysis of data throughout the trial, we will follow the SPIRIT 2013 statement which defines standard protocol items for clinical trials.DiscussionBased on our findings, we will discuss the feasibility of a future randomised controlled trial examining the benefits and harms of FearFighter™ versus no intervention for anxiety disorders in adults.Trial registrationClinicalTrials.gov Identifier: NCT02499055, registered on 1 July 2015.
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