Transdiagnostic versus disorder-specific and clinician-guided versus self-guided internet-delivered treatment for generalized anxiety disorder and comorbid disorders: A randomized controlled trial

Dear, Blake F.; Staples, Lauren G.; Terides, Matthew D.; Karin, Eyal; Zou, Judy; Johnston, Luke; Gandy, Milena; Fogliati, Vincent J.; Wootton, Bethany M.; McEvoy, Peter M.; Titov, Nickolai

doi:10.1016/j.janxdis.2015.09.003

Cited by 193 publications

(168 citation statements)

References 65 publications

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“…These findings are consistent with the results of previous studies that found no difference or small but statistically nonsignificant differences between different levels of guidance, not only in online interventions targeting depression, but also in online interventions for anxiety disorders [65,66], posttraumatic stress disorder [67], eating disorders [68], and alcohol abuse [69]. Given the level of standardization found in the IC arm of this study and in similarly constructed guided IBI, the guidance itself oftentimes consists of individualizing only a minor amount of text and might thus be considered a small “add-on” to already effective treatments.…”

Section: Discussionsupporting

confidence: 93%

Benefits of Individualized Feedback in Internet-Based Interventions for Depression: A Randomized Controlled Trial

Zagorscak

Heinrich

Sommer

et al. 2018

Psychother Psychosom

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Background: Even though there is an increasing number of studies on the efficacy of Internet-based interventions (IBI) for depression, experimental trials on the benefits of added guidance by clinicians are scarce and inconsistent. This study compared the efficacy of semistandardized feedback provided by psychologists with fully standardized feedback in IBI. Methods: Participants with mild-to-moderate depression (n = 1,089, 66% female) from the client pool of a health insurance company participated in a cognitive-behavioral IBI targeting depression over 6 weeks. Individuals were randomized to weekly semistandardized e-mail feedback from psychologists (individual counseling; IC) or to automated, standardized feedback where a psychologist could be contacted on demand (CoD). The contents and tasks were identical across conditions. The primary outcome was depression; secondary outcomes included anxiety, rumination, and well-being. Outcomes were assessed before and after the intervention and 3, 6, and 12 months later. Changes in outcomes were evaluated using latent change score modeling. Results: Both interventions yielded large pre-post effects on depression (Beck Depression Inventory-II: d_IC = 1.53, d_CoD = 1.37; Patient Health Questionnaire-9: d_IC = 1.20, d_CoD = 1.04), as well as significant improvements of all other outcome measures. The effects remained significant after 3, 6, and 12 months. The groups differed with regard to attrition (IC: 17.3%, CoD: 25.8%, p = 0.001). Between-group effects were statistically nonsignificant across outcomes and measurement occasions. Conclusion: Adding semistandardized guidance in IBI for depression did not prove to be more effective than fully standardized feedback on primary and secondary outcomes, but it had positive effects on attrition.

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Section: Discussionsupporting

confidence: 93%

Benefits of Individualized Feedback in Internet-Based Interventions for Depression: A Randomized Controlled Trial

Zagorscak

Heinrich

Sommer

et al. 2018

Psychother Psychosom

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“…These interventions were almost identical in structure and therapeutic content. All trials were delivered using the same evidence based online treatment approach (Macquarie University Online Model; Titov, et al, 2015), were conducted within the same research clinic, the eCentreClinic (www.ecentreclinic.org), and resulted in similar symptom reductions. Together, these trials represent a large random intake of adults into treatment over period of two years with a total of 1262 adult participants, of whom 1098 (87%) were successfully assessed at both pre and post treatment time points.…”

Section: The Samplementioning

confidence: 99%

“…The PHQ-9 is widely used in clinical trials (Clark, 2011;Titov et al, 2015), comprising of 9 items, with high internal consistency, and high sensitivity to the presence and change of clinical depression diagnoses (Kroenke, et al, 2001). Scores on the PHQ-9 correspond to the cumulative experience of common depressive symptoms, over the preceding 2-week period.…”

Section: Symptom Measurementioning

confidence: 99%

Measurement of Symptom Change Following Web-Based Psychotherapy: Statistical Characteristics and Analytical Methods for Measuring and Interpreting Change (Preprint)

Karin¹,

Dear²,

Heller³

et al. 2018

Preprint

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Highlights In this paper we explore the statistical characteristics of depressive symptom change (PHQ9; Kroenke, Spitzer, & Williams, 2001) associated with a large web-based psychotherapy sample (ICBT; n=1096), and compare between two common ways to measure and interpret symptom change (linear and proportional change). Results demonstrated that within both treatment and waitlist conditions, symptoms changed proportionally to baseline (e.g. 50-55% treatment related change across individuals from different baselines, and ±30% change for individuals the waitlist).Additional features such as (1) a strong relationship between an individual's baseline score and the rate of symptom change, and (2) positive distributional skewness at post treatment, also suggest proportional change. Analyses demonstrate the measurement of proportional symptom change also enabled (1) a more accurate in predicting symptom outcomes (measurement error reduction of over 40%), (2) more interpretable estimate of change (percentage improvement) which is aligned with the aims of treatment (remission of symptoms), (3) a clearer ability to differentiate between treatment related and non-treatment related symptom change, and (4) overcome an artificial increase between the estimation of treatment efficacy and baseline symptom severity. This research suggests that the measurement and interpretation of symptom change as a proportional function (percentage improvement) can be more suitable than common linear alternatives such as Cohen's d. Although some statistical jargon is used, the intention of this paper is to convey the statistical methodology, and the take home messages about symptom measurement in a way that is approachable to any practitioner. AbstractObjective: The aims of this study were to (1) explore the underlying characteristics of depressive symptom change (PHQ9) following psychotherapy, and (2) compare the suitability of different ways to measure and interpret symptom change. A treatment sample of web-based psychotherapy participants (n=1098), and a waitlist sample (n=96) were used to (1) explore the statistical characteristics of depressive symptom change, and (2) compare the suitability of two common types of change functions; linear and proportional change.Methods: These objectives were explored using hypotheses which tested (1) the relationship between baseline symptoms and the rate of change, (2) the shape of symptom score distribution following treatment, and (3) Conclusions: This study suggests that symptom scales, sharing an implicit feature of score bounding, are associated with a proportional function of change. Selecting statistics that overlook this proportional change (e.g., Cohen's d) is problematic and leads to (1) artificially increased estimates of change with higher baseline symptoms, (2) increased measurement error, and (3) confounded estimates of treatment efficacy and clinical change.

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“…Andererseits fanden neuere Studien keine bedeutsamen Unterschiede zwischen geleiteter und ungeleiteter Selbsthilfe [z.B. Berger et al, 2011;Dear et al, 2015], sodass der Nutzen von Guidance nicht abschließend beurteilt werden kann. Für nicht Internet-basierte Selbsthilfeansätze bei Schizophrenie konnte eine Meta-Analyse aufzeigen, dass diese mittlere bis große Effektstärken bei Positivsymptomatik erzielen (d = 0,78; N = 11 Studien [Scott et al, 2015] [Rotondi et al, 2010].…”

Section: Dissemination Evidenzbasierter Psychologischer Interventioneunclassified

Internet- und mobilbasierte Interventionen bei Schizophrenie

Moritz

Berger

2017

Verhaltenstherapie

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Internet- und mobilbasierte Interventionen wie beispielsweise Online-Selbsthilfeprogramme oder Rückfall-Früherkennungs-Systeme mittels Textnachrichten können das Behandlungsangebot für von Schizophrenie Betroffene auf vielfältige Art und Weise erweitern. So können evidenzbasierte Ansätze wie die kognitive Verhaltenstherapie für Schizophrenie, die bisher aufgrund des Versorgungsdefizits vielen Betroffenen nicht zur Verfügung stehen, als Internet-basierte Selbsthilfeprogramme disseminiert werden. Auch pharmakologische Behandlungen können mit technischen Hilfsmitteln unterstützt werden. Chancen und Risiken dieser Interventionen werden aus Sicht von Behandelnden und Betroffenen auf der Grundlage bisher publizierter Studien diskutiert. Der Zugang zu und die Bedienung von Computern oder Smartphones stellt vielen empirischen Untersuchungen zufolge für die meisten Menschen mit Schizophrenie keine Barriere dar. Auch wenn sich die Wirksamkeit von Internet- und mobilbasierten Ansätzen für Schizophrenie im Moment noch nicht abschließend beurteilen lässt, ist zu erwarten, dass die neuen Entwicklungen auf diesem Feld für Betroffene eine größere Auswahl an Behandlungsangeboten hervorbringen wird, zwischen denen sie je nach Lebenssituation und Bedürfnissen wählen können.

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Transdiagnostic versus disorder-specific and clinician-guided versus self-guided internet-delivered treatment for generalized anxiety disorder and comorbid disorders: A randomized controlled trial

Cited by 193 publications

References 65 publications

Benefits of Individualized Feedback in Internet-Based Interventions for Depression: A Randomized Controlled Trial

Benefits of Individualized Feedback in Internet-Based Interventions for Depression: A Randomized Controlled Trial

Measurement of Symptom Change Following Web-Based Psychotherapy: Statistical Characteristics and Analytical Methods for Measuring and Interpreting Change (Preprint)

Internet- und mobilbasierte Interventionen bei Schizophrenie

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