Saving clinicians' time by delegating routine aspects of therapy to a computer: a randomized controlled trial in phobia/panic disorder

2004 ◽  
Vol 34 (1) ◽  
pp. 9-17 ◽  
Author(s):  
I. M. MARKS ◽  
M. KENWRIGHT ◽  
M. McDONOUGH ◽  
M. WHITTAKER ◽  
D. MATAIX-COLS
Keyword(s):  
Panic Disorder ◽  
Outcome Measures ◽  
Primary Outcome ◽  
Exposure Therapy ◽  
Controlled Trial ◽  
Dropout Rate ◽  
Post Treatment ◽  
Exposure Group ◽  
Drop Outs

Background. The demand for time-consuming psychotherapy of phobia/panic exceeds the supply of trained therapists. Delegating routine therapy aspects to a computer might ease this problem.Method. Ninety-three out-patients with phobia or panic disorder were randomized in a 2[ratio ]2[ratio ]1 ratio to have self-exposure therapy guided either mainly by a stand-alone computer system (FearFighter) or entirely face-to-face by a clinician, or to have mainly computer-guided self-relaxation as a placebo. Both computer groups (FearFighter and relaxation) had brief back-up advice from a clinician. Primary outcome measures were self- and blind-assessor ratings of Main Problem and Goals, and Global Phobia.Results. Drop-outs occurred significantly more often in the two self-exposure groups (43% if mainly computer-guided, 24% if entirely clinician-guided) than with self-relaxation (6%); the difference between the two self-exposure groups was not significant. Even with all drop-outs included, the mainly computer-guided exposure group and the relaxation group had 73% less clinician time per patient than did the entirely clinician-guided exposure group. The two self-exposure groups had comparable improvement and satisfaction at post-treatment and at 1-month follow-up, while relaxation was ineffective. Mean improvement on the primary outcome measures (self- and assessor-rated) was 46% computer, 49% clinician, 9% relaxation at post-treatment (week 10) and 58% computer, 53% clinician and −4% relaxation at 1-month follow-up (week 14). Mean effect sizes on the primary outcome measures were 2·9 computer, 3·5 clinician and 0·5 relaxation at post-treatment; and 3·7 computer, 3·5 clinician and 0·5 relaxation at 1-month follow-up. The assessor did not rate patients at follow-up.Conclusions. Despite its (non-significantly) higher dropout rate, self-exposure therapy for panic/phobia cut clinician time per patient by 73% without losing efficacy when guided mainly by a computer rather than entirely by a clinician. The finding needs confirmation at a follow-up that is longer and includes a blind assessor. Self-relaxation had the highest rate of completers but was ineffective.

Facilitating access to iCBT: a randomized controlled trial assessing a translated version of an empirically validated program using a minimally monitored delivery model

2019 ◽  
Vol 48 (2) ◽  
pp. 185-202
Author(s):  
Miguel Robichaud ◽  
France Talbot ◽  
Nickolai Titov ◽  
Blake F. Dear ◽  
Heather D. Hadjistavropoulos ◽  
...  
Keyword(s):  
Treatment Group ◽  
Outcome Measures ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Post Treatment ◽  
Effect Sizes ◽  
Anxiety And Depression ◽  
Control Group ◽  
Access To Treatment ◽  
Delivery Model

AbstractBackground:Despite its established efficacy, access to internet-delivered CBT (iCBT) remains limited in a number of countries. Translating existing programs and using a minimally monitored model of delivery may facilitate its dissemination across countries.Aims:This randomized control trial aims to evaluate the efficacy of an iCBT transdiagnostic program translated from English to French and offered in Canada using a minimally monitored delivery model for the treatment of anxiety and depression.Method:Sixty-three French speakers recruited in Canada were randomized to iCBT or a waiting-list. A French translation of an established program, the Wellbeing Course, was offered over 8 weeks using a minimally monitored delivery model. Primary outcome measures were the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), which were obtained pre-treatment, post-treatment and at 3-month follow-up.Results:Mixed-effects models revealed that participants in the treatment group had significantly lower PHQ-9 and GAD-7 scores post-treatment than controls with small between-groups effect sizes (d = 0.34 and 0.37, respectively). Within-group effect sizes on primary outcome measures were larger in the treatment than control group. Clinical recovery rates on the PHQ-9 and GAD-7 were significantly higher among the treatment group (40 and 56%, respectively) than the controls (13 and 16%, respectively).Conclusions:The provision of a translated iCBT program using a minimally monitored delivery model may improve patients’ access to treatment of anxiety and depression across countries. This may be an optimal first step in improving access to iCBT before sufficient resources can be secured to implement a wider range of iCBT services.

scholarly journals Exposure therapy and sertraline in social phobia: 1-year follow-up of a randomised controlled trial

2003 ◽  
Vol 182 (4) ◽  
pp. 312-318 ◽  
Author(s):  
Tone Tangen Haug ◽  
Svein Blomhoff ◽  
Kerstin Hellstrøm ◽  
Ingar Holme ◽  
Mats Humble ◽  
...  
Keyword(s):  
Placebo Group ◽  
Social Phobia ◽  
Exposure Therapy ◽  
Short Form ◽  
Therapy Group ◽  
Controlled Trial ◽  
Exposure Group ◽  
Significant Deterioration ◽  
Randomised Controlled

BackgroundMaintenance of treatment effect is important for the choice of treatment for social phobia.AimsTo examine the effect of exposure therapy and sertraline 28 weeks after cessation of medical treatment.MethodIn this study 375 patients with social phobia were randomised to treatment with sertraline or placebo for 24 weeks, with or without the addition of exposure therapy Fifty-two weeks after inclusion, 328 patients were evaluated by the same psychometric tests as at baseline and the end of treatment (24 weeks).ResultsThe exposure therapy group and the placebo group had a further improvement in scores on social phobia during follow-up: mean change in the Clinical Global Impression – Social Phobia overall severity score was 0.45 (95% CI 016–0.65, P < 0.01) for the exposure group, and 0.25 (95% CI 0.00–0.48, P < 0.05) for the placebo group. At week 52 the sertraline plus exposure group and the sertraline-alone group had a significant deterioration on the 36-item Short Form Health Survey compared with exposure alone.ConclusionsExposure therapy alone yielded a further improvement during follow-up, whereas exposure therapy combined with sertraline and sertraline alone showed a tendency towards deterioration after the completion of treatment.

scholarly journals Motivation-Matched Approach to the Treatment of Problem Gambling: A Case Series Pilot Study

2016 ◽  
pp. 124 ◽  
Author(s):  
Melissa J. Stewart ◽  
Parnell L. Davis MacNevin ◽  
David C. Hodgins ◽  
Sean P. Barrett ◽  
Jennifer Swansburg ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Controlled Trial ◽  
Case Series ◽  
Post Treatment ◽  
Secondary Outcome ◽  
Gambling Behaviour ◽  
Problem Gamblers ◽  
Treatment Gains ◽  
Matched Treatment

The aim of the present case series was to provide a preliminary assessment of the utility of a motivation-matched treatment for problem gamblers. On the basis of their primary underlying motivations for gambling, 6 problem gamblers received either action-motivated (n = 4) or escape-motivated (n = 2) treatment. Drawing upon a cognitive-behavioural framework, this 6-session motivation-matched treatment was designed to address gamblers' maladaptive motivations for gambling (i.e., the need or desire for "escape" or "action"), as well as the effects of conditioning and maladaptive thinking patterns unique to each gambling motive subtype. Assessments were conducted at pre-treatment, post-treatment, and 3- and 6-month follow-up. Primary outcome measures included gambling behaviour (i.e., gambling frequency, time, and money spent gambling), severity of gambling problems, and gambling-related impairment or disability; secondary outcome measures included gambling-related craving, gambling abstinence self-efficacy, positively and negatively reinforcing gambling situations, and gambling outcome expectancies. Overall, participants showed pre- to post-treatment improvements on the majority of these measures, with relatively less immediate post-treatment treatment gains observed on measures that assessed positively and negatively reinforcing gambling situations and gambling-related impairment or disability. However, treatment gains at the 3- and 6-month follow-up were shown for most participants on these latter measures as well. Findings suggest promise for this novel treatment approach. The next step in this line of research is to conduct a randomized, controlled trial to compare the efficacy of this motivation-matched treatment for disordered gambling with treatment as usual.

Prognostic indices with brief and standard CBT for panic disorder: I. Predictors of outcome

2007 ◽  
Vol 37 (10) ◽  
pp. 1493-1502 ◽  
Author(s):  
MICHAEL G. T. DOW ◽  
JUSTIN A. KENARDY ◽  
DEREK W. JOHNSTON ◽  
MICHELLE G. NEWMAN ◽  
C. BARR TAYLOR ◽  
...  
Keyword(s):  
Panic Disorder ◽  
Controlled Trial ◽  
Clinical Effectiveness ◽  
Dependent Measure ◽  
Behavioural Therapy ◽  
Post Treatment ◽  
Computer Assisted ◽  
Predictors Of Outcome ◽  
Social Difficulties

ABSTRACTBackgroundAlthough the effectiveness of cognitive behavioural therapy (CBT) in the management of panic disorder (PD) is now well established, there have been few studies of predictors of outcome with this patient group using clinical effectiveness trial data, a hypothesis-testing model, and a dependent measure of clinically significant change.MethodThe data for this study came from a randomized controlled trial of three forms of CBT delivery for PD with and without agoraphobia (two 6-week CBT programmes, one of which was computer assisted, and one therapist-directed 12-week CBT programme), comprising a total of 186 patients across two sites. Based on previous related research, five hypothesized predictors of post-treatment and follow-up outcome were identified and examined, using a series of bivariate and multivariate analyses.ResultsThe results in general supported the hypotheses. Strength of blood/injury fears, age of initial onset of panic symptoms, co-morbid social anxieties and degree of agoraphobic avoidance were predictive of both measures of post-treatment outcome. Degree of residual social difficulties and the continued use of anxiolytics at post-treatment were also shown to predict poor outcome at the 6-month follow-up. However, strength of continuing dysfunctional agoraphobic cognitions by the end of active treatment did not predict outcome at follow-up for the sample as a whole.ConclusionsThe identification of consistent predictors of outcome with CBT has many clinical and research benefits. As CBT, however, is being delivered increasingly in a variety of brief formats, further research is required to identify moderators of response to these ‘non-standard’ treatment formats.

scholarly journals Translating Virtual Reality Cue Exposure Therapy for Binge Eating into a Real-World Setting: An Uncontrolled Pilot Study

2021 ◽  
Vol 10 (7) ◽  
pp. 1511
Author(s):  
Katherine Nameth ◽  
Theresa Brown ◽  
Kim Bullock ◽  
Sarah Adler ◽  
Giuseppe Riva ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Eating Disorder ◽  
Binge Eating ◽  
Real World ◽  
Exposure Therapy ◽  
Post Treatment ◽  
Cue Exposure ◽  
Treatment Gains ◽  
Intent To Treat

Binge-eating disorder (BED) and bulimia nervosa (BN) have adverse psychological and medical consequences. Innovative interventions, like the integration of virtual reality (VR) with cue-exposure therapy (VR-CET), enhance outcomes for refractory patients compared to cognitive behavior therapy (CBT). Little is known about the feasibility and acceptability of translating VR-CET into real-world settings. To investigate this question, adults previously treated for BED or BN with at least one objective or subjective binge episode/week were recruited from an outpatient university eating disorder clinic to receive up to eight weekly one-hour VR-CET sessions. Eleven of 16 (68.8%) eligible patients were enrolled; nine (82%) completed treatment; and 82% (9/11) provided follow-up data 7.1 (SD = 2.12) months post-treatment. Overall, participant and therapist acceptability of VR-CET was high. Intent-to-treat objective binge episodes (OBEs) decreased significantly from 3.3 to 0.9/week (p < 0.001). Post-treatment OBE 7-day abstinence rate for completers was 56%, with 22% abstinent for 28 days at follow-up. Among participants purging at baseline, episodes decreased from a mean of one to zero/week, with 100% abstinence maintained at follow-up. The adoption of VR-CET into real-world clinic settings appears feasible and acceptable, with a preliminary signal of effectiveness. Findings, including some loss of treatment gains during follow-up may inform future treatment development.

scholarly journals Effect of Core Stabilizing Training on Young Individuals Presenting Different Stages of Degenerative Disc Disease—Preliminary Report

2021 ◽  
Vol 18 (7) ◽  
pp. 3499
Author(s):  
Tomasz Kuligowski ◽  
Błażej Cieślik ◽  
Natalia Kuciel ◽  
Agnieszka Dębiec-Bąk ◽  
Anna Skrzek
Keyword(s):  
Lumbar Spine ◽  
Outcome Measures ◽  
Degenerative Disc Disease ◽  
Preliminary Report ◽  
Primary Outcome ◽  
Core Stability ◽  
Post Intervention ◽  
Disc Disease ◽  
Degenerative Disc

The aim of this study was to assess the efficacy of stabilizing training for the deep core muscles of the lumbar spine in subjects with degenerative disc disease. This study was conducted on 38 participants. The participants were divided into two groups: the extrusion group (EXT, n = 17) and the protrusion group (PRO, n = 21). All the subjects underwent a four-week-long core stability exercise-based treatment (five sessions/week). Clinical outcome measures were assessed pre-intervention (pre), post-intervention (post) and four weeks after the intervention (follow-up). The primary outcome measures were the spinal range of motion (ROM; Spinal Mouse® device) and the Oswestry Disability Index (ODI). In the PRO group, the ROM decreased from 88.52° pre-intervention to 83.33° post-intervention and to 82.82° at follow-up (p = 0.01), while the ODI decreased from 16.14 points pre-intervention to 6.57 points post-intervention, with 9.42 points at follow-up (p < 0.01). In the EXT group, the ROM decreased from 81.00° pre-intervention to 77.05° post-intervention, then increased to 77.94° at follow-up (p = 0.03), while the ODI decreased from 22.58 points pre-intervention to 15.41 points post-intervention and to 14.70 points at follow-up (p < 0.001). Although the stabilizing exercise sessions improved the clinical outcomes in each group, we cannot make conclusions as to whether the type of intervertebral disc damage significantly affects the results of stabilizing exercise-based treatment.

scholarly journals Computerised cognitive–behavioural therapy for adults with intellectual disability: randomised controlled trial

2017 ◽  
Vol 211 (2) ◽  
pp. 95-102 ◽  
Author(s):  
Patricia Cooney ◽  
Catherine Jackman ◽  
David Coyle ◽  
Gary O'Reilly
Keyword(s):  
Intellectual Disability ◽  
Randomised Controlled Trial ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Primary Outcome Measure ◽  
Cognitive Behavioural ◽  
Randomised Controlled

BackgroundDespite the evidence base for computer-assisted cognitive–behavioural therapy (CBT) in the general population, it has not yet been adapted for use with adults who have an intellectual disability.AimsTo evaluate the utility of a CBT computer game for adults who have an intellectual disability.MethodA 2 × 3 (group × time) randomised controlled trial design was used. Fifty-two adults with mild to moderate intellectual disability and anxiety or depression were randomly allocated to two groups: computerised CBT (cCBT) or psychiatric treatment as usual (TAU), and assessed at pre-treatment, post-treatment and 3-month follow-up. Forty-nine participants were included in the final analysis.ResultsA significant group x time interaction was observed on the primary outcome measure of anxiety (Glasgow Anxiety Scale for people with an Intellectual Disability), favouring cCBT over TAU, but not on the primary outcome measure of depression (Glasgow Depression Scale for people with a Learning Disability). A medium effect size for anxiety symptoms was observed at post-treatment and a large effect size was observed after follow-up. Reliability of Change Indices indicated that the intervention produced clinically significant change in the cCBT group in comparison with TAU.ConclusionsAs the first application of cCBT for adults with intellectual disability, this intervention appears to be a useful treatment option to reduce anxiety symptoms in this population.

The conceptual invariance, trajectory, and outcome associations of working alliance in unguided and guided internet-based psychological interventions: A randomized controlled trial (Preprint)

2021 ◽  
Author(s):  
Xiaochen Luo ◽  
Matteo Bugatti ◽  
Lucero Molina ◽  
Jacqueline L. Tilley ◽  
Brittain Mahaffey ◽  
...  
Keyword(s):  
Working Alliance ◽  
Support Group ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Post Treatment ◽  
Depression Symptoms ◽  
Therapy Program ◽  
Initial Sessions ◽  
Clinician Support

BACKGROUND The role of working alliance is largely unknown for internet-based interventions (IBI), an effective alternative for traditional psychotherapy. OBJECTIVE This study examined the conceptual invariance, trajectory, and outcome associations of working alliance in internet-based interventions incorporating or excluding clinician support via text or video. METHODS One hundred and forty-three adults with subclinical anxiety, stress, and/or depression symptoms were randomized to one of three treatment conditions for 7 weeks. All participants received access to MyCompass, an internet-delivered Cognitive Behavioral Therapy program. Participants in Condition 1 did not receive clinician support. Participants in Condition 2 and 3 received supplemental asynchronous clinician support via text or video respectively. Working alliance was measured weekly. Symptom outcomes were assessed at baseline, post-treatment, and 1-month follow-up. RESULTS We found scalar invariance of working alliance, indicating that working alliance was conceptually invariant across three conditions. Working alliance decreased significantly over time only in the text support group. Stronger baseline level and Faster increases in alliance predicted better outcomes at both post-treatment and follow-up only in the video support group. CONCLUSIONS Working alliance is methodologically comparable with or without clinician support and is generally established at initial sessions of IBI. Better alliance contributed to better outcomes only when clinician support is available via videos. CLINICALTRIAL clinicaltrials.gov ID: NCT05122429

scholarly journals Effectiveness of Standardized Physical Therapy Exercises for Patients With Difficulty Returning to Usual Activities After Decompression Surgery for Subacromial Impingement Syndrome: Randomized Controlled Trial

2016 ◽  
Vol 96 (6) ◽  
pp. 787-796 ◽  
Author(s):  
David Høyrup Christiansen ◽  
Poul Frost ◽  
Deborah Falla ◽  
Jens Peder Haahr ◽  
Lars Henrik Frich ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Outcome Measures ◽  
Exercise Intervention ◽  
Controlled Trial ◽  
Exercise Group ◽  
Subacromial Impingement Syndrome ◽  
Decompression Surgery ◽  
Subacromial Decompression ◽  
Randomized Controlled

Background Little is known about the effectiveness of exercise programs after decompression surgery for subacromial impingement syndrome. For patients with difficulty returning to usual activities, special efforts may be needed to improve shoulder function. Objective The purpose of this study was to evaluate the effectiveness at 3 and 12 months of a standardized physical therapy exercise intervention compared with usual care in patients with difficulty returning to usual activities after subacromial decompression surgery. Design A multicenter randomized controlled trial was conducted. Setting The study was conducted in 6 public departments of orthopedic surgery, 2 departments of occupational medicine, and 2 physical therapy training centers in Central Denmark Region. Patients One hundred twenty-six patients reporting difficulty returning to usual activities at the postoperative clinical follow-up 8 to 12 weeks after subacromial decompression surgery participated. Intervention A standardized exercise program consisting of physical therapist–supervised individual training sessions and home training was used. Outcome Measures The primary outcome measure was the Oxford Shoulder Score. Secondary outcome measures were the Constant Score and the Fear-Avoidance Beliefs Questionnaire. Results At 3 and 12 months, follow-up data were obtained for 92% and 83% of the patients, respectively. Intention-to-treat analyses suggested a between-group difference on the Oxford Shoulder Score favoring the exercise group at 3 months, with an adjusted mean difference of 2.0 (95% confidence interval=−0.5, 4.6), and at 12 months, with an adjusted mean difference of 5.8 (95% confidence interval=2.8, 8.9). Significantly larger improvements for the exercise group were observed for most secondary and supplementary outcome measures. Limitations The nature of the exercise intervention did not allow blinding of patients and care providers. Conclusion The standardized physical therapy exercise intervention resulted in statistically significant and clinically relevant improvement in shoulder pain and function at 12 months compared with usual care.

scholarly journals A Virtual Reality-Based Self-Help Intervention for Dealing with the Psychological Distress Associated with the COVID-19 Lockdown: An Effectiveness Study with a Two-Week Follow-Up

2021 ◽  
Vol 18 (15) ◽  
pp. 8188
Author(s):  
Giuseppe Riva ◽  
Luca Bernardelli ◽  
Gianluca Castelnuovo ◽  
Daniele Di Lernia ◽  
Cosimo Tuena ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Psychological Distress ◽  
Outcome Measures ◽  
Perceived Stress ◽  
Social Connectedness ◽  
Primary Outcome ◽  
Post Intervention ◽  
Stress Levels ◽  
Secondary Outcomes

The aim of this study is to investigate the effectiveness of a novel self-administered at-home daily virtual reality (VR)-based intervention (COVID Feel Good) for reducing the psychological burden experienced during the COVID-19 lockdown in Italy. A total of 40 individuals who had experienced at least two months of strict social distancing measures followed COVID Feel Good between June and July 2020 for one week. Primary outcome measures were depression, anxiety, and stress symptoms, perceived stress levels, and hopelessness. Secondary outcomes were the experienced social connectedness and the level of fear experienced during the COVID-19 pandemic. Linear mixed-effects models were fitted to evaluate the effectiveness of the intervention. Additionally, we also performed a clinical change analysis on primary outcome measures. As concerning primary outcome measures, participants exhibited improvements from baseline to post-intervention for depression levels, stress levels, general distress, and perceived stress (all p < 0.05) but not for the perceived hopelessness (p = 0.110). Results for the secondary outcomes indicated an increase in social connectedness from T0 to T1 (p = 0.033) but not a significant reduction in the perceived fear of coronavirus (p = 0.412). Among these study variables, these significant improvements were maintained from post-intervention to the 2-week follow-up (p > 0.05). Results indicated that the intervention was associated with good clinical outcomes, low-to-no risks for the treatment, and no adverse effects or risks. Globally, evidence suggests a beneficial effect of the proposed protocol and its current availability in 12 different languages makes COVID Feel Good a free choice for helping individuals worldwide to cope with the psychological distress associated with the COVID-19 crisis, although large scale trials are needed to evaluate its efficacy.

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