Making self-help more helpful: A randomized controlled trial of the impact of augmenting self-help materials with implementation intentions on promoting the effective self-management of anxiety symptoms.

2011 ◽  
Vol 79 (1) ◽  
pp. 123-128 ◽  
Author(s):  
Rachel Varley ◽  
Thomas L. Webb ◽  
Paschal Sheeran
Keyword(s):  
Randomized Controlled Trial ◽  
Implementation Intentions ◽  
Controlled Trial ◽  
Anxiety Symptoms ◽  
Self Management ◽  
Randomized Controlled ◽  
Self Help ◽  
The Impact

scholarly journals CANreduce 2.0 – the effects of adherence-focused guidance for Internet self-help among cannabis misusers: results of a three-arm randomized controlled trial (Preprint)

2021 ◽  
Author(s):  
Christian Baumgartner ◽  
Michael Patrick Schaub ◽  
Andreas Wenger ◽  
Doris Malischnig ◽  
Mareike Augsburger ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Anxiety Symptoms ◽  
Cannabis Use ◽  
Cannabis Use Disorder ◽  
General Anxiety ◽  
Cannabis Dependence ◽  
Randomized Controlled ◽  
Self Help ◽  
Significant Difference

BACKGROUND Despite increasing demand for treatment among cannabis misusers in many countries, most misusers are not in treatment. Internet-based self-help offers an alternative for those hesitant to seek face-to-face therapy, though low-effectiveness and adherence issues often arise. Through adherence-focused guidance enhancement (AFGE), we aimed to increase adherence to, and the effectiveness of Internet-based self-help among cannabis misusers. OBJECTIVE A three-arm randomized controlled trial was conducted comparing the effectiveness of (1) an AFGE Internet-based self-help intervention with social presence (AFGE-SP), (2) a similar intervention with an impersonal service team (AFGE-ST), and (3) Internet access as usual (IAU, controls). METHODS From July 2016—May 2019, 575 cannabis misusers (70.6% males, mean age=28.3) not otherwise in treatment were recruited from the general population. The primary outcome was cannabis-use days over the preceding 30 days. Secondary outcomes included cannabis-dependence severity, changes in cannabis misuse disorder (CMD) symptoms, and intervention adherence. RESULTS All groups exhibited reduced cannabis-use days after 3 months (AFGE-SP: -8.2; AFGE-ST: -9.8; IAU: -4.2). AFGE-ST participants reported significantly fewer cannabis-use days than IAU controls (P = .01, d = .60); a similar reduction in the AFGE-SP (d=.40) group failed to achieve significance (P =.07). There was no significant difference between the two intervention groups. AFGE-ST patients also exhibited superior improvements in cannabis-use disorder, cannabis-dependence severity, and general anxiety symptoms after three months. CONCLUSIONS Adding an impersonal service team to the AFGE Internet-based self-help intervention significantly reduced cannabis use, cannabis use disorder, dependence severity, and general anxiety symptoms. CLINICALTRIAL http://www.isrctn.com/ISRCTN11086185

scholarly journals Effectiveness and Cost-Effectiveness of a Self-Guided Internet Intervention for Social Anxiety Symptoms in a General Population Sample: Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
John Powell ◽  
Veronika Williams ◽  
Helen Atherton ◽  
Kylie Bennett ◽  
Yaling Yang ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Cost Effectiveness ◽  
Social Anxiety ◽  
General Population ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Anxiety Symptoms ◽  
Cognitive Behavioral ◽  
Randomized Controlled ◽  
Self Help

BACKGROUND Many people are accessing digital self-help for mental health problems, often with little evidence of effectiveness. Social anxiety is one of the most common sources of mental distress in the population, and many people with symptoms do not seek help for what represents a significant public health problem. OBJECTIVE This study aimed to evaluate the effectiveness of a self-guided cognitive behavioral internet intervention for people with social anxiety symptoms in the general population. METHODS We conducted a two-group randomized controlled trial in England between May 11, 2016, and June 27, 2018. Adults with social anxiety symptoms who were not receiving treatment for social anxiety were recruited using online advertisements. All participants had unrestricted access to usual care and were randomized in a 1:1 ratio to either a Web-based unguided self-help intervention based on cognitive behavioral principles or a waiting list control group. All outcomes were collected through self-report online questionnaires. The primary outcome was the change in 17-item Social Phobia Inventory (SPIN-17) score from baseline to 6 weeks using a linear mixed-effect model that used data from all time points (6 weeks, 3 months, 6 months, and 12 months). RESULTS A total of 2122 participants were randomized, and 6 were excluded from analyses because they were ineligible. Of the 2116 eligible randomized participants (mean age 37 years; 80.24%, 1698/2116 women), 70.13% (1484/2116) had follow-up data available for analysis, and 56.95% (1205/2116) had data on the primary outcome, although attrition was higher in the intervention arm. At 6 weeks, the mean (95% CI) adjusted difference in change in SPIN-17 score in the intervention group compared with control was −1.94 (−3.13 to −0.75; <italic>P</italic>=.001), a standardized mean difference effect size of 0.2. The improvement was maintained at 12 months. Given the high dropout rate, sensitivity analyses explored missing data assumptions, with results that were consistent with those of the primary analysis. The economic evaluation demonstrated cost-effectiveness with a small health status benefit and a reduction in health service utilization. CONCLUSIONS For people with social anxiety symptoms who are not receiving other forms of help, this study suggests that the use of an online self-help tool based on cognitive behavioral principles can provide a small improvement in social anxiety symptoms compared with no intervention, although dropout rates were high. CLINICALTRIAL ClinicalTrials.gov NCT02451878; https://clinicaltrials.gov/ct2/show/NCT02451878

scholarly journals Effectiveness and Cost-Effectiveness of a Self-Guided Internet Intervention for Social Anxiety Symptoms in a General Population Sample: Randomized Controlled Trial

10.2196/16804 ◽  
2020 ◽  
Vol 22 (1) ◽  
pp. e16804
Author(s):  
John Powell ◽  
Veronika Williams ◽  
Helen Atherton ◽  
Kylie Bennett ◽  
Yaling Yang ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Cost Effectiveness ◽  
Social Anxiety ◽  
General Population ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Anxiety Symptoms ◽  
Cognitive Behavioral ◽  
Randomized Controlled ◽  
Self Help

Background Many people are accessing digital self-help for mental health problems, often with little evidence of effectiveness. Social anxiety is one of the most common sources of mental distress in the population, and many people with symptoms do not seek help for what represents a significant public health problem. Objective This study aimed to evaluate the effectiveness of a self-guided cognitive behavioral internet intervention for people with social anxiety symptoms in the general population. Methods We conducted a two-group randomized controlled trial in England between May 11, 2016, and June 27, 2018. Adults with social anxiety symptoms who were not receiving treatment for social anxiety were recruited using online advertisements. All participants had unrestricted access to usual care and were randomized in a 1:1 ratio to either a Web-based unguided self-help intervention based on cognitive behavioral principles or a waiting list control group. All outcomes were collected through self-report online questionnaires. The primary outcome was the change in 17-item Social Phobia Inventory (SPIN-17) score from baseline to 6 weeks using a linear mixed-effect model that used data from all time points (6 weeks, 3 months, 6 months, and 12 months). Results A total of 2122 participants were randomized, and 6 were excluded from analyses because they were ineligible. Of the 2116 eligible randomized participants (mean age 37 years; 80.24%, 1698/2116 women), 70.13% (1484/2116) had follow-up data available for analysis, and 56.95% (1205/2116) had data on the primary outcome, although attrition was higher in the intervention arm. At 6 weeks, the mean (95% CI) adjusted difference in change in SPIN-17 score in the intervention group compared with control was −1.94 (−3.13 to −0.75; P=.001), a standardized mean difference effect size of 0.2. The improvement was maintained at 12 months. Given the high dropout rate, sensitivity analyses explored missing data assumptions, with results that were consistent with those of the primary analysis. The economic evaluation demonstrated cost-effectiveness with a small health status benefit and a reduction in health service utilization. Conclusions For people with social anxiety symptoms who are not receiving other forms of help, this study suggests that the use of an online self-help tool based on cognitive behavioral principles can provide a small improvement in social anxiety symptoms compared with no intervention, although dropout rates were high. Trial Registration ClinicalTrials.gov NCT02451878; https://clinicaltrials.gov/ct2/show/NCT02451878

scholarly journals Mobile App for Improved Self-Management of Type 2 Diabetes: Multicenter Pragmatic Randomized Controlled Trial (Preprint)

2018 ◽  
Author(s):  
Payal Agarwal ◽  
Geetha Mukerji ◽  
Laura Desveaux ◽  
Noah M Ivers ◽  
Onil Bhattacharyya ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Mobile App ◽  
Self Management ◽  
Pragmatic Randomized Controlled Trial ◽  
Randomized Controlled ◽  
Intervention Impact ◽  
The Impact ◽  
Hba1c Levels

BACKGROUND As the increasing prevalence of type 2 diabetes mellitus has put pressure on health systems to appropriately manage these patients, there have been a growing number of mobile apps designed to improve the self-management of diabetes. One such app, BlueStar, has been shown to significantly reduce hemoglobin A1c (HbA1c) levels in small studies and is the first app in the United States to receive Food and Drug Administration approval as a mobile prescription therapy. However, the impact of the app across real-world population among different clinical sites and health systems remains unclear. OBJECTIVE The primary objective of this study was to conduct a pragmatic randomized controlled trial of the BlueStar mobile app to determine if app usage leads to improved HbA1c levels among diverse participants in real-life clinical contexts. We hypothesized that this mobile app would improve self-management and HbA1c levels compared with controls. METHODS The study consisted of a multicenter pragmatic randomized controlled trial. Overall, 110 participants randomized to the immediate treatment group (ITG) received the intervention for 6 months, and 113 participants randomized to the wait-list control (WLC) group received usual care for the first 3 months and then received the intervention for 3 months. The primary outcome was glucose control measured by HbA1c levels at 3 months. Secondary outcomes assessed intervention impact on patient self-management, experience of care, and self-reported health utilization using validated scales, including the Problem Areas in Diabetes, the Summary of Diabetes Self-Care Activities, and the EuroQol-5D. Intervention usage data were collected directly from the app. RESULTS The results of an analysis of covariance controlling for baseline HbA1c levels did not show evidence of intervention impact on HbA1c levels at 3 months (mean difference [ITG−WLC] −0.42, 95% CI −1.05 to 0.21; P=.19). Similarly, there was no intervention effect on secondary outcomes measuring diabetes self-efficacy, quality of life, and health care utilization behaviors. An exploratory analysis of 57 ITG participants investigating the impact of app usage on HbA1c levels showed that each additional day of app use corresponded with a 0.016-point decrease in participants’ 3-month HbA1c levels (95% CI −0.03 to −0.003). App usage varied significantly by site, as participants from 1 site logged in to the app a median of 36 days over 14 weeks (interquartile range [IQR] 10.5-124); those at another site used the app significantly less (median 9; IQR 6-51). CONCLUSIONS The results showed no difference between intervention and control arms for the primary clinical outcome of glycemic control measured by HbA1c levels. Although there was low usage of the app among participants, results indicate contextual factors, particularly site, had a significant impact on overall usage. Future research into the patient and site-specific factors that increase app utilization are needed. CLINICALTRIAL Clinicaltrials.gov NCT02813343; https://clinicaltrials.gov/ct2/show/NCT02813343 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT02813343)

scholarly journals Ameliorating Patient Stigma Amongst Staff Working With Personality Disorder: Randomized Controlled Trial of Self-Management Versus Skills Training

2014 ◽  
Vol 43 (6) ◽  
pp. 692-704 ◽  
Author(s):  
Sue Clarke ◽  
Georgina Taylor ◽  
Helen Bolderston ◽  
Joanna Lancaster ◽  
Bob Remington
Keyword(s):  
Randomized Controlled Trial ◽  
Personality Disorder ◽  
Controlled Trial ◽  
Skills Training ◽  
Self Management ◽  
Future Research ◽  
Training Intervention ◽  
Staff Attitudes ◽  
Randomized Controlled ◽  
The Impact

Background: Patients diagnosed with a personality disorder (PD) are often stigmatized by the healthcare staff who treat them. Aims: This study aimed to compare the impact on front-line staff of a self-management Acceptance and Commitment Therapy-based training intervention (ACTr) with a knowledge- and skills-based Dialectical Behaviour Training intervention (DBTr). Method: A service-based randomized controlled trial was conducted comparing the effects of 2-day ACTr (N = 53) and DBTr (N = 47) staff workshops over 6 months. Primary outcome measures were staff attitudes towards patients and staff-patient relationships. Results: For both interventions, staff attitudes, therapeutic relationship, and social distancing all improved pre- to postintervention, and these changes were maintained at 6-month follow-up. Conclusions: Although offering different resources to staff, both ACTr and DBTr were associated with an improved disposition towards PD patients. Future research could evaluate a combined approach, both for staff working with PD patients and those working with other stigmatized groups.

scholarly journals Short-Term Postpartum Blood Pressure Self-Management and Long-Term Blood Pressure Control: A Randomized Controlled Trial

Hypertension ◽  
2021 ◽  
Author(s):  
Jamie A. Kitt ◽  
Rachael L. Fox ◽  
Alexandra E. Cairns ◽  
Jill Mollison ◽  
Holger H. Burchert ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Dietary Factors ◽  
Self Management ◽  
Chronic Hypertension ◽  
Randomized Controlled ◽  
Short Period ◽  
The Impact

Women with hypertensive pregnancies are 4× more likely to develop chronic hypertension. Previously, we showed a short period of blood pressure (BP) self-management following hypertensive pregnancy resulted in persistently lower BP after 6 months. We now report the impact on long-term BP control. Women who participated in the postpartum randomized controlled trial, SNAP-HT (Self-Management of Postnatal Hypertension; NCT02333240), were invited for 24-hour ambulatory and clinic BP measures. Height and weight were measured by calibrated scales and standardized tape measures, activity by 7-day wrist-worn accelerometer, and dietary factors assessed by questionnaire. Sixty-one of 70 eligible women were followed up 3.6±0.4 years after their original pregnancy. Twenty-four–hour diastolic BP was 7.0 mm Hg lower in those originally randomized to postpartum BP self-management instead of usual care. This difference remained significant after adjustment for either BP at the time of delivery (−7.4 mm Hg [95% CI, −10.7 to −4.2]; P <0.001) or pregnancy booking BP (−6.9 mm Hg [95% CI, −10.3 to −3.6]; P <0.001). Adjustment for current salt intake, age, body mass index, waist-to-hip ratio, arm circumference, parity, alcohol intake, and physical activity had no effect on this difference. Reductions in diastolic BP at 6 months, following self-management of BP postpartum, are maintained 3.6 years later as measured by lower 24-hour diastolic BP. Interventions to optimize BP control during the puerperium in women with hypertensive pregnancies improve BP in the longer term, in a cohort at increased risk of developing chronic hypertension and major adverse cardiovascular events. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02333240.

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