Low-Intensity Interventions and EMDR Therapy

2021 ◽  
pp. EMDR-D-21-00009
Author(s):  
Louise Maxfield
Keyword(s):  
Group Therapy ◽  
Behavioral Therapy ◽  
Face To Face ◽  
Low Intensity ◽  
Randomized Controlled ◽  
Stress Studies ◽  
Self Help ◽  
Health Specialist ◽  
Mhealth Apps ◽  
Emdr Therapy

Unlike high intensity treatment, in which clients have face-to-face contact with a mental health specialist, clients in low-intensity treatment have limited or no contact with a specialist. Instead, their treatment is usually provided through self-help procedures, which are delivered via (guided) computer programs, books, or mHealth apps. Other treatments sometimes considered low intensity are brief treatments, group therapy, and interventions delivered by nonspecialists. Advantages include effectiveness, accessibility, efficiency, and affordability. Concerns related to safety, engagement, and adherence in self-help programs may be addressed by (asynchronous) therapist guidance. This article describes low-intensity treatments, and their relevance for eye movement desensitization and reprocessing (EMDR) therapy. Hundreds of randomized controlled trials (RCTs) have found self-help interventions to be efficacious, with many producing the same level of results as the traditional face-to-face procedure. Guided self-help cognitive behavioral therapy is recommended for the treatment of posttraumatic stress disorder in the guidelines of both the National Institute for Health and Care Excellence and International Society of Traumatic Stress Studies. Only three self-help-EMDR RCTs have been conducted. This author advocates for reconceptualizing EMDR group therapy as “guided EMDR-self-help therapy,” because it is a highly manualized, heavily scripted treatment, in which the client works independently on their own material. In this respect, it offers an excellent template for the future development of efficacious low-intensity EMDR interventions. Developing safe, easy-to-use, affordable, and readily available low-intensity interventions will make effective EMDR treatment available to many millions of people around the world.

scholarly journals 0363 Efficacy of Cognitive Behavioral Therapy Delivered via Telemedicine vs. Face-to-Face: Preliminary Results from a Randomized Controlled Non-Inferiority Trial

SLEEP ◽  
2019 ◽  
Vol 42 (Supplement_1) ◽  
pp. A148-A148 ◽  
Author(s):  
J Todd Arnedt ◽  
Deirdre A Conroy ◽  
Ann J Mooney ◽  
Kelley Dubuc ◽  
Alexander Yang ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Face To Face ◽  
Preliminary Results ◽  
Randomized Controlled

scholarly journals Treating depression with a smartphone-delivered self-help cognitive behavioral therapy for insomnia: study protocol for a parallel group randomized controlled trial

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Victoria Ka-Ying Hui ◽  
Christy Yim-Fan Wong ◽  
Eric Ka-Yiu Ma ◽  
Fiona Yan-Yee Ho ◽  
Christian S. Chan
Keyword(s):  
Randomized Controlled Trial ◽  
Hong Kong ◽  
Major Depression ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Smartphone Application ◽  
Cognitive Behavioral ◽  
Randomized Controlled ◽  
Self Help

Abstract Background Depression is a major public health concern. Emerging research has shown that cognitive behavioral therapy for insomnia (CBT-I) is effective in treating individuals with comorbid insomnia and depression. Traditional face-to-face CBT-I encounters many obstacles related to feasibility, accessibility, and help-seeking stigma. CBT-I delivered via smartphone application could be a potential solution. This paper reports a protocol designed to evaluate the efficacy of a self-help smartphone-based CBT-I, using a waitlist group as control, for people with major depression and insomnia. Methods A two-arm parallel randomized controlled trial is conducted in a target sample of 285 non-suicidal Hong Kong Chinese older than 17 years of age with major depression and insomnia. Participants complete an online rapid screening, followed by a telephone diagnostic interview. Those who meet the eligibility criteria are randomized in a ratio of 1:1 to receive either CBT-I immediately or to a waitlist control condition. The CBT-I consists of six weekly modules and is delivered through a smartphone application proACT-S. This smartphone app has been pilot tested and revamped to improve user experience. An online randomized algorithm is used to perform randomization to ensure allocation concealment. The primary outcomes are changes over the measurement points in sleep quality, insomnia severity, and depression severity. The secondary outcomes include changes over the measurement points in anxiety, subjective health, treatment expectancy, and acceptability of treatment. Assessments are administered at baseline, post-intervention, and 6-week follow-up. The recruitment is completed. Important adverse events, if any, are documented. Multilevel linear mixed model based on intention-to-treat principle will be conducted to examine the efficacy of the CBT-I intervention. Discussion It is expected that proACT-S is an efficacious brief sleep-focused self-help treatment for people with major depression and insomnia. If proven efficacious, due to its self-help nature, proACT-S may be applicable as a community-based early intervention, thereby reducing the burden of the public healthcare system in Hong Kong. Trial registration ClinicalTrials.gov NCT04228146. Retrospectively registered on 14 January 2020.

scholarly journals Efficacy of EMDR Therapy for Anxiety Disorders

2019 ◽  
Vol 13 (4) ◽  
pp. 325-332 ◽  
Author(s):  
Elisa Faretta ◽  
Mariella Dal Farra
Keyword(s):  
Anxiety Disorders ◽  
Behavioral Therapy ◽  
Self Esteem ◽  
Generalized Anxiety ◽  
First Line ◽  
Randomized Controlled ◽  
Specific Phobias ◽  
Positive Effect ◽  
Emdr Therapy ◽  
First Line Treatment

Six randomized controlled trials (RCTs) investigated the efficacy of eye movement desensitization and reprocessing (EMDR) therapy for adults with anxiety disorders over a span of 20 years (1997–2017). Three RCTs focused on panic disorder, with or without agoraphobia (PDA); two studies targeted specific phobias, whereas the dependent variable of another RCT was “self-esteem,” considered as a mediator factor for anxiety disorders. In four RCTs, EMDR therapy demonstrated a positive effect on panic and phobic symptoms, whereas one RCT on PDA was partly negative and one study failed in improving self-esteem in patients with anxiety disorders. Considered as a whole, these preliminary data suggest EMDR therapy may be effective not only for PD but also for specific phobias. Further controlled studies are needed to corroborate these findings and also to systematically evaluate the efficacy of EMDR therapy for generalized anxiety disorder, social anxiety, and agoraphobia. Because cognitive behavioral therapy (CBT) is presently considered a first-line treatment for anxiety disorders, controlled comparisons between EMDR therapy and CBT would be especially useful in future investigations of EMDR treatment of anxiety disorders.

scholarly journals Hands-off: Study protocol of a two-armed randomized controlled trial of a web-based self-help tool to reduce problematic pornography use

2020 ◽  
Vol 9 (2) ◽  
pp. 433-445
Author(s):  
Beáta Bőthe ◽  
Christian Baumgartner ◽  
Michael P. Schaub ◽  
Zsolt Demetrovics ◽  
Gábor Orosz
Keyword(s):  
Randomized Controlled Trial ◽  
Positive Emotions ◽  
Psychological Intervention ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Self Report ◽  
Intention To Treat ◽  
Randomized Controlled ◽  
Self Help ◽  
Pornography Use

AbstractBackground and AimsThe past-year prevalence of problematic pornography use (PPU) was 1–6% in adult populations. As a result of treatment obstacles and barriers, such as unaffordable treatments, only a minority of problematic pornography users may seek treatment. Having a free, online, self-help program may overcome treatment barriers and may help those individuals who cannot receive traditional or offline treatment for PPU. Although the effectiveness of such online programs reducing substance use and problematic gambling have been reported, no prior study has examined the efficacy of an online self-help intervention aiming to reduce PPU.MethodsThis two-armed randomized controlled trial (RCT) will examine the effectiveness of an online self-help program (Hands-off) to reduce PPU, while also considering psychopathological comorbidities. The six-week intervention condition includes six core modules developed to reduce PPU based on motivational interviewing, cognitive behavioral therapy, mindfulness, and wise social-psychological intervention techniques. The target sample size is 242 participants. Self-report questionnaires will be administered at baseline, right after the end of the intervention, at one-month, and three-month follow-ups after the end of the intervention. The primary outcome will be the level of PPU. Secondary outcomes will include pornography use frequency, pornography craving, pornography use-avoidance self-efficacy, sex mindset, sexual satisfaction, negative and positive emotions, and life satisfaction. Data will be analyzed on an intention-to-treat basis using linear mixed models.ResultsResults will be reported at conferences and published in a scientific peer-reviewed journal. The participants will be sent a lay-person-friendly summary of the results via e-mail.

Treatment of adjustment disorders (DRAFT)

2018 ◽  
Author(s):  
Patricia Casey
Keyword(s):  
Psychological Interventions ◽  
Pharmacological Interventions ◽  
Small Pilot Study ◽  
Homogeneous Population ◽  
Low Intensity ◽  
Randomized Controlled ◽  
Self Help ◽  
Randomized Controlled Studies ◽  
Variable Nature ◽  
The Many

There are few randomized controlled studies of the treatment of AD. This is due to the transience of the symptoms, the difficulty obtaining a homogeneous population owing to the absence of diagnostic criteria, and the variable nature of the stressor, among others. Clinical guidelines specify that brief psychological interventions are preferred, and these incorporate elements from the many approaches now available on the assumption that their mechanism of action will also be effective in AD. Few have been tested specifically in AD. Low-intensity therapies specific to AD are being developed, such as biblio-therapy and online self-help. Pharmacological interventions have not been tested in quality trials, but despite this, antidepressants continue to be frequently prescribed. A few trials of anxiolytics have found some benefit for all the agents examined, but none used placebo. EMDR was found to be beneficial in a small pilot study and is worthy of further study.

scholarly journals 0532 Cognitive Behavioral Therapy Delivered Via Telemedicine vs. Face-to-Face: Results from a Randomized Controlled Non-Inferiority Trial

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A203-A204
Author(s):  
J Arnedt ◽  
D Conroy ◽  
A Mooney ◽  
K DuBuc ◽  
S Balstad ◽  
...  
Keyword(s):  
Behavioral Therapy ◽  
Severity Index ◽  
Healthcare Services ◽  
Post Treatment ◽  
Self Report ◽  
Daytime Functioning ◽  
Face To Face ◽  
Randomized Controlled ◽  
Pre Treatment

Abstract Introduction Telemedicine is increasingly an option for delivery of healthcare services, but its efficacy and acceptability for delivering CBT for insomnia has not been adequately tested. In a randomized controlled non-inferiority trial, we compared face-to-face and telemedicine delivery (via the AASM SleepTM platform) of CBT for insomnia for improving sleep and daytime functioning at post-treatment and 12-week follow-up. Methods Sixty-five adults with chronic insomnia (46 women, mean age 47.2 ± 16.3 years) were recruited primarily from insomnia clinics and screened for disqualifying sleep, medical, and mental health disorders. Eligible participants were randomized to 6 sessions of CBT for insomnia delivered face-to-face (n=32) or via AASM SleepTM (n=33). Participants completed self-report measures of insomnia (Insomnia Severity Index, ISI) and daytime functioning (fatigue, depression, anxiety, and overall functioning) at pre-treatment, post-treatment, and 12-week follow-up. The ISI was the primary non-inferiority outcome. Results Telemedicine was non-inferior to face-to-face delivery of CBT for insomnia, based on a non-inferiority margin of 4 points on the ISI (β = -0.07, 95% CI -2.28 to 2.14). Compared to pre-treatment, ISI scores improved significantly at post-treatment (β = -9.02, 95% CI -10.56 to -7.47) and at 12-week follow-up (β = -9.34, 95% CI -10.89 to -7.79). Similarly, daytime functioning measures improved from pre- to post-treatment, with sustained improvements at 12-week follow-up. Scores on the fatigue scale were lower in the telemedicine group at both post-treatment (F=4.64, df=1,119, p<.03) and follow-up (F=5.79, df=1,119, p<.02). Conclusion Insomnia and daytime functioning improve similarly whether CBT for insomnia is delivered via telemedicine or face-to-face. Telemedicine delivery of CBT for insomnia should be implemented more systematically to improve access to this evidence-based treatment. Support American Sleep Medicine Foundation Grant # 168-SR-17 (JT Arnedt, PhD)

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