scholarly journals A meta-analysis of effects of Internet CBT for anxiety disorders: open community versus clinical service recruitment (Preprint)

2018 ◽  
Author(s):  
Geke Romijn ◽  
Neeltje Batelaan ◽  
Robin Kok ◽  
Jeroen Koning ◽  
Anton van Balkom ◽  
...  
Keyword(s):  
Anxiety Disorders ◽  
Effect Size ◽  
Meta Analysis ◽  
Behavioural Therapy ◽  
Routine Care ◽  
Clinical Service ◽  
Effect Sizes ◽  
Current Evidence ◽  
Significant Difference ◽  
Small Effect Size

BACKGROUND Ample studies show the high potential of Internet-delivered cognitive behavioural therapy (iCBT) for anxiety disorders. However, evidence for its effectiveness in routine care is scarce. We conducted a meta-analysis to compare results obtained in trials with open recruitment to results obtained in trials with clinical service recruitment and updated previous findings. OBJECTIVE The present study thus aims 1) to update the current evidence on iCBT for anxiety disorders by assessing overall efficacy and 2) to assess whether open recruitment results are comparable to those with recruitment in a routine care context. METHODS Randomised controlled trials were included in which the effects of iCBT for anxiety disorders were compared to wait-list controls (WLC) or face-to-face (f2f) CBT controls. Pooled effect sizes based on anxiety measures (primary outcome), depression and quality of life measures (secondary outcomes) were computed. RESULTS We included 42 studies with 53 comparisons (43 open recruitment comparisons and 10 clinical recruitment comparisons). Overall effect size of (1) iCBT versus WLC was g=0.72 (p<.001) and (2) iCBT versus f2f CBT g=0.12 (p=0.11). Subgroup analyses revealed (3) iCBT clinical recruitment studies with WLC as comparator: g=0.29 (p<0.01), while iCBT open recruitment studies with WLC comparators showed a higher significant effect of g=0.76 (p<0.001). (4) Clinical recruitment studies comparing iCBT to f2f CBT revealed a non-significant and small effect size g=0.06 (p=0.51) while open recruitment studies comparing iCBT to f2f CBT showed an effect of g=0.19 (p=0.09). Comparing clinical recruitment trials with open recruitment trials showed a significant difference in effect size (p<.001) based on WLC comparators, and no significant difference (p=0.38) based on f2f CBT comparators. CONCLUSIONS iCBT is effective in samples recruited in routine clinical practice, but effect sizes are smaller than those found in open recruitment trials. More studies with routine care populations are needed to further validate these findings.

Two decades of digital interventions for anxiety disorders: a systematic review and meta-analysis of treatment effectiveness

2021 ◽  
pp. 1-13
Author(s):  
Darin Pauley ◽  
Pim Cuijpers ◽  
Davide Papola ◽  
Clara Miguel ◽  
Eirini Karyotaki
Keyword(s):  
Systematic Review ◽  
Anxiety Disorder ◽  
Confidence Interval ◽  
Anxiety Disorders ◽  
Effect Size ◽  
Meta Analysis ◽  
Bibliographic Databases ◽  
Wait List ◽  
Digital Interventions ◽  
Significant Difference

Abstract Background Digital interventions for anxiety disorders are a promising solution to address barriers to evidence-based treatment access. Precise and powerful estimates of digital intervention effectiveness for anxiety disorders are necessary for further adoption in practice. The present systematic review and meta-analysis examined the effectiveness of digital interventions across all anxiety disorders and specific to each disorder v. wait-list and care-as-usual controls. Methods A systematic search of bibliographic databases identified 15 030 abstracts from inception to 1 January 2020. Forty-seven randomized controlled trials (53 comparisons; 4958 participants) contributed to the meta-analysis. Subgroup analyses were conducted by an anxiety disorder, risk of bias, treatment support, recruitment, location and treatment adherence. Results A large, pooled effect size of g = 0.80 [95% Confidence Interval: 0.68–0.93] was found in favor of digital interventions. Moderate to large pooled effect sizes favoring digital interventions were found for generalized anxiety disorder (g = 0.62), mixed anxiety samples (g = 0.68), panic disorder with or without agoraphobia (g = 1.08) and social anxiety disorder (g = 0.76) subgroups. No subgroups were significantly different or related to the pooled effect size. Notably, the effects of guided interventions (g = 0.84) and unguided interventions (g = 0.64) were not significantly different. Supplemental analysis comparing digital and face-to-face interventions (9 comparisons; 683 participants) found no significant difference in effect [g = 0.14 favoring digital interventions; Confidence Interval: −0.01 to 0.30]. Conclusion The precise and powerful estimates found further justify the application of digital interventions for anxiety disorders in place of wait-list or usual care.

scholarly journals A-17 Category Test performance in individuals with alcohol versus methamphetamine dependence

2019 ◽  
Vol 34 (6) ◽  
pp. 876-876
Author(s):  
A Walker ◽  
A Hauson ◽  
S Sarkissians ◽  
A Pollard ◽  
C Flora-Tostado ◽  
...  
Keyword(s):  
Effect Size ◽  
Test Performance ◽  
Neuropsychological Functioning ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Significant Heterogeneity ◽  
Category Test ◽  
Methamphetamine Dependence ◽  
Significant Difference ◽  
Axis I

Abstract Objective The Category Test (CT) has consistently been found to be sensitive at detecting the effects of alcohol on the brain. However, this test has not been as widely used in examining the effects of methamphetamine. The current meta-analysis compared effect sizes of studies that have examined performance on the CT in alcohol versus methamphetamine dependent participants. Data selection Three researchers independently searched nine databases (e.g., PsycINFO, Pubmed, ProceedingsFirst), extracted required data, and calculated effect sizes. Inclusion criteria identified studies that had (a) compared alcohol or methamphetamine dependent groups to healthy controls and (b) matched groups on either age, education, or IQ (at least 2 out of 3). Studies were excluded if participants were reported to have Axis I diagnoses (other than alcohol or methamphetamine dependence) or comorbidities known to impact neuropsychological functioning. Sixteen articles were coded and analyzed for the current study. Data synthesis Alcohol studies showed a large effect size (g = 0.745, p < 0.001) while methamphetamine studies evidenced a moderate effect size (g = 0.406, p = 0.001); both without statistically significant heterogeneity (I2 = 0). Subgroup analysis revealed a statistically significant difference between the effect sizes from alcohol versus methamphetamine studies (Q-between = 5.647, p = 0.017). Conclusions The CT is sensitive to the effects of both alcohol and methamphetamine and should be considered when examining dependent patients who might exhibit problem solving, concept formation, and set loss difficulties in everyday living.

Effectiveness of Hydrodilatation in Adhesive Capsulitis of Shoulder: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 107 (4) ◽  
pp. 285-293 ◽  
Author(s):  
M. Saltychev ◽  
K. Laimi ◽  
P. Virolainen ◽  
M. Fredericson
Keyword(s):  
Confidence Interval ◽  
Effect Size ◽  
Meta Analysis ◽  
Adhesive Capsulitis ◽  
Treatment Method ◽  
Pain Severity ◽  
Current Evidence ◽  
Number Needed To Treat ◽  
Small Effect Size ◽  
Shoulder Motion

Background and Aims: Even though hydrodilatation has been used for 50 years, the evidence on its effectiveness is not clear. Only one earlier review has strictly focused on this treatment method. The aims of this study are to evaluate the evidence on the effectiveness of hydrodilatation in treatment of adhesive capsulitis and, if appropriate, to assess the correlation between the effects of this procedure and the amount of fluid injected. Materials and Methods: A literature search on MEDLINE, Embase, Scopus, Cochrane Central, Web of Science, and CINAHL databases was done; random-effects meta-analysis and meta-regression were employed; and cost-effectiveness and safeness analyses were left outside the scope of the review. Results: Of the 270 records identified through search, 12 studies were included in qualitative and quantitative analysis and seven were included in a meta-analysis. The lower 95% confidence interval for the effect of hydrodilatation on pain severity was 0.12 indicating small effect size and mean number needed to treat 12. The pooled effect of hydrodilatation on disability level was insignificant 0.2 (95% confidence interval: −0.04 to 0.44). The lower 95% confidence interval for the effect of hydrodilatation on the range of shoulder motion was close to zero (0.07) indicating small effect size with mean number needed to treat 12. The amount of injected solution did not have a substantial effect on pain severity or range of shoulder motion. The heterogeneity level I2 was acceptable from 0% to 60%. Conclusion: According to current evidence, hydrodilatation has only a small, clinically insignificant effect when treating adhesive capsulitis.

scholarly journals Effectiveness of Digital Education on Communication Skills Among Medical Students: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration

10.2196/12967 ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. e12967 ◽  
Author(s):  
Bhone Myint Kyaw ◽  
Pawel Posadzki ◽  
Sophie Paddock ◽  
Josip Car ◽  
James Campbell ◽  
...  
Keyword(s):  
Medical Students ◽  
Communication Skills ◽  
Effect Size ◽  
Meta Analysis ◽  
Traditional Learning ◽  
Digital Education ◽  
Significant Difference ◽  
Small Effect Size ◽  
Quality Evidence

Background Effective communication skills are essential in diagnosis and treatment processes and in building the doctor-patient relationship. Objective Our aim was to evaluate the effectiveness of digital education in medical students for communication skills development. Broadly, we assessed whether digital education could improve the quality of future doctors’ communication skills. Methods We performed a systematic review and searched seven electronic databases and two trial registries for randomized controlled trials (RCTs) and cluster RCTs (cRCTs) published between January 1990 and September 2018. Two reviewers independently screened the citations, extracted data from the included studies, and assessed the risk of bias. We also assessed the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations assessment (GRADE). Results We included 12 studies with 2101 medical students, of which 10 were RCTs and two were cRCTs. The digital education included online modules, virtual patient simulations, and video-assisted oral feedback. The control groups included didactic lectures, oral feedback, standard curriculum, role play, and no intervention as well as less interactive forms of digital education. The overall risk of bias was high, and the quality of evidence ranged from moderate to very low. For skills outcome, meta-analysis of three studies comparing digital education to traditional learning showed no statistically significant difference in postintervention skills scores between the groups (standardized mean difference [SMD]=–0.19; 95% CI –0.9 to 0.52; I2=86%, N=3 studies [304 students]; small effect size; low-quality evidence). Similarly, a meta-analysis of four studies comparing the effectiveness of blended digital education (ie, online or offline digital education plus traditional learning) and traditional learning showed no statistically significant difference in postintervention skills between the groups (SMD=0.15; 95% CI –0.26 to 0.56; I2=86%; N=4 studies [762 students]; small effect size; low-quality evidence). The additional meta-analysis of four studies comparing more interactive and less interactive forms of digital education also showed little or no difference in postintervention skills scores between the two groups (SMD=0.12; 95% CI: –0.09 to 0.33; I2=40%; N=4 studies [893 students]; small effect size; moderate-quality evidence). For knowledge outcome, two studies comparing the effectiveness of blended online digital education and traditional learning reported no difference in postintervention knowledge scores between the groups (SMD=0.18; 95% CI: –0.2 to 0.55; I2=61%; N=2 studies [292 students]; small effect size; low-quality evidence). The findings on attitudes, satisfaction, and patient-related outcomes were limited or mixed. None of the included studies reported adverse outcomes or economic evaluation of the interventions. Conclusions We found low-quality evidence showing that digital education is as effective as traditional learning in medical students’ communication skills training. Blended digital education seems to be at least as effective as and potentially more effective than traditional learning for communication skills and knowledge. We also found no difference in postintervention skills between more and less interactive forms of digital education. There is a need for further research to evaluate the effectiveness of other forms of digital education such as virtual reality, serious gaming, and mobile learning on medical students’ attitude, satisfaction, and patient-related outcomes as well as the adverse effects and cost-effectiveness of digital education.

scholarly journals Enduring effects of psychological treatments for anxiety disorders: meta-analysis of follow-up studies

2018 ◽  
Vol 212 (6) ◽  
pp. 333-338 ◽  
Author(s):  
Borwin Bandelow ◽  
Anne Sagebiel ◽  
Michael Belz ◽  
Yvonne Görlich ◽  
Sophie Michaelis ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Cognitive Behavioural Therapy ◽  
Psychological Treatment ◽  
Meta Analysis ◽  
Behavioural Therapy ◽  
Control Groups ◽  
Cognitive Behavioural ◽  
Significant Difference

BackgroundIt is a widespread opinion that after treatment with psychotherapy, patients with anxiety disorders maintain their gains beyond the active treatment period, whereas patients treated with medication soon experience a relapse after treatment termination.AimsWe aimed to provide evidence on whether enduring effects of psychotherapy differ from control groups.MethodWe searched 93 randomised controlled studies with 152 study arms of psychological treatment (cognitive–behavioural therapy or other psychotherapies) for panic disorder, generalised anxiety disorder and social anxiety disorder that included follow-up assessments. In a meta-analysis, pre-post effect sizes for end-point and all follow-up periods were calculated and compared with control groups (medication: n = 16 study arms; pill and psychological placebo groups: n = 17 study arms).ResultsGains with psychotherapy were maintained for up to 24 months. For cognitive–behavioural therapy, we observed a significant improvement over time. However, patients in the medication group remained stable during the treatment-free period, with no significant difference when compared with psychotherapy. Patients in the placebo group did not deteriorate during follow-up, but showed significantly worse outcomes than patients in cognitive–behavioural therapy.ConclusionsNot only psychotherapy, but also medications and, to a lesser extent, placebo conditions have enduring effects. Long-lasting treatment effects observed in the follow-up period may be superimposed by effects of spontaneous remission or regression to the mean.Declaration of interestIn the past 12 months and in the near future, Dr Bandelow has been/will be on the speakers/advisory board for Hexal, Mundipharma, Lilly, Lundbeck, Pfizer and Servier. Dr Wedekind was on the speakers' board of AstraZeneca, Essex Pharma, Lundbeck and Servier. All other authors have nothing to declare.

Cognitive–behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential bias

2014 ◽  
Vol 204 (1) ◽  
pp. 20-29 ◽  
Author(s):  
S. Jauhar ◽  
P. J. McKenna ◽  
J. Radua ◽  
E. Fung ◽  
R. Salvador ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cognitive Behavioural Therapy ◽  
Effect Size ◽  
Negative Symptoms ◽  
Meta Analysis ◽  
Behavioural Therapy ◽  
Effect Sizes ◽  
Positive Symptoms ◽  
Cognitive Behavioural ◽  
Control Intervention

BackgroundCognitive–behavioural therapy (CBT) is considered to be effective for the symptoms of schizophrenia. However, this view is based mainly on meta-analysis, whose findings can be influenced by failure to consider sources of bias.AimsTo conduct a systematic review and meta-analysis of the effectiveness of CBT for schizophrenic symptoms that includes an examination of potential sources of bias.MethodData were pooled from randomised trials providing end-of-study data on overall, positive and negative symptoms. The moderating effects of randomisation, masking of outcome assessments, incompleteness of outcome data and use of a control intervention were examined. Publication bias was also investigated.ResultsPooled effect sizes were −0.33 (95% CI −0.47 to −0.19) in 34 studies of overall symptoms, −0.25 (95% CI −0.37 to −0.13) in 33 studies of positive symptoms and −0.13 (95% CI −0.25 to −0.01) in 34 studies of negative symptoms. Masking significantly moderated effect size in the meta-analyses of overall symptoms (effect sizes −0.62 (95% CI −0.88 to −0.35) v. −0.15 (95% CI −0.27 to −0.03), P = 0.001) and positive symptoms (effect sizes −0.57 (95% CI −0.76 to −0.39) v. −0.08 (95% CI −0.18 to 0.03), P<0.001). Use of a control intervention did not moderate effect size in any of the analyses. There was no consistent evidence of publication bias across different analyses.ConclusionsCognitive–behavioural therapy has a therapeutic effect on schizophrenic symptoms in the ‘small’ range. This reduces further when sources of bias, particularly masking, are controlled for.

scholarly journals From problem-solving to sensemaking: A comparative meta-analysis of preparatory approaches for future learning

2021 ◽  
Author(s):  
Tanmay Sinha ◽  
Manu Kapur
Keyword(s):  
Problem Solving ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Bayesian Analyses ◽  
Ps I ◽  
Significant Difference ◽  
Small Effect Size ◽  
Moderate Effect ◽  
The Difference ◽  
Future Learning

Against the backdrop of a growing body of research showing the effectiveness of problem-solving activities followed by instruction (PS-I), we report a meta-analysis of the effectiveness of three broad categories of preparatory activities on future learning from instruction: (a) problem-solving followed by instruction (PS-I), (b) scaffolded problem-solving followed by instruction (+PS-I), or (c) an alternative sensemaking activity followed by instruction (!PS-I)? We examined 118 experimental comparisons spanning 33 articles that compared PS-I with +PS-I and !PS-I designs. Although scaffolding was descriptively associated with a small effect size, there was no significant difference relative to PS-I (Hedge’s g -0.08 [95% CI -0.20, 0.04]). Additionally, PS-I exhibited a non-significant moderate effect (Hedge’s g 0.22 [95% CI -0.06, 0.51]) compared to !PS-I. Bayesian analyses strongly favored the null hypothesis for the comparison of PS-I with +PS-I (suggesting a 99% probability of the difference in effect between these designs being less than 0.2), while it suggested a 40.37% probability of at least a moderate effect favoring PS-I relative to !PS-I. Further, the estimation of true effect sizes after accounting for the publication bias suggested moderate effect sizes in favor of PS-I, when considering both comparison conditions +PS-I (Hedge’s g 0.55) and !PS-I (Hedge’s g 0.64).

scholarly journals Efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders: systematic review

2012 ◽  
Vol 200 (1) ◽  
pp. 15-21 ◽  
Author(s):  
Catrin Lewis ◽  
Jennifer Pearce ◽  
Jonathan I. Bisson
Keyword(s):  
Cost Effectiveness ◽  
Anxiety Disorders ◽  
Effect Size ◽  
Meta Analysis ◽  
Cochrane Collaboration ◽  
Waiting List ◽  
Self Help ◽  
Cost Effective Treatment ◽  
Significant Difference ◽  
Meta Analyses

BackgroundSelf-help interventions for psychiatric disorders represent an increasingly popular alternative to therapist-administered psychological therapies, offering the potential of increased access to cost-effective treatment.AimsTo determine the efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders.MethodRandomised controlled trials (RCTs) of self-help interventions for anxiety disorders were identified by searching nine online databases. Studies were grouped according to disorder and meta-analyses were conducted where sufficient data were available. Overall meta-analyses of self-helpv.waiting list and therapist-administered treatment were also undertaken. Methodological quality was assessed independently by two researchers according to criteria set out by the Cochrane Collaboration.ResultsThirty-one RCTs met inclusion criteria for the review. Results of the overall meta-analysis comparing self-help with waiting list gave a significant effect size of 0.84 in favour of self-help. Comparison of self-help with therapist-administered treatments revealed a significant difference in favour of the latter with an effect size of 0.34. The addition of guidance and the presentation of multimedia or web-based self-help materials improved treatment outcome.ConclusionsSelf-help interventions appear to be an effective way of treating individuals diagnosed with social phobia and panic disorder. Further research is required to evaluate the cost-effectiveness and acceptability of these interventions.

A Meta-Analysis on the Efficacy of Exposure-Based Treatment in Anxiety Disorders: Implications for Disgust

2020 ◽  
Vol 20 (2) ◽  
pp. 31-49
Author(s):  
Simona A. PASCAL ◽  
Ioana R. PODINA ◽  
Cătălin NEDELCEA
Keyword(s):  
Anxiety Disorders ◽  
Emotional Distress ◽  
Effect Size ◽  
Meta Analysis ◽  
Medium Effect ◽  
Small Effect Size ◽  
Medium Effect Size ◽  
Exposure Sessions ◽  
And Gender ◽  
Meta Analyses

Despite of several meta-analyses indicating that exposure-based treatments (EBT) are successful in addressing anxiety and fear symptoms, less is known whether this is also the case for disgust, which also accompanies anxiety disorders. Therefore, the aim of the current meta-analysis was to compare the efficacy of EBT on disgust and anxiety (emotional distress), against control condition. This meta-analysis included a total of eight studies. Overall, there was a medium effect size (g = .57, 95% CI: .26 to .88, p < .001) for emotional distress; a medium effect size for anxiety (g = .79, 95% CI: .24 to 1.34, p = .005), yet a small effect size for disgust (g = .36, 95% CI: .05 to .68, p = .024). These findings prompt that current EBT are not tailored to address disgust symptoms accompanying many forms of anxiety disorders, although literature points more and more to a need in this respect. We also examined potential moderator variables (the year of publication, the number of exposure sessions, age of the sample, and gender composition). Additionally, we discussed several strengths and limitations, one of the most important being the small number of studies regarding the subject and their heterogeneity.

Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies

2010 ◽  
Vol 40 (12) ◽  
pp. 1943-1957 ◽  
Author(s):  
P. Cuijpers ◽  
T. Donker ◽  
A. van Straten ◽  
J. Li ◽  
G. Andersson
Keyword(s):  
Anxiety Disorders ◽  
Meta Analysis ◽  
Routine Care ◽  
Drop Out ◽  
Depression And Anxiety ◽  
Face To Face ◽  
Self Help ◽  
Significant Difference ◽  
Post Test ◽  
The Difference

BackgroundAlthough guided self-help for depression and anxiety disorders has been examined in many studies, it is not clear whether it is equally effective as face-to-face treatments.MethodWe conducted a meta-analysis of randomized controlled trials in which the effects of guided self-help on depression and anxiety were compared directly with face-to-face psychotherapies for depression and anxiety disorders. A systematic search in bibliographical databases (PubMed, PsycINFO, EMBASE, Cochrane) resulted in 21 studies with 810 participants.ResultsThe overall effect size indicating the difference between guided self-help and face-to-face psychotherapy at post-test was d=−0.02, in favour of guided self-help. At follow-up (up to 1 year) no significant difference was found either. No significant difference was found between the drop-out rates in the two treatments formats.ConclusionsIt seems safe to conclude that guided self-help and face-to-face treatments can have comparable effects. It is time to start thinking about implementation in routine care.

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