Impact of Users' Attitudes Toward Anonymous Internet Interventions for Cannabis vs. Alcohol Use: A Secondary Analysis of Data From Two Clinical Trials

Background: Numerous trials have demonstrated the efficacy of internet interventions targeting alcohol or cannabis use, yet a substantial proportion of users do not benefit from the format, warranting further research to identify moderators of treatment effects. Users' initial attitudes toward treatment is a potential moderator, yet no previous study has investigated users' attitudes in the context of internet interventions for addictive disorders.Method: In this secondary analysis on two internet-based trials targeting harmful alcohol use (n = 1,169) and regular cannabis use (n = 303), respectively, we compared user groups' attitudes at the item level; explored within-group heterogeneity by submitting attitude scores to a k-means cluster analysis; and investigated whether latent subgroups in each user group moderated the treatment effects. Outcome models were run using generalized linear models with 10,000 bias-corrected bootstraps accounting for subject-level clustering.Results: While substance groups and latent subgroups converged in enjoying the anonymity provided by the format, their interest toward treatment differed. Outcome analyses revealed a significant and negative time by subgroup effect on grams of cannabis consumed and screening test score (CAST), favoring the subgroup with positive treatment attitudes. There were not any significant effects of subgroup on alcohol consumption. Despite initial treatment reluctance, participants in the neutral subgroup decreased their cannabis use (gram) significantly when receiving the intervention vs. control.Conclusions: This first, exploratory study revealed key differences between substance groups' attitudes, but more importantly that within-group heterogeneity appear to affect cannabis outcomes. Assessing attitudes could be key in patient-treatment matching, yet more research is needed.

Feasibility and Preliminary Efficacy of a Transdiagnostic Internet Intervention for Adolescents with Anxiety and Depressive Disorders (Preprint)

BACKGROUND Transdiagnostic interventions delivered for children and adolescents show promising results. In order to increase access to treatment, recent developments in technology has led to alternatives to face to face interventions. Transdiagnostic Internet interventions can be effective for adult anxiety and depressive disorders, but research is more limited regarding the efficacy of such treatments for young populations diagnosed with anxiety and or depressive disorders. OBJECTIVE This study aims to investigate the feasibility and preliminary efficacy of a transdiagnostic internet intervention for adolescents diagnosed with anxiety and depressive disorders based on Rational emotive behavior therapy. METHODS We tested the preliminary efficacy of a six-week intervention in an open trial, pre-post design including 15 participants. RESULTS Our results suggest that the intervention is feasible and can be included as a treatment for adolescents with anxiety and depressive disorders, being associated with moderate to large pre-post effect sizes on self-reported anxiety and depressive symptoms, as well as on negative patterns of thinking and knowledge acquisition. Satisfaction with the intervention was high. CONCLUSIONS Transdiagnostic Internet interventions for adolescents with anxiety and depressive symptoms are feasible. Future testing of the efficacy of such interventions in randomized controlled trials should be conducted.

Sample size, sample size planning, and the impact of study context: systematic review and recommendations by the example of psychological depression treatment

Background Sample size planning (SSP) is vital for efficient studies that yield reliable outcomes. Hence, guidelines, emphasize the importance of SSP. The present study investigates the practice of SSP in current trials for depression. Methods Seventy-eight randomized controlled trials published between 2013 and 2017 were examined. Impact of study design (e.g. number of randomized conditions) and study context (e.g. funding) on sample size was analyzed using multiple regression. Results Overall, sample size during pre-registration, during SSP, and in published articles was highly correlated (r's ≥ 0.887). Simultaneously, only 7–18% of explained variance related to study design (p = 0.055–0.155). This proportion increased to 30–42% by adding study context (p = 0.002–0.005). The median sample size was N = 106, with higher numbers for internet interventions (N = 181; p = 0.021) compared to face-to-face therapy. In total, 59% of studies included SSP, with 28% providing basic determinants and 8–10% providing information for comprehensible SSP. Expected effect sizes exhibited a sharp peak at d = 0.5. Depending on the definition, 10.2–20.4% implemented intense assessment to improve statistical power. Conclusions Findings suggest that investigators achieve their determined sample size and pre-registration rates are increasing. During study planning, however, study context appears more important than study design. Study context, therefore, needs to be emphasized in the present discussion, as it can help understand the relatively stable trial numbers of the past decades. Acknowledging this situation, indications exist that digital psychiatry (e.g. Internet interventions or intense assessment) can help to mitigate the challenge of underpowered studies. The article includes a short guide for efficient study planning.

Web-based treatment of harmful alcohol use and alcohol dependence: A randomized controlled trial (Preprint)

BACKGROUND Problematic alcohol use is a major contributor to health loss. Many people with harmful use or alcohol dependence are not reached by treatment, due to limited availability or stigma. They might use internet interventions as an alternative way of getting support. Internet interventions have previously been shown to be effective in reducing alcohol consumption in studies that included hazardous use, but few studies with specific focus on harmful use or alcohol dependence have been conducted. The importance of internet cognitive behavioral therapy (ICBT) programs and therapist guidance in internet interventions are still unclear. OBJECTIVE To investigate the effects of a web-based alcohol-program with or without therapist guidance. METHODS We conducted a three-armed randomized controlled trial comparing therapist-guided ICBT and self-help ICBT with an information only control condition. Help-seeking adult internet-users (n=1169) with alcohol dependence (>=3 ICD criteria) or harmful alcohol use (AUDIT>15) were included in the study during the recruitment period, from March 2015 to March 2017. Participants in the therapist-guided ICBT and self-help ICBT groups had 12-week access to a program consisting of five main and three extra modules as well as a drinking-calendar with automatic feedback. The guidance was given by experienced therapists trained in motivational interviewing. The primary outcome measure was weekly alcohol consumption in standard drinks (12 g of ethanol). Secondary outcomes were alcohol related problems measured with the total AUDIT-score, diagnostic criteria for alcohol dependence (ICD-10 criteria) and Alcohol Use Disorder (DSM-5), depression (MADRS-S), anxiety (GAD-7), health (EQ-5D-5L), readiness to change (Readiness Ruler) and access to other treatment or support. Follow-up was conducted 3 (post-treatment) and 6 months after recruitment. RESULTS Participants had a mean age of 45 (SD=13) years and 56% were women. At 3-months follow-up the therapist-guided ICBT and control group differed significantly in weekly alcohol consumption (-3.84, 95 CI=-6.53 to -1.16, t=2.81, p=.005, d=0.27). No significant differences were found in weekly alcohol consumption between the self-help ICBT group and the therapist-guided ICBT at 3 months, between self-help ICBT and the control group at 3 months or between any of the groups at 6 months. CONCLUSIONS In this study we did not find a therapist-guided ICBT program to be more effective than the same program as self-help ICBT in reducing alcohol consumption or other alcohol-related outcomes. In the short run therapist-guided ICBT seems be more effective than information. Only some internet help-seekers might need a multi-session program and therapist guidance in order to change their drinking when they use internet interventions. CLINICALTRIAL Trial registration: ClinicalTrials.gov, identifier: NCT02377726, https://clinicaltrials.gov/ct2/show/NCT02377726 This trial was approved by the Stockholm Regional Ethical Review Board (No. 2014/1758-31/2).

Sport Cyberpsychology in Action During the COVID-19 Pandemic (Opportunities, Challenges, and Future Possibilities): A Narrative Review

Interest in sport cyberpsychology has become more popular over the last decade, primarily due to the increased use of technology and the online world, including social media, within sport settings (Hurley, 2018). In 2020, this became even more apparent for many athletes, their support teams and their sport organisations, when their professional and social worlds became cyber-dominated due to the COVID-19 pandemic. Many challenges were encountered by: (i) the athletes, in their efforts to remain active and well during this time when all competitions were cancelled and (ii) the healthcare professionals, working with these athletes, in their efforts to continue to support the athletes, when severe travel restrictions and social distancing were in place for considerable periods of time. The purpose of this paper, using a narrative review process, is to present and scrutinise an array of Internet interventions, remote psychological supports and applications (apps) that the athletes and their support personnel used to help them meet their physical, social, and emotional needs during the pandemic. The beneficial and restrictive features of these online options will be presented. Two main themes will be considered in order to focus this discussion, namely, (i) the potential physical and mental opportunities and challenges using the online world extensively during this time presented for the individuals working in sport and (ii) suggestions for how such online interventions used by the athletes, their coaches and sport science personnel during the pandemic may be maintained in some positive ways into the future, to help the athletes prepare for their upcoming competitions, their training and their future careers when they retire from elite sport.

The Role of Emotion Regulation and Self-Efficacy in an Internet Intervention for Grief: A Mediation Analysis. (Preprint)

BACKGROUND Internet interventions for mental disorders and psychological problems such as prolonged grief have established their efficacy. However, less is known about how internet interventions work and through which mechanisms they are linked to the outcomes. OBJECTIVE As a first step in identifying mechanisms of change, this study examined emotion regulation and loss-related coping self-efficacy as putative mediators in a randomised controlled trial of a guided internet intervention for prolonged grief symptoms after spousal bereavement or separation/divorce. METHODS The sample consisted of older adults who reported prolonged grief or adaptation problems after bereavement or separation/divorce and sought help from a guided internet intervention. They were recruited mainly via newspaper articles. Outcome variables were grief symptoms assessed with the Texas Revised Inventory of Grief and psychopathology symptoms assessed with the Brief Symptom Inventory. Six module-related items assessed loss-focused emotion regulation and loss-related coping-self-efficacy. Path models with the simultaneous inclusion of emotion regulation and self-efficacy investigated the specificity and relative strength of these variables as parallel mediators. RESULTS A total of 100 participants who took part in the guided internet intervention. Average age was 51 years; 80% were separated/divorced, 69% were female and 76% were of Swiss origin. The internet intervention increased emotion-regulation skills (b = .34; P = .001) and loss-related self-efficacy (b = .30; P = .002) which both correlated with improvements in grief and psychopathology symptoms. Path models including both putative mediators simultaneously indicated that emotion regulation was directly associated with improvements in grief symptoms (b = .40; P = <.001) but not psychopathology symptoms (b = .01; P = .638). Loss-related self-efficacy was directly related to improvements in psychopathology symptoms (b = .28; P = .017) but not grief symptoms (b = .16; P = .186). The path from the intervention to the improvement in grief remained significant (b = .25; P = .007) in contrast to the path from the intervention to improvements in psychopathology (b = .13; P = .179). CONCLUSIONS Emotion regulation and loss-related coping self-efficacy are promising therapeutic targets for optimizing internet interventions for grief. Emotion regulation appears to be more important for enabling grief processing whereas loss-related coping self-efficacy might be more relevant for improving psychopathology in general. Emotion regulation and coping self-efficacy should be further examined as transdiagnostic or disorder-specific putative mediators in internet interventions for other disorders. CLINICALTRIAL ClinicalTrials.gov NCT02900534; https://clinicaltrials.gov/ct2/show/NCT02900534. INTERNATIONAL REGISTERED REPORT RR2-doi:10.1186/s13063-016-1759-5