Highlights • Study compared disorder-specific and transdiagnostic treatment approaches. • Study also compared clinician-guided and self-guided treatment approaches. • Study is 1 of 4 related ...randomised controlled trials examining these issues. • Study focused on major depressive disorder and comorbid anxiety disorders. • No marked differences were observed between the treatment approaches.
Almost nothing is known about the potential negative effects of Internet-based psychological treatments for depression. This study aims at investigating deterioration and its moderators within ...randomized trials on Internet-based guided self-help for adult depression, using an individual patient data meta-analyses (IPDMA) approach.
Studies were identified through systematic searches (PubMed, PsycINFO, EMBASE, Cochrane Library). Deterioration in participants was defined as a significant symptom increase according to the reliable change index (i.e. 7.68 points in the CES-D; 7.63 points in the BDI). Two-step IPDMA procedures, with a random-effects model were used to pool data.
A total of 18 studies (21 comparisons, 2079 participants) contributed data to the analysis. The risk for a reliable deterioration from baseline to post-treatment was significantly lower in the intervention v. control conditions (3.36 v. 7.60; relative risk 0.47, 95% confidence interval 0.29-0.75). Education moderated effects on deterioration, with patients with low education displaying a higher risk for deterioration than patients with higher education. Deterioration rates for patients with low education did not differ statistically significantly between intervention and control groups. The benefit-risk ratio for patients with low education indicated that 9.38 patients achieve a treatment response for each patient experiencing a symptom deterioration.
Internet-based guided self-help is associated with a mean reduced risk for a symptom deterioration compared to controls. Treatment and symptom progress of patients with low education should be closely monitored, as some patients might face an increased risk for symptom deterioration. Future studies should examine predictors of deterioration in patients with low education.
The paper presents a simple and economical method of carbovibro-arc surfacing of metal surfaces. This method has been used to apply wear-resistant cermet coatings made of multicomponent pastes ...21.17Fe–4.75C–33.48Cr–1.45Si–1.35B–2.8Mn with the addition of 25 wt% В4С and 10 wt% Na3AlF6 on a steel substrate. The microstructure and phase composition of the cermet coating have been studied, and the distribution of microhardness from its surface to the metal substrate has been determined. It has been found that the main zone of the coating consists of the CrFe4 and B0.7Fe3C0.3 strengthening phases located in the matrix, which is a solid solution of C, B, Cr, and Mn in iron. Tribological tests of samples with and without the protective cermet coating have been carried out by the measuring sliding method; 2D and 3D images of the surfaces of wear grooves have been obtained. It has been found that coated samples have a 2 times lower coefficient of friction and 2.8 times higher wear resistance than uncoated samples. Protective cermet coatings have been applied to commercial parts of agricultural machinery (shins). Comparative tests of shins with protective coatings and uncoated commercial shins have been carried out in real field conditions. It has been found that the service life of parts with the developed cermet coating is 2.5–3 times higher than that of uncoated commercial parts. It is shown that this technology allows one to reduce soil contamination with metal debris and increase the performance of combines.
•Wear-resistant cermet coatings on a steel substrate from multicomponent pastes•2D and 3D images of the surfaces of wear grooves•The coated samples have a 2 times lower coefficient of friction and 2.8 times higher wear resistance.
Highlights • Study compared disorder-specific and transdiagnostic treatment approaches. • Study also compared clinician-guided and self-guided treatment approaches. • Study is 1 of 4 related ...randomised controlled trials examining these issues. • Study focused on Social Anxiety Disorder and comorbid disorders. • No marked differences were observed between the treatment approaches.
This study compared a remote-delivered pain management program, the Pain Course, when delivered in online and workbook formats. Participants (n = 178) were randomised into 2 groups: (1) an Internet ...Group (n = 84) who were provided with secure accounts to the program in an online format; or (2) a Workbook Group (n = 94) who were mailed workbook versions of the program. The content of both programs was identical and comprised 5 core lessons, which participants were encouraged to work through over an 8-week period, according to a prescribed timetable. All participants were provided with weekly contact with a clinical psychologist through email and telephone throughout the program. The overall findings suggest that the workbook format was no less effective or acceptable than the validated online format. Significant improvements (avg. improvement; Internet Group vs Workbook Group) in levels of disability (PDI: 16% vs 24%; RMDQ: 12% vs 15%), anxiety (GAD-7: 36% vs 26%), and depression (PHQ-9: 36% vs 36%) were observed in both groups immediately posttreatment. Further improvements were observed in disability levels to 3-month follow-up, and improvements across the other primary outcomes were maintained until 12-month follow-up. High treatment completion rates and levels of satisfaction were reported in both groups, and both groups required a similarly small amount of clinician contact per participant (M = 74.85 minutes; SD = 41.03). These results highlight the public health potential of remote-delivered pain management programs, delivered in either workbook or online formats, as methods of increasing access to pain management.
Highlights • Study compared disorder-specific and transdiagnostic treatment approaches. • Study also compared clinician-guided and self-guided treatment approaches. • Study is 1 of 4 related ...randomized controlled trials examining these issues. • Study focused on generalized anxiety disorder and comorbid disorders. • No marked differences were observed between the treatment approaches.
In internet-delivered cognitive behavioural therapy (ICBT) programs, beyond standardized core ICBT lessons, brief additional resources are sometimes available to clients to address comorbid concerns ...or offer additional information/strategies. These resources remain understudied in terms of how they are selected and perceived by clients, as well as their relationship to satisfaction and outcomes.
Among clients (N = 793) enrolled in a 5-lesson transdiagnostic ICBT course, we examined client use and perceptions of 18 additional resources at 8 weeks in terms of whether clients found resources informative (yes/no) and or helpful (yes/no). Resources elaborated on cognitive strategies (managing beliefs, risk calculation) or on managing specific problems (agricultural stress, alcohol misuse, anger, assertiveness, chronic conditions, communication, grief, health anxiety, motivation, pain, panic, postpartum depression/anxiety, PTSD, sleep, workplace accomodations, worry). Clients also completed symptom measures and ICBT satisfaction questions at 8 weeks.
Approximately 50 % (n = 398) of clients rated the resources and, on average, clients reported that 3.35 (SD = 3.34) resources were informative and 2.35 (SD = 2.52) resources were helpful as measured by direct questions developed for this study. Higher pre-treatment PTSD and GAD scores were related to a greater number of resources perceived as informative and or helpful. Rating more resources as informative and or helpful had a weak but positive association with ICBT satisfaction and depression, anxiety, PTSD and insomnia change scores. Limitations of the study include that 31 % (n = 245) did not respond to questions about use of resources and 18.9 % (n = 150) said they did not review resources.
There is considerable use of diverse additional resources in ICBT in routine care. Associations suggest that clients are using resources to personalize treatment to their needs and these resources are associated with treatment satisfaction and outcomes. The correlational associations between symptoms and perceived helpfulness of resources can help inform personalization algorithms to optimize ICBT delivery for clients. Further research on how to match clients with, encourage use of, and maximize benefits of resources would be beneficial.
•Brief additiogepnal resources can help to personalize ICBT.•Resources on worry, beliefs, and sleep were downloaded most often.•Positive resource ratings were associated with ICBT satisfaction.•Positive resource ratings were associated with symptom change scores.
•Internet-delivered cognitive behaviour therapy (ICBT) often involves weekly support.•In this trial, patients chose ICBT with standard or optional therapist support.•Few patients chose optional ...support (22%) compared to standard support (78%).•Patients who chose optional support had lower symptoms of anxiety and panic.•Engagement, completion rates, and outcomes were similar between groups.
Emerging evidence from research trials suggests that Internet-delivered cognitive behaviour therapy (ICBT) produces similar symptom improvements whether patients receive weekly therapist support (standard support) or therapist support only when requested (optional support). It remains unknown, however, how many patients receiving ICBT as part of routine clinical care would prefer optional support compared to standard support and how outcomes compare when patients select their preferred treatment option. In this uncontrolled trial, we investigated patient preference and outcomes for standard versus optional support among patients with depression and or anxiety who were offered an 8-week transdiagnostic ICBT intervention in routine care. Of 401 patients accepted for ICBT, 22% selected optional support and 78% selected standard support. At assessment, patients who selected optional support had lower symptoms of anxiety and panic than patients who selected standard support. At post-treatment, both groups achieved similar large improvements in symptoms of anxiety and depression, with improvements sustained at 3-month follow-up. Patients receiving optional support sent and received fewer messages compared to patients receiving standard support. This study demonstrates the potential of optional therapist support to meet the needs and preferences of patients and to also reduce therapist costs in routine care.
Depression and anxiety are common among people who have experienced an acute coronary event (e.g., heart attack). Multidisciplinary cardiac rehabilitation programs often focus on reducing risk ...factors associated with future cardiac events, however, mental health interventions are not routinely available. Given known difficulties with access to mental health treatment, the present study sought to explore the efficacy and acceptability of an Internet-delivered cognitive behavioural therapy program (Cardiac Wellbeing Course) among participants who experienced an acute coronary event. The five-lesson course was delivered over eight weeks and was provided with brief weekly contact, via telephone and secure email with a guide. Participants were randomized to the Cardiac Wellbeing Course (n = 25) or waiting-list control group (n = 28). Symptoms were assessed at pre-treatment, post-treatment, and four-week follow-up. Completion rates (84%) and satisfaction ratings (95%) were high. Statistically significant between-group improvements were observed for the treatment group on primary measures of general anxiety (Cohen's d = 1.62; 67% reduction), depression (Cohen's d = 1.09; 61% reduction), and physical activity levels (Cohen's d = 0.27; 70% increase). Statistically significant improvements were also observed on secondary measures of distress (Cohen's d = 0.98; 51% reduction), cardiac anxiety (Cohen's d = 0.92; 34% reduction), and mental-health quality of life (Cohen's d = 0.23; 24% improvement). The changes were maintained at four-week follow-up. The current findings add to the existing literature and highlight the potential of Internet-delivered cognitive behavioural therapy programs among participants who have experienced an acute coronary event.
•Randomized controlled trial of Internet-delivered therapy for a cardiac population•Large improvements in anxiety and depression (d = 1.62, 1.09) compared to controls•Improvements in activity levels and heart-focused anxiety also observed•High completion rates (84%) and satisfaction ratings (95%) of course•Future research should examine integration of the course in healthcare settings.
Highlights • Internet-delivered cognitive behaviour therapy (ICBT) in practice requires further study. • This trial compared ICBT (n=458) offered in specialized and nonspecialized clinics. • ICBT ...completion rates and satisfaction were high and symptom improvement was large. • There were no differences in ICBT delivered in specialized or nonspecialized clinics. • The findings support the public health potential of ICBT.
PDF
