4,372 research outputs found

    Efficacy of a self-applied online program to promote resilience and coping skills in university students in four Spanish-speaking countries: study protocol for a randomized controlled trial

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    Background: There is evidence of a high prevalence of depression and anxiety in university students. Therefore, college time is a key period where prevention of mental disorders through interventions that promote resilience and mental health can be relevant. Currently, there are interventions available, but these are insufficient for those who need them. Online interventions are tools that can facilitate global accessibility and are easy for young people to use. CORE (Cultivating Our Resilience) is a self-administered online program, based on Ryff’s psychological well-being model, to promote resilience and coping skills in university students at risk of developing symptoms of depression or anxiety. The objective is to evaluate the effectiveness of this intervention protocol in comparison with an active control condition targeting healthy lifestyle, and a waiting list control condition. The study will be conducted in four populations of Spanish-speaking university students (Spain, Argentina, Colombia, and Mexico). Methods: The study design is a randomized controlled trial (RCT). At least 324 university students will be randomly assigned to three conditions: 1) CORE, a 6-week training program to improve resilience; 2) HLP, a 6-week training to promote a healthy lifestyle; and 3) WL, waiting list control condition. The primary outcome measure will be the Connor-Davidson resilience scale. Additionally, measures of anxiety, depression, quality of life and socio-demographic variables (age, sex, incomes, marital status, among others) will be collected. Participants will be evaluated at pre-treatment, after each module, 6 weeks after allocation, and at 3-month follow-up. Intention-to-treat and per-protocol analyses will be performed. Discussion: The results of this study will contribute to research on Internet-administered interventions and the implementation of a protocol that includes a series of components designed to improve resilience and coping skills, increase psychological well-being, and prevent depression and anxiety disorders in Spanish-speaking university students. In addition, avenues will be opened up for new research on the effectiveness of these interventions focused on the prevention and promotion of mental health in Spanish-speaking countries

    Web Health Application for ADHD Monitoring (WHAAM): Context-Driven Framework

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    The Framework (FW) summarizes the experiences and vision of the WHAAM project partners, providing the basis for the development of the WHAAM app and online services. There are many approaches to the treatment of ADHD, with excellent resources available. This FW is a working tool based on partners' experiences, inspiring subsequent project activities. It is divided into three parts: part A explores general issues related to ADHD, focusing on key life contexts such as school, family, and social relationships. Each context is explored in terms of assessment, intervention and support. Part B delves into the relationship between ICT use and ADHD treatment. Finally, Part C briefly explains the main features of the WHAAM app, including functionality and interfaces. The WHAAM project considers the app and online service accessible via PC and mobile devices as a significant advancement in monitoring process management

    The prodrome of autism: early behavioral and biological signs, regression, peri- and post-natal development and genetics

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    Autism is one of the most heritable neurodevelopmental conditions and has an early onset, with symptoms being required to be present in the first 3 years of life in order to meet criteria for the ‘core’ disorder in the classification systems. As such, the focus on identifying a prodrome over the past 20 years has been on pre-clinical signs or indicators that will be present very early in life, certainly in infancy. A number of novel lines of investigation have been used to this end, including retrospective coding of home videos, prospective population screening and ‘high risk’ sibling studies; as well as the investigation of pre- and peri-natal, brain developmental and other biological factors. Whilst no single prodromal sign is expected to be present in all cases, a picture is emerging of indicative prodromal signs in infancy and initial studies are being undertaken to attempt to ameliorate the early presentation and even ‘prevent’ emergence of the full syndrome

    Efficacy of an internet-based psychological intervention for problem gambling and gambling disorder: Study protocol for a randomized controlled trial

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    Gambling Disorder is a prevalent non-substance use disorder, which contrasts with the low number of people requesting treatment. Information and Communication Technologies (ICT) could help to enhance the dissemi- nation of evidence-based treatments and considerably reduce the costs. The current study seeks to assess the efficacy of an online psychological intervention for people suffering from gambling problems in Spain. The proposed study will be a two-arm, parallel-group, randomized controlled trial. A total of 134 participants (problem and pathological gamblers) will be randomly allocated to a waiting list control group (N = 67) or an intervention group (N = 67). The intervention program includes 8 modules, and it is based on motivational interviewing, cognitive-behavioral therapy (CBT), and extensions and innovations of CBT. It includes several complementary tools that are present throughout the entire intervention. Therapeutic support will be provided once a week through a phone call with a maximum length of 10 min. The primary outcome measure will be gambling severity and gambling-related cognitions, and secondary outcome measures will be readiness to change, and gambling self-efficacy. Other variables that will be considered are depression and anxiety symptoms, positive and negative affect, difficulties in emotion regulation strategies, impulsivity, and quality of life. In- dividuals will be assessed at baseline, post-treatment, and 3-, 6-, and 12-month follow-ups. During the treatment, participants will also respond to a daily Ecological Momentary Intervention (EMI) in order to evaluate urges to gamble, self-efficacy to cope with gambling urges, gambling urge frequency, and whether gambling behaviour occurs. The EMI includes immediate automatic feedback depending on the participant's responses. Treatment acceptance and satisfaction will also be assessed. The data will be analysed both per protocol and by Intention-to- treat. As far as we know, this is the first randomized controlled trial of an online psychological intervention for gambling disorder in Spain. It will expand our knowledge about treatments delivered via the Internet and contribute to improving treatment dissemination, reaching people suffering from this problem who otherwise would not receive help. Trial registration: Clinicaltrials.gov as NCT04074681. Registered 22 July 2019

    Efficacy of an internet-based psychological intervention for problem gambling and gambling disorder: Study protocol for a randomized controlled trial

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    Gambling Disorder is a prevalent non-substance use disorder, which contrasts with the low number of people requesting treatment. Information and Communication Technologies (ICT) could help to enhance the dissemination of evidence-based treatments and considerably reduce the costs. The current study seeks to assess the efficacy of an online psychological intervention for people suffering from gambling problems in Spain. The proposed study will be a two-arm, parallel-group, randomized controlled trial. A total of 134 participants (problem and pathological gamblers) will be randomly allocated to a waiting list control group (N = 67) or an intervention group (N = 67). The intervention program includes 8 modules, and it is based on motivational interviewing, cognitive-behavioral therapy (CBT), and extensions and innovations of CBT. It includes several complementary tools that are present throughout the entire intervention. Therapeutic support will be provided once a week through a phone call with a maximum length of 10 min. The primary outcome measure will be gambling severity and gambling-related cognitions, and secondary outcome measures will be readiness to change, and gambling self-efficacy. Other variables that will be considered are depression and anxiety symptoms, positive and negative affect, difficulties in emotion regulation strategies, impulsivity, and quality of life. Individuals will be assessed at baseline, post-treatment, and 3-, 6-, and 12-month follow-ups. During the treatment, participants will also respond to a daily Ecological Momentary Intervention (EMI) in order to evaluate urges to gamble, self-efficacy to cope with gambling urges, gambling urge frequency, and whether gambling behaviour occurs. The EMI includes immediate automatic feedback depending on the participant''s responses. Treatment acceptance and satisfaction will also be assessed. The data will be analysed both per protocol and by Intention-to treat. As far as we know, this is the first randomized controlled trial of an online psychological intervention for gambling disorder in Spain. It will expand our knowledge about treatments delivered via the Internet and contribute to improving treatment dissemination, reaching people suffering from this problem who otherwise would not receive help

    Virtual Reality Exposure Therapy for Adolescents with Public Speaking Anxiety

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    Bakgrunn: Presentasjonsangst er en av de vanligste fryktene blant ungdom. Angsten innebærer en redsel for å bli negativt evaluert, etterfulgt av en følelse av å bli flau eller ydmyket når man snakker foran andre. Eksponeringsterapi for presentasjonsangst er utfordrende å gjennomføre, da en trenger et reelt publikum som kan fungere som det fryktede stimuli. Virtual Reality (VR) kan være løsningen, da teknologien er i stand til å skape et virtuelt publikum, som kan oppleves som ekte. For voksne med presentasjonsangt finnes det flere randomiserte kontrollerte VR-studier som viser gode kliniske effekter, men en vet lite om effekten relatert til ungdom. Ingen studier har tidligere evaluert effekten av selvveiledet, automatiserte og spillbaserte VR-intervensjoner for ungdom med presentasjonsangst. Mål: Denne oppgaven adresserte aktuelle kunnskapshull ved å kartlegge den kliniske effekten og gjennomførbarheten av to VR-intervensjoner for ungdom med presentasjonsangst: en terapeutveiledet og en selvveiledet, automatisert og spillbasert intervensjon. Målet med Artikkel I var å undersøke gjennomførbarheten og den kliniske effekten av en terapeutveiledet, enkelt-sesjons VR-intervensjon for ungdom med presentasjonsangst. Hovedmålet med Artikkel II var å undersøke den kliniske effekten av en selvveiledet, automatisert og spillbasert VR-intervensjon sammenlignet med venteliste og en selvveiledet nettbasert intervensjon. Et sekundært mål var å undersøke om VR-intervensjonen førte til en økning i påfølgende eksponeringsøvelser under det nettbaserte eksponeringsprogrammet, sammenlignet med de som mottok nettbasert psykoedukasjons- og eksponeringsprogram. Målet med Artikkel III var å undersøke om intervensjonene rettet mot presentasjonsangst også førte til en reduksjon i symptomer på perfeksjonisme og om symptomer på perfeksjonisme modererte den kliniske effekten av intervensjonene for presentasjonsangst. Metode: To kliniske studier ga data for tre studier: en ikke-randomisert gjennomførbarhet- og pilotstudie (papir I) og en to-faset, firearmet randomisert kontrollert studie (papir II og III). Begge studiene undersøkte effekter og moderatorer av behandling: symptomer på generalisert sosial angst ved baseline og tilstedeværelse i det virtuelle miljøet (artikkel I) og om perfeksjonisme modererte behandlingsresultatet (artikkel III). Selvrapporterte symptomer på presentasjonsangst ble innhentet under intervensjons- og oppfølgingsperioden i begge studiene, i tillegg til hjertefrekvensmålinger under VR-eksponeringen i Artikkel I, selvrapporterte symptomer på generalisert sosial angst i Artikkel II og III, og perfeksjonisme i Artikkel III. Gjennomførbarhets- og pilotstudien i Artikkel I inkluderte N=27 ungdommer som deltok i en terapeutveiledet, 90-minutters VR-intervensjon på én sesjon ved klinikken. To-faset, firearmede randomiserte kontrollerte studien i Artikkel II og III inkluderte N=100 ungdommer som deltok i et seks ukers digitalt selvveiledet intervensjonsprogram. Ungdommene ble randomisert i fire grupper, med følgende fase én + fase to intervensjon; 1) Kun VR, 2) VR + nettbasert eksponeringsprogram, 3) Nettbasert psykoedukasjon + eksponeringsprogram, 4) Venteliste + nettbasert psykoedukasjonsprogram. Resultater: Resultater fra Artikkel I viste en signifikant reduksjon i presentasjonsangstsymptomer fra pre til post, og symptomene holdt seg stabile ved en og tre måneders oppfølging. Basert på tilbakemeldinger fra ungdommene, ble gjennomførbarheten av intervensjonen økt i løpet av studien, noe som resulterte i ingen manglende besvarelser ved oppfølging. Symptomer på generalisert sosial angst ved baseline og tilstedeværelse modererte ikke de kliniske effektene. Det var en liten økning i hjertefrekvensen under VR-eksponeringsoppgavene. Resultater fra Artikkel II viste en signifikant større reduksjon i presentasjonsangstsymptomer blant ungdommene som mottok VR-intervensjonen sammenlignet med ventelistegruppen. Resultatene viste også at VR + nettbasert eksponeringsprogram var like effektivt sammenlignet med kun VR og nettbasert psykoedukasjon + eksponeringsprogram. I tillegg hadde alle fire grupper en signifikant reduksjon i presentasjonsangstsymptomer. I motsetning til hypotesen fullførte ikke ungdommer som mottok VR-intervensjon et høyere antall in-vivo-eksponeringsoppgaver i løpet av nettbasert eksponeringsprogram sammenlignet med de som mottok nettbasert psykoedukasjon og eksponeringsprogram. De kliniske effektene holdt seg stabile ved tre måneders oppfølging. Resultater fra Artikkel III viste at intervensjonene ikke reduserte perfeksjonisme på gruppenivå, men det var signifikante individuelle forskjeller i endringer over tid. En nedgang i perfeksjonisme var assosiert med en større reduksjon på alle utfallsmål fra post til oppfølging. Det var ingen signifikante interaksjonseffekter mellom presentasjonsangstsymptomer og nivået av perfeksjonisme før behandling. Høye nivåer av perfeksjonisme før behandling var assosiert med dårligere langsiktige resultater for begge gruppene som mottok det nettbaserte eksponeringsprogrammet. Konklusjon: Denne oppgaven bidrar til det voksende evidensgrunnlaget for VR-eksponeringsterapi, og den første som demonstrerer potensialet til både terapeutveiledet og selvveiledet VR-behandling for ungdom generelt, og spesielt for de med presentasjonsangst. Resultatene indikerer at VR-behandling kan fungere som et indisert forebyggingsprogram for ungdom med PSA. Studiene som inngår i oppgaven er gjennomført ved hjelp av et solid design. Gjennomførbarhet og pilotering var første trinn, før man for første gang med denne målgruppen evaluerte de kliniske effektene i en randomisert kontrollert studie. I tillegg har oppgaven undersøkt relevante moderatorer av behandlinger; rollen til perfeksjonisme og hvordan den kan hindre bedring. Disse resultatene kan være veiledende for hvordan optimalisere fremtidige intervensjoner for ungdom med presentasjonsangst. Fremtidige studier bør undersøke om VR-terapi har en langsiktig forebyggende effekt på utvikling av generalisert sosial angst da dette fortsatt er uklart for denne aldersgruppen.Background: Public Speaking Anxiety (PSA) is one of the most common fears reported by adolescents. PSA involves the fear of being negatively evaluated, followed by a feeling of being embarrassed or humiliated when speaking in front of others. Providing state-of-the-art in-vivo exposure therapy for PSA is difficult due to the logistics of recruiting an actual audience trained to act as the feared stimuli. An attractive way of resolving this obstacle is through Virtual Reality (VR) technology, which is capable of creating an immersive experience of being in front of a virtual audience, as if it was real. Although there are several randomized controlled trials demonstrating the clinical efficacy of VR exposure therapy for adults with PSA, little is known about its clinical effects on adolescents. Moreover, no past study has evaluated self-guided and automated VR interventions for adolescents with PSA. Aims: This thesis addressed these key knowledge gaps by exploring the clinical effects and feasibility of both therapist-guided and self-guided, and automated VR interventions for adolescents with PSA. The aim of Paper I was to investigate the feasibility and the clinical effects of a therapist-guided, single-session VR-intervention for adolescents with PSA, using low-cost consumer VR hardware. The primary aim of Paper II was to investigate the clinical efficacy of a self-guided, automated, and gamified VR intervention compared with waitlist and self-guided online programs. A secondary aim was to explore whether the VR intervention led to an increase in subsequent exposure tasks during the online exposure program compared to those receiving the online psychoeducation and exposure program. The aim of Paper III was to investigate whether interventions targeting PSA also led to a reduction in symptoms of perfectionism and whether symptoms of perfectionism moderated the clinical efficacy of self-guided interventions for PSA. Methods: Two clinical trials provided data for three studies: one non-randomized feasibility and pilot study (Paper I) and a two-phased, four-armed randomized controlled study (Paper II and III). Both trials investigated effects and moderators of treatment: baseline generalized social anxiety symptoms and presence in the virtual environment (Paper I) and whether perfectionism moderated treatment outcome (Paper III). Self-reported PSA were assessed during the intervention and follow-up period in both studies, in addition to heart rate measurements during the VR exposure in Paper I, self-reported symptoms of generalized SAD in Paper II and III, and perfectionism in Paper III. The non-randomized feasibility and pilot study in Paper I included N=27 adolescents who participated in a therapist-guided, 90-minutes single-session VR intervention at the clinic. The two-phased, four-armed randomized controlled study in Paper II and III included N=100 adolescents who participated in a six weeks digital self-guided interventions program. The adolescents were randomized into four groups, with the following phase one + phase two intervention; 1) VR only, 2) VR + online exposure program, 3) Online psychoeducation + exposure program, 4) Waitlist + online psychoeducation program. Results: Results from Paper I revealed a significant decrease in PSA symptoms from pre to post, and symptoms remained stable at one- and three-month follow-up. Based on feedback from the adolescents, the feasibility of the intervention was increased during the trial, resulting in no missing data. Baseline generalized social anxiety symptoms and presence did not moderate the clinical effects. There was a small increase in heart rate during the VR exposure tasks. Results from Paper II revealed a significantly greater reduction in PSA symptoms among the adolescents who received the VR intervention compared to the the waitlist group. The results also demonstrated that VR + online exposure program was as equally effective as compared to VR only and online psychoeducation + exposure program. Moreover, all groups had a significant reduction in PSA symptoms. Contrary to the hypothesis, adolescents who received VR training did not complete a higher number of in-vivo-exposure tasks during the online exposure program compared to those receiving online psychoeducation and exposure program. The clinical effects remained stable at three-month follow-up. Results from Paper III revealed that the interventions did not reduce perfectionism at a group level, however, there were significant individual differences in changes over time. A decrease in perfectionism was associated with a larger reduction on all outcome measures from post to follow-up. There were no significant interaction effects between PSA symptoms and the pre-treatment level of perfectionism. High pre-treatment levels of perfectionism was associated with poorer long-term outcomes for both groups receiving the online exposure program. Conclusions: In sum, this thesis contributes to the growing evidence base for VR exposure therapy, and is among the first to demonstrate the potential of both therapist-guided and self-guided, VR interventions for adolescents in general and with PSA in particular. The results indicate that VR may serve as an indicated prevention program for adolescents with PSA. The studies included in the thesis is conducted through a strong design with feasibility and piloting as a first step before evaluating, for the first time with this target group, the clinical effects in a randomized controlled trial. Moreover, the thesis has investigated relevant moderators of treatments, specifically the role of perfectionism and how it may hinder treatment improvement. These results can provide guidance on how to optimize future interventions for the large group of adolescents with PSA. Future studies should investigate whether VR interventions have a long-term preventive effect on the development of generalized social anxiety as this remains unclear for this age group.Doktorgradsavhandlin

    Using an Interactive Computer Training to Train Teachers in Function-Based Assessment and Intervention

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    Since many educators receive little-to-no formal training in evidence-based classroom management strategies, it may be helpful to train general education teachers in strategies that direct them to the underlying causes of problem behavior. One such strategy is functional behavior assessment, which is the process of gathering information to determine the function of problem behavior, or why behavior is occurring. One potentially effective way of training teachers in this process may be to use an interactive computer training, which has previously been used to train a variety of complex behavior analytic skills with other populations. In the current study, we trained four general education teachers (grades K - 8th) in a function-based approach to problem behavior using an interactive computer training. We evaluated the effects of the training using a multiple baseline across participants design, measuring participants\u27 percentage correct composite scores in assessment sessions. Composite scores represented participants\u27 overall accuracy collecting structured antecedent-behavior-consequence data from video examples, analyzing descriptive data presented in charts, and selecting, function-matched interventions. We also assessed whether the skills trained generalized to longer videos by calculating the percentage of Generalization Probes components participants included in their baseline and post-training narrative responses. We found that only one of four teachers (P6) achieved mastery-level performances in post-training assessment session composite scores. However, we also found that three of four participants (P1, P6, and P7) included a greater percentage of response components in post-training Generalization Probes after completing the interactive computer training. Potential explanations for these performances are discussed. We also explored the relationship between measures of within-session responding in the interactive computer training modules and training outcomes. Finally, we collected social validity data to assess participants\u27 perceptions of the interactive computer training and the content covered within. Social validity data revealed that three of four participants (P1, P6, and P7) found the fully-remote training to be acceptable and all participants reported that learning about function-based approach to problem behavior was beneficial. We conclude by discussing ways the interactive computer training and the methods of assessing skill acquisition used in this study might be improved in future research

    In Case of an Emergency: The Development and Effects of a Digital Intervention for Coping With Distress in Norway During the COVID-19 Pandemic

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    Background: The COVID-19 pandemic and its consequences has been found to negatively affect the general population’s psychological well-being. Objective: The objectives of this paper are to report on the development and clinical effects of a self-guided Internet-delivered intervention for adults in Norway who suffer from mild to moderate psychological distress during the COVID-19 pandemic. Methods: The participants, recruited between April and December 2020, were randomized to receive a new treatment module either every third or every fifth day. The clinical outcomes were self-reported depressive and anxiety symptoms and change in positive and negative emotions. Results: A total of 1256 individuals accessed the pre-screening survey, 407 were eligible and 92 provided contact information, where 82 were included in the study, n = 44 in the 3-day group and n = 38 in the 5-day group. Overall, the statistical analyses showed a significant decrease in depressive and anxiety symptoms and an increase in positive emotions, with small and moderate within group effect sizes. No significant differences between the groups were identified in clinical outcomes or adherence. Conclusion: These findings indicate that psychological distress in the general population during the COVID-19 pandemic may be reduced through the use of a scalable self-guided Internet-delivered intervention. Furthermore, the lack of significant differences between the 5-day and 3-day group may indicate that the intervention can be delivered at a more intensive pace without negatively affecting treatment outcomes. The results need to be interpreted with caution as the sample was self-selected, as well as the lack of passive control group. Hence the results may be attributed to external factors.publishedVersio

    How are information and communication technologies supporting routine outcome monitoring and measurement-based care in psychotherapy? A systematic review

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    Psychotherapy has proven to be effective for a wide range of mental health problems. However, not all patients respond to the treatment as expected (not-on-track patients). Routine outcome monitoring (ROM) and measurement-based care (MBC), which consist of monitoring patients between appointments and using this data to guide the intervention, have been shown to be particularly useful for these not-on-track patients. Traditionally, though, ROM and MBC have been challenging, due to the difficulties associated with repeated monitoring of patients and providing real-time feedback to therapists. The use of information and communication technologies (ICTs) might help reduce these challenges. Therefore, we systematically reviewed evidence regarding the use of ICTs for ROM and MBC in face-to-face psychological interventions for mental health problems. The search included published and unpublished studies indexed in the electronic databases PubMed, PsycINFO, and SCOPUS. Main search terms were variations of the terms "psychological treatment", "progress monitoring or measurement-based care", and "technology". Eighteen studies met eligibility criteria. In these, ICTs were frequently handheld technologies, such as smartphone apps, tablets, or laptops, which were involved in the whole process (assessment and feedback). Overall, the use of technology for ROM and MBC during psychological interventions was feasible and acceptable. In addition, the use of ICTs was found to be effective, particularly for not-on-track patients, which is consistent with similar non-ICT research. Given the heterogeneity of reviewed studies, more research and replication is needed to obtain robust findings with different technological solutions and to facilitate the generalization of findings to different mental health populations
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