Journal Staff

Background: Internet-based cognitive behavioral therapy (ICBT) is a form of guided self-help that has been found to be effective for addressing several problems. The target for this type of therapy is usually restricted to one specific disorder. Tailoring the treatment widens the scope of ICBT in that it can address comorbid conditions directly. Objectives: The working, or therapeutic, alliance has been found to predict outcome in studies of face-to-face therapy. The extent to which these findings apply to ICBT is largely unknown. We therefore decided to find out whether the working alliance could predict outcome in tailored ICBT for anxiety disorders. Methods: Data were obtained from the treatment group (n=27) in a randomized controlled trial aiming to test the effects of tailored ICBT for anxiety disorders. The forthcoming study was designed to test the hypothesis that the working alliance measured both pre-treatment and early in treatment (week 3) can predict treatment outcome as measured by the Clinical Outcomes in Routine Evaluation–Outcome Measure (CORE-OM) in a heterogeneous group of patients with anxiety disorders (n=27). Results: Working alliance measured at week 3 into the treatment correlated significantly with the residual gain scores on the primary outcome measure (r=-.47, P=.019, n=25), while expected working alliance pre-treatment did not (r=-.17, P=.42, n=27). Conclusions: These results raise questions about the importance of working alliance in ICBT treatments, and suggest that the working alliance could be important in ICBT.Funding Agencies|Swedish Council for Working Life and Social Research|2008-1145|</p

Response: Rights as Trumps of What?

Background: Smartphone technology presents a novel and promising opportunity to extend the reach of psychotherapeutic interventions by moving selected parts of the therapy into the real-life situations causing distress. This randomised controlled trial will investigate the effects of a transdiagnostic, Internet-administered cognitive behavioural (iCBT) self-help program for anxiety, supplemented with a smartphone application. The effect of added therapist support will also be studied. Methods/Design: One hundred and fifty participants meeting diagnostic criteria for social anxiety disorder and/or panic disorder will be evenly randomised to either one of three study groups: 1, smartphone-supplemented iCBT with therapist support; 2, smartphone-supplemented iCBT without therapist support; or 3, an active waiting list control group with delayed treatment. Primary outcome measure will be the Generalised Anxiety Disorder 7-item self-rating scale. Secondary measures include other anxiety, depression and quality of life measures. In addition to pre- and post-treatment measurements, the study includes two mid-treatment (days 24 and 48) and two follow-up assessments (12 and 36 months) to assess rapid and long-term effects. Discussion: To our knowledge, this is the first study to investigate the effectiveness of smartphone-supplemented iCBT for anxiety disorders. Hence, the findings from this trial will constitute great advancements in the burgeoning and promising field of smartphone-administered psychological interventions. Limitations are discussed

An Exploratory Factor Analysis of the Negative Effects Questionnaire for Monitoring and Reporting Adverse and Unwanted Events

Research conducted during the last decades has provided increasing evidence for the use of psychological treatments for a number of psychiatric disorders and somatic complaints. However, by focusing only on the positive outcomes, less attention has been given to the potential of negative effects. Despite indications of deterioration and other adverse and unwanted events during treatment, little is known about their occurrence and characteristics. Hence, in order to facilitate research of negative effects, a new instrument for monitoring and reporting their incidence and impact was developed using a consensus among researchers, self-reports by patients, and a literature review: the Negative Effects Questionnaire. Participants were recruited via a smartphone-delivered self-help treatment for social anxiety disorder and through the media (N = 653). An exploratory factor analysis was performed, resulting in a six-factor solution with 32 items, accounting for 57.64% of the variance. The derived factors were: symptoms, quality, dependency, stigma, hopelessness, and failure. Items related to unpleasant memories, stress, and anxiety were experienced by more than one-third of the participants. Further, increased or novel symptoms, as well as lack of quality in the treatment and therapeutic relationship rendered the highest self-reported negative impact. In addition, the findings were discussed in relation to prior research and other similar instruments of adverse and unwanted events, giving credence to the items that are included. The instrument is presently available in eleven different languages and can be freely downloaded and used from www.neqscale.com

Моральний аспект у детективних романах А. Конана Дойля і А. Крісті

Objectives: To investigate whether posttraumatic stress symptoms (PTSS) are related to attentional bias towards cancer-related stimuli among parents of children recently diagnosed with cancer. Methods: Sixty-two parents completed questionnaires measuring PTSS, depression, and anxiety and the emotional Stroop task via the Internet. The emotional Stroop task included cancer-related words, cardiovascular disease-related words, and neutral words. Results: Participants were split in two groups based on the median of PTSS: High-PTSS and Low-PTSS. There was a significant interaction between word-type and group and a planned contrast test of this interaction indicated that the High-PTSS group had longer response latencies on cancer-related words compared to the other word-type and group combinations. Conclusions: Findings suggest that PTSS are related to attentional bias towards cancer-related stimuli among parents of children recently diagnosed with cancer. Implications of this finding for the understanding of PTSS in this population, future research, and clinical practice are discussed

What makes internet therapy work?

Abstract Internet therapy is a novel treatment approach that is used to deliver cognitive behaviour therapy. Treatment components are mainly delivered in the form of texts presented via webpages, and support is provided via e-mail. A growing number of controlled trials suggest that Internet therapy works well when (a) a proper diagnosis is made before the treatment starts, (b) a comprehensive treatment is provided, (c) the treatment is user friendly and not overly technically advanced, and (d) support and a clear deadline are provided for the duration of the treatment. Several issues remain for exploration in future research, such as mediating and moderating mechanisms and the role of tailoring the intervention. Keywords: Internet therapy; guided self-help; web design; deadline effect Introductio

Self-help interventions for anxiety disorders: An overview.

Anxiety disorders are highly prevalent and are associated with a marked impairment in quality of life and a huge economic cost to society. Unfortunately, a considerable number of people who struggle with anxiety do not seek or receive adequate treatment. Self-help interventions have been proposed to constitute a relatively cheap, effective, efficient, and low-threshold intervention for anxiety disorders. This paper offers a critical discussion of their advantages and disadvantages and the evidence for their effectiveness. We conclude that guided self-help can play a major role in mental health care for patients with anxiety disorders. However, several research questions need to be answered before broad-scale dissemination is possible. The Internet will continue to play a prominent role in the further development of this field of research and clinical practice

Telepsychology: public speaking fear treatment on the internet

El objetivo es presentar un sistema de telepsicología para el tratamiento del miedo a hablar en público. El sistema utiliza procedimientos de auto-ayuda y está compuesto por: a) Un protocolo de evaluación que rastrea información clínicamente relevante; b) Un protocolo de tratamiento basado en procedimientos cognitivo-comportamentales que cuenta con una serie de vídeos de audiencias reales que permiten a la persona afrontar las situaciones temidas. Está organizado en bloques separados a los que se accede a medida que se supera cada fase previa. c) Un protocolo de control que rastrea el progreso durante todo el proceso y controla que la persona no se salta partes del tratamiento (algo común en procedimientos de autoayuda). Este sistema es el primero en todo el mundo totalmente autoaplicado que utiliza internet como soporte. Este estudio constituye la tesis de licenciatura de la solicitante (obteniendo la máxima calificación, sobresaliente por unanimidad), siendo la directora la Dra. Baños de la Universidad de Valencia. La solicitante diseñó el sistema, escribió la mayor parte de los protocolos, controló cada fase del proceso y redactó el manuscrito final

What can be learned about gambling from a learning perspective?:A narrative review

Gambling is a field that harbors both harmless recreational activities and pathological varieties that may be considered an addictive disorder. It is also a field that deserves special interest from a learning theoretical perspective, since pathological gambling represents both a pure behavioral addiction involving no ingestion of substances and behavior that exhibits extreme resistance to extinction. As the field of applied psychology of learning, or behavior analysis, espouses a bottom-up approach, the basis of understanding begins in basic research on behavioral principles. This article provides a narrative review of the field of laboratory experiments conducted to disentangle the learning processes of gambling behavior. The purpose of this review is to give an overview of learning principles in gambling that has been demonstrated under lab conditions and that may be of importance in the development of clinical applications when gambling has become a problem. Several processes, like the importance of delay and probability discounting, reinforcement without actual winning, and rule governed behavior have been experimentally verified. The common denominator appears to be that they impede extinction. Other areas, especially Pavlovian conditioning, are scarce in the literature. Our recommendations for the future would be to study Pavlovian and instrumental conditioning in interaction. Treatment programs should profit from strategies that serve to enhance extinction learning. We also conclude that online gambling should provide a promising environment for controlled research on how to limit excessive gambling, provided that the gambling companies are interested in that.</p

Tratamientos psicológicos para la depresión aplicados a través de Internet y con el apoyo de un clínico: Una actualización

Guided internet-delivered cognitive behaviour therapy (ICBT) has been tested in many trials since the early studies dating back to the late 1990’s. The aim of this review was to investigate the most recent literature on guided ICBT for depression. We identified 11 controlled studies published between January 2013 and September 2014. Overall, large treatment effects were observed with a few exceptions. A majority (7 studies) provided some information regarding unwanted effects such as deterioration. Three studies directly compared guided ICBT against face-to-face CBT. We added an earlier study and calculated meta-analytic summary statistics for the four studies involving a total of 336 participants. The average effect size difference was Hedges g = 0.12 (95% CI: -0.08~0.32) in the direction of favouring guided ICBT, but with no practical importance. We conclude that guided ICBT is a promising treatment for depression and mood disorders and that the research is rapidly expanding.La terapia cognitivo-conductual aplicada vía internet (TCCI) ha sido puesta a prueba en muchos ensayos desde los primeros estudios en 1990. El objetivo de esta revisión fue investigar la literatura más reciente sobre la TCCI para la depresión. Se identificaron 11 estudios controlados publicados entre enero 2013 y septiembre 2014. Se observaron grandes efectos del tratamiento, con pocas excepciones. La mayoría (7 estudios) proporcionó información sobre los efectos no deseados, como el deterioro. Tres estudios compararon directamente la TCCI con TCC cara-a-cara. Se añadió un estudio anterior y se calcularon estadísticas de resumen meta-analíticos para los cuatro estudios incluyendo un total de 336 participantes. La diferencia promedia de tamaño del efecto fue Hedges g = 0.12 (95% CI: -0.08~0.32) en favor de la TCCI. Se concluye que la TCCI es un tratamiento prometedor para la depresión y los trastornos del estado de ánimo y que la investigación se está expandiendo rápidamente

The Potential of Consumer-Targeted Virtual Reality Relaxation Applications: Descriptive Usage, Uptake and Application Performance Statistics for a First-Generation Application

Virtual Reality (VR) technology can be used to create immersive environments that promote relaxation and distraction, yet it is only with the recent advent of consumer VR platforms that such applications have the potential for widespread dissemination, particularly in the form of consumer-targeted self-help applications available at regular digital marketplaces. If widely distributed and used as intended, such applications have the potential to make a much-needed impact on public mental health. In this study, we report real-world aggregated uptake, usage and application performance statistics from a first-generation consumer-targeted VR relaxation application which has been publicly available for almost 2 years. While a total of 40,000 unique users signals an impressive dissemination potential, average session duration was lower than expected, and the data suggests a low number of recurrent users. Usage of headphones and auxiliary input devices was relatively low, and some application performance issues were evident (e.g., lower than intended framerate and occurrence of overheating). These findings have important implications for the design of the future VR relaxation applications, revealing primarily that user engagement needs to be addressed in the early stage of development by including features that promote prolonged and recurrent use (e.g., gamification elements)