Automated mobile virtual reality cognitive behavior therapy for aviophobia in a natural setting: a randomized controlled trial

Background: Access to evidence-based psychological treatment is a challenge worldwide. We assessed the effectiveness of a fully automated aviophobia smartphone app treatment delivered in combination with a $5 virtual reality (VR) viewer.Methods: In total, 153 participants from the Dutch general population with aviophobia symptoms and smartphone access were randomized in a single-blind randomized controlled trial to either an automated VR cognitive behavior therapy (VR-CBT) app treatment condition (n = 77) or a wait-list control condition (n = 76). The VR-CBT app was delivered over a 6-week period in the participants' natural environment. Online self-report assessments were completed at baseline, post-treatment, at 3-month and at 12-month follow-up. The primary outcome measure was the Flight Anxiety Situations Questionnaire (FAS). Analyses were based on intent-to-treat.Results: A significant reduction of aviophobia symptoms at post-test for the VR-CBT app compared with the control condition [p Conclusions: This study is the first to show that fully automated mobile VR-CBT therapy delivered in a natural setting can maintain long-term effectiveness in reducing aviophobia symptoms. In doing so, it offers an accessible and scalable evidence-based treatment solution that can be applied globally at a fraction of the cost of current treatment alternatives

Guided digital health intervention for depression in Lebanon: randomised trial

<jats:sec><jats:title>Background</jats:title><jats:p>Most people with mental disorders in communities exposed to adversity in low-income and middle-income countries (LMICs) do not receive effective care. Digital mental health interventions are scalable when digital access is adequate, and can be safely delivered during the COVID-19 pandemic.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>To examine the effects of a new WHO-guided digital mental health intervention, Step-by-Step, supported by a non-specialist helper in Lebanon, in the context of concurring economic, humanitarian and political crises, a large industrial disaster and the COVID-19 pandemic.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We conducted a single-blind, two-arm pragmatic randomised trial, comparing guided Step-by-Step with enhanced care as usual (ECAU) among people suffering from depression and impaired functioning. Primary outcomes were depression (Patient Health Questionnaire 9 (PHQ-9)) and impaired functioning (WHO Disability Assessment Schedule-12 (WHODAS)) at post-treatment.</jats:p></jats:sec><jats:sec><jats:title>Findings</jats:title><jats:p>680 people with depression (PHQ-9>10) and impaired functioning (WHODAS>16) were randomised to Step-by-Step or ECAU. Intention-to-treat analyses showed effects on depression (standardised mean differences, SMD: 0.71; 95% CI: 0.45 to 0.97), impaired functioning (SMD: 0.43; 95% CI: 0.21 to 0.65), post-traumatic stress (SMD: 0.53; 95% CI: 0.27 to 0.79), anxiety (SMD: 0.74; 95% CI: 0.49 to 0.99), subjective well-being (SMD: 0.37; 95% CI: 0.12 to 0.62) and self-identified personal problems (SMD: 0.56; 95% CI 0.29 to 0.83). Significant effects on all outcomes were retained at 3-month follow-up.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Guided digital mental health interventions can be effective in the treatment of depression in communities exposed to adversities in LMICs, although some uncertainty remains because of high attrition.</jats:p></jats:sec><jats:sec><jats:title>Clinical implications</jats:title><jats:p>Guided digital mental health interventions should be considered for implementation in LMICs.</jats:p></jats:sec><jats:sec><jats:title>Trial registration number</jats:title><jats:p>ClinicalTrials.gov <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="clintrialgov" xlink:href="NCT03720769">NCT03720769</jats:ext-link>.</jats:p></jats:sec&gt

Free school choice and the educational achievement gap

In the Netherlands, school choice is free and all schools are equally funded by the government. We measured distance from home to school as a proxy for the selectivity of choice and used characteristics of the nearest school to explain the choice of a school other than the nearest school. Almost 89% of all pupils in the 4 largest cities do not select the nearest school. Native Dutch pupils tend to prefer a school with lower percentages of nonwestern migrant students and a higher mean school SES and exam score. Immigrant students tend to choose a school with higher percentages of nonwestern migrant students