Tratamiento transdiagnóstico por internet de la ansiedad y la depresión

Anxiety and depression are common, chronic, disabling and frequently comorbid, but manypeople experience barriers accessing treatment. Internet-delivered psychological treatments (iPT)have considerable potential to increase access, while transdiagnostic (TD) interventions, which aimto simultaneously treat multiple disorders, represent an emerging approach that may facilitate thetreatment of comorbidity. The present paper describes a conceptual and pragmatic rationale for combiningiPT and TD approaches. It also describes the authors’ experiences in developing and evaluatingTD iPT protocols for anxiety and depression. The results of 4 randomised controlled trials and oneopen trial (N = 572) are reviewed. The results of these trials are encouraging and indicate TD iPT cansignificantly reduce symptoms of both principal and comorbid disorders. However, independent replicationof the existing findings is required and many outstanding questions remain. We watch withinterest how further conceptual and technological developments influence the content and deliveryof these interventions.La ansiedad y la depresión son fenómenos comunes, crónicos, incapacitantes y frecuentementecomórbidos, pero muchas personas tienen dificultades para acceder a su tratamiento. Lostratamientos psicológicos administrados por internet poseen un gran potencial para incrementar elacceso de los pacientes, mientras que las intervenciones transdiagnósticas, que se dirigen a tratarsimultáneamente múltiples trastornos, representan un enfoque emergente que podría facilitar eltratamiento de dicha comorbilidad. El presente trabajo describe los fundamentos conceptuales ypragmáticos para la aplicación del transdiagnóstico a través de internet. También se describe la experienciade los autores en el desarrollo y evaluación de protocolos transdiagnósticos administradospor internet para el tratamiento de la ansiedad y la depresión. Se revisan los resultados procedentesde 4 ensayos controlados aleatorizados y un ensayo abierto (N = 572). Los resultados de estos ensayosson alentadores e indican que el transdiagnóstico administrado por internet puede reducir significativamentetanto los síntomas de los trastornos principales como de los trastornos comórbidos.Sin embargo, aparte de que existen cuestiones sin resolver, se requiere una replicación independientede los resultados existentes. Observamos con interés la forma en que los futuros desarrollos teóricosy tecnológicos influyan sobre el contenido y administración de estas intervenciones

Towards a new model of attentional biases in the development, maintenance, and management of pain

Individuals with chronic pain demonstrate attentional biases towards pain-related stimuli. However, the clinical importance of these biases is yet to be determined and a sound theoretical model for explaining the role of attentional biases in the development and maintenance of pain is lacking. Within this article, we (1) systematically review prospective and experimental research exploring attentional biases and pain outcomes in light of current theoretical models and (2) propose a theoretical framework for understanding attention bias in pain. Across prospective research, an attentional pattern of vigilance-avoidance was observed. Interventions targeting attentional biases were less consistent; however, there were promising findings amongst studies that found attentional training effects, particularly for laboratory research. The proposed Threat Interpretation Model suggests a relationship between threat, interpretation and stimuli in determining attentional processes, which whilst tentative generates important testable predictions regarding the role of attention in pain, and builds upon previous theoretical and empirical work in this area

The UniWellbeing course: A randomised controlled trial of a transdiagnostic internet-delivered cognitive behavioural therapy (CBT) programme for university students with symptoms of anxiety and depression

AbstractAnxiety and depression are prevalent among university students and many universities offer psychological services to assist students. Unfortunately, students can experience barriers that prevent access to these services and many university services experience difficulties meeting demand. The present pragmatic randomised controlled trial examined the preliminary efficacy and acceptability of a transdiagnostic and internet-delivered cognitive behavioural therapy (CBT) programme for university students seeking help with anxiety and depression. Participants were randomly allocated to either a treatment group (n=30) or a waitlist-control group (n=23). The treatment group received weekly contact with a therapist, via telephone or a secure messaging system, as well as automated emails that guided their progress through the programme. Significant reductions were found on standard measures of anxiety (Cohen's d=0.66; 95% CI: 0.13 to 1.17) and depression (Cohen's d=0.81; 95% CI: 0.27 to 1.32) among the treatment group participants, but no significant differences were found between the treatment and control groups at post-treatment. However, more pronounced reductions were found among treatment group participants with clinical level symptoms of anxiety (Cohen's d=1.33; 95% CI: 0.62 to 1.99) and depression (Cohen's d=1.59; 95% CI: 0.81 to 2.30), who reported significantly lower levels of symptoms than control group participants at post-treatment. These reductions were maintained at 3-month follow-up and participants rated the intervention as acceptable. The results provide preliminary support for the potential of iCBT for university students with anxiety and depression. However, larger scale implementation trials considering a broader range of outcomes are required.Trial registrationAustralian and New Zealand Clinical Trials Registry: ACTRN12612000212853

Characteristics and Treatment Preferences of People with Symptoms of Posttraumatic Stress Disorder: An Internet Survey

Background: Although Posttraumatic Stress Disorder (PTSD) is a severe and disabling anxiety disorder, relatively few people with this condition access evidence-based care. Barriers to treatment are multiple and complex, but the emerging field of Internet therapy for PTSD may improve access to evidence-based treatment. However, little is known about the characteristics of people with PTSD who seek online treatment, or whether they perceive internet treatment as an acceptable treatment option. Methodology: An online survey was used to collect information about the demographic and symptom characteristics of individuals with elevated levels of PTSD symptoms, and this was compared to data from corresponding sample from a national survey. Previous treatment experiences, perceived barriers to treatment and treatment preferences for Internet therapy and face-to-face treatment were also compared. Principal Findings: High levels of PTSD symptoms were reported by survey respondents. Psychological distress and disability was greater than reported by individuals with PTSD from a national survey. Half of the sample reported not having received treatment for PTSD; however, 88% of those who reported receiving treatment stated they received an evidence-based treatment. Primary barriers to treatment included cost, poor awareness of service availability, lack of prior treatment response and not perceiving personal distress as severe enough to warrant treatment. Most survey respondents indicated they were willing to try Internet treatment for PTSD. Conclusions: The Internet sample was symptomatically severe and multiple barriers existed to treatment. Internet therapy is an acceptable option for the treatment of PTSD in an internet sample.6 page(s

A supportive text message intervention for individuals living with endometriosis (EndoSMS) : randomized controlled pilot and feasibility trial

Introduction: As a high symptom burden chronic condition, endometriosis is associated with diminished quality of life (QoL) and psychological distress. The EndoSMS text message intervention was developed to inform and support individuals living with endometriosis. The primary aim of this study is to assess the acceptability, feasibility and preliminary efficacy of EndoSMS, to improve endometriosis-specific QoL and reduce psychological distress in a randomised controlled trial, compared with care as usual. We will additionally assess the impact of EndoSMS on self-efficacy for managing endometriosis. Methodology: A two-arm parallel pilot randomised controlled trial with waitlist control was conducted. Baseline assessments included QoL, psychological distress, self-efficacy, demographic and medical variables. Following baseline survey completion, participants were randomised to either the Intervention (EndoSMS: 3-months of text messaging) or Control condition. At 3-month follow-up, all participants completed an online survey reassessing outcomes, and Intervention participants provided quantitative and qualitative user feedback on EndoSMS. Results: Data collection commenced on 18 November 2021 and was completed on 30 March 2022. Descriptive statistics will be used to analyse feasibility and acceptability of the intervention. Preliminary efficacy analyses will be conducted using linear mixed models for QoL, psychological distress and self-efficacy outcomes. Subgroup analyses will also be conducted for typically underserved populations (e.g., rural/regional). Conclusion: This pilot will provide acceptability, feasibility and preliminary efficacy evidence for the impact of a supportive text messaging program for endometriosis. It will contribute to understanding how to optimally support individuals in living with and managing their endometriosis. Trial Registration: Australian New Zealand Clinical Trials Registry

Co-design and development of EndoSMS, a supportive text message intervention for individuals living with endometriosis : mixed methods study

Background: Endometriosis, which affects 1 in 10 people assigned female at birth, is a chronic systemic inflammatory disease with a high symptom burden and adverse socioemotional impacts. There is a need for an accessible, cost-effective, and low-burden intervention to support individuals in managing their endometriosis condition. Objective: This study aimed to co-design and evaluate the acceptability, readability, and quality of a bank of supportive SMS text messages (EndoSMS) for individuals with endometriosis. Methods: In phase 1 of this mixed method design, 17 consumer representatives (individuals with endometriosis) participated across three 3-hour web-based (Zoom, Zoom Video Communications, Inc) focus groups. The transcripts were encoded and analyzed thematically. In phase 2, consumer representatives (n=14) and health care professionals (n=9) quantitatively rated the acceptability, readability, and appropriateness of the developed text messages in a web-based survey. All the participants initially completed a background survey assessing sociodemographic and medical factors. Results: Consumer representatives demonstrated diverse sociodemographic characteristics (Mage=33.29), varying in location (metropolitan vs rural or regional), employment, and relationship and educational statuses. Participants reached a consensus regarding the delivery of 4 SMS text messages per week, delivered randomly throughout the week and in one direction (ie, no reply), with customization for the time of day and use of personal names. Seven main areas of unmet need for which participants required assistance were identified, which subsequently became the topic areas for the developed SMS text messages: emotional health, social support, looking after and caring for your body, patient empowerment, interpersonal issues, general endometriosis information, and physical health. Through a web-based survey, 371 co-designed SMS text messages were highly rated by consumers and health care professionals as clear, useful, and appropriate for individuals with endometriosis. Readability indices (Flesch-Kincaid scale) indicated that the SMS text messages were accessible to individuals with a minimum of 7th grade high school education. Conclusions: On the basis of the needs and preferences of a diverse consumer representative group, we co-designed EndoSMS, a supportive SMS text message program for individuals with endometriosis. The initial evaluation of the SMS text messages by consumer representatives and health professionals suggested the high acceptability and suitability of the developed SMS text messages. Future studies should further evaluate the acceptability and effectiveness of EndoSMS in a broader population of individuals with endometriosis

Improving Adherence and Clinical Outcomes in Self-Guided Internet Treatment for Anxiety and Depression: A 12-Month Follow-Up of a Randomised Controlled Trial

Background: A recent paper reported the outcomes of a study examining a new self-guided internet-delivered treatment, the Wellbeing Course, for symptoms of anxiety or depression. This study found the intervention resulted in significant symptom reductions. It also found that automated emails increased treatment completion and clinical improvements in a subsample with elevated anxiety and depression. Aims: To examine the clinical outcomes and the effect of automated emails at 12 months post-treatment. Method: Participants, who were randomly allocated to a Treatment Plus Automated Emails Group (TEG; n = 100), a standard Treatment Group (TG; n = 106) or delayed-treatment Waitlist Control Group (Control; n = 51), were followed up at 12 months post-treatment. Eighty-one percent, 78% and 87% of participants in the TEG, TG and treated Waitlist Control Group provided symptom data at 12-month follow-up, respectively. The primary outcome measures were the Patient Health Questionnaire-9 Item Scale (PHQ-9) and the Generalized Anxiety Disorder-7 Item Scale (GAD-7).Results: Significant improvements in symptoms of anxiety and depression were observed over time in both the TEG and TG (Fs >69, ps .05), and were associated with large effect sizes. No statistically significant differences in symptoms were found between the TEG and TG at post-treatment, 3-month or 12-month follow-up. Previously reported symptom differences between TEG and TG participants with comorbid symptoms were no longer present at 12-month follow-up (ps >.70).Conclusions: The overall benefits of the Wellbeing Course were sustained at 12-month follow-up. Although automated emails facilitated Course completion and reductions in symptoms for participants with comorbid anxiety and depression from pre-post treatment, these differences were no longer observed at 12-month follow-up. The results indicate that automated emails promote more rapid treatment response for people with elevated and comorbid symptoms, but may not improve longer term outcomes

Use of eHealth technologies to enable the implementation of musculoskeletal Models of Care: Evidence and practice

Musculoskeletal (MSK) conditions are the second leading cause of morbidity-related burden of disease globally. EHealth is a potentially critical factor that enables the implementation of accessible, sustainable and more integrated MSK models of care (MoCs). MoCs serve as a vehicle to drive evidence into policy and practice through changes at a health system, clinician and patient level. The use of eHealth to implement MoCs is intuitive, given the capacity to scale technologies to deliver system and economic efficiencies, to contribute to sustainability, to adapt to low-resource settings and to mitigate access and care disparities. We follow a practice-oriented approach to describing the ‘what’ and ‘how’ to harness eHealth in the implementation of MSK MoCs. We focus on the practical application of eHealth technologies across care settings to those MSK conditions contributing most substantially to the burden of disease, including osteoarthritis and inflammatory arthritis, skeletal fragility-associated conditions and persistent MSK pain

The Acceptability of Internet-Based Treatment and Characteristics of an Adult Sample with Obsessive Compulsive Disorder: An Internet Survey

Background: Obsessive-compulsive disorder (OCD) is a disabling anxiety disorder, but most individuals delay seeking treatment. Internet-based cognitive behavioural therapy (iCBT) is an innovative service delivery method that may help to improve access to care, but the acceptability to consumers of such programs has not yet been established. Methodology: People with symptoms of OCD were invited to complete an online survey enquiring about demographic characteristics, symptom severity, and acceptability of Internet-based treatment. Demographic and symptom severity data were compared with people with OCD identified in a national epidemiological survey and with a sample of patients with OCD from a specialist outpatient anxiety clinic. Participants: 129 volunteers to an online Internet survey, 135 patients at a specialist anxiety disorders outpatient clinic, and 297 cases identified in a national epidemiological survey. Main Measures: Demographic characteristics, and severity of symptoms as measured by the Kessler 10-Item scale, the 12-item World Health Organisation Disability Assessment Schedule - Second Edition and the Yale Brown Obsessive Compulsive Scale - Self Report Version. Principal Findings: The Internet sample was similar demographically but reported more severe symptoms than the comparison groups, although had similar severity of symptoms of OCD compared with other clinical samples reported in the literature. Participants reported Internet-based treatment for OCD would be highly acceptable. Conclusions: Internet-based treatment may reduce barriers to accessing treatment to people with OCD. Individuals in this study were similar demographically to other samples and had similar severity of symptoms as those identified in other clinical samples, suggesting that Internet-based treatment using techniques employed in face-to-face treatment may be effective in this group. Internet-based treatments for OCD need to be developed and evaluated