Internet-based cognitive behavior therapy for obsessive compulsive disorder: A pilot study

<p>Abstract</p> <p>Background</p> <p>Cognitive behavior therapy (CBT) is widely regarded as an effective treatment for obsessive compulsive disorder (OCD), but access to CBT therapists is limited. Internet-based CBT (ICBT) with therapist support is a way to increase access to CBT but has not been developed or tested for OCD. The aim of this study was to evaluate ICBT for OCD.</p> <p>Method</p> <p>An open trial where patients (N = 23) received a 15-week ICBT program with therapist support consisting of psychoeducation, cognitive restructuring and exposure with response prevention. The primary outcome was the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), which was assessed by a psychiatrist before and immediately after treatment. Secondary outcomes were self-rated measures of OCD symptoms, depressive symptoms, general functioning, anxiety and quality of life. All assessments were made at baseline and post-treatment.</p> <p>Results</p> <p>All participants completed the primary outcome measure at all assessment points. There were reductions in OCD symptoms with a large within-group effect size (Cohen's <it>d </it>= 1.56). At post-treatment, 61% of participants had a clinically significant improvement and 43% no longer fulfilled the diagnostic criteria of OCD. The treatment also resulted in statistically significant improvements in self-rated OCD symptoms, general functioning and depression.</p> <p>Conclusions</p> <p>ICBT with therapist support reduces OCD symptoms, depressive symptoms and improves general functioning. Randomized trials are needed to confirm the effectiveness of this new treatment format.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01348529">NCT01348529</a></p

Integrating Mindfulness into Positive Psychology: a Randomised Controlled Trial of an Online Positive Mindfulness Program

The purpose of the present study was to test the efficacy of an 8-week online intervention-based Positive Mindfulness Program (PMP) that integrated mindfulness with a series of positive psychology variables, with a view to improving wellbeing scores measured in these variables. The positive mindfulness cycle, based on positive intentions and savouring, provides the theoretical foundation for the PMP. The study was based on a randomised wait-list controlled trial; and 168 participants (128 females, mean age = 40.82) completed the intervention which included daily videos, meditations, and activities. The variables tested included wellbeing measures, such as gratitude, self-compassion, self-efficacy, meaning, and autonomy. Pre- and post- intervention data, including one month after the end of the intervention, were collected from both experimental and control groups. The post-test measurements of the experimental participants showed a significant improvement in all the dependent variables compared with the pre-test ones and were also significantly higher than those of the control group. One month after the intervention, the experimental group participants retained their improvement in 10 out of the 11 measurements. These positive results indicate that PMP may be effective in enhancing wellbeing and other positive variables in adult, non-clinical populations

The EVIDENT-trial: protocol and rationale of a multicenter randomized controlled trial testing the effectiveness of an online-based psychological intervention

Klein JP, Berger T, Schroeder J, et al. The EVIDENT-trial: protocol and rationale of a multicenter randomized controlled trial testing the effectiveness of an online-based psychological intervention. BMC Psychiatry. 2013;13(1): 239.Background: Depressive disorders are among the leading causes of worldwide disability with mild to moderate forms of depression being particularly common. Low-intensity treatments such as online psychological treatments may be an effective way to treat mild to moderate depressive symptoms and prevent the emergence or relapse of major depression. Methods/Design: This study is a currently recruiting multicentre parallel-groups pragmatic randomized-controlled single-blind trial. A total of 1000 participants with mild to moderate symptoms of depression from various settings including in-and outpatient services will be randomized to an online psychological treatment or care as usual (CAU). We hypothesize that the intervention will be superior to CAU in reducing depressive symptoms assessed with the Personal Health Questionnaire (PHQ-9, primary outcome measure) following the intervention (12 wks) and at follow-up (24 and 48 wks). Further outcome parameters include quality of life, use of health care resources and attitude towards online psychological treatments. Discussion: The study will yield meaningful answers to the question of whether online psychological treatment can contribute to the effective and efficient prevention and treatment of mild to moderate depression on a population level with a low barrier to entry

An Individual Participant Data meta-analysis of psychological interventions for preventing depressive relapse

This is the author accepted manuscript.Data availability: This is individual participant data from randomised controlled trials which cannot be shared publicly due to ethical and consent restrictions that are in place. For data access, please contact the corresponding author. Data access can be provided if these conditions are met 1) there is approval from all co-authors for the data to be shared, 2) there is a data sharing agreement in place (which adheres to the requirements for data sharing by the Amsterdam University Medical Centre), 3) individual studies have participant consent and ethics approvals in place to allow for further onward sharing 4) there is an analysis plan in place that all co-authors agree with. Upon data sharing data can only be used for the specified purposes.Code availability: Analysis code can be found here: https://osf.io/fyr7hMajor depressive disorder (MDD) is a leading cause of disability worldwide, identifying effective strategies to prevent depressive relapse is crucial. This individual patient data meta-analysis (IPDMA) addresses whether and for whom psychological interventions can be recommended for relapse prevention of MDD. One and two-stage IPDMA on 14 randomised controlled trials (N = 1720) were conducted. The relapse risk over 12 months was substantially lower for those who received a psychological intervention versus treatment as usual (TAU), antidepressant or evaluation only control (Hazard Ratio (HR): 0.60 (95% CI 0.48 – 0.74). The number of previous depressive episodes moderated the treatment effect, with psychological interventions demonstrating greater efficacy for patients with three or more prior episodes. Our results suggest that adding psychological interventions to current treatment in order to prevent depressive relapse is recommended. For patients at lower risk of relapse, less intensive approaches may be indicated.Alliance for Public Health, Amsterdam University Medical Centr