From Placebo to self-help: Investigating retention, outcome and mechanisms in self-directed gratitude interventions

The research presented in this thesis explored unguided self-help therapy, primarily using a gratitude technique. Psychological mechanisms that underlie the placebo response may also play a primary role in beneficial response to unguided selfhelp therapy. Retention (whether participants completed the intervention), outcome (whether the technique effectively reduced symptoms), and mechanisms (the psychological processes which antecede outcome and retention), were investigated with participants engaging in procedures to improve a diverse range of symptoms, namely, mood, sleep disturbance, body dissatisfaction, depression and anxiety. Studies one and two investigated the role of two placebo mechanisms, response expectancy and motivational concordance, as predictors of outcome following a gratitude technique. Response expectancy contributed to outcome to a greater extent in a laboratory setting, whereas motivational concordance explained greater outcome variance in a real-world setting. Studies three, four and five compared a gratitude technique to a problemfocused technique and a wait list control. Across all three studies, being randomly allocated to a gratitude technique resulted in greater retention than being a llocated to a problem-focused technique. Use of a gratitude technique resulted in equivalent significant reductions in body dissatisfaction (Study three), depression (Study four) and worry (Study five), compared to a problem-focused cognitive restructuring technique, and was significantly more effective than being on a waitlist in all three studies. There was some evidence that different mechanisms affect outcome and retention. Placebo theory and the contextual model of psychotherapy provide useful insight into the factors that affect outcome and retention in self-help therapy

Renewed:Protocol for a randomised controlled trial of a digital intervention to support quality of life in cancer survivors

International audienceIntroduction Low quality of life is common in cancer survivors. Increasing physical activity, improving diet, supporting psychological well-being and weight loss can improve quality of life in several cancers and may limit relapse. The aim of the randomised controlled trial outlined in this protocol is to examine whether a digital intervention (Renewed), with or without human support, can improve quality of life in cancer survivors. Renewed provides support for increasing physical activity, managing difficult emotions, eating a healthier diet and weight management.Methods and analysis A randomised controlled trial is being conducted comparing usual care, access to Renewed or access to Renewed with brief human support. Cancer survivors who have had colorectal, breast or prostate cancer will be identified and invited through general practice searches and mail-outs. Participants are asked to complete baseline measures immediately after screening and will then be randomised to a study group; this is all completed on the Renewed website. The primary outcome is quality of life measured by the European Organization for Research and Treatment of Cancer QLQ-c30. Secondary outcomes include anxiety and depression, fear of cancer recurrence, general well-being, enablement and items relating to costs for a health economics analysis. Process measures include perceptions of human support, intervention usage and satisfaction, and adherence to behavioural changes. Qualitative process evaluations will be conducted with patients and healthcare staff providing support.Ethics and dissemination The trial has been approved by the NHS Research Ethics Committee (Reference 18/NW/0013). The results of this trial will be published in peer-reviewed journals and through conference presentations.Trial registration number ISRCTN96374224; Pre-results