Can reduce - the effects of chat-counseling and web-based self-help, web-based self-help alone and a waiting list control program on cannabis use in problematic cannabis users: a randomized controlled trial

BACKGROUND: In European countries, including Switzerland, as well as in many states worldwide, cannabis is the most widely used psychoactive substance after alcohol and tobacco. Although approximately one in ten users develop serious problems of dependency, only a minority attends outpatient addiction counseling centers. The offer of a combined web-based self-help and chat counseling treatment could potentially also reach those users who hesitate to approach such treatment centers and help them to reduce their cannabis use.Methods/design: This paper presents the protocol for a three-armed randomized controlled trial that will test the effectiveness of a web-based self-help intervention in combination with, or independent of, tailored chat counseling compared to a waiting list in reducing or enabling the abstention from cannabis use in problematic users. The primary outcome will be the weekly quantity of cannabis used. Secondary outcome measures will include the number of days per week on which cannabis is used, the severity of cannabis use disorder, the severity of cannabis dependence, cannabis withdrawal symptoms, cannabis craving, the use of alcohol, tobacco, and other non-cannabis illicit drugs, changes in mental health symptoms, and treatment retention. The self-help intervention will consist of 8 modules designed to reduce cannabis use based on the principles of motivational interviewing, self-control practices, and methods of cognitive behavioral therapy. The two additional individual chat-counseling sessions in the additional chat condition will be based on the same therapy approaches and tailored to participants' self-help information data and personal problems. The predictive validity of participants' baseline characteristics on treatment retention and outcomes will be explored. DISCUSSION: To the best of our knowledge, this will be the first randomized controlled trial to test the effectiveness of online self-help therapy in combination or without chat counseling in reducing or enabling the abstention from cannabis use. It will also investigate predictors of outcome and retention for these interventions. This trial is registered at Current Controlled Trials and is traceable as ISRCTN59948178

Computer and psychotherapy – do they fit? Review of the state of development of internet-based and blended interventions in psychotherapy

Die Verbreitung moderner Medien wirkt sich zunehmend auf psychologische Behandlungsangebote aus. Während die empirische Basis internetbasierter Interventionen zur Behandlung häufiger psychischer Beeinträchtigungen wächst und ihre Anwendung in der Regelversorgung gegenwärtig international erprobt wird, bestehen zusätzliche Bestrebungen, das gewonnene Knowhow mit konventioneller Psychotherapie zu kombinieren. Die daraus entstehende Behandlungsform der „gemischten Psychotherapie“ („blended therapy“) hat das deklarierte Ziel, das Beste aus beiden Welten zu vereinen. Nach einer einleitenden Begriffsbestimmung gibt die vorliegende Übersichtsarbeit Einblick in die Inhalte und die Bestandteile internetbasierter sowie gemischter Interventionen. Der aktuelle Forschungsstand wird skizziert und vor dem Hintergrund der praktischen Anwendbarkeit durch eine Zusammenschau quantitativer und qualitativer Studien dargelegt. Besonderes Augenmerk gilt der Rolle der therapeutischen Unterstützung und der Beschaffenheit der therapeutischen Allianz bei internetbasierten Interventionen sowie den Stärken und Schwächen beider Behandlungsstrategien. Ziel ist es, sowohl die Entwicklung als auch das Potenzial beider Forschungsrichtungen plausibel und realistisch darzustellen und in eine strategische Versorgungsperspektive zu setzen.Modern media have an increasing impact on psychological health services. While the empirical foundation of internet-based interventions for frequently occurring mental disorders grows and their effectiveness is investigated in routine care trials, efforts also exist to transfer the knowledge gained to classical psychotherapy. The resulting treatment format “blended therapy” aims to combine the best of both worlds. After an introductory definition of both terms this overview describes the contents and components of internet-based and blended interventions. Summarizing the current state of research with an emphasis on feasibility, selected quantitative and qualitative articles are presented. The article depicts the development, application and potential of both interventional strategies and focuses on the role of therapist support as well as on the nature of the therapeutic alliance. Strengths and weaknesses of each intervention are addressed and integrated into a strategic perspective