Internet-Delivered Cognitive Behavioral Therapy for Generalized Anxiety Disorder in Nationwide Routine Care : Effectiveness Study

Background: Therapist-supported, internet-delivered cognitive behavioral therapy (iCBT) is efficacious for generalized anxiety disorder (GAD), but few studies are yet to report its effectiveness in routine care. Objective: In this study, we aim to examine whether a new 12-session iCBT program for GAD is effective in nationwide routine care. Methods: We administered a specialized, clinic-delivered, therapist-supported iCBT for GAD in 1099 physician-referred patients. The program was free of charge for patients, and the completion time was not predetermined. We measured symptoms with web-based questionnaires. The primary measure of anxiety was the GAD 7-item scale (GAD-7); secondary measures were, for pathological worry, the Penn State Worry Questionnaire and, for anxiety and impairment, the Overall Anxiety Severity and Impairment Scale. Results: Patients completed a mean 7.8 (SD 4.2; 65.1%) of 12 sessions, and 44.1% (485/1099) of patients completed all sessions. The effect size in the whole sample for GAD-7 was large (Cohen d=0.97, 95% CI 0.88-1.06). For completers, effect sizes were very large (Cohen d=1.34, 95% CI 1.25-1.53 for GAD-7; Cohen d=1.14, 95% CI 1.00-1.27 for Penn State Worry Questionnaire; and Cohen d=1.23, 95% CI 1.09-1.37 for Overall Anxiety Severity and Impairment Scale). Noncompleters also benefited from the treatment. Greater symptomatic GAD-7–measured relief was associated with more completed sessions, older age, and being referred from private or occupational care. Of the 894 patients with a baseline GAD-7 score ≥10, approximately 421 (47.1%) achieved reliable recovery. Conclusions: This nationwide, free-of-charge, therapist-supported HUS Helsinki University Hospital–iCBT for GAD was effective in routine care, but further research must establish effectiveness against other treatments and optimize the design of iCBT for GAD for different patient groups and individual patients.Background: Therapist-supported, internet-delivered cognitive behavioral therapy (iCBT) is efficacious for generalized anxiety disorder (GAD), but few studies are yet to report its effectiveness in routine care. Objective: In this study, we aim to examine whether a new 12-session iCBT program for GAD is effective in nationwide routine care. Methods: We administered a specialized, clinic-delivered, therapist-supported iCBT for GAD in 1099 physician-referred patients. The program was free of charge for patients, and the completion time was not predetermined. We measured symptoms with web-based questionnaires. The primary measure of anxiety was the GAD 7-item scale (GAD-7); secondary measures were, for pathological worry, the Penn State Worry Questionnaire and, for anxiety and impairment, the Overall Anxiety Severity and Impairment Scale. Results: Patients completed a mean 7.8 (SD 4.2; 65.1%) of 12 sessions, and 44.1% (485/1099) of patients completed all sessions. The effect size in the whole sample for GAD-7 was large (Cohen d=0.97, 95% CI 0.88-1.06). For completers, effect sizes were very large (Cohen d=1.34, 95% CI 1.25-1.53 for GAD-7; Cohen d=1.14, 95% CI 1.00-1.27 for Penn State Worry Questionnaire; and Cohen d=1.23, 95% CI 1.09-1.37 for Overall Anxiety Severity and Impairment Scale). Noncompleters also benefited from the treatment. Greater symptomatic GAD-7–measured relief was associated with more completed sessions, older age, and being referred from private or occupational care. Of the 894 patients with a baseline GAD-7 score ≥10, approximately 421 (47.1%) achieved reliable recovery. Conclusions: This nationwide, free-of-charge, therapist-supported HUS Helsinki University Hospital–iCBT for GAD was effective in routine care, but further research must establish effectiveness against other treatments and optimize the design of iCBT for GAD for different patient groups and individual patients.Peer reviewe

Proposal, project, practice, pause: developing a framework for evaluating smart domestic product engagement

Smart homes are fast becoming a reality, with smart TVs, smart meters and other such “smart” devices/systems already representing a substantial household presence. These, which we collectively term “smart domestic products” (SDPs), will need to be promoted, adopted, and normalized into daily routines. Despite this, the marketing canon lacks a substantive discourse on pertinent research. We look to help correct this by melding ideas from organizational sociology, innovation diffusion and appropriation studies, and service dominant logic. Consequently, we suggest a framework for research that responds directly to the specific characteristics of SDPs. Using the SDP eco-system as a context, our framework emphasizes the interplay of embeddedness, practice, value and engagement. It comprises a four-stage horizontal/ longitudinal axis we describe as proposal, project, practice and pause. Cross-sectionally we focus on value, and combine aspects of existing thought to suggest how this impacts each stage of our engagement continuum. We subsequently identify perceived personal advantage as the resultant of these two axes and propose this as the key for understanding consumer and SDP sociomaterial engagement. This article also advances a definition of SDPs and ends with an agenda for further research

Social media conflicts during the financial crisis: Managerial implications for retail banks

Social media can be used proactively to disseminate accurate corporate information and address undesirable consumer behaviors online in order to help counteract negativity in the business environment in the wake of a financial crisis. Social media thus has become a popular open forum for financial institutions such as retail banks to engage in corporate dialogue with consumers. We recommend that financial services firms preemptively use their social media?based online communities in order to disseminate accurate corporate information in times of a financial crisis. Particularly, firms can choose between a range of reactive and proactive strategies to manage social conflict in the wake of a financial crisis

Customer Loyalty to Content-Based Web Sites: The Case of an Online Health Care Service

Contains fulltext : 138685.pdf (publisher's version ) (Open Access)Past e‐service research has largely concentrated on customer responses to online retailers. The present study sheds light on the determinants of customer loyalty to a content‐based service, a healthcare Web site. Content‐based service providers must build a loyal customer base in order to attract advertisers and sponsors. Lack of trust has been one of the most important reasons for consumers not adopting online services involving financial exchanges, but trust appears to be equally important to exchanges that require divulging sensitive information, such as health issues. Results reveal that loyalty to the health site is satisfaction‐driven, but that trust is the main antecedent of satisfaction. Need fulfilment, responsiveness, security and technical functionality of the Web site are shown to influence trust. Managerial implications are provided.12 p

Shifting sands: actor role and identity reconfigurations in service systems

Building on previous actor-to-actor perspectives in service systems, this study mapped the dialectic trajectory of actor role and identity transitions in the context of family caregiving. The study employed the theoretical lens of role and identity transitions and drew on in-depth, qualitative interviews with 22 unpaid family caregivers caring for dependent relatives to demonstrate how family caregiver roles and identities co-evolve throughout the caregiving journey. Our findings elucidate three dynamic reconfigurations of role and identity transitions in family caregiving. We evince how such transitions vary in both degree and type, and range from incremental to disruptive, as actors assume and detach from roles and associated identities. Theoretical contributions shed light on the emergent and nuanced nature of role and identity transitions, as roles and identities synchronously and asynchronously co-evolve in a service system in conjunction with changed relations between actors, society, and the service system. The paper concludes with implications for enhancing actor engagement in dynamic service systems