Internet-based support and coaching - Exploring the feasibility of an intervention for young people with ADHD and autism spectrum disorder

Background: For individuals with Neurodevelopmental Disorders (NDDs), such as Attention-Deficit/ Hyperactivity Disorder (ADHD) and autism spectrum disorder (ASD), adolescence and young adulthood can be a vulnerable period associated with a loss of significant structure and support. They can also have a difficult time taking advantage of available support- and treatment options, due to their core deficits. There is limited research into support and treatment specifically targeting individuals with ADHD and/or ASD in this age group, and into how it can be tailored to fit their experienced needs. Methods: With the aim of evaluating the feasibility of an internet-based support and coaching model (IBSC) encompassing 8 weeks of twice weekly chat sessions (and two clinic visits), two studies were conducted using complementary methodological perspectives. Study I used a non-randomized controlled design, including 50 individuals with ADHD and/or ASD ages 15-32 years old in two naturalistic clinical settings. Participants received the intervention (n=30) or Treatment-As-Usual (TAU) (n=20). Six participants dropped out from the Intervention group. Self-report questionnaires were administered at baseline, at the end of the Intervention and after 6-months, including assessments of quality of life, sense of coherence, self-esteem, anxiety and depressive symptoms. Study II, sought to investigate the experiences of the participants taking part in IBSC, using semi-structured interviews with 16 individuals who had received IBSC and analysing data using qualitative content analysis. Results: Results from study I showed significant between-group effects regarding anxiety at post intervention and at 6-month follow-up, and for depressive symptoms at post intervention. A deterioration in the TAU group partly explained these results. The Intervention group experienced a significant increase in self-esteem and a decrease in anxiety at 6-month follow-up. Study II generated three themes; Deciding to participate, Taking part in the coaching process, and The significance of format with a total of ten subthemes. In summary, there was an appreciation of several aspects of the format that corresponded with their needs, e.g. being text-based and accessible from one´s home environment. Participants voiced unmet needs and underscored the importance of coaches’ knowledge about NDDs. Incomplete personal interaction and a desire for increased flexibility in regard to frequency and form of communication were also voiced. Conclusions: IBSC shows promise as a feasible approach to supporting adolescents and young adults with ADHD and/or ASD. Future studies should determine for which diagnostic category the model is best suited and to what degree

Andersson G: Internet-delivered attention bias modification training in individuals with social anxiety disorder - a double blind randomized controlled trial

R E S E A R C H A R T I C L E Open Access Internet-delivered attention bias modification training in individuals with social anxiety disorder -a double blind randomized controlled trial Abstract Background: Computerized cognitive bias modification for social anxiety disorder has in several well conducted trials shown great promise with as many as 72% no longer fulfilling diagnostic criteria after a 4 week training program. To test if the same program can be transferred from a clinical setting to an internet delivered home based treatment the authors conducted a randomized, double-blind placebo-controlled trial. Methods: After a diagnostic interview 79 participants were randomized to one of two attention training programs using a probe detection task. In the active condition the participant was trained to direct attention away from threat, whereas in the placebo condition the probe appeared with equal frequency in the position of the threatening and neutral faces

Internet-Based Support and Coaching With Complementary Clinic Visits for Young People With Attention-Deficit/Hyperactivity Disorder and Autism : Controlled Feasibility Study

Background: Individuals with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) can experience obstacles in traditional health care situations due to difficulties associated with their impairment. Objective: This controlled study aims to investigate the feasibility of an internet-based support and coaching intervention (IBSC), including 2 weekly chat sessions and 2 complementary clinic visits with coaches over the course of 8 weeks, for adolescents and young adults with ADHD and/or ASD in 2 naturalistic routine care settings. Methods: Individuals with ADHD and/or ASD aged 15-32 years were recruited in 2 clinical settings, where they received either IBSC (n=24) or treatment as usual (TAU; n=20). Outcome measures included self-report questionnaires assessing quality of life (Manchester Short Assessment for Quality of Life), sense of coherence (Sense Of Coherence 29), self-esteem (Rosenberg Self-Esteem Scale), and anxiety and depressive symptoms (Hospital Anxiety and Depression Scale [HADS] and Montgomery-Åsberg Depression Rating Scale-Self-reported, respectively). Results: Significant between-group effects were observed in measures of anxiety (HADS) at postintervention (P=.02) as well as at the 6-month follow-up (P=.004). Significant between-group effects were also noted for depressive symptoms (HADS) postintervention (P=.04). The between-group effects were partially explained by a deterioration in the TAU group. A significant increase in self-esteem (P=.04) as well as a decrease in anxiety (P=.003) at the 6-month follow-up was observed in the intervention group following IBSC. Findings from a qualitative study of the intervention are consistent with the results. Conclusions: The findings from this study suggest that IBSC holds promise as a feasible complement or alternative to traditional face-to-face health care meetings

Experiences of an internet-based support and coaching model for adolescents and young adults with ADHD and autism spectrum disorder - a qualitative study

Background: There is a great demand for non-medical treatment and support targeting the needs of adolescents and young adults with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). There is also a lack of qualitative studies providing in-depth insight into these individuals own experiences within this area. The current study aimed to explore how adolescents and young adults with ADHD, ASD or both experienced taking part in an internet-based support and coaching intervention. Methods: Sixteen participants with ASD, ADHD or both who had participated in an 8-week internet-based support and coaching model, were interviewed using semi-structured interviews. Data was analyzed using qualitative content analysis. Results: Analysis yielded three themes; Deciding to participate, Taking part in the coaching process and The significance of format. Various motives for joining were expressed by participants, such as viewing the technology as familiar and appealing and expecting it to be better suited to their situation. There was also a previously unfulfilled need for support among participants. In deciding to take part in the intervention the coaches competence and knowledge were considered essential, often in the light of previously negative experiences. Taking part in the coaching process meant feeling reassured by having someone to turn to in view of shared obstacles to seeking and receiving help. The support was used for talking through and receiving advice on matters related to their diagnosis. Findings further revealed appreciation for aspects relating to the format such as communicating through the written word, being in ones own home and an experience of immediacy. Some disadvantages were voiced including incomplete personal interaction and failing technology. There were also suggestions for greater flexibility. Conclusions: The in-depth qualitative data obtained from this study suggest that the current model of support and the internet-based format have specific qualities that could play an important role in the support of adolescents and young adults with ADHD and ASD. Although not a replacement for face-to-face interaction, it could be a promising complement or alternative to other support and treatment options.Funding Agencies|Health and Medical Care Committee of the Regional Executive Board, Region Vastra Gotaland; Health and Medical Care Committee of the Regional Executive Board, Region Halland; Vardal Institute; Swedish Institute for Health Sciences; Fredrik and Ingrid Thurings Foundation; Department of Health Sciences at University West</p

Table_3_Internet-delivered therapist-assisted cognitive behavioral therapy for gambling disorder: a randomized controlled trial.docx

ObjectivesCognitive behavioral therapy (CBT) is the most promising treatment for gambling disorder (GD) but only 21% of those with problematic gambling seek treatment. CBT over the Internet might be one way to reach a larger population. The aim of this study was to assess the effectiveness of Internet-delivered CBT with therapist guidance compared to an active control treatment.MethodsUsing a single-blinded design, 71 treatment-seeking gamblers (18–75 years) diagnosed with GD were randomized to 8 weeks of Internet-delivered CBT guided by telephone support, or 8 weeks of Internet-delivered motivational enhancement paired with motivational interviewing via telephone (IMI). The primary outcome was gambling symptoms measured at a first face-to-face assessment, baseline (treatment start), every 2 weeks, post-treatment, and 6-month follow-up. Gambling expenditures, time spent gambling, depression, anxiety, cognitive distortions, and quality of life were assessed as secondary outcomes. Analysis was performed on the full analysis sample (n = 60), with intention-to-treat sensitivity analyses (n = 69).ResultsIn the CBT group, 80% stayed in treatment until the final week, compared to 67% in IMI. Post-treatment and at 6-month follow-up, no differences were found between CBT and IMI for any outcome measure. An exploratory analysis of the total sample (n = 60) showed a significant effect of time during treatment on gambling symptoms (d, [95% CI] 0.52, [−1.15, 2.02]) and all secondary outcomes except the gambling diary (depression (0.89, [−1.07–2.65]); anxiety (0.69, [−1.20–2.38])); cognitive distortions (0.84, [−0.73–2.29]); quality of life (0.60, [−0.61–1.70])). Post-treatment, there were no clinical gambling symptoms in either group. Some deterioration was seen between post-treatment and 6-month follow-up on gambling symptoms (0.42, [−1.74–2.43]), depression (0.59, [−0.82–1.86]), and anxiety (0.30, [−0.99–1.48]). Additionally, it was observed that the largest reduction in gambling symptoms was between the first assessment and baseline.ConclusionBoth treatments offered in this study were effective at reducing gambling symptoms. It is also possible that the process of change started before treatment, which gives promise to low-intensity interventions for GD. Additional research is needed as this approach could be both cost-effective and has the potential to reach more patients in need of treatment than is currently possible.Clinical trial registration:https://www.isrctn.com/, identifier ISRCTN38692394.</p

Table_2_Internet-delivered therapist-assisted cognitive behavioral therapy for gambling disorder: a randomized controlled trial.DOCX

ObjectivesCognitive behavioral therapy (CBT) is the most promising treatment for gambling disorder (GD) but only 21% of those with problematic gambling seek treatment. CBT over the Internet might be one way to reach a larger population. The aim of this study was to assess the effectiveness of Internet-delivered CBT with therapist guidance compared to an active control treatment.MethodsUsing a single-blinded design, 71 treatment-seeking gamblers (18–75 years) diagnosed with GD were randomized to 8 weeks of Internet-delivered CBT guided by telephone support, or 8 weeks of Internet-delivered motivational enhancement paired with motivational interviewing via telephone (IMI). The primary outcome was gambling symptoms measured at a first face-to-face assessment, baseline (treatment start), every 2 weeks, post-treatment, and 6-month follow-up. Gambling expenditures, time spent gambling, depression, anxiety, cognitive distortions, and quality of life were assessed as secondary outcomes. Analysis was performed on the full analysis sample (n = 60), with intention-to-treat sensitivity analyses (n = 69).ResultsIn the CBT group, 80% stayed in treatment until the final week, compared to 67% in IMI. Post-treatment and at 6-month follow-up, no differences were found between CBT and IMI for any outcome measure. An exploratory analysis of the total sample (n = 60) showed a significant effect of time during treatment on gambling symptoms (d, [95% CI] 0.52, [−1.15, 2.02]) and all secondary outcomes except the gambling diary (depression (0.89, [−1.07–2.65]); anxiety (0.69, [−1.20–2.38])); cognitive distortions (0.84, [−0.73–2.29]); quality of life (0.60, [−0.61–1.70])). Post-treatment, there were no clinical gambling symptoms in either group. Some deterioration was seen between post-treatment and 6-month follow-up on gambling symptoms (0.42, [−1.74–2.43]), depression (0.59, [−0.82–1.86]), and anxiety (0.30, [−0.99–1.48]). Additionally, it was observed that the largest reduction in gambling symptoms was between the first assessment and baseline.ConclusionBoth treatments offered in this study were effective at reducing gambling symptoms. It is also possible that the process of change started before treatment, which gives promise to low-intensity interventions for GD. Additional research is needed as this approach could be both cost-effective and has the potential to reach more patients in need of treatment than is currently possible.Clinical trial registration:https://www.isrctn.com/, identifier ISRCTN38692394.</p

Table_4_Internet-delivered therapist-assisted cognitive behavioral therapy for gambling disorder: a randomized controlled trial.DOCX

ObjectivesCognitive behavioral therapy (CBT) is the most promising treatment for gambling disorder (GD) but only 21% of those with problematic gambling seek treatment. CBT over the Internet might be one way to reach a larger population. The aim of this study was to assess the effectiveness of Internet-delivered CBT with therapist guidance compared to an active control treatment.MethodsUsing a single-blinded design, 71 treatment-seeking gamblers (18–75 years) diagnosed with GD were randomized to 8 weeks of Internet-delivered CBT guided by telephone support, or 8 weeks of Internet-delivered motivational enhancement paired with motivational interviewing via telephone (IMI). The primary outcome was gambling symptoms measured at a first face-to-face assessment, baseline (treatment start), every 2 weeks, post-treatment, and 6-month follow-up. Gambling expenditures, time spent gambling, depression, anxiety, cognitive distortions, and quality of life were assessed as secondary outcomes. Analysis was performed on the full analysis sample (n = 60), with intention-to-treat sensitivity analyses (n = 69).ResultsIn the CBT group, 80% stayed in treatment until the final week, compared to 67% in IMI. Post-treatment and at 6-month follow-up, no differences were found between CBT and IMI for any outcome measure. An exploratory analysis of the total sample (n = 60) showed a significant effect of time during treatment on gambling symptoms (d, [95% CI] 0.52, [−1.15, 2.02]) and all secondary outcomes except the gambling diary (depression (0.89, [−1.07–2.65]); anxiety (0.69, [−1.20–2.38])); cognitive distortions (0.84, [−0.73–2.29]); quality of life (0.60, [−0.61–1.70])). Post-treatment, there were no clinical gambling symptoms in either group. Some deterioration was seen between post-treatment and 6-month follow-up on gambling symptoms (0.42, [−1.74–2.43]), depression (0.59, [−0.82–1.86]), and anxiety (0.30, [−0.99–1.48]). Additionally, it was observed that the largest reduction in gambling symptoms was between the first assessment and baseline.ConclusionBoth treatments offered in this study were effective at reducing gambling symptoms. It is also possible that the process of change started before treatment, which gives promise to low-intensity interventions for GD. Additional research is needed as this approach could be both cost-effective and has the potential to reach more patients in need of treatment than is currently possible.Clinical trial registration:https://www.isrctn.com/, identifier ISRCTN38692394.</p

Table_1_Internet-delivered therapist-assisted cognitive behavioral therapy for gambling disorder: a randomized controlled trial.DOCX

ObjectivesCognitive behavioral therapy (CBT) is the most promising treatment for gambling disorder (GD) but only 21% of those with problematic gambling seek treatment. CBT over the Internet might be one way to reach a larger population. The aim of this study was to assess the effectiveness of Internet-delivered CBT with therapist guidance compared to an active control treatment.MethodsUsing a single-blinded design, 71 treatment-seeking gamblers (18–75 years) diagnosed with GD were randomized to 8 weeks of Internet-delivered CBT guided by telephone support, or 8 weeks of Internet-delivered motivational enhancement paired with motivational interviewing via telephone (IMI). The primary outcome was gambling symptoms measured at a first face-to-face assessment, baseline (treatment start), every 2 weeks, post-treatment, and 6-month follow-up. Gambling expenditures, time spent gambling, depression, anxiety, cognitive distortions, and quality of life were assessed as secondary outcomes. Analysis was performed on the full analysis sample (n = 60), with intention-to-treat sensitivity analyses (n = 69).ResultsIn the CBT group, 80% stayed in treatment until the final week, compared to 67% in IMI. Post-treatment and at 6-month follow-up, no differences were found between CBT and IMI for any outcome measure. An exploratory analysis of the total sample (n = 60) showed a significant effect of time during treatment on gambling symptoms (d, [95% CI] 0.52, [−1.15, 2.02]) and all secondary outcomes except the gambling diary (depression (0.89, [−1.07–2.65]); anxiety (0.69, [−1.20–2.38])); cognitive distortions (0.84, [−0.73–2.29]); quality of life (0.60, [−0.61–1.70])). Post-treatment, there were no clinical gambling symptoms in either group. Some deterioration was seen between post-treatment and 6-month follow-up on gambling symptoms (0.42, [−1.74–2.43]), depression (0.59, [−0.82–1.86]), and anxiety (0.30, [−0.99–1.48]). Additionally, it was observed that the largest reduction in gambling symptoms was between the first assessment and baseline.ConclusionBoth treatments offered in this study were effective at reducing gambling symptoms. It is also possible that the process of change started before treatment, which gives promise to low-intensity interventions for GD. Additional research is needed as this approach could be both cost-effective and has the potential to reach more patients in need of treatment than is currently possible.Clinical trial registration:https://www.isrctn.com/, identifier ISRCTN38692394.</p

Table_5_Internet-delivered therapist-assisted cognitive behavioral therapy for gambling disorder: a randomized controlled trial.docx

ObjectivesCognitive behavioral therapy (CBT) is the most promising treatment for gambling disorder (GD) but only 21% of those with problematic gambling seek treatment. CBT over the Internet might be one way to reach a larger population. The aim of this study was to assess the effectiveness of Internet-delivered CBT with therapist guidance compared to an active control treatment.MethodsUsing a single-blinded design, 71 treatment-seeking gamblers (18–75 years) diagnosed with GD were randomized to 8 weeks of Internet-delivered CBT guided by telephone support, or 8 weeks of Internet-delivered motivational enhancement paired with motivational interviewing via telephone (IMI). The primary outcome was gambling symptoms measured at a first face-to-face assessment, baseline (treatment start), every 2 weeks, post-treatment, and 6-month follow-up. Gambling expenditures, time spent gambling, depression, anxiety, cognitive distortions, and quality of life were assessed as secondary outcomes. Analysis was performed on the full analysis sample (n = 60), with intention-to-treat sensitivity analyses (n = 69).ResultsIn the CBT group, 80% stayed in treatment until the final week, compared to 67% in IMI. Post-treatment and at 6-month follow-up, no differences were found between CBT and IMI for any outcome measure. An exploratory analysis of the total sample (n = 60) showed a significant effect of time during treatment on gambling symptoms (d, [95% CI] 0.52, [−1.15, 2.02]) and all secondary outcomes except the gambling diary (depression (0.89, [−1.07–2.65]); anxiety (0.69, [−1.20–2.38])); cognitive distortions (0.84, [−0.73–2.29]); quality of life (0.60, [−0.61–1.70])). Post-treatment, there were no clinical gambling symptoms in either group. Some deterioration was seen between post-treatment and 6-month follow-up on gambling symptoms (0.42, [−1.74–2.43]), depression (0.59, [−0.82–1.86]), and anxiety (0.30, [−0.99–1.48]). Additionally, it was observed that the largest reduction in gambling symptoms was between the first assessment and baseline.ConclusionBoth treatments offered in this study were effective at reducing gambling symptoms. It is also possible that the process of change started before treatment, which gives promise to low-intensity interventions for GD. Additional research is needed as this approach could be both cost-effective and has the potential to reach more patients in need of treatment than is currently possible.Clinical trial registration:https://www.isrctn.com/, identifier ISRCTN38692394.</p

Internet-delivered attention bias modification training in individuals with social anxiety disorder : a double blind randomized controlled trial

Background: Computerized cognitive bias modification for social anxiety disorder has in several well conducted trials shown great promise with as many as 72% no longer fulfilling diagnostic criteria after a 4 week training program. To test if the same program can be transferred from a clinical setting to an internet delivered home based treatment the authors conducted a randomized, double-blind placebo-controlled trial. Methods: After a diagnostic interview 79 participants were randomized to one of two attention training programs using a probe detection task. In the active condition the participant was trained to direct attention away from threat, whereas in the placebo condition the probe appeared with equal frequency in the position of the threatening and neutral faces. Results: Results were analyzed on an intention-to-treat basis, including all randomized participants. Immediate and 4-month follow-up results revealed a significant time effect on all measured dimensions (social anxiety scales, general anxiety and depression levels, quality of life). However, there were no time x group interactions. The lack of differences in the two groups was also mirrored by the infinitesimal between group effect size both at post test and at 4-month follow-up. Conclusion: We conclude that computerized attention bias modification may need to be altered before dissemination for the Internet. Trial registration: ISRCTN0171512