Efficacy of an internet-based psychological intervention for problem gambling and gambling disorder: Study protocol for a randomized controlled trial

Gambling Disorder is a prevalent non-substance use disorder, which contrasts with the low number of people requesting treatment. Information and Communication Technologies (ICT) could help to enhance the dissemi- nation of evidence-based treatments and considerably reduce the costs. The current study seeks to assess the efficacy of an online psychological intervention for people suffering from gambling problems in Spain. The proposed study will be a two-arm, parallel-group, randomized controlled trial. A total of 134 participants (problem and pathological gamblers) will be randomly allocated to a waiting list control group (N = 67) or an intervention group (N = 67). The intervention program includes 8 modules, and it is based on motivational interviewing, cognitive-behavioral therapy (CBT), and extensions and innovations of CBT. It includes several complementary tools that are present throughout the entire intervention. Therapeutic support will be provided once a week through a phone call with a maximum length of 10 min. The primary outcome measure will be gambling severity and gambling-related cognitions, and secondary outcome measures will be readiness to change, and gambling self-efficacy. Other variables that will be considered are depression and anxiety symptoms, positive and negative affect, difficulties in emotion regulation strategies, impulsivity, and quality of life. In- dividuals will be assessed at baseline, post-treatment, and 3-, 6-, and 12-month follow-ups. During the treatment, participants will also respond to a daily Ecological Momentary Intervention (EMI) in order to evaluate urges to gamble, self-efficacy to cope with gambling urges, gambling urge frequency, and whether gambling behaviour occurs. The EMI includes immediate automatic feedback depending on the participant's responses. Treatment acceptance and satisfaction will also be assessed. The data will be analysed both per protocol and by Intention-to- treat. As far as we know, this is the first randomized controlled trial of an online psychological intervention for gambling disorder in Spain. It will expand our knowledge about treatments delivered via the Internet and contribute to improving treatment dissemination, reaching people suffering from this problem who otherwise would not receive help. Trial registration: Clinicaltrials.gov as NCT04074681. Registered 22 July 2019

Smartphone Apps for the Treatment of Mental Disorders: Systematic Review

Background: Smartphone apps are an increasingly popular means for delivering psychological interventions to patients suffering from a mental disorder. In line with this popularity, there is a need to analyze and summarize the state of the art, both from a psychological and technical perspective. Objective: This study aimed to systematically review the literature on the use of smartphones for psychological interventions. Our systematic review has the following objectives: (1) analyze the coverage of mental disorders in research articles per year; (2) study the types of assessment in research articles per mental disorder per year; (3) map the use of advanced technical features, such as sensors, and novel software features, such as personalization and social media, per mental disorder; (4) provide an overview of smartphone apps per mental disorder; and (5) provide an overview of the key characteristics of empirical assessments with rigorous designs (ie, randomized controlled trials [RCTs]). Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews were followed. We performed searches in Scopus, Web of Science, American Psychological Association PsycNET, and Medical Literature Analysis and Retrieval System Online, covering a period of 6 years (2013-2018). We included papers that described the use of smartphone apps to deliver psychological interventions for known mental disorders. We formed multidisciplinary teams, comprising experts in psychology and computer science, to select and classify articles based on psychological and technical features. Results: We found 158 articles that met the inclusion criteria. We observed an increasing interest in smartphone-based interventions over time. Most research targeted disorders with high prevalence, that is, depressive (31/158,19.6%) and anxiety disorders (18/158, 11.4%). Of the total, 72.7% (115/158) of the papers focused on six mental disorders: depression, anxiety, trauma and stressor-related, substance-related and addiction, schizophrenia spectrum, and other psychotic disorders, or a combination of disorders. More than half of known mental disorders were not or very scarcely (<3%) represented. An increasing number of studies were dedicated to assessing clinical effects, but RCTs were still a minority (25/158, 15.8%). From a technical viewpoint, interventions were leveraging the improved modalities (screen and sound) and interactivity of smartphones but only sparingly leveraged their truly novel capabilities, such as sensors, alternative delivery paradigms, and analytical methods. Conclusions: There is a need for designing interventions for the full breadth of mental disorders, rather than primarily focusing on most prevalent disorders. We further contend that an increasingly systematic focus, that is, involving RCTs, is needed to improve the robustness and trustworthiness of assessments. Regarding technical aspects, we argue that further exploration and innovative use of the novel capabilities of smartphones are needed to fully realize their potential for the treatment of mental health disorders

Assessment of the quality of multiple-choice exams through the Item Response Theory: implementation in the subject of “Psychological Assessment”

[EN] Multiple Choice testing (MCT) is one of the most popular approaches to the assessment of knowledge acquisition. Preparing a MCT is complex; however, its metric quality (in terms of difficulty, discrimination capacity, or distractors effectiveness) is not usually assessed. “Item Response Theory" (IRT) is a statistical approach that may assist when evaluating the quality of a MCT. IRT lets to estimate indices that may be used later as a way to improve the quality of the assessment. The aim of this work was to present the results of a teaching innovation project in which the IRT was employed to analyze the MCT used during the last 3 courses in the subject «Psychological Evaluation» (Degree in Speech Therapy). Results suggested that a significant proportion of the questions analyzed presented certain limitations, such as the excessive prevalence of easy items (between 45%-67.5%) or ineffective distractors (between 17.5%-26.6%). Yet, these issues did not impact the discrimination capacity of the MCT. These results serve as a basis for proposing initiatives to improve evaluations through MCT, which ultimately will result in a fairer and more balanced evaluation of the students of the subject.[ES] Los Exámenes de Alternativa Múltiple (EAM) son la forma más popular de evaluar la adquisición de conocimiento. Elaborar un EAM entraña cierta complejidad; sin embargo, rara vez se analiza en qué grado los EAM cumplen los criterios de calidad exigibles a estas pruebas (p.e., en términos de dificultad, capacidad de discriminación o eficacia de los distractores). La «Teoría de Respuesta al Ítem (TRI)» es una aproximación estadística que puede ayudar a la hora de evaluar la calidad de un EAM a través de la obtención de índices objetivos que, en una fase posterior, se pueden usar para mejorar la evaluación. El objetivo de este trabajo es presentar los resultados de un Proyecto de Innovación Docente en el que se analizó, mediante TRI, los EAM usados durante los últimos tres cursos en la asignatura «Evaluación Psicológica» (Grado en Logopedia). Los resultados sugieren que una proporción importante de preguntas analizadas presentaban limitaciones relacionadas con la excesiva presencia de ítems fáciles (entre el 45%-67.5%) o distractores ineficaces (entre el 17.5%-26.6%), si bien esto no afectó sobre su capacidad de discriminación. Estos resultados sirven de base para proponer iniciativas que permitan mejorar las evaluaciones a través de EAM.Castro-Calvo, J.; Pons-Cañaveras, D.; Beltrán-Martínez, P.; Atienza-González, F.; Bellver-Pérez, A.; De La Barrera-Marzal, U.; Díaz-Martínez, A.... (2022). Análisis de la calidad de exámenes de alternativa múltiple a través de la teoría de respuesta al item: aplicación en la asignatura de “Evaluación Psicològica”. Editorial Universitat Politècnica de València. 379-391. https://doi.org/10.4995/INRED2022.2022.1590537939

Eficacia diferencial de un programa de intervención auto-aplicado a través de Internet para la prevención y el tratamiento de la depresión leve o moderada con apoyo y sin apoyo por parte del terapeuta

Introducción: La depresión es uno de los trastornos psicológicos más prevalentes en la población general y uno de los más incapacitantes. En el momento actual, existen múltiples argumentos que sugieren que su prevención y tratamiento deberían ser una estrategia de salud prioritaria. Contamos con tratamientos psicológicos basados en la evidencia (TBE) para la depresión e intervenciones centradas en su prevención. Sin embargo, presentan limitaciones, siendo una de las más destacadas el hecho de que la prestación de servicios de salud mental es generalmente inferior a la adecuada en términos de accesibilidad y calidad. Un enfoque que facilita la diseminación de los TBE es el uso de programas de tratamiento que utilizan como soporte Internet. Los resultados obtenidos hasta el momento con los programas auto-aplicados a través de Internet son consistentes y prometedores. Sin embargo, existen problemas por resolver. Entre ellos destaca las altas tasas de abandonos. Este problema puede tener distintas causas, y una de ellas puede ser el apoyo proporcionado o no proporcionado por parte del terapeuta. Método: Hemos desarrollado un protocolo de intervención para prevenir y/o tratar la depresión (leve o moderada) totalmente auto-aplicado a través de Internet. Se basa en las técnicas cognitivo-comportamentales clásicas, como la activación comportamental, e incluye otras estrategias psicológicas para mejorar el estado de ánimo positivo. El total de la muestra definitiva del estudio estuvo compuesta por 124 participantes, todos ellos con sintomatología depresiva de gravedad mínima, leve o moderada y con un acontecimiento estresante en sus vidas que les generaba interferencia. Dichos participantes fueron asignados aleatoriamente a una de las tres condiciones experimentales: 1) Tratamiento Auto-aplicado a través de Internet sin apoyo humano por parte del terapeuta, 2) Tratamiento Auto-aplicado a través de Internet con apoyo humano por parte del terapeuta y 3) Control lista de espera. Cabe destacar que ambos grupos de intervención recibieron apoyo a través de las Tecnologías de la Información y la Comunicación (TICs): mensajes al móvil, correos electrónicos y feedback que proporciona el propio programa de intervención. Los resultados muestran que el protocolo de tratamiento utilizado y aplicado a través de Internet ha demostrado ser eficaz para mejorar la situación clínica de los participantes, tanto con apoyo semanal por parte del terapeuta, como sin apoyo por parte del mismo, observándose en ambos grupos de intervención mejorías significativamente superiores respecto al grupo control lista de espera. Resultados: Los resultados han constatado también que la interferencia provocada por los acontecimientos estresantes vividos por los participantes se ha reducido significativamente en aquellos que han realizado el programa de intervención en comparación con los del grupo control lista de espera. Además, ambas modalidades de aplicación del programa de intervención han sido igualmente eficaces desde un punto de vista estadístico y el programa informático utilizado para la aplicación del tratamiento a través de Internet ha sido bien valorado y aceptado por todos los participantes

An Internet-based program for depression using activity and physiological sensors: efficacy, expectations, satisfaction, and ease of use

Purpose: Computerized cognitive behavioral therapy (CCBT) has been shown to be efficacious. Moreover, CCBT can be enhanced by using physiological and activity sensors, but there is no evidence about the acceptability of all these tools. The objective of this study is to examine the efficacy, expectations, satisfaction, and ease of use of an Internet-based CCBT program for preventing depression, with and without sensors (electroencephalography, electrocardiograhpy ECG, and actigraphy), in a high-risk population (unemployed men). Patients and methods: Sixty participants at risk of depression (unemployed men) were randomly assigned to three experimental conditions: 1) intervention program (N=22), 2) intervention program plus sensors (N=19), and 3) control group (N=19). Participants completed depression, anxiety, positive and negative affect, and perceived stress measures. Furthermore, they also completed the measures for expectation, satisfaction, and the ease of use of the program. Results: Results showed that the two intervention groups improved significantly more than the control group on the clinical variables, and the improvements were greater in the group that used sensors than in the group that did not use them. Furthermore, participants in both intervention groups scored high on expectations and satisfaction with the CCBT program (with and without sensors). The mean score for usability was 88 out of 100 (standard deviation =12.32). No significant differences were found between groups on any of these variables. Conclusion: This is the first study to analyze the efficacy, expectations, satisfaction, and ease of use of an Internet-based program using physiological and activity sensors. These results suggest that an Internet program for depression with or without physiological and activity sensors is effective, satisfactory, and easy to useOPTIMI (European Union's Seventh Framework Program Personal Health Systems). 248544. Ministerio de Ciencia e Innovación. PSI2010-17563. CIBER of Physiopathology of Obesity and Nutrition, an initiative of ISCII

Analysis of Outcomes in Ischemic vs Nonischemic Cardiomyopathy in Patients With Atrial Fibrillation A Report From the GARFIELD-AF Registry

IMPORTANCE Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes